Memory Care in Iowa

Table of Contents

Memory Care in Iowa

Table of Contents

• The Cost of Memory Care in Iowa
• Iowa Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Iowa?
• More Ways To Pay for Memory Care in Iowa
• Memory Care Laws and Regulations in Iowa
• Free and Low-Cost Resources for Seniors in Iowa
• Iowa 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.

Using data from the 2021 Genworth Cost of Care Survey, we added 25% to the cost of assisted living to calculate the cost of memory care. 

In Iowa, the average monthly cost of memory care is $5,459, which is close to the United States median of $5,625. Memory care is cheaper in the nearby states of Missouri and Nebraska at $3,750 and $5,095, respectively. Communities in Illinois ($5,610) and Minnesota ($5,635) charge slightly more than they do in Iowa.

The costs of memory care are fairly similar across the state, with only a slight variation depending on location. The most affordable cities in the state are Sioux City ($5,185) and Davenport ($5,438). Seniors in the state capital of Des Moines have the most expensive care costs in Iowa at $6,004 per month. Cedar Rapids is not much cheaper at an estimated $5,935 for memory care.

Medicaid in Iowa doesn't cover memory care costs in assisted living or home-based environments. It does offer the Home- and Community-Based Services Elderly Waiver, which can be used by qualifying seniors to cover some of the costs of memory care. 

• Who Is Eligible: To receive Medicaid coverage in Iowa, applicants must be 65 years or older and be U.S. citizens or legal residents. Seniors are required to reside in Iowa and meet certain financial and medical guidelines.
• How To Apply: Seniors can apply through the online benefits portal or visit their local Department of Human Services office to apply in person. 

Home- and Community-Based Services Elderly Waiver

Iowa's Home- and Community-Based Services Elderly Waiver is offered to eligible individuals to provide the support and care services they need in a community setting instead of a nursing home. The waiver doesn't cover room and board in an assisted living community. Services covered by the waiver include personal care, case management, housekeeping and nonmedical transportation.

• Who Is Eligible: Applicants must be assessed as needing skilled nursing level care. Seniors are required to qualify for Medicaid before applying for the waiver.
• How To Apply: Medicaid enrollees can contact Member Services at (800) 338-8366 to apply. Seniors who aren't currently covered by Medicaid must contact the Department of Human Services to apply for coverage and the waiver.

Medicaid Eligibility for Seniors in Iowa

Seniors in Iowa must meet certain income and medical guidelines to qualify for Medicaid coverage in the state. Single applicants are limited to an annual income of $30,276, while married couples are capped at $60,552 per year. Asset limits are $2,000 for single applicants and $3,000 for couples. Asset limits don't include properties or vehicles. 

2022 Medicaid Income Limits for Seniors in Iowa

Seniors should include the following documents with their application to prove they meet all the guidelines for coverage:

• Birth certificate
• Proof of citizenship or legal resident status in the United States
• Proof of current income
• Proof of current address in Iowa
• Bank statements for the past 60 months
• Power of attorney
• Title deed for any property owned and a recent professional property evaluation
• Copies of burial arrangements
• Insurance policies

How To Get Help Applying for Medicaid in Iowa

Services are available in Iowa to assist seniors and their families in the Medicaid 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.

Memory Care Regulation

In Iowa, facilities that provide residential assisted living and primarily serve the elderly are known as assisted living programs. The Iowa Department of Inspections and Appeals, Health Facilities Division, is responsible for inspecting and licensing ALPs. To become certified to provide dementia care, an ALP must meet specific requirements. The Department only certifies a facility as a dementia care unit after approving its:

• Policies
• Staffing plan
• Admission and discharge guidelines
• Safety procedures
• Service plan

After passing an initial inspection, a facility receives a two-year license. To ensure compliance with state regulations and that adequate care is provided to residents, the department conducts inspections of each ALP every other year going forward and in response to complaints.

Facility Scope of Care

Assisted living programs provide housing and care services to three or more residents in a homelike environment. ALPs and DCUs must employ a 24-hour response staff to meet the scheduled and unscheduled needs of residents and adequately provide for their supervision, security and safety. Facilities should encourage family involvement and emphasize resident dignity, individuality, independence and choice.

ALPs and DCUs must offer assistance with activities of daily living, but residents may receive help with no more than four ADLs. Health-related care and therapies may be provided by a licensed practical nurse or registered nurse on a part-time basis. These services are limited to 28 hours per week, for no more than 21 days per month. Facilities are also required to provide residents with access to a personal emergency response system, 24/7.

Hot meals prepared according to the recommendations of the National Academy of Science's Food and Nutrition Board must be provided to residents at least once each day. Residents may receive a therapeutic diet, if it is prescribed by a health care provider and overseen by a licensed dietitian.

Admissions Requirements

ALPs and DCUs may accept elderly individuals with a wide range of conditions and care needs. The following table offers insight into the circumstances that may allow or restrict a person's admission.

Residents Who May Be Admitted

Seniors with:

• Alzheimer's and related dementia disorders
• Stable chronic illnesses
• Intellectual, developmental or physical disabilities
• Mental health conditions
• Controlled behavioral issues
• A terminal illness and in need of temporary hospice care

Residents Who May NOT Be Admitted

Individuals who:

• Require full-time medical care
• Are bedbound
• Need two-person assistance with transferring, standing or evacuating
• Have routine unmanageable incontinence
• Are medically unstable
• Require assistance with all ADLs
• Pose a danger to others or themselves
• Require drug or alcohol rehabilitation
• Suffer from uncontrolled mental illness

Care Plan Requirements

ALPs and DCUs are required to assess each resident's functional, health and cognitive status within their first 30 days of occupancy and develop a plan for the individual's care. A multidisciplinary team consisting of human services and health professionals must take part in plan development for residents who require personal and health care-related services.

A resident must be reassessed, and their care plan updated, after any significant change in their condition occurs or once per year at a minimum. The service plan for a resident of a DCU must include activities deemed appropriate for the individual's abilities and interests.

When indicated by a resident's assessment results, a managed risk agreement should be drafted between the facility and individual, and/or their representative.

If an ALP or DCU contracts with a third party to provide health-related or personal care to residents, details of the contracted services must be included in each resident's care plan.

Medication Management Requirements

Per state regulations, residents of ALPs and DCUs may self-administer medications, or have them administered by the facility's nursing staff. The Iowa Nurse Practice Act states that nurses may also delegate the administration of medication to unlicensed personnel. If administration is delegated to other facility personnel, an RN must be employed to ensure that doctors' orders remain up to date and prescriptions are properly administered and to regularly monitor residents for adverse reactions.

Facility Requirements

Private apartments are not required in ALPs and DCUs in Iowa, and resident accommodations do not have to include kitchenettes. Rooms may be single or double occupancy, and they must have a private bathroom equipped with a sink, toilet and bathtub or shower. Single occupancy rooms in facilities constructed after 2001 must provide 240 square feet of living space, and double occupancy rooms must provide a minimum of 340 square feet, excluding bathrooms.

Facilities providing dementia care are required to have operating exit door alarm systems and entrance door locks that staff can disable or remove in the event of a safety concern. As a necessary safety measure, staff must also have the ability to disable any kitchen appliances installed in residents' rooms.

Staffing Requirements

There are no mandated minimum staff ratios for licensed ALPs in Iowa, but a facility must employ a sufficient number of trained and qualified personnel to meet the needs of its residents, 24 hours per day.

Each facility is required to have a program manager who oversees daily operations and staffing and staff members to assist with residents' daily living activities. Programs that provide health-related services or administer medications must employ a registered nurse to monitor the health status of residents and manage medications. At least one on-duty awake staff member is required at all times in DCUs.

Program managers and registered nurses must complete an AL management or nursing course within six months of being hired. Training on the facility's fire safety, emergency and accident procedures is required for all personnel.

Staff hired or contracted to work in a dementia care program or unit must receive at least eight hours of dementia-specific training and education in their first 30 days of employment. Direct care personnel are required to complete two hours of dementia-related continuing education each year.

Medicaid Policy

The Iowa Medicaid program does not pay the full cost of care in ALP facilities and DCUs. However, it does offer the Home- and Community-Based Services Elderly Waiver, which covers the costs of specific services provided by a facility. These include personal and respite care and transportation services. The waiver is not an entitlement of Iowa Medicaid, so participation may be limited, and eligible individuals may be placed on a waiting list depending on availability.

Reporting Abuse

Suspected abuse or neglect of a resident of a DCU may be reported to the Iowa Health Facilities Division Complaint Unit. Concerned individuals may file a complaint about the incident by phone at 877-686-0027, or fax the details to 515-281-7106. A report may also be made by mail to this address:

Iowa Department of Inspections and Appeals Health Facilities Division/Complaint Unit Lucas State Office Building - Third Floor 321 E. 12th Street Des Moines, IA 50319 - 0083

Seniors and their family members in Iowa have access to numerous organizations that offer support, information and guidance regarding dementia and memory loss.

Note: The following information was compiled and most recently updated on 2/8/2022. 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.