TABLE OF CONTENTS
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.
At $7,021 per month, New Hampshire has the region’s highest average cost for assisted living, according to Genworth Financial’s 2019 Cost of Care Survey. This is almost $3,000 above the nationwide median of $4,051 and substantially higher than the average assisted living rates in surrounding states. Average costs in Maine, Rhode Island, Vermont and Massachusetts vary by less than $500, and range from $5,169 to $5,640 per month. Taking 25% as the average extra cost for memory care over standard assisted living, seniors in New Hampshire seeking memory care can expect to pay $8,776 per month.
The cost of assisted living in Manchester, New Hampshire’s largest city, is expensive compared to the average amounts paid in other major cities in the region. At $7,132 per month, Manchester’s average is $690 higher than the $6,442 per month that Boston seniors pay and $532 more than the monthly rate of $6,600 for comparable care in Portland, Maine. The price discrepancy is even greater between Manchester and Burlington, Vermont, and Providence, Rhode Island, which have average assisted living costs of $5,113 and $5,195, respectively. Seniors should also keep in mind that these figures are for basic assisted living, and memory care may cost up to $1,000 more on a monthly basis.
Seniors and disabled adults with chronic illnesses, such as dementia, who need help paying for memory care services may qualify for New Hampshire Medicaid’s Choices for Independence Waiver program. The CFI waiver pays for a range of care and supportive services in a community setting, such as a memory care facility, so eligible individuals can relocate from or avoid being admitted to a nursing home.
Depending on a person’s needs, the program may cover the cost of case management, transition assistance, residential care services, periodic skilled nursing care, nonmedical transportation and specialized durable medical equipment. Services received through the CFI program cannot exceed 80% of what the state would pay in a Medicaid-funded nursing home. The program is available statewide, but enrollment is capped, so eligible seniors who apply may be placed on a waiting list based on the current number of participants.
The New Hampshire Department of Health and Human Services administers the State Supplement Program, which provides benefits to eligible blind, disabled and elderly residents. These cash benefits are paid twice per month, and the funds may be put toward the costs incurred in a memory care facility.
In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:
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.
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:
SRHCFs must also ensure that residents have access to nursing, rehabilitation and behavioral health care services if required.
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:|
|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:|
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.
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.
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.
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.
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.
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
|Alzheimer’s Association – Massachusetts – New Hampshire Chapter|
|800-272-3900||The Alzheimer’s Association’s MA-NH Chapter is a valuable source of information, education, support and access to local resources for seniors living with memory loss and their loved ones. Assistance is available through the association’s online contact form and toll-free telephone helpline.|
|Alzheimer’s Impact Movement – New Hampshire|
|Fill in the online form to join AIM, complete an application to become an advocacy volunteer or sign up to learn about advocacy opportunities||AIM is a nationwide nonpartisan organization. The nonprofit advocates for dementia-related public policies and engages with lawmakers to increase government investment in memory loss research, support and care services.|
|ActivMed Memory Screening|
|Call 603-319-8863 for more information or to schedule a screening||ActivMed Practices & Research offers free memory screenings for adults aged 50 and over at its New Hampshire location. After an initial assessment, yearly follow-ups are provided to assess cognitive changes.|
|Locate a memory cafe in your area|
|Memory cafes found in New Hampshire communities offer welcoming environments, a variety of dementia-friendly activities and opportunities for socialization and mutual support.|
|New Hampshire Legal Assistance|
|For information and assistance call 888-353-9944||Nonprofit NHLA provides free help with civil legal matters for New Hampshire seniors aged 60 and older. Assistance is available for various issues that older adults with dementia may experience, such as financial exploitation, involuntary commitment proceedings, access to public benefits, disputes with senior care facilities and illegal debt collection.|