Memory Care in Iowa

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.

The Genworth Cost of Care Survey 2019 shows that assisted living costs an average of $4,078 per month in Iowa, which is $27 more than the national median of $4,051. Prices are somewhat lower in neighboring Minnesota and Nebraska, where costs average $3,800 and $3,819, respectively. Rates in other surrounding states span a wide range. The monthly cost is only $2,881 in Missouri, whereas the average in Illinois is $4,170 per month. When a 25% margin is factored in on top of the average assisted living rate in Iowa, seniors can expect to pay about $5,100 for memory care on a monthly basis.

Assisted living costs differ across Iowa due to various factors. Dubuque has the highest average cost of $4,579 per month. The rate is slightly less in Des Moines, the state’s capital and largest city, at $4,350. Seniors in Davenport pay an average of $4,65 per month, while the median cost is just $4,020 in Cedar Rapids. Seniors should keep in mind that these surveyed rates are only for standard assisted living, and the monthly cost for memory care services may be up to $1,200 higher.

Iowa Medicaid Programs for Memory Care

Home- and Community-Based Services Elderly Waiver

Iowa Medicaid offers the Home- and Community-Based Services Elderly Waiver to eligible individuals with the goal of providing care and support services in a community setting, such as in a memory care facility, instead of a nursing home. The waiver provides case management and the development of a personalized care plan to meet a senior’s needs. Specific benefits are covered in an assisted living program setting, including personal and respite care and transportation services. The waiver does not cover the room and board portion of assisted living program fees.

• Who Is Eligible: To qualify for the Elderly waiver, applicants must be aged 65 or older and meet the functional and financial eligibility requirements of the Iowa Medicaid program. An applicant must also be assessed as needing a skilled or nursing facility level of care.
• How to Apply: Seniors not already enrolled in Medicaid may contact the Iowa Department of Human Services office in their county to apply for coverage and the Elderly Waiver. Current Medicaid enrollees may call Member Services at 800-338-8366 for more information about the waiver.

Non-Medicaid Financial Assistance Programs for Memory Care in Iowa

Medicare Advantage Plans

Iowa seniors who are currently enrolled in Original Medicare may decide to switch to a Medicare Advantage Plan to help reduce their costs for memory care. MA plans, which are also known as Medicare Part C plans, are offered through Medicare-approved private insurance companies. These plans cover all of the services normally provided through Medicare Parts A and B. Most MA plans also provide Part D prescription drug coverage, as well as extra benefits. The additional benefits vary between plans and providers but may include vision, hearing and dental care, nonemergency medical transportation, wellness programs and personal care services.

Thanks to recent changes in federal guidelines, a Medicare beneficiary who lives in an assisted living facility may now use it as their home address. This may allow MA enrollees to claim and be reimbursed for certain expenses, such as personal care and other eligible services provided by their assisted living programs. These memory-care related expenses may not be covered under all MA plans.

• Who Is Eligible: To enroll in an MA plan, a senior must already be an Original Medicare beneficiary. Individuals are eligible to enroll in an MA plan regardless of preexisting conditions, such as a dementia or Alzheimer’s diagnosis. Once enrolled, MA plan members remain responsible for paying their Part B Medicare premiums, along with any Part C plan costs.
• How to Apply: The Medicare program website includes a plan finder tool, which interested individuals can use to compare and choose from MA plans offered by providers in Iowa. For details on how and when to apply, seniors and their family members can call Medicare at 800-633-4227 or contact a plan provider directly.

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 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.

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