I. Paying for Memory Care in Maryland

The Cost of Memory Care in Maryland

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 average monthly cost of assisted living in Maryland is $4,300, which is almost $250 more than the national monthly average of $4,051. Assuming the cost averages 25% more than assisted living, seniors can expect to pay around $5,375 each month for memory care in Maryland.

Within the state, costs can vary widely. In Cumberland, assisted living costs an average of $3,750 per month, which is the most affordable area of the state. In California, the cost rises to $6,263 per month, which is more than $2,500 higher than the rate in Cumberland. Costs in Maryland’s largest city, Baltimore, are close to the average, at $4,225 per month. These prices are for standard assisted living; depending on the area and facility, memory care may cost $1,000-$2,000 more each month.

   

Maryland Medicaid Programs for Memory Care

Community Personal Assistant Services

The Community Personal Assistant Services program is designed to help people who wish to remain in their homes but require some assistance with activities of daily living. Providers may be self-employed and chosen by program participants, or agency-employed providers whose services are arranged by the program administration. Services can include personal assistance, nurse monitoring and support planning.

  • Who is Eligible: To qualify for Community Personal Assistant Services, applicants must meet the program’s medical level of care and require help with activities of daily living. They must also be living in the community. Financially, a single person can have an income of up to $2,349 per month.
  • How to Apply: People interested in Community Personal Assistant Services should contact the Maryland Medicaid Long Term Care and Waiver Services office at 410-767-1739.

Community First Choice

Community First Choice aids people who wish to stay in the community but need assistance to avoid nursing home admission. Services provided by the program include assistive technology, nurse monitoring and personal assistance services. These services can be provided in the enrollee’s home or an adult foster care or assisted living facility. Assistance provided is based on an individual’s needs and is generally self-directed. The program allows family members to be hired as caregivers.

  • Who is Eligible: Applicants must have an income of less than $2,349 per month, which is 300% of the Supplemental Security Income limit. Functionally, applicants must require assistance with at least two activities of daily living. A higher need for care increases the range of services participants have access to.
  • How to Apply: Those interested in Community First Choice must first apply for Medicaid through the Maryland Health Connection website. Further information is available through a person’s local Area Agency on Aging.

Community Options Waiver

The Community Options Waiver is for people who need nursing home level care but wish to receive care in their home or a group living community. A group living community may include assisted living facilities, but not all assisted living facilities participate in the program. Services provided can include behavior counseling, respite care and environmental modifications. Applicants may be added to a waiting list in some counties.

  • Who is Eligible: Applicants aged 65 and over must be assessed as needing a nursing home level of care. Those aged 18-64 must also be physically disabled. Asset and income limits apply. For single applicants, the current income limit is $2,349 per month.
  • How to Apply: Those living at home can contact their local Maryland Access Point. Applicants living in a nursing home can contact their local Area Agency on Aging or the facility’s social worker.

Medical Day Care Services Waiver

Seniors in Maryland can use the Medical Day Care Services waiver to access daytime supervision in a licensed day care center. This provides respite to primary caregivers and allows seniors to participate in social activities. The program also provides participants with meals, medication monitoring and a nursing assessment.

  • Who is Eligible: To qualify for the waiver, applicants must be at least 16 years old, require a nursing home level of care, and not be enrolled in another home and community-based waiver. To meet the financial criteria, single applicants must have an income of less than $2,349 per month.
  • How to Apply: Interested seniors can apply for the Medical Day Care Services waiver through the Adult Evaluation and Review Services representative at their local Health Department office.

Increased Community Services Program

The Increased Community Services Program is designed to help elderly people in nursing homes move back into their own home, the home of a relative or an assisted living facility. It provides assistance with transitioning to a new living arrangement and long-term support to help individuals live in the community. This includes personal assistance, medical alert systems and adult day care.

  • Who is Eligible: Applicants must currently live in a nursing home and have been there for at least three months and must require a nursing home level of care. Financially, the applicant’s income must not exceed the cost of their nursing home and their assets must be below the program’s asset limit. In addition, the care they require in the new residence must not exceed what was being paid for in the nursing home.
  • How to Apply: Interested seniors can apply by contacting their local Maryland Access Point.

Non-Medicaid Financial Assistance Programs for Memory Care in Maryland

Senior Care Services Program

The Senior Care Services Program aids residents at risk of entering a nursing home and allows them to stay in their own home or the home of a caregiver. A major focus of the program is care coordination, and other services available include respite care, home modifications and personal care.

  • Who is Eligible: Eligibility for the Senior Care Services Program is determined at the county level. However, generally applicants must be at least 65 years old and require assistance with one to three activities of daily living. Asset and income limits also apply.
  • How to Apply: Interested seniors can apply through their local Maryland Access Point.

Assisted Living Subsidy

The Assisted Living Subsidy provides financial assistance to Maryland seniors to help pay for the cost of assisted living. The subsidy is only available in limited counties and at facilities participating in the program. Communities in the program are small, accommodating no more than 16 residents. Waiting lists for this program may apply.

  • Who is Eligible: The Assisted Living Subsidy is available to people at least 62 years old who require assistance with activities of daily living. They must also have a monthly income of less than $2,904 for singles and meet certain asset limits.
  • How to Apply: The local Maryland Access Point can determine if the subsidy is available in the applicant’s area and assist with an application.

Congregate Housing Services Program

Group homes in the Congregate Housing Services Program receive money directly from the program to provide residents with services such as meals, housekeeping, medication reminders and some personal assistance. The program is designed for people who require less care than what is offered in a traditional assisted living facility, but who cannot live independently. The program is only available in certain communities.

  • Who is Eligible: The minimum age for applicants is 62 and participants must be permanently or temporarily disabled. The income limit is $2,904 for single applicants, and an asset limit also applies.
  • How to Apply: Interested seniors can apply directly to participating communities or contact the Maryland Department of Aging at 800-243-3425.

In-Home Aide Services

In-Home Aide Services are available to Maryland residents 18 years and older who require help to stay in their homes. The program provides case management, self-training and assistance with activities of daily living. Services are provided at a reduced rate based on the participant’s income. A waiting list exists for the program and those with the highest need are given priority.

  • Who is Eligible: The program is available to all adult Maryland residents who require assistance to stay in their homes. There’s no fixed financial eligibility criteria, however seniors enrolled in a Medicaid program must get support services through that program.
  • How to Apply: The program is coordinated at the county level and those interested should contact their local Social Services department.

Project Home

Project Home assists people who can’t live alone but can live in a foster care environment. The program provides meals and accommodation and may include transportation, social activities and some assistance with activities of daily living. Participants are asked to pay program fees, but financial assistance may be available for those unable to afford them. Waiting lists do exist for Project Home and priority is given to those most in need.

  • Who is Eligible: The program is available to those aged 18 and over who have a disability. There are no income limits for enrollment, but individuals must have less than $2,000 in assets. If participants require medication, they must be able to self-medicate.
  • How to Apply: Those interested in the program can apply through their county’s Social Services department.

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.

II. Memory Care Laws and Regulations in Maryland

Memory Care Regulation

Assisted living facilities in Maryland that are licensed to care for individuals with memory impairment are considered assisted living programs (ALPs) and are regulated by the Department of Health. There are three types of licenses available based on the level of care provided. The department or their delegates conduct facility inspections every 15 months, or more often if required.

ALPs must complete an assisted living disclosure form, and facilities with an Alzheimer’s special care unit must include details regarding the unique design features and activities provided to meet the needs of residents with dementia.

Facility Scope of Care

All ALPs must provide three nutritious meals daily and snacks throughout the day. They must also aid in coordinating health services, provide assistance with two or more ADLs and offer occasional assistance in accessing recreational services. Programs can provide minor interventions to manage disruptive behavior and occasional psychological episodes.

Facilities with level two licenses provide a higher level of support with ADLs and can assist with frequent disruptive behaviors or psychological episodes. Level three programs also provide ongoing access to comprehensive health services, frequent assistance with ADLs and intensive supervision to manage behaviors that may disrupt or harm the resident or others. They must also monitor and manage psychological episodes that may require immediate intervention.

Admissions Requirements

There is a wide range of residents who can be admitted to ALPs, but facilities must meet certain restrictions as well. This table gives an overview of who may or may not be admitted.

Residents Who May Be AdmittedOlder adults and people with:

  • Dementia
  • Mental health conditions
  • Developmental disabilities
  • Physical disabilities
Residents Who May NOT Be AdmittedThose who require:

  • More than intermittent nursing care
  • Treatment of certain skin ulcers
  • Ventilator treatments
  • Skilled monitoring, testing and close monitoring and adjustment of medications
  • Monitoring of a chronic condition that is not easily controllable
  • Treatment for certain communicable diseases

And those who:

  • Are a danger to self or others
  • Are at risk for health or safety complications that cannot be adequately managed

Care Plan Requirements

Individuals must be assessed to identify the level of care they require to meet their medical, cognitive and psychiatric needs. The assessment also determines their treatment requirements, ability to self-administer medication and their ADL and risk factor management needs. Any problematic behaviors are noted. The assessment must be reviewed every 6 months, and a full assessment must be performed after a non-routine hospitalization or significant change in condition.

Medication Management Requirements

Level one programs can assist with self-administration of medications, while level two and three programs can administer medication and monitor the effects of medications and treatments. Each resident’s ability to self-administer must be reviewed by a licensed health care professional at least quarterly. Health professionals must also review individual’s regimes within 14 days of admission, and a licensed pharmacist must conduct an on-site review at least every six months for any resident receiving nine or more medications.

Facility Requirements

ALPs can have a maximum of two residents per unit, although this limit may be waived if programs have previously received a waiver. There must be at least one toilet for every four residents. A minimum of one bathtub or shower is required for every four residents in facilities with eight or fewer residents. Larger facilities must have one for every eight residents.

Staffing Requirements

Facilities must have enough staff available to make sure residents’ scheduled and unscheduled needs can be met. A waiver to use electronic monitoring instead of awake overnight staff can be granted when a physician or nurse determines residents don’t require overnight assistance.

Each facility must have a manager to direct daily operations and an alternate nominated for periods when the manager is unavailable. There must be a registered nurse available to provide nursing services, and medication technicians and direct care staff must also be available. Initial training is required and individuals who perform personal care must demonstrate competence to the delegating nurse. Managers must complete 20 hours of continuing education every 2 years.

Medicaid Policy

Room and board in ALPs is not covered by standard Maryland Medicaid. Waiver programs, including the Community Options Waiver, do assist with the cost of some care services provided by level two and three ALPs. Services in level one programs are not covered by any Medicaid waivers.

Reporting Abuse

Maryland has a range of reporting options for anyone with concerns or complaints about the treatment of residents in ALPs. Both Adult Protective Services and the Office of Health Care Quality investigate complaints. Residents with Medicaid insurance can report concerns to the Medicaid Fraud Control Unit of the Maryland Attorney General’s office. In addition, the Maryland Department of Aging, Long-Term Care Ombudsman Program investigates and attempts to resolve complaints made by residents of assisted living facilities.

III. Free Memory Care Resources in Maryland

ResourceContactDescription
Johns Hopkins Memory and Alzheimer’s Treatment Center410-550-6337In addition to evaluation and treatment, the Johns Hopkins Memory and Alzheimer’s Treatment Center has family and patient resources available, including a social group. Individuals may be able to participate in the center’s research trials.
Alzheimer’s Association of Maryland800-272-3900The Alzheimer’s Association has information and support available to people with Alzheimer’s disease and their families. Support groups are also available around the state.
Family Caregiver Support Program410-767-1100The Family Caregiver Support Program provides information and assistance to family members looking after individuals of any age who have Alzheimer’s disease or a related condition. Respite care and supplemental services are also available.