Memory Care in New Hampshire

Table of Contents

Memory Care in New Hampshire

Table of Contents

• The Cost of Memory Care in New Hampshire
• New Hampshire Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in New Hampshire?
• More Ways To Pay for Memory Care in New Hampshire
• Memory Care Laws and Regulations in New Hampshire
• Free and Low-Cost Resources for Seniors in New Hampshire
• New Hampshire 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 in the 2021 Genworth Cost of Care Survey to calculate the cost of memory care. 

Seniors in New Hampshire pay an average of $7,566 per month for memory care. This amount is almost $2,000 more than the national average of $5,625. Communities in nearby Maine charge a similar amount at $7,331, while those in Massachusetts are far more costly at around $8,125 per month. Vermont is the most affordable state in the vicinity, with an average monthly cost of $6,563.

Data is only available for one city in New Hampshire: Manchester, with a monthly average cost of $10,076. Across the state border in Boston, MA, seniors pay significantly less at around $8,524 each month. In Portland, ME, the costs are similar to those in Boston at an estimated $8,156 per month. 

The New Hampshire Medicaid Program is designed to assist low-income seniors and chronically ill adults with receiving the medical care and services they require. It doesn't cover memory care services in an assisted living community or home-based environment. The Choices for Independence Waiver Program may cover some of the costs and make memory care an affordable option.

• Who Is Eligible: Applicants must be 65 years or older or an adult with a chronic disability, be U.S. citizens or legal residents, reside in New Hampshire and meet the financial Medicaid program requirements.
• How To Apply: Applicants can apply online or in person through the New Hampshire Department of Human and Health Services.

Choices for Independence Waiver Program

The Choices for Independence Waiver Program is aimed at seniors who are eligible for Medicaid and medically qualify for nursing home care. The program is designed to delay or prevent the move to a nursing home by providing the required care services to seniors in a less restrictive environment such as an assisted living community. Benefits are provided on a case-by-case basis and may include nonmedical transportation, intermittent skilled nursing care, personal care services, physical therapy, occupational therapy and specialized medical equipment. 

• Who Is Eligible: Applicants must be eligible for Medicaid in New Hampshire, be residents of New Hampshire and undergo a medical evaluation to show they require nursing home level care.
• How To Apply: Seniors must first apply for and be accepted by Medicaid. Interested applicants can then contact their local ServiceLink office or call the ServiceLink Helpline at (866) 634-9412.

Medicaid Eligibility for Seniors in New Hampshire

Seniors applying for Medicaid in New Hampshire are required to meet certain income guidelines to qualify for coverage. Single applicants have a monthly income limit of $2,523, while married couples must receive less than $5,046 or $2,523 per spouse. The asset limit in New Hampshire is $2,500 for single applicants and $5,000 for dual applicants.

2022 Medicaid Income Limits for Seniors in New Hampshire

Additional requirements for eligibility include being a citizen of the United States or a legal resident and being a resident of New Hampshire.

Documents that may be required for the application include:

• Birth certificate
• Proof of citizenship or legal resident status
• Bank statements
• Proof of income
• Proof of current address
• Title deeds for any property owned
• Insurance policies
• Power of attorney

How To Get Help Applying for Medicaid in New Hampshire

Services are available to assist seniors and their loved ones in the application process.

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

In New Hampshire, the Department of Health and Human Services Health Facilities Administration is responsible for licensing and inspecting assisted living facilities, including those that offer memory care. The administration performs routine inspections to ensure compliance with state rules and regulations and conducts unscheduled inspections in response to complaints. New Hampshire has two types of licensed AL facilities: supported residential health care facilities (SRHCFs) and residential care facilities (RCFs).

State regulations do not include special requirements for facilities that provide memory care, other than prohibiting the use of mechanical constraints and stipulating that staffing must be adequate to meet the needs of residents.

Facility Scope of Care

SRHCFs and RCFs must provide necessary services to ensure the health and safety of residents and limit the likelihood of injuries and accidents. At a minimum, the scope of care must cover:

• 24-hour oversight and protective care
• Crisis intervention and emergency response services
• Assistance with ordering and taking medications
• Assistance with arranging medical and dental care
• Housekeeping and laundry services
• On-site recreational and social activities
• Supervision as required
• Three nutritionally balanced meals per day, along with snacks and prescribed therapeutic diets

SRHCFs must also ensure that residents have access to nursing, rehabilitation and behavioral health care services if required.

Admissions Requirements

New Hampshire regulations allow RCFs and SRHCFs to accept individuals with various conditions who require assistance with activities of daily living and instrumental activities of daily living, including those with cognitive impairment. An overview of the circumstances that determine whether a person may reside in an RCF or SRHCF is provided in the following table.

Residents Who May Be Admitted By RCFs And SRHCFs

Seniors and adults who have:

• Care needs compatible with those offered by a facility
• Alzheimer's disease or a related dementia
• Physical or intellectual disabilities
• Stable chronic illnesses
• Mental health conditions
• Controlled behavioral issues

Residents Who May Be Retained By SRHCFs

Residents who required ongoing nursing or medical care and whose needs may be met by the facility's staff or a licensed home health care provider.

Residents Who May NOT Be Admitted or Must Be Discharged By RCFs:

Individuals who:

• Require specialized equipment to transfer to or from a chair or bed
• Need 24-hour nursing care
• Require ongoing nursing or medical care due to a change in health status
• Cannot self-evacuate in the event of an emergency

Care Plan Requirements

New residents of SRHCFs and RCFs must be evaluated by a trained assessor using an HFA-approved tool. Assessments must be conducted every six months and after any noted change in a resident's condition. If indicated, a nursing assessment must be performed that covers a resident's vital signs; medication use; clinical services and physical, behavioral, cognitive and mental status. Qualified facility staff must develop a care plan for each resident based on their assessment results.

Medication Management Requirements

Residents of SRHCFs and RCFs may self-administer medications and verbally self-direct staff to help, if necessary. SRHCF staff may supervise self-administration by residents but may not handle medications. A licensed nurse may delegate the administration of oral medications to unlicensed staff members, who may also administer enemas, glycerin suppositories, topical products and medicinal baths/shampoos with direction. In RCFs, medications may be administered by a licensed nurse or a medication nursing assistant.

Facility Requirements

Per state regulations, licensed SRHCFs and RCFs are not required to provide private apartments. Resident accommodations may be single or double occupancy and should include a sink and toilet. Facilities must have one bathtub or shower for every six residents. SRHCFs that offer memory care should be equipped with a wander prevention system, a locked security system or an alarmed system that locks automatically when a resident wearing an electronic sensor approaches. RCFs with 16 or fewer residents must have a wander prevention system installed if awake staff is not on duty at night.

Staffing Requirements

SRHCFs and RCFs must employ an administrator to handle daily operations, sufficient direct care staff to provide residents with personal care assistance and a licensed nurse to administer medications. In SRHCFs, the on-staff nurse must also oversee health services and assist with resident assessments, and they may also delegate medication administration to a certified nursing assistant.

There are no minimum staffing ratios in New Hampshire assisted living facilities. Instead, administrators determine personnel requirements according to their facility's size and the service needs of its residents. SRHCFs and RCFs must have at least one awake staff member on duty around the clock. Overnight staffing is not required in facilities with less than eight beds that are equipped with electronic communication systems.

Regulations require facility administrators to complete 12 hours of continuing education on relevant topics each year. Direct care personnel must receive a comprehensive orientation and initial training within one week of being hired, and they must be provided with ongoing training during their employment.

Medicaid Policy

New Hampshire Medicaid only provides coverage for care received in a nursing home as an entitlement. The plan does offer the Choices for Independence Waiver program, which can help defray monthly expenses for seniors who wish to live in a less restrictive assisted living setting. Assistance is capped at 80% of the cost of care in a nursing facility, but the waiver does cover a variety of services that may benefit memory care residents.

Reporting Abuse

Incidents of resident neglect or abuse in a New Hampshire SRHCF or RCF facility should be reported to the Office of the Long-Term Care Ombudsman. Complaints may be made by email, by calling 800-442-5640 or by completing and faxing a facility initial report form to 603-271-5574. Alternatively, a completed report form may be mailed to:

Office of the Long-Term Care Ombudsman Office of the Commissioner NH Department of Health and Human Services 129 Pleasant Street Concord, NH 03301

A number of resources are available to guide and assist seniors and their caregivers along the difficult journey that is Alzheimer's. These resources provide information, education and support along the way to ensure seniors enjoy the best quality of life possible.

Note: The following information was compiled and most recently updated on 2/10/2022. 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.