Memory Care in Massachusetts

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 cost of assisted living averages $5,640 per month in Massachusetts, which is about $1,600 more than the national average of $4,051. Given that memory care often costs about 25% more than standard assisted living, Massachusetts residents can expect to pay approximately $7,050 per month.

The cost of care is often linked closely with the geographic area where it is received. Even within the same state, there can be significant differences in assisted living costs. For example, facilities in the Boston area charge an average of $6,442 per month. In Pittsfield, in the western region of the state, the average cost is much lower at $3,013. In Springfield and Barnstable Town, prices are relatively comparable and near the state average at $5,350 and $5,550, respectively. These averages apply to standard assisted living, and memory care may run $750-$1,600 more per month, depending on the region.

Massachusetts Medicaid Programs for Memory Care

Senior Care Options

MassHealth, the combined CHIP and Medicaid program in Massachusetts, offers long-term care options for seniors and the disabled. Senior Care Options is a program through which seniors can receive comprehensive health care and social support services in their own homes, the home of a loved one or while living at a covered long-term care facility. It offers services with no co-pay, reducing out-of-pocket costs for seniors. Respite care for family members taking on the role of primary caregiver is one of the covered options.

• Who is Eligible: To qualify for Senior Care Options, seniors must live in one of the six areas served by an SCO. Applicants must be age 65 or older and qualify for the MassHealth standard plan. If paying a share of the cost, those payments continue under SCO. Those currently paying Medicare premiums for Part A and/or B, even if eligible for MassHealth, must continue while enrolled in an SCO program.
• How to Apply: Those interested in applying for SCO may contact a MassHealth customer service representative or the local SCO provider. The individual provider may be able to offer more information about the enrollment process and will work with individuals on an eligibility determination.

Programs of All-Inclusive Care for the Elderly

The PACE program is designed to allow seniors to remain in their own homes or with loved ones for as long as possible. Under this program, seniors may receive assistance with meals, personal care, home health care, and other in-home services. Nursing home care and respite care are both available when needed, along with comprehensive medical care. All services are coordinated through the interdisciplinary team that helps create a care plan for each participant.

• Who is Eligible: To qualify for PACE, seniors must be at least 55 years old with a recognized disability such as Alzheimer’s disease. While MassHealth eligibility is not a requirement, those who qualify for MassHealth may be able to have their premiums billed directly to Medicaid. Other enrollment qualifications include being eligible for nursing home placement, currently living in the community and being local to a PACE provider organization.
• How to Apply: To enroll in PACE, seniors must contact the local PACE organization that will coordinate their care. To find the nearest PACE center, click here.

Moving Forward Plan Waivers

There are two types of MFP waivers available to eligible Massachusetts seniors — MFP Residential Supports and MFP Community Living. The residential supports program is for those who need around-the-clock supervision and assistance, similar to the level of care available in a nursing home. The community living waiver is for those seniors who can live in the community with the right combination of support services. Depending on the waiver program, MFP may directly pay some of the costs of an assisted living community.

• Who is Eligible: To qualify for an MFP waiver, seniors must have been institutionalized for at least 90 days and have a disability or be at least 65 years old. Applicants must meet the financial eligibility requirements for MassHealth standard and be able to be safely supported in the community.
• How to Apply: To apply, applicants must fill out and mail in a completed application form to UMass MFP Waiver Unit at 333 South Street, Shrewsbury, MA 01545.

Personal Care Attendant Program

Massachusetts seniors can employ an attendant to provide home health and personal care services with financial assistance provided through the Personal Care Attendant Program. Seniors or their primary caregivers must be able to handle the hiring, management and firing process. If overtime work is required, seniors must complete a request form and get pre-authorization for additional funds.

• Who is Eligible: Seniors enrolled in MassHealth Standard or CommonHealth may qualify for the Personal Care Attendant Program. Eligibility requirements include approval from a primary care doctor and a diagnosed disability that results in the need for hands-on assistance with at least two activities of daily living such as mobility, bathing/grooming, dressing/undressing, passive range-of-motion exercises, taking medications, eating, and toileting.
• How to Apply: To apply for the Personal Care Attendant Program, seniors can contact a local PCA Agency or call MassHealth customer service at 800-841-2900.

Non-Medicaid Financial Assistance Programs for Memory Care in Massachusetts

Family and Caregiver Support Program

Those caring for a senior aged 60 or older or with Alzheimer’s at any age may qualify for assistance through the Family and Caregiver Support Program. This program is offered via a partnership between the Executive Office of Elder Affairs and local Area Agencies on Aging. Depending on the region, services might include financial assistance with home care services, counseling, respite care, and caregiver training. An in-home assessment from a caregiver specialist is often the first step toward creating a coordinate plan for services and supports.

• Who is Eligible: Eligibility for the Family Caregiver Support Program varies by region.
• How to Apply: To apply, contact a caregiver specialist by calling 844 422-6277

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

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:

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.