Memory Care in Nebraska

Table of Contents

Memory Care in Nebraska

Table of Contents

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

The average monthly cost of memory care in Nebraska is $5,095, which is about 10% lower than the national average of $5,625. Communities in Nebraska, in general, charge lower monthly fees than those in the nearby states of Kansas ($5,725), Iowa ($5,459) and Colorado ($5,938). The exception is South Dakota, where the state average is much lower at $4,188 per month.

Cost data is available for three cities in Nebraska, and the cost of care varies by more than $2,000 between them. Seniors in the state capital of Lincoln pay the highest fees at an average of $5,894 per month. Omaha is slightly lower in cost at $5,815, and the most affordable option in the state is Grand Island at a monthly average of $3,633. 

Although Medicaid doesn't cover the cost of memory care in Nebraska, seniors may be able to get some financial assistance through the state's Aged and Disabled Waiver Program. Medicaid does ensure that low-income seniors are able to cover some of their health care costs.

• Who is eligible: Seniors must be 65 years or older and reside in the state of Nebraska. They must also meet certain financial and medical criteria in order to qualify. 
• How to apply: Applicants can apply online through Access Nebraska or in person at their local Department of Health and Human Services Office.

Aged and Disabled Waiver Program

The Aged and Disabled Waiver Program helps seniors cover the costs of care in an assisted living or memory care facility. The program is provided on a sliding scale, with benefits depending on the senior's income and care requirements. Some of the services that may be covered include personal assistance with the tasks of daily living, housekeeping, nonmedical transport, recreational activities, health monitoring and medication reminders. Unfortunately, the waiver does not cover the costs of room and board. 

• Who is eligible: Applicants are required to be 65 or older and meet the medical requirements of the program. They must meet the income guidelines of Medicaid and be U.S. citizens or legal residents.
• How to apply: Seniors can apply for this waiver at their local Area Agency on Aging or by contacting the Department of Health and Human Services at 800-358-8802.

Medicaid Eligibility for Seniors in Nebraska

Medicaid benefits are available to seniors who have limited financial resources available and may be unable to afford the health care they require. In Nebraska, single applicants are limited to an income level of $13,596 per year and married couples may not earn more than $18,312 on an annual basis. Assets may not exceed $4,000 for individuals and $6,000 for dual applicants. 

2022 Medicaid Income Limits for Seniors in Nebraska

To qualify for the long-term care benefits offered by Medicaid, seniors must meet certain other criteria:

• Reside in the state of Nebraska
• Be a U.S. Citizen or Legal Resident
• Meet certain medical requirements

A list of items that may be required at the time of application include:

• Social Security number
• Proof of current address
• Proof of monthly and annual income
• Current expenses
• Proof of U.S. citizenship or legal resident status
• A list of assets and proof of ownership of the assets
• Power of attorney
• Information regarding current insurance policies

How to Get Help Applying for Medicaid in Nebraska

Seniors and their family members who require help completing the Medicaid application form may contact one of the agencies or departments listed in the table below.

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

Assisted living facilities (ALFs) that offer memory care services are licensed and regulated through the Nebraska Department of Health and Human Services, Licensure Unit. ALFs provide shelter, meals and care for a minimum of four residents, and may contain an Alzheimer’s special care unit (ASCU), which is a secure, segregated area for residents with Alzheimer’s disease, dementia or a related cognitive disorder. ASCUs may also be freestanding facilities that specialize solely in memory care.

As part the initial licensing process, and each subsequent renewal, ALFs must file a written document with the DHHS that includes:

• A description of the services offered and the staff that provides them
• A breakdown of the facility’s charges
• The facility’s move-out requirements
• The facility’s resident services agreement or updates to the agreement
• Whether Medicaid is accepted and any related policies or limitations

ALFs that are marketed as offering memory care must file a separate statement that details the facility’s:

• Philosophy and mission
• Admission, transfer and discharge criteria
• Resident assessment practices and policies
• Staffing guidelines
• Physical features and activities that support dementia care
• Policies regarding family involvement

To receive and maintain a license in Nebraska, ALFs must pass initial and periodic inspections to ensure compliance with state regulations. The DHHS randomly inspects up to 25% of all ALFs each year, and may make an unscheduled inspection when an accident, resident injury or death or other concerning incident occurs, or if a complaint is filed against a facility. All ALFs are inspected at least once every five years.

Facility Scope of Care

ALFs and ASCUs must provide services that promote the well-being, safety and health of seniors in a residential setting. At minimum, the scope of care should include admission and continued-stay assessments, accommodations, three daily meals, 24-hour access to staff and support with activities of daily living (ADLs). Facilities may also provide:

• Case management
• Personal care
• Transportation
• Housekeeping and laundry services
• Beauty and barber services
• Behavioral management
• Spiritual activities
• Up to 10 hours per week of nursing services, for a duration of no more than 21 days

Residents or their legal representatives may also arrange for care services through a licensed hospice or home health agency, or from private duty personnel, if they assume responsibility.

Admissions Requirements

ALFs in Nebraska may accept residents with a range of care requirements and conditions, but must follow state regulations regarding who may be admitted. The following table offers details about the conditions that determine if a person may or may not receive care in an assisted living setting:

Residents Who May Be Admitted

Seniors and adults with:

• Physical, developmental or intellectual disabilities
• Stable chronic illnesses
• Mental health conditions
• Alzheimer’s disease and other forms of dementia
• Controlled behavioral issues

Residents Who May NOT Be Admitted

Individuals who:

• Require complex, ongoing nursing care
• Have unstable or unpredictable conditions
• May pose a danger to other residents or compromise facility operations

Care Plan Requirements

An ALF must evaluate each new resident to determine their care needs. A care plan or resident services agreement must be then drawn up that outlines the services the facility will provide to meet the person’s needs, and details the cost of these services. This plan must be reassessed and updated as the resident’s condition and care needs change.

Medication Management Requirements

Each resident entering or living in an ALF or ASCU must provide the facility with an annually updated list of all prescription drugs, biologicals, supplements and devices used or taken. The dosage, reported use and instructions for use must be included.

Facilities responsible for providing access to or administering medications may accomplish this in one of three ways:

• Residents deemed capable of doing so may self-administer medications with or without supervision
• A licensed health care professional may administer medications
• A trained, competent medication aide may administer medications with appropriate direction and monitoring

Facility Requirements

ALFs and ASCUs must meet the state fire codes and standards to ensure resident safety. Each facility is inspected by the Nebraska State Fire Marshal and the specific requirements for fire alarms, sprinkler systems and fire drills are determined by the evacuation capabilities of its residents.

Resident accommodations in an ALF or ASCU may consist of a single bedroom or an apartment. If apartments are provided, they must feature separate sleeping and kitchen areas, and a private bathroom containing a sink, toilet and tub or shower.

ALFs built before 2007 may house four residents per unit, while a maximum of two residents are allowed per unit in facilities constructed after that date. Older facilities must have a sink and toilet for every six residents, and a bathing room for every 16 residents. Newer facilities must provide one sink and toilet for every four resident beds, and one bath or shower for every eight residents. With new construction, a toilet room with a handwashing sink is required for each bedroom, and a minimum of one bath or shower room to serve every eight bedrooms.

Staffing Requirements

ALFs and ASCUs in Nebraska are required to employ an administrator who is responsible for the facility’s overall day-to-day operations, as well as a substitute to act in the administrator’s absence. Facilities must have sufficient direct care staff on duty to provide adequate personal care to residents, and trained medication aides to administer medications. Each ALF must also appoint a registered nurse to review the facility’s medication administration policy and procedures annually, and oversee medication aide training.

Administrators must complete 30 hours of relevant training during the first six months of their employment, while an orientation and training related to their duties is required for direct care staff. All staff must complete a minimum of 12 hours of ongoing training per year.

The administrator and care staff of an ASCU or memory care facility must receive training in the Alzheimer’s disease process, and the facility’s dementia care and supervision philosophy. Skills training in providing care for those unable to perform personal care, who may wander or have behavior issues is also required. All staff must receive a minimum of four hours of dementia care continuing education annually.

Medicaid Policy

Nebraska’s state Medicaid plan does not pay for care in ALFs and ASCUs as an entitlement. However, the state offers the Medicaid Aged and Disabled waiver to help cover the cost of provided services, certain assistive technology and some supplies in these care settings. Nebraskans who qualify for the waiver are responsible for paying the room and board portion of their facility fees. The A & D waiver is also subject to an enrollment cap, and depending on availability, eligible applicants may be placed on a waiting list before being accepted into the program.

Reporting Abuse

Nebraska residents have several available options to report an incident of abuse or neglect in an ALF or ASCU. If the incident occurred in a facility that receives Medicaid payments, concerned individuals may file a complaint with the Medicaid Fraud and Patient Abuse Unit of the Nebraska Attorney General’s office. Alternatively, they may report the incident to the DHHS Licensure Unit, or call 800-942-7830 to contact the local Long-Term Care Ombudsman.

The following organizations provide information and support services for seniors with dementia and their loved ones in Nebraska.

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.