Memory Care in Illinois

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.

According to the Genworth Cost of Care Survey 2019, the cost of assisted living in Illinois averages $4,170 per month, which is slightly higher than the nationwide average of $4,051 per month. Based on the statewide average cost of assisted living, families can expect to pay between $5,004 and $5,421 per month for memory care. Compared to its bordering states, Illinois is relatively expensive for assisted living. More affordable care may be found in Kentucky ($3,497), Indiana ($4,100), Iowa ($4,078) and Missouri ($2,881). Only Wisconsin has more expensive average assisted living costs at $4,350 per month.

Assisted living costs vary widely throughout different regions of the state. In Springfield, for example, the cost of assisted living is on par with the statewide average at $4,170 per month. In the state’s capital city of Chicago, on the other hand, the average monthly fee for this type of care is $4,740. In Decatur, assisted living is considerably more affordable at $3,646. These are standard assisted living rates; families should expect to pay an additional $1,000-$2,000 per month for memory care services.

Illinois Medicaid Programs for Memory Care

HealthChoice Illinois

HealthChoice Illinois provides a wide range of services and long-term supports for adults aged 65 and over. This program is mandatory for those who qualify for Medicaid, including those who also qualify for Medicare. It is a consolidation of several programs, including the Integrated Care Program, the Family Health Program and the Managed Long-Term Services and Supports Program. All Illinois counties have the same four available plans, including BlueCross Community Health Plans, IlliniCare Health, Meridian Health Plan and Molina Healthcare, and Cook County residents may also select CountyCare Health Plan or NextLevel Health Partners. All plans cover basic services like hospice care, behavioral health services and therapy, though some plans may offer extra benefits.

• Who Is Eligible: To be eligible for HealthChoice Illinois, applicants must qualify for Medicaid. They must have a gross monthly income of no more than $1,041, and no more than $2,000 in countable assets.
• How to Apply: Seniors may apply for this program through the Illinois Department of Healthcare and Family Services website or by calling 877-912-8880.

Illinois Medicaid-Medicare Alignment Initiative

The Illinois Medicaid-Medicare Alignment Initiative provides streamlined services for those who are dually eligible for Medicare and Medicaid, enabling them to receive all services through one plan. In addition to covering basic services, such as mental health services, prescription drugs and doctor visits, it features additional benefits, including adult day health care and assistance with daily living activities. This program is only available in the Greater Chicago region and Central Illinois.

• Who Is Eligible: To be eligible for MMAI, seniors must qualify for and be enrolled in Medicare and Medicaid and live within the service area.
• How to Apply: Information for applying for MMAI is available on the Illinois Department of Healthcare and Family Services website or by calling the Illinois Department on Aging at 800-252-8966. To enroll in this program, seniors can reach out to the Medicare-Medicaid Alignment Initiative at 877-912-8880.

Illinois Supportive Living Program

The Supportive Living Program provides personal care and other services to low-income seniors who qualify for nursing home care, but prefer to live in an assisted living facility. While room-and-board expenses are not covered, either in assisted living or in memory care, supportive services like personal care, homemaking and laundry, medication management and recreation are included. This Medicaid waiver program has limited funding, meaning that eligible applicants may be placed on a wait-list.

• Who Is Eligible: To qualify for this program, applicants must be at least 65 years old and meet Regular Medicaid’s income and asset guidelines. Additionally, they must need help with at least two activities of daily living and reside in an approved assisted living facility.
• How to Apply: Seniors who qualify for the state’s SLP should contact the Department of Healthcare and Family Services, Bureau of Long Term Care at 217-782-0545 or 844-528-8444.

Non-Medicaid Financial Assistance Programs for Memory Care in Illinois

National Family Caregiver Support Program

The NFCSP provides grants to states to fund programs for caregivers who care for loved ones in their own homes. Among these programs, which are typically administered by local Area Agencies on Aging, is the Respite Program. While this program doesn’t directly fund memory care services, it can provide caregivers with the support they need to delay moving their loved one to a residential facility. Generally, caregivers receive a voucher for a dollar amount or a certain number of hours for which respite care is approved.

• Who Is Eligible: Eligibility differs with each administering Area Agency on Aging and is typically dependent on the senior’s age, health status, geographic region and veteran status. Priority may be given to low-income applicants.
• How to Apply: Families should apply for this program through their local Area Agency on Aging.

More Ways to Pay for Memory Care

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.
• Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

Memory Care Regulation

In Illinois, memory care is provided in assisted living facilities, which are classified as assisted living establishments, shared housing establishments and supportive living facilities, depending on the accommodations they provide and how they’re funded. The Illinois Department of Public Health licenses and monitors assisted living and shared housing establishments, and the state’s Department of Healthcare and Family Services governs supportive living facilities, which are Medicaid-approved residential settings for low-income adults.

Assisted living facilities that provide care for adults with Alzheimer’s disease and other forms of dementia through special care units or freestanding centers are required to disclose this information to their governing agency as well as the resident or their representative.

Information that must be provided in writing includes:

• Their dementia treatment philosophy
• What distinguishes the facility as appropriate for residents with dementia
• Its preadmission, admission and discharge procedures
• How care needs are assessed and care plans implemented
• Its minimum and maximum staffing ratios
• Its physical environment
• The types of activities it provides
• The degree and nature of family involvement and the cost of memory care

Facility Scope of Care

Memory care facilities located within assisted living or shared housing establishments are required to provide services, including housekeeping, laundry, security, emergency response systems and assistance with four or fewer activities of daily living. Residents may contract with home health agencies for care beyond what is provided by the facility. Additionally, facilities are required to provide at least 1.4 hours of services daily for each memory care resident.

In supportive living facilities, residents receive a wide scope of personal and health-related services. These include personal care, medication management and assistance with self-administration, social, recreational and exercise programs, emergency call systems, monitoring by a 24-hour security staff, emergency call systems, health referrals, transportation services, daily checks and maintenance services. Nursing services must also be provided, including assessments, short-term medication administration assistance for self-administered medications and health counseling.

Admissions Requirements

To be admitted to a facility that offers memory care, adults must be at least 22 years old, and their care needs must fall within the scope of care provided by the facility.

Seniors who aren’t eligible for admissions include those who:

• Pose a threat to others or themselves
• Are unable to communicate their needs
• Need total assistance with two or more or partial assistance with five or more activities of daily living
• Require more than minimal assistance with moving to a safe area in the event of an emergency
• Are diabetics that require routine insulin injections by a licensed healthcare professional or require routine sliding scale insulin injections

Care Plan Requirements

Prior to admission to an assisted living or shared housing establishment, a prospective resident must receive a comprehensive assessment by a physician to evaluate their physical, cognitive and psychosocial condition. At least one specified tool, including the Functional Activities Questionnaire, the Functional Assessment Staging and the Clock Drawing Test, must be used to assess the prospective resident’s stage in the Alzheimer’s disease process.

In supportive living facilities, residents receive an initial assessment within 24 hours of admission and a comprehensive assessment within two weeks of admission by a licensed practical or registered nurse.

Medication Management Requirements

Memory care facilities may provide medication reminders to residents and supervise the taking of self-administered medication, as well as medication administration by a licensed healthcare professional employed by the facility as an optional service.

Medication has to be stored in its original container in a locked cabinet, container or room that is inaccessible to residents. A separate medication record must be maintained for each resident that includes their name; the name, dosage, directions and route of administration of the medication; the date and time of when the medication is supposed to be given; what time it’s actually given and the signature or initials of the employee who administered the medication.

Facility Requirements

Facility requirements for memory care facilities vary depending on whether they’re located within an assisted living establishment, a shared housing establishment or a supportive living facility.

In assisted living and shared housing establishments, each unit must have a bathroom with an operational toilet, sink, mirror, bathing facilities, a means of ventilation and assistive devices as necessary. Additionally, each unit in an assisted living establishment must be able to accommodate small kitchen appliances.

In supportive living facilities, units licensed on or after October 18, 2004, must have a full bathroom, lockable doors, emergency call systems, a kitchenette with a sink, microwave or stove and a refrigerator and a separate bedroom for each occupant.

Staffing Requirements

In assisted living and shared housing establishments, the manager and a sufficient number of staff members must have the qualifications, education, skills and experience to meet memory care residents’ around-the-clock scheduled and unscheduled needs.

In supportive living facilities, there must be at least one licensed nurse on-site at all times to provide medication management services, and there must be at least one CNA on each shift per 10 residents.

Medicaid Policy

Services in supportive living facilities are covered by Medicaid’s Supportive Living Program waiver program. Medicaid does not pay for services provided in assisted living or shared housing establishments.

Reporting Abuse

Assisted living and shared housing establishments are required to report suspected abuse, neglect or financial exploitation to the Department of Public Health within 24 hours after receiving the allegation, and they must investigate and develop a written report within two weeks of the initial report. Supportive living facilities must report suspected abuse to the Department of Healthcare and Family Services. Abuse can also be reported to the regional ombudsman, through the Senior HelpLine or to the Illinois State Police Medicaid Fraud Unit.