Memory Care in Maine

Table of Contents

Memory Care in Maine

Table of Contents

• The Cost of Memory Care in Maine
• Maine Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Maine?
• More Ways To Pay for Memory Care in Maine
• Memory Care Laws and Regulations in Maine
• Free and Low-Cost Resources for Seniors in Maine
• Maine 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 calculated the cost of memory care by adding 25% to the assisted living costs reported in the 2021 Genworth Cost of Care Survey. 

The average monthly cost of memory care in Maine is $7,331. This is significantly more than the national median of $5,625. Communities in Maine, on average, charge slightly less than those in New Hampshire ($7,566). Seniors living in Vermont and New York pay less on average for memory care at $6,563 and $5,725, respectively.

Data is only available for three cities in Maine, but the costs vary greatly between the three areas. Seniors residing in the popular city of Portland can expect to pay around $8,156 per month for memory care. The most affordable option can be found in Bangor, where memory care costs an estimated $5,938 each month. Communities in Lewiston charge around $6,855.

Medicaid in Maine (MaineCare) does not cover the costs of memory care services in an assisted living environment. However, the Elderly and Adults with Disabilities Waiver may be able to cover some of the costs. Seniors do have to qualify for Medicaid to apply for the waiver.

• Who Is Eligible: Seniors age 65 and over or adults with a disability. Applicants must meet income guidelines and be U.S. citizens or legal residents.
• How To Apply: Download the My Maine Connection App, email or fax the application form to the Department of Health and Human Services or apply in person at a Department of Health and Human Services District Office.

Elderly and Adults with Disabilities Waiver

The Elderly and Adults with Disabilities Waiver aims to prevent or delay admission to a nursing home and enable seniors to continue living in a community setting. The waiver doesn't pay for room and board, but it does cover some of the expenses associated with memory care in an assisted living facility. Some of the services covered include personal care services, assistive technologies, some skilled nursing care, case management and nonmedical transportation. Physical, occupational and speech therapy services may be covered if required.

• Who Is Eligible: Applicants must be U.S. citizens or legal residents, Maine residents and at least 65 years old. Seniors need to be assessed to ensure they meet the medical requirements of the waiver. Applicants are required to meet the financial guidelines of MaineCare.
• How To Apply: Seniors can complete an online application or an in-person application at a Department of Health and Human Services District Office.

Medicaid Eligibility for Seniors in Maine

Seniors must meet certain income requirements to be eligible for MaineCare. Income limits are $2,523 per month for single applicants and $5,046 for married couples if both spouses are applying. Single applicants may own assets amounting to $10,000, and married couples are allowed up to $15,000 in assets.

2022 Medicaid Income Limits for Seniors in Maine

There are certain other requirements to be eligible for MaineCare. Seniors must be U.S. citizens or legal residents, and they must currently reside in Maine.

Some of the documents required to apply for MaineCare include:

• Proof of citizenship or legal residency
• Proof of current address
• Copies of burial arrangements
• Power of attorney documents
• Proof of income
• Bank statements for the past 60 months
• Title deeds for any property owned and a recent property evaluation

How To Get Help Applying for Medicaid in Maine

In Maine, caregivers and seniors have access to services that can help them apply for Medicaid.

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, seniors looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance can 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.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 loan will need to be paid back after the sale of the home. The most commonly used type of reverse mortgage 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 can 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

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.

Residents Who May Be Admitted

Adults and seniors who:

• Have received a physician's diagnosis of Alzheimer's disease or another form of dementia
• Display the early signs and symptoms of dementia but have not yet been diagnosed

Residents Who May NOT Be Admitted or May Be Discharged

Individuals who:

• Have care needs that cannot be met by the facility
• Intentionally cause physical damage to the property
• Pose a direct threat to the safety and health of other residents

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 dlrs.complaint@maine.gov, 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.

Seniors and their caregivers have access to free resources that provide information and support to help them as they deal with the changes that accompany 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.