Memory Care in Massachusetts

Table of Contents

Memory Care in Massachusetts

Table of Contents

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

To find the median for Massachusetts and the United States, we've used data from the 2021 Genworth Cost of Care Survey and added 25% to the state and national averages for assisted living, which are $6,500 and $4,500, respectively.

At $8,125 per month, the typical fee for memory care in Massachusetts is above the national average of $5,625 by almost 36.4%. However, it's not unusual for states in the northeast to be costlier than normal, with Massachusetts regularly placed in the top 10 of the least affordable states in the union.

Massachusetts isn't the most expensive state in New England for memory care, a position held by Rhode Island, where the median fee is $8,533. However, it's costlier than the other states that share its borders, such as New Hampshire ($7,566), New York ($5,725), Connecticut ($6,411) and Vermont ($6,563).

Medicaid in Massachusetts is known as MassHealth. Of the six coverage types available, MassHealth Standard applies to low-income state residents aged 65 and older whose medical needs justify long-term care in residential facilities. Those residing in a memory care community may be eligible for the Group Adult Foster Care waiver and SSI-G.

Group Adult Foster Care and SSI-G

Group Adult Foster Care is a waiver program that covers some costs for seniors who satisfy its medical and financial criteria and reside in MassHealth-certified facilities. It pays for personal care services, administration of medications, housekeeping and transportation but doesn't pay room-and-board costs. However, seniors in receipt of SSI may be eligible for SSI-G, an assisted living benefit that does pay for room and board in qualifying facilities.

Who Is Eligible

To be eligible, the applicant must:

• Be unable to perform at least one daily living task without assistance, such as bathing or dressing
• Provide confirmation of medical needs from a licensed doctor
• Have an income and assets that are within the waiver's financial constraints

How To Apply

There are several ways seniors can apply for the waiver:

• By mail: Download and post a completed copy of the application form to MassHealth Enrollment Center, Central Processing Unit, P.O. Box 290754, Charlestown, MA 02129-0214.
• By fax: Send a completed application form to 617-887-8799.
• In person: Schedule an appointment with a MassHealth representative at the nearest enrollment center.

Medicaid Eligibility for Seniors in Massachusetts

The applicant's financial situation determines their eligibility for Medicaid in Massachusetts. The annual income limit of $2,523 applies to all applicants, but asset limits are determined by the household environment. For residents of single-person households, it's $2,000. For single applicants in two-person households, it's also $2,000, but the non-applicant's assets also factor, and they can't exceed $137,400. When both residents of a two-person household apply for Medicaid, their assets shouldn't be more than $2,523 each, or their application will likely be rejected.

2022 Medicaid Income Limits for Seniors in Massachusetts

In addition to having income and assets that fall within the guidelines, Medicaid applicants must also satisfy other criteria. They include:

• Being 65 years old or more
• Residing in Massachusetts
• Being a U.S. citizen or legal resident
• Having a medical condition that requires nursing home levels of care

How to Get Help Applying for Medicaid in Massachusetts

Applying for aid can confuse some seniors due to Medicaid's options for various vulnerable groups and sometimes complicated eligibility criteria. Fortunately, there are organizations with advisors and counselors dedicated to making the process easier for applicants. 

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

Massachusetts regulations regarding care facilities for the elderly or those with memory impairments fall under the aegis of the Executive Office of Elder Affairs. Assisted living residences are certified rather than licensed in Massachusetts. Certification is obtained through this office after an initial compliance inspection. Recertification requires an additional inspection that must occur at least once every two years.

To qualify as a dementia facility or one that offers specialized care, organizations must meet all the general requirements of an ALR and have secured entry and exit doors. They must provide detailed descriptions of the physical makeup of the facility and a list of safety features designed to minimize risks to residents with cognitive impairments.

Facility Scope of Care

In special care units, ALRs provide standard levels of care and assistance with the activities of daily living along with specialized care. An ALR may not offer round-the-clock nursing care or advanced nursing services, even through a third-party service, unless the need for constant care is expected to last for 90-days or less. The only exception to the rule is hospice care provided in-house, as this is generally of limited duration. In general, an ALR may contract with a licensed third-party service provider to offer intermittent nursing care for residents who require an intermediate level of care.

Some of the services expected in dementia care units include:

• Assistance with the activities of daily living
• Assistance with instrumental activities of daily living
• Meals and snacks provided per approved nutrition plans
• Medication management
• 24/7 awake staff to assist with residents who have alternative schedules
• Daily planned activities that provide stimulation for gross motor control, self-care opportunities, social events, and sensory and memory stimulating activities

Admissions Requirements

Not every senior is a good fit for the special care wing of an ALR. Here is a brief look at which seniors might be admitted and reasons why a senior may need to seek alternative care options:

Residents Who May Be Admitted

Adults of any age diagnosed with Alzheimer’s or another dementia disorder and elderly persons aged 55 or older with:

Residents Who May Be Admitted Older adults and people with:

• Dementia or other cognitive impairments
• Mental health disorders
• Developmental disabilities
• Mobility challenges

Residents Who May NOT Be Admitted Those who:

• Need constant access to skilled nursing care
• Are expected to need nursing care for more than 90 days

Care Plan Requirements

Before accepting a new resident, an ALR must perform an assessment and develop a care plan that ensures the facility can meet the resident’s needs. If the facility determines it can, it must work with a health care provider and use their recent assessment of the resident to come up with a comprehensive service plan. All service plans must include information about the individual’s current diagnosis, medications, allergies, dietary needs, level of assistance required in an emergency, any history of psychosocial issues, ability to self-manage medications and the level of personal care required. Within 30 days of admission, the facility must review the care plan and make any necessary adjustments. A review is also required every time the resident’s condition changes or at least every six months.

Medication Management Requirements

Staff who have completed personal care service training may assist with the management of self-administered medications. This may include opening containers, reading labels to residents, reminding them to take medications and observing residents as they take medicine. Direct medication administration may also be available as an optional service. Medication administration may only be provided by a medical practitioner or registered or licensed nurse. A nurse can only administer medications directly from the pharmacy with all labeling intact and as prescribed.

Facility Requirements

ALRs offering dementia care must have secured entry and exit doors. An ALR must provide private or semiprivate rooms that have lockable doors. Newly constructed ALRs must provide a private bathroom for every unit. Older ALRs may offer a half-bath for each unit and a bathing facility for every three residents. Each ALR unit must contain a kitchenette or access to a refrigerator, sink and heating element, though the use of these facilities may be restricted or monitored.

Staffing Requirements

Any staff member employed by an ALR that has direct contact with residents, including all food service employees, must complete a seven-hour orientation before starting work. Staff planning to work in a special care unit must participate in an additional seven hours of training specific to the care needs of the special resident population. Any employee providing personal care services must complete an extra hour of orientation training dedicated to self-administered medications. All ALFs must have a manager and/or service coordinator. These employees complete two hours of training specific to dementia care. Personal care staff must also complete at least 54 hours of training. Licensed nurses, CNAs, certified home health aides and qualified personal care homemakers are exempt from this requirement. Those who need additional training must complete 20 hours of training with a registered nurse.

Each year, staff must complete at least 10 hours of ongoing education, with at least two of those hours devoted to care for Alzheimer’s patients. For those who work in the special care unit must complete an additional four hours of specialized training in caring and communicating with those who have Alzheimer’s or other dementias.

Medicaid Policy

MassHealth Standard does not cover room and board costs associated with ALRs. However, some Medicaid waiver programs may offer financial assistance with in-home health services and personal care that may apply to those costs. Massachusetts also offers a supplement to Social Security to help with the room and board costs of assisted living.

Reporting Abuse

Seniors and their family members can report abuse at an assisted living residence to the Executive Office of Elder Affairs online or by mail.

Seniors in need of memory care support and their families can access a wealth of free and low-cost resources in Massachusetts. Those listed here can provide detailed information about the condition, help seniors and their loved ones develop health care plans and find others in the community on similar journeys to their own. There's also support for memory care facility residents with complaints about the quality of their care.

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.