Memory Care in New Jersey

Table of Contents

Memory Care in New Jersey

Table of Contents

• The Cost of Memory Care in New Jersey
• New Jersey Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in New Jersey?
• More Ways To Pay for Memory Care in New Jersey
• Memory Care Laws and Regulations in New Jersey
• Free and Low-Cost Memory Care Resources in New Jersey
• New Jersey 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.

To determine the average cost of memory care in New Jersey, we added 25% to assisted living costs as listed in the 2021 Genworth Cost of Care Survey. 

The cost of assisted living in New Jersey for seniors needing memory care services averages $8,119 per month, which is $2,494 higher than the national average rate of $5,625. New Jersey's neighboring state of Delaware reports slightly lower prices for memory care at $7,494, while in New York ($5,725) and Pennsylvania ($5,125), costs are lower by more than $2,000 per month. 

The costs for memory care in New Jersey can vary widely depending on the location sought for assisted living. For instance, the capital city of Trenton has one of the state's highest rates at $10,181 monthly, with memory care in Ocean City averaging $818 less at $9,363. Costs in Atlantic City are less than the state average at $7,259, while rates in Vineland are on par with the state's median costs at $8,000 per month. 

Medicaid Managed Long Term Services and Supports

The New Jersey Comprehensive Medicaid Waiver encompasses the state's Medicaid Managed Long Term Services and Supports (MLTSS) program. This program provides eligible seniors with medical care and support services via a managed health care organization (HMO or MCO) under the auspices of NJ FamilyCare. Assisted living and memory care services may be covered under this managed care program for seniors who meet eligibility requirements and have personal care needs consistent with several daily living tasks. 

• Who Is Eligible: Individuals who are U.S. citizens and residents of New Jersey must be 65 years old and up to be considered for the MLTSS program. Applicants must meet clinical guidelines for needing a nursing home level of care. Financial eligibility requirements include limits on gross income and countable assets. 
• How To Apply: Seniors already covered under the state's Medicaid program, NJ FamilyCare, must contact their managed care organization's member services department to set up an assessment for long-term care services and/or placement. If not already covered under NJ FamilyCare, individuals must first apply for Medicaid by contacting a representative of the Aging and Disability Resource Connection within their county to receive help with the application process or by applying online or in person to a local county Department of Social Services office.

Medicaid Eligibility for Seniors in New Jersey

The financial eligibility requirements for seniors applying to receive long-term care services in New Jersey are limited to certain maximum monthly income amounts and countable liquid assets. The current 2022 income limit cap for a single applicant is $2,523 per month. There is a resource limit restriction of $2,000 or less.

However, if income is more than the eligibility limit, applicants can open a Qualified Income Trust (QIT) with the amount in excess of the limit amount to qualify for services.

All income and assets must be disclosed for a "look-back" period that includes transactions performed over the past five years to determine financial eligibility. Some assets may be exempt for applicants, such as a primary home (with an equity limit of $858,000), one vehicle, an irrevocable funeral trust and certain life insurance policies. 

2022 Medicaid Income Limits for Seniors in New Jersey

In addition to meeting financial and clinical requirements, applicants to New Jersey Medicaid Long Term Services and Supports must also:

• Have a disability, be blind or be 65 years old and up
• Be a U.S. citizen, permanent resident or qualified alien
• Reside in New Jersey
• Be nursing home-qualified 

How To Get Help Applying for Medicaid in New Jersey

Helpful resources in New Jersey are available to assist applicants when applying for MLTSS. 

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 option can be a good way to fund memory care in the short term, but the loans will need to be paid back after the home's sale. The most commonly used type of reverse mortgage 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 Jersey, assisted living facilities (ALFs) that provide residential memory care are regulated and licensed through the Department of Health (DOH), Division of Health Facilities Evaluation and Licensing. ALFs are licensed for a minimum of four residents, but New Jersey regulations do not specify maximum occupancy limits. There are two types of residential ALFs in the state:

• Assisted living residences (ALRs), which are purpose-built
• Comprehensive personal care homes (CPCHs), which are converted residential boarding homes

Facilities that offer Alzheimer's and dementia care are required to have admission and discharge guidelines in place and ensure that staff attend a mandatory dementia training program. Additionally, facilities must have a written plan for activities, safety policies and specific procedures relating to memory care residents that can be provided to staff, residents, family members or the public upon request.

To ensure compliance with state regulations and continued quality of care, the Division of Health Facilities Evaluation and Licensing performs unannounced inspections of all licensed facilities every two years, as well as investigative inspections in response to complaints.

Facility Scope of Care

ALR and CPCH facilities in New Jersey should operate according to assisted living values that encourage and promote independence, dignity and privacy for residents in a homelike environment. These facilities provide housing along with a coordinated range of 24-hour supportive services to meet the needs of residents. The personal and health-related services offered may be provided by the facility's staff or arranged through outside providers and may include:

• Assistance with personal care
• Nutritious daily meals plus snacks
• Necessary nursing care
• Pharmacy services
• Social work services
• Recreational and social activities
• Supervision and assistance with self-administration of medication
• Administration of medication by trained staff
• Healthcare services
• Transportation

Admissions Requirements

According to New Jersey regulations, assisted living settings are appropriate for those who can respond to their environment, demonstrate independent activity, interact with others and express volition. State regulations allow ALR and CPCH facilities to accept individuals with a wide range of disabilities and frailties. They also stipulate that 20% of a facility's residents must require a nursing home level of care. The table below provides a general guide on individuals who may and may not be admitted to an ALR or CPCH:

Residents Who May Be Admitted

Disabled adults aged 18 or older and seniors who:

• Require assistance with several activities of daily living, including bathing, dressing, toileting, eating and mobility
• Suffer from cognitive impairment, dementia or Alzheimer's
• Have a chronic or unstable medical, behavioral, emotional or psychological condition
• Require hospice care

Residents Who May NOT Be Admitted

Those who:

• Require mechanical ventilation or a respirator
• Are in a vegetative state
• Are aggressive, disruptive or combative
• Pose a danger to other residents

Care Plan Requirements

ALR and CPCH facilities in New Jersey are required to obtain a healthcare provider's assessment for each resident in the 30 days prior to their admission. This is necessary to verify that the level of care the facility provides is appropriate for the individual's needs. Details on the person's nursing requirements, preferences and usual routines should also be obtained from their current caregivers, if applicable.

When a resident is admitted, an initial assessment by an RN is required to determine what services the individual needs, and a general service plan must be developed within 14 days after admission. If the person requires healthcare services based on the initial assessment, an RN must complete an additional assessment. Those diagnosed with Alzheimer's or other forms of dementia must be assessed to determine their cognitive and functional abilities.

Based on these assessments, the facility is required to develop a personalized care plan for the individual during their first 14 days of residency. The service and care plans for each resident must be reviewed quarterly and revised as needed to reflect changes in their physical and/or cognitive condition.

Medication Management Requirements

New Jersey has specific rules regarding the administration of medications in ALR and CPCH facilities, including injections of pre-drawn insulin, disposable insulin pens and epinephrine. A facility may designate staff to provide supervision and assistance to residents who self-administer medications. These staff members must receive training from the facility's RN or a licensed pharmacist.

Alternatively, facilities may designate trained, supervised staff, including certified home health aides and nurse aides to administer medication. These staff members must complete a medication aide course, pass an exam to become certified and be supervised by an RN. It is also required that facilities use a unit-dose drug distribution system for the delegated administration of medications.

Facility Requirements

ALRs and CPCH facilities in New Jersey may offer single- or double-occupancy accommodations, with a maximum of two residents per room. ALRs must provide apartment-style units that have a lockable entry door, kitchenette and private bathroom with a toilet, bathtub/shower and sink. Rooms in CPCH facilities may have shared bathrooms, and kitchenettes are not required. However, each room must have a lockable entry door.

The amount of living space required in a unit depends on the type of facility:

• Newly constructed or renovated ALR facilities should provide 150 square feet of usable floor area in private apartments, and 230 square feet in shared units
• CPCH facilities must provide 80 square feet of open floor space in single-occupancy rooms, and 130 square feet in shared rooms.

Staffing Requirements

Assisted living facilities in New Jersey are required to have sufficient professional and unlicensed staff on duty to provide the basic care, assistance and supervision residents require, based on assessments of each resident's needs. ALRs and CPCHs must appoint an administrator who holds a valid New Jersey assisted living or nursing home administrator license, and employ personal care staff who are certified homemaker/home health aides, certified nurse aides or have passed a personal care assistant training course.

There is no minimum staff-to-resident ratio required in ALRs and CPCHs, but state regulations include specific staffing guidelines for these facilities:

• In facilities licensed for more than 60 residents, the administrator or a designated alternate must be on-site and available on a full-time basis.
• Facilities with fewer than 60 residents are required to have an administrator or an alternate on-site on a half-time basis.
• Facilities must have an RN on the premises or on call around the clock, as well as at least one personal care assistant and an additional staff member awake and on-site 24 hours per day.

ALRs and CPCHs are also required to provide personal care staff with orientation training before they begin working with residents. This training should cover assisted living concepts, care of residents with physical impairments, pain management and infection prevention and control, as well as abuse and neglect, resident rights and emergency procedures.

Ongoing training is also required for all direct-care staff members:

• Facility administrators need to complete 30 hours of DOH-approved continuing education every three years.
• PCAs must complete 20 hours of continuing education every two years.
• Staff who administer medications need to complete 10 hours of related continuing education every two years.

Additionally, facilities that offer memory care services must provide training in dementia and Alzheimer's care for all staff members directly involved in the care of memory-impaired residents.

Medicaid Policy

New Jersey Medicaid covers the cost of services provided in ALR and CPCH facilities for eligible enrollees through the Managed Long Term Services and Supports program. However, those who qualify for the program are responsible for paying the room and board portion of the monthly fees charged by their facility.

Reporting Abuse

The New Jersey Long-Term Care Ombudsman is authorized through the Older Americans Act to investigate, resolve or refer complaints involving residents of ALRs and CPCHs. Concerned parties can file anonymous complaints regarding neglect, abuse, bodily injuries, exploitation or crimes by contacting the ombudsman's office at 877-582-6995. Complaints about treatment or care in facilities licensed through the New Jersey DOH may be made by calling the department's Division of Health Facilities Evaluation and Licensing complaint hotline at 800-792-9770.

New Jersey families and seniors living with memory-related impairments may be able to access several free or low-cost resources through government-run or nonprofit organizations. Services such as nutritional assistance, transportation and advocacy are a few of the resources available.

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.