Memory Care in Nebraska

Because of the specialized staff training and resources required to provide high-quality memory care, it typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

Assisted living costs an average of $3,819 per month in Nebraska, according to the 2019 Genworth Cost of Care Survey, which is $232 less than the national median of $4,051. The rate in Nebraska is also significantly lower than the costs paid in the surrounding states of Iowa, Colorado and Kansas, which average $4,078, $4,095, and $4,473, respectively. Nebraskan seniors can expect to pay $4,773 per month for memory care services, after adding 25% to the cost of basic assisted living.

The average rates paid for assisted living can also vary greatly within Nebraska, based on geographic location and facility features. In Omaha, the state’s most populous city, the average cost is $4,000 per month. In the capital, Lincoln, the average monthly price jumps to $5,860. Farther west in the smaller community of Grand Island, the cost of assisted living averages just $3,945 per month. Keep in mind that these city averages represent the cost of standard assisted living, and the rates for memory care may be $875 to $1,750 higher per month.

Nebraska Medicaid Programs for Memory Care

Medicaid Aged and Disabled Waiver

Nebraska offers the Medicaid Aged and Disabled waiver to help seniors who require daily assistance, including memory care, remain in the community rather than living in a nursing facility. By providing financial assistance so individuals can stay at home, or in an assisted living community, the state reduces its overall cost of care and allows seniors to enjoy a higher quality of life. The A & D waiver does not pay facility room and board fees, but does cover essential care provided in an assisted living setting, as well as transitional costs to relocate from a nursing home, assistive technologies, nonmedical transportation, nutrition services, respite care and other expenses.

• Who Is Eligible: Applicants must be aged 65 or older and meet Medicaid’s criteria as either “categorically needy” or “medically needy” to qualify for the A & D waiver. This entails meeting specific functional standards and having income and assets below the program’s current limits.
• How to Apply: To apply for this waiver, interested seniors may contact the Nebraska Department of Health and Human Services at 800-358-8802. Alternatively, they may contact the Area Agency on Aging serving their locale.

Non-Medicaid Financial Assistance Programs for Memory Care in Nebraska

Medicare Advantage Plans

Nebraska seniors who are currently enrolled in Original Medicare may be able to recoup some of the costs associated with memory care services by switching to a Medicare Advantage plan. These plans are also referred to as Part C coverage, and are only offered through Medicare-approved private insurance companies. MA plans must provide the same basic services as Original Medicare Parts A and B, and many offer Part D coverage for prescription drugs, as well. Most include a range of additional benefits, such as dental, hearing and vision care, nonemergency medical transportation, personal emergency response systems, wellness programs and more.

Recently, Medicare expanded the range of extra benefits available to enrollees with chronic health conditions, including Alzheimer’s disease and dementia. The program also now allows a senior to use the assisted living or memory care facility where they reside as their address of record. These changes let residents claim and be reimbursed for additional qualified expenses, such as personal care assistance, through certain MA plans.

• Who Is Eligible: Seniors must be currently enrolled in traditional Medicare Parts A and B to qualify for an MA plan. Making the change to an MA plan is only allowed during specific periods each year. Enrollees must continue to pay a monthly Medicare Part B premium, in addition to any MA plan costs.
• How to Apply: Interested seniors may use the Medicare plan finder tool to compare the coverage and cost of plans available in their area. To learn about the enrollment periods and details of the application process, seniors may contact a plan provider directly, or call Medicare at 800-633-4227.

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

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:

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.