Memory Care in Maine

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.

In Maine, the average cost of assisted living is $5,169 per month, which is over $1,100 higher than the national monthly median of $4,051. Costs in the neighboring states of Vermont, Massachusetts and New Hampshire range from $5,339 to $7,021, while the average rate in Rhode Island is relatively comparable, at $5,199 per month. Using an anticipated 25% increase in cost for memory care, residents of Maine who need this type of care can expect to pay an average of $6,461 per month.

The cost of assisted living care in Maine can vary considerably when location and facility choice are factored in. The average cost is $6,600 per month in Portland, the state’s largest metropolitan area. In nearby Lewiston, the monthly average drops to $5,385. Further northeast in Bangor, seniors pay an average of $4,753 per month. These are rates for assisted living, and the monthly cost of memory care may be $600 to $900 higher.

Maine Medicaid Programs for Memory Care

Elderly and Adults with Disabilities Waiver

The Maine state Medicaid plan, MaineCare, offers an Elderly and Adults with Disabilities Waiver that may provide some financial aid for eligible seniors who need memory care services. This waiver is designed to postpone or prevent admission to a nursing home by helping seniors remain in a community setting, such as an assisted living program, residential care facility or private nonmedical institution. The waiver does not pay for room and board or dementia-specific services, but it may help a senior lower their overall cost of care through the benefits it covers. These may include care coordination; financial management assistance; speech, occupational and physical therapy; personal care; skills training and nonmedical transportation.

• Who Is Eligible: Applicants must be Maine residents and aged 65 and older, or aged 64 and younger and disabled, to qualify for the EAD waiver program. Applicants must be financially eligible for MaineCare coverage and be assessed to verify that they meet the program’s functional criteria.
• How to Apply: Interested individuals can complete an online application or visit the Department of Health and Human Services district office serving their area. For more information about the program, seniors can call 855-797-4357.

Non-Medicaid Financial Assistance Programs for Memory Care in Maine

Affordable Assisted Living Program

The Maine Office of Aging and Disability Services administers the Affordable Assisted Living Program to help individuals on fixed incomes pay for assisted living services in certain state-approved facilities. The program does not pay for specialized dementia care, but it can help offset some of the costs a senior would otherwise incur on a monthly basis. Approved participants pay a co-pay and an income-based share of the cost of provided services and supports, which may include meals, personal care, medication administration, housekeeping and emergency response systems.

• Who Is Eligible: A financial and functional assessment must be completed to determine eligibility for the AAL program, and seniors must meet the guidelines to qualify for MaineCare coverage.
• How to Apply: Seniors must apply for MaineCare first, then call OADS’ assessing services agency at 833-525-5784 to be prescreened and schedule an in-person assessment by a registered nurse, if required.

State Supplement Payment

The Maine Department of Health and Human Services provides eligible residents with a monthly state supplement payment that may be used to help pay for day-to-day necessities or put toward the cost of memory care facility room and board or provided services. The amount of the benefit varies depending on the recipient’s living arrangement.

• Who Is Eligible: Maine residents who meet the eligibility criteria for the Supplemental Security Income program through the Social Security Administration automatically qualify for the SSP benefit. Individuals who are over the SSI income limit or do not meet the citizenship requirement may still be eligible for the SSP and should apply.
• How to Apply: Maine seniors can apply for SSP benefits online, or by printing, filling out and mailing in a paper application. For help completing an application, seniors can call 855-797-4357 or visit their local DHHS office.

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

The Maine Department of Health and Human Services, Division of Licensing and Certification, is responsible for licensing and overseeing assisted housing facilities that offer memory care. The DLC conducts periodic licensing and safety code inspections and responds to complaints. In Maine, memory care services may be offered in assisted living programs (ALPs), Level IV residential care facilities (RCFs) and private nonmedical institutions (PNI), which may contain a separate, secured memory care unit. The state has specific licensing requirements for memory care units to ensure that residents receive personalized care in an environment that promotes their quality of life, dignity and independence.

Facility Scope of Care

The services offered by ALP, RCF and PNI facilities must include assistance with activities of daily living, meals, recreational and social activities, care management and supervision, medication management and nursing services. Memory care units are also required to provide appropriate weekly therapeutic activities that may lessen residents’ anxiety, restlessness and wandering, aid their eating and sleeping patterns, improve their cooperation and socialization and delay the deterioration of cognitive skills. Activities must be chosen according to the needs of each resident and incorporated into their personal care plan.

Admissions Requirements

ALPs, RCFs and PNIs in Maine may admit individuals with a wide range of care needs and conditions, including those with memory loss, Alzheimer’s disease and dementia. Facilities that provide memory care must have a written policy in place regarding preadmission screening and procedures for the admission and discharge of residents. State regulations place certain admission and discharge restrictions on memory care units, as shown in the following table.

Care Plan Requirements

Memory care unit residents who exhibit symptoms of dementia but were not formally diagnosed must receive a diagnostic evaluation within 45 days of admission. Care plans must be developed for each new resident detailing specific services, therapies and treatments that will be provided to promote their self-care abilities, encourage independence and maintain their dignity and privacy while ensuring their safety and comfort and taking their preferred manner of living into consideration. ALP residents must be reassessed every six months, while residents of RCFs and PNIs must be reassessed every 12 months.

Medication Management Requirements

Residents of licensed facilities must be evaluated upon admission to determine whether they can self-administer medications or need assistance. Staff in memory care units may provide medication administration assistance to residents. They may read medication labels for residents, check dosages and remove prescribed dosages from a container, observe while residents take their medications and maintain medication records. Unlicensed staff members who have completed a DLC-approved training program may administer certain medications that require injection.

Facility Requirements

Maine regulations stipulate that memory care units should provide a safe environment that enhances the quality of life of residents and reduces agitation, tension and behavior problems. Memory care units in ALFs must feature individual apartments with a kitchen or kitchenette, a bathroom and a living area. RCFs and PNIs may offer private and shared rooms for a maximum of two occupants. In addition to meeting specific facility requirements, memory care units must also provide:

• Multipurpose rooms for dining, individual and group activities, as well as family visits
• Comfortable seating in common areas
• Ample space to allow freedom of movement within the unit
• A secured outdoor area with walkways for ambulation
• Adequate, even lighting
• A high-contrast color scheme and nonreflective surfaces
• Egress control devices on exterior doors that release in an emergency
• Identification of each resident’s unit to aid in recognition
• Encouragement and assistance in decorating residents’ units with familiar furnishings and personal items

Staffing Requirements

State-licensed ALPs, level IV RCFs and PNIs must employ an administrator who holds an appropriate professional license to oversee day-to-day operations. Level IV RCFs and PNIs must also employ or contract with a registered nurse to observe resident signs and symptoms, recommend staff training and make regular reviews of resident and medication records. Level IV facilities with more than 10 beds must also contract with a pharmacist to perform quarterly consultations, at a minimum.

There are no minimum staff ratios required in assisted living programs. Level IV RCF and PNI facilities with fewer than 10 beds must have one responsible staff member awake and on duty at all times, while those with 10 beds or more must have two awake staff members on duty around the clock. Additionally, facilities with 10 or more beds must maintain minimum direct care staff-to-resident ratios of 1:12 on day shifts, 1:18 during evening shifts and 1:30 on overnight shifts.

Memory care units in licensed Maine facilities must employ staff who have received specialized dementia care training. Facilities are required to have sufficient staff on duty during the day, evening and overnight shifts to meet the needs of residents and provide the services outlined in their care plans.

New memory care unit staff members must complete 16 hours of combined classroom and clinical orientation on specific topics pertaining to dementia care. In addition to an overview of Alzheimer’s disease and dementia, an orientation must cover communication basics, activity-focused care, creating a therapeutic environment and dealing with difficult behavior and family issues.

Medicaid Policy

The Maine state Medicaid plan offers the Elderly and Adults with Disabilities Waiver, which may help eligible seniors pay for a variety of services in licensed facilities that provide memory care.

Reporting Abuse

Anyone who has concerns about the neglect or abuse of a resident or the living conditions in a Maine memory care unit may file a complaint with the Division of Licensing and Certification. Complaints may be made by emailing the division at [email protected], calling 800-383-2441 or completing a complaint form.

Staff of the Maine Long-Term Care Ombudsman Program are also authorized to investigate complaints and may be reached by calling 800-499-0229.