Memory Care in New Jersey

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.

In New Jersey, the average monthly cost of assisted living is $6,400. This is approximately $2,350 higher than the national median of $4,051 per month, but only $365 above the average paid in neighboring Delaware. Other nearby states have significantly lower costs; assisted living averages $4,630 per month in New York, and only $3,913 in Pennsylvania. If the average cost of memory care is 25% higher than the rate for assisted living, New Jersey residents who need residential memory care can expect to pay about $8,000 per month.

Assisted living costs in New Jersey vary considerably, depending on the facility chosen and where it is located. Trenton residents pay the highest average monthly price at $6,750, while those in Vineland pay the lowest rate at $4,600 per month. Costs in Atlantic City and Ocean City are also below the state average, at $5,200 and $4,896, respectively. Additionally, these rates are for assisted living, so it’s important to keep in mind that memory care may cost up to $2,000 more per month.

New Jersey Medicaid Programs for Memory Care

Medicaid Managed Long Term Services and Supports (MLTSS)

MLTSS is a New Jersey Medicaid program that provides comprehensive healthcare and support services for qualified individuals. All MLTSS services are coordinated through Medicaid-approved managed care organizations (MCOs). Room and board expenses in assisted living facilities are not covered by MLTSS, but the program does pay for medical services normally covered by Medicaid and supportive services, including care management, assisted living services, personal care, mental health and addiction services and personal emergency response systems.

• Who is Eligible: To be eligible for MLTSS, individuals must be New Jersey residents and U.S. citizens or qualified aliens who are disabled or aged 65 or older. Applicants must meet the financial criteria to qualify for New Jersey Medicaid, which includes a maximum of $2,349 in monthly income and $2,000 in assets for an individual, or $3,000 for a couple. Additionally, individuals must demonstrate the need for a nursing home level of care based on functional and cognitive assessments.
• How to Apply: Those who wish to apply for the MLTSS program must first apply for Medicaid benefits either online or by visiting their county social services office. Those already enrolled in Medicaid should contact their MCO’s member services department or the nearest Aging and Disability Resource Connection location to begin the MLTSS application process.

Non-Medicaid Financial Assistance Programs for Memory Care in New Jersey

State Supplemental Payment

The state of New Jersey provides a monthly cash State Supplemental Payment to eligible residents, which may be used to cover the cost of memory care in a licensed assisted living facility.

• Who is Eligible: New Jersey residents who meet the eligibility requirements of the federal Supplemental Security Income program may also qualify for state SSP benefits. Individuals are limited to a monthly income equal to or less than the current federal benefit rate and no more than $2,000 in assets. Married couples are limited to $3,000 in joint assets.
• How to Apply: Interested seniors can schedule an appointment to apply for both benefit programs by calling the Social Security Administration at 800-772-1213 or visiting the nearest SSA office.

Medicare Advantage Plans

Individuals who qualify for Medicare may opt for coverage through a Medicare Advantage or Part C plan available through approved private insurance companies. In addition to providing Medicare Part A and B services, many MA plans include Part D coverage for prescription drugs, and additional services, such as hearing, vision and dental care, transportation to medical appointments, meals and other benefits.

Medicare recently redefined what’s considered an enrollee’s home to include assisted living settings where memory care is provided, which allows some of the costs residents incur to be covered by MA plans.

• Who is Eligible: U.S. citizens and legal residents aged 65 and older who are enrolled in Original Medicare Parts A and B are eligible to switch to an MA plan. Eligibility is not limited by income or preexisting health conditions, however, enrollees are responsible for paying Part B and any applicable MA plan premiums.
• How to Apply: Interested individuals can use Medicare’s plan finder tool to compare MA plans available in their area, and then contact individual plan providers or call Medicare at 800-633-4227 to learn how and when they can apply.

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

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:

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.