Memory Care in Missouri

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.

Missouri is a comparatively inexpensive place to receive assisted living services, meaning that families typically pay relatively affordable monthly rates for memory care services. Statewide, the average cost of assisted living is $2,881 per month, which is nearly 34% lower than the national average of $4,051. Based on the statewide average cost of assisted living, families should expect to pay between $3,457 and $3,745 per month for memory care.

Across the state, assisted living and memory care costs vary, with some cities having lower prices than the state average and some cities having considerably higher costs. The most affordable city for assisted living is the southwestern city of Joplin, where assisted living averages $2,750 per month and memory care costs an average of 25% more at $3,438. The priciest city in the state is St. Louis, where assisted living costs $3,848 per month and memory care is an average of $4,810. Jefferson City, the state capital, is also one of the more expensive cities in the state for senior care. Here, assisted living averages $3,754 per month and memory care averages $4,692.

Missouri Medicaid Programs for Memory Care

Aged and Disabled Waiver

The Aged and Disabled waiver program provides in-home services for seniors aged 63 and over who qualify for nursing home-level care due to certain impairments and unmet needs but wish to remain in their own home. This waiver may make it easier for family members to care for a loved one at home as an alternative to institutionalized care. It pays for a wide range of services to promote safety in the home for seniors with mild to moderate Alzheimer’s disease, including homemaker services, respite care, adult day health care, chore services and home-delivered meals.

• Who is Eligible: To qualify for this waiver program, applicants must be permanent residents of Missouri and at least 63 years old. They must have functional disabilities that typically need nursing home-level care. Additionally, they must meet Missouri Medicaid’s income and asset guidelines.
• How to Apply: To receive services under this waiver program, seniors should contact their local Area Agency on Aging.

Supplemental Nursing Care

MO HealthNet’s Supplemental Nursing Care waiver program provides a cash benefit to eligible seniors to help them pay for costs associated with assisted living. The payment the program participant receives is based on whether they’re living in a residential care facility, which does not provide assistance with daily living activities, or an assisted living facility, which does provide this level of care. As of 2020, this program pays out $156 per month to residents in residential care facilities and $292 per month for those in assisted living facilities, as well as a $50 personal needs allowance.

• Who is Eligible: To be eligible for this waiver program, an applicant must be screened for and certified by the Department of Health and Human Services for nursing home care or state mental hospital care, and they must meet the state’s Medicaid income, asset and residency guidelines.
• How to Apply: To learn more about this program and apply for services, seniors should contact their local Family Support Division county office or call the state hotline at 1-855-373-4636.

Non-Medicaid Financial Assistance Programs for Memory Care in Missouri

Older Americans Act

The Older Americans Act is a federal program that provides services to those aged 60 and over. These services are offered through local Area Agencies on Aging, which offer an array of services, including congregate or home-delivered meals; homemaker, chore, personal care or respite services; health promotion and access services, such as transportation, advocacy and case management. While these services don’t pay for memory care directly, they may free up resources to make care more affordable.

• Who is Eligible: To be eligible for services under this program, participants must be at least 60 years of age. While there are no income limits, priority is given to low-income seniors.
• How to Apply: To find out what services are available, seniors should contact their local AAA 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

In Missouri, memory care is generally provided in assisted living facilities, which are residences that accommodate three or more people and provide lodging and care services under the direction of a licensed physician. Assisted living facilities are licensed and monitored by the Missouri Department of Health and Senior Services. The facility must be inspected prior to licensing and then on an annual basis.

Facility Scope of Care

Assisted living facilities provide 24-hour care and supervision, as well as nursing services, assistance with daily living activities and recreational activities. They must also provide assistance with storage, distribution and administration of medications. Assisted living facilities are required to provide at least three meals per day. Doctor-prescribed specialty diets can be provided by the facility, but must be reviewed on a quarterly basis by a physician, registered nurse, dietitian or nutritionist. Assisted living facilities are also required to provide individualized evacuation plans for memory care residents who are unable to evacuate independently.

Admissions Requirements

Assisted living facilities that provide memory care can accommodate a wide range of residents. However, there are some restrictions regarding who may not be admitted. These are outlined in the table below.

Care Plan Requirements

Memory care facilities are required to complete screening prior to admission to confirm that the prospective resident is eligible for admission. Within five days of admitting a resident, the facility must use an assessment tool approved by the Department of Health and Senior Services to conduct a physical exam to record the new resident’s medical status and any special orders regarding their care needs.

This assessment must be repeated on a semiannual basis and whenever the resident has a significant change in their health or abilities. Based on this assessment, the facility develops a personalized care plan that addresses the resident’s needs, goals and expectations, along with an evacuation plan if the resident requires more than minimal assistance to evacuate the building in the event of an emergency.

Medication Management Requirements

Memory care residents may only self-administer prescription and over-the-counter medication if a licensed health care provider approves. Each resident’s medication must be reviewed by a pharmacist, registered nurse or physician on a monthly basis.

Unless they are a licensed nurse, pharmacist or physician, staff members who administer medication must be certified, at the minimum, as a medication technician or a Level I medication aide. Insulin can only be administered by a licensed physician or registered nurse, or a medication technician or a Level I medication aide who has passed the state’s insulin administration course. Injections, excluding insulin, may only be administered by a licensed physician or registered nurse.

Facility Requirements

Apartment-style units and private bathrooms are not required. Rooms may be single or double occupancy, with a maximum of four residents per room. There must be at least one toilet and sink per every six residents and one tub or shower for every 20 residents. Facilities are required to be homelike, which may include living rooms or common rooms where residents can socialize, family-style kitchens and eating areas, laundry areas for resident use, private bathrooms, outdoor common areas and a place where residents can enjoy privacy and exercise control over their environment.

Staffing Requirements

Memory care facilities must have a licensed administrator, a licensed nurse and direct care staff. If the facility provides medication administration, it must have a Level I medication aide or a certified medication technician to administer medications. The facility has to be under the supervision of a physician who is kept informed of treatments and medications prescribed to residents.

Memory care facilities must have a staff-to-resident ratio of 1:15 during the day and evening and 1:20 at night. There must be enough staff members available to meet residents’ needs at all times, even if this exceeds minimum staffing ratios.

Medicaid Policy

Personal care may be covered in memory care facilities by the state’s Medicaid plan. Additionally, MO HealthNet may cover services under one of two waiver programs, including the Aged and Disabled waiver and the Supplemental Nursing Care waiver.

Reporting Abuse

Assisted living facilities are required to report abuse, neglect or exploitation to the Missouri ombudsman program. Anyone else who has concerns about the treatment or quality of care seniors receive in an assisted living facility may bring their concern or complaint to the ombudsman as well.