Memory Care in Florida

Table of Contents

Memory Care in Florida

Table of Contents

• The Cost of Memory Care in Florida
• Florida Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Florida?
• More Ways To Pay for Memory Care in Florida
• Memory Care Laws and Regulations in Florida
• Free and Low-Cost Resources for Seniors in Florida
• Florida COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

We've calculated the average cost of memory care in Florida by adding 25% to the expenses of assisted living reported in the 2021 Genworth Cost of Care Survey.

The average memory care community in Florida charges around $5,000, which is less than the national average of $5,625. Communities in Florida charge more per month on average than those in the nearby states of Georgia ($4,419), Alabama ($4,379) and Mississippi ($4,375). 

The cost of memory care varies greatly across the state of Florida. Seniors living in the highly populated city of Miami pay around $5,481 per month, while those in the state capital of Tallahassee pay an estimated $5,813 each month. The most expensive city in that state is Naples at $6,625, and in comparison, the cheapest option is Gainesville, where seniors in memory care pay an average of $2,938.

In 2014, Florida consolidated all Medicaid waivers for home and community-based care under the Statewide Medicaid Managed Care Long-Term Care Program banner. It's a nursing home diversion program that funds a range of nonmedical, medical and support-based programs. These waivers don't specifically cover memory care but rather offer a variety of services aiming to prevent or delay nursing home placement. Services covered by the program include personal care, therapy services, behavior management, medication management and transportation. 

• Who Is Eligible: Applicants must be 65 years or older, be a U.S. citizen, permanent resident or legal alien and require a nursing home level of care.
• How To Apply: Seniors over the age of 65 and adults over the age of 18 with a qualifying disability can apply for SMMC-LTC by contacting either Florida's Department of Children and Families Automated Community Connection to Economic Self Sufficiency (ACCESS) or the Statewide Medicaid Helpline at (877) 254-1055.

Medicaid Eligibility for Seniors in Florida

In Florida, Medicaid eligibility is based on a number of predetermined factors such as age, income and assets. Seniors can't have more than $2,000 in assets, excluding an owner-occupied home, which may have a value of up to $636,000. Individual annual income may not exceed $18,075 before taxes.

2022 Medicaid Income Limits for Seniors in Florida

Seniors applying for Medicaid must meet certain requirements and provide documents proving they qualify for coverage. An income verification letter from Social Security and proof of income for the past five years must be presented. Seniors must submit copies of all personal checks of $500 or more written in the past 60 months, along with statements from any investment or bank accounts used during that time. 

Additional documentation required includes: 

• Verification of citizenship or legal status
• Income tax returns for the past five years
• Copies of power of attorney, wills and any other documents related to the senior's estate or care
• Copies of the title to any homes or vehicles owned
• Two appraisals conducted by professionals, indicating the current market value of any property owned
• Copies of any burial arrangements

How To Get Help Applying for Medicaid in Florida

Seniors in Florida who need assistance applying for Medicaid can contact the ACCESS Customer Call Center. In addition, they can request help from local senior service agencies, and some senior centers provide Medicaid counseling and workshops to guide seniors through that application process.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

In Florida, assisted living facilities of all sizes and types are licensed through the Bureau of Health Facility Regulation.

Assisted living facilities, or ALFs, include private homes, homes for the aged, boarding homes and other buildings which directly or indirectly provide accommodation, meals, and assistance with one or home activities of daily living for more than 24 hours to one or more adults not related to the owner or operator.

Facility Scope of Care

Florida provides a number of specialty licenses for ALFs that meet the requirements for a standard license. These specialty licenses are designed to deliver enhanced services above and beyond the usual supports provided in an assisted living facility in order to allow residents to age in place in the most appropriate, least-restrictive placement.

ALFs licensed to provide limited nursing services (LNS) can perform specific procedures and treatments such as ear and eye irrigation, intermittent catheterization, conducting range of motion exercises and conducting nursing assessments performed by a registered nurse.

ALFs licensed as an Extended Congregate Care facility can provide all of the services available under the standard and LNS license regulations in addition to any nursing services which are within the scope of practice for a registered nurse. Facilities that are covered by an ECC license can provide a higher level of care than what is offered in standard ALFs, and this care may include supports and treatments for those with Alzheimer's and other dementias.

Admissions Requirements

In accordance with Florida state law, each ALF must assess the appropriateness of each prospective resident in relation to the services and supports offered at the ALF. This chart provides an overview of the requirements:

Residents Who May Be Admitted

Older adults and people who:

• are capable of performing activities of daily living, including transfers, with some assistance
• able to participate in social and communal activities

Residents Who May NOT Be Admitted

Those who:

• need 24-hour nursing supervision
• have pressure sores classified at Stage II or worse
• are not capable of performing activities of daily living with supervision and/or some assistance
• are violent towards themselves or others
• cannot participate in communal meals and leisure activities.

Applicants who may not be Residents in ECC-licensed ALFs must be moved to a hospital or nursing facility if they are bedridden for two weeks or more.

Care Plan Requirements

Newly-placed ALF residents must be examined by an advanced RN practitioner or licensed physician no more than 60 days prior to, or 30 days following admission, and a medical report must be provided to the ALF administrator. This report is used to develop a personalized care plan that must be reviewed on a monthly basis by a licensed nurse employed by, or contracted to, the facility.

Residents must also receive a resident agreement which outlines the specific supplies, supports, and accommodations along with the daily, weekly and monthly care cost and information. This agreement must cover resident rights, refund policies, bed hold policies and disclosure of any religious affiliations of the facility.

Medication Management Requirements

Unlicensed staff are allowed to assist with the self-administration of medications, while licensed nursing staff are allowed to administer prescription and over-the-counter medications.

Assistance with self-administration of medications can include reading the label to the resident, opening the medication container and removing the prescribed dose, and applying topical medications.

Facility Requirements

While standard and LNS-licensed ALFs are not required to provide private accommodations, ECC facilities must provide either a private or semi-private room or apartment. A maximum of four residents can share a single bathroom.

Staffing Requirements

ALFs that offer dementia care must have 24-hour staffing and mechanisms in place to monitor residents, and that staff must remain awake if the facility has 17 or more residents.

Facilities with a secure area for residents with dementia must be staffed by workers who have completed at least four hours of specialized training in memory care before being assigned to the secure unit. Direct care staff must continue to complete at least four hours of dementia-specific training for the duration of their employment at the facility.

Medicaid Policy

ALF room and board rates for Florida Medicaid participants are negotiated between the facility operator and the Medicaid State Plan.

Reporting Abuse

Concerns or complaints regarding any licensed health care facility that is regulated by Florida's Agency for Health Care Administration can be filed by calling the Complaint Administration Unit, Agency for Health Care Administration, at (888) 419-3456. Complaints against unlicensed health care facilities can be reported by calling (888) 419-3456.

Seniors and their caregivers in Florida have access to a number of services and resources that can assist and support them. These resources are provided free of charge or for a low cost by government departments and nonprofit organizations. 

Note: The following information was compiled and most recently updated on 2/3/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.