Memory Care in North Dakota

Table of Contents

Memory Care in North Dakota

Table of Contents

• The Cost of Memory Care in North Dakota
• North Dakota Medicaid Programs for Memory Care
• Can You Use Medicare to Pay for Memory Care in North Dakota?
• More Ways to Pay for Memory Care in North Dakota
• Memory Care Laws and Regulations in North Dakota
• Free and Low-Cost Resources for Seniors in North Dakota
• North Dakota 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 find the median for North Dakota, its neighboring states and the country, we've taken assisted living figures published in the 2021 Genworth Cost of Care Survey and added 25%. Our estimates find that North Dakota's typical fee of $4,239 compares favorably with the national average of $5,625 per month. In major cities, costs range from $2,750 in Grand Forks to $4,638 in Bismarck and $4,800 in Fargo.

North Dakota's costs are more affordable than most of its neighbors. Only South Dakota's average fees of $4,188 are lower. In Wyoming, a typical memory care facility charges $5,211 for its services, while across the border in Montana, it's $5,563. The costliest state close to North Dakota is Minnesota where seniors can expect to pay around $5,635 per month for memory care. It's the only state bordering North Dakota with fees above the national average although the difference is only $10.

North Dakota's Medicaid program helps low-income seniors and the disabled who would otherwise be unable to afford the cost of long-term care. However, it only pays for the entire cost of care for seniors residing in nursing home facilities. Those who need similar levels of support but don't qualify for institutional Medicaid can apply for one of two waiver programs designed to help. These include the Basic Care Assistance Program and the Medicaid Waiver for Home and Community Based Services.

Basic Care Assistance Program

The Basic Care Assistance Program provides financial help to seniors who are eligible for Medicaid and choose to reside in basic care facilities, a term that relates to assisted living and memory care. The program won't cover room and board, but it pays the shortfall if a senior's income can't meet their health and medical costs. Seniors can keep $60 per month as a personal allowance and may, in some cases, retain some income to cover necessary expenses, such as health insurance.

• Who Is Eligible: This program is open to seniors who are aged 65 or older and qualify for regular Medicaid. Applicants must submit a functional assessment conducted by a social worker to determine the level of health care needed.
• How to Apply: Seniors can apply in person by making  an appointment with their local Department of Human Services office. Alternatively, state residents may complete an online application or call the nearest DHS office to request a printed application.

Medicaid Waiver for Home and Community Based Services

This waiver, commonly known as HCBS, can help meet health and medical costs for seniors who require nursing home levels of care but reside in another type of residential facility, including memory care units. The waiver covers some or all health care and medical costs depending on the applicant's financial circumstances, but it won't pay for room and board.

• Who Is Eligible: This program is available to individuals who are currently qualified for Medicaid. The applicant must be disabled and/or aged 65 years or older and be residing at home and be able to direct their own care. The state requires applicants to be screened for nursing home levels of care.
• How To Apply: Seniors who are interested in receiving benefits through this program should contact their nearest Department of Human Services office. Be aware there's likely to be a waiting list.

Medicaid Eligibility for Seniors in North Dakota

Applicants must satisfy the program's income and asset limits to qualify for Medicaid in North Dakota. A single applicant residing alone or with their spouse cannot have a monthly income greater than $940, or their application will be rejected. When both spouses in a two-person household apply, the monthly income limit is $1,267. Countable assets also affect eligibility. These typically include savings accounts, checking accounts, stocks, bonds and other resources specific to the applicant. For single applicants, the limit is $3,000, which doubles to $6,000 if both seniors in a two-person household apply. If one member of a two-person household applies, their spouse cannot have assets of more than $137,400.

2022 Medicaid Income Limits for Seniors in North Dakota

In addition to having incomes and assets that fall within the program's limits, seniors must also satisfy additional criteria. These include:

• Being a U.S. citizen or a legal permanent resident
• Residing in North Dakota
• Being aged 65 or older
• Needing assistance with daily tasks, such as personal care

How to Get Help Applying for Medicaid in North Dakota

Applying for Medicaid in North Dakota can be confusing. Fortunately, there are several organizations dedicated to providing free information and assistance.

Montana

Various state and local resources are available at no cost to help Montanans get access to Medicaid and other public programs or benefits. These websites also contain useful information related to Medicaid that may clear up some questions.

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

Facilities that are licensed to provide memory care in North Dakota include assisted living facilities and basic care facilities. Assisted living facilities are overseen by the Department of Health and the Department of Human Services, and basic care facilities follow rules designated by the Department of Health.

North Dakota’s assisted living facilities have fewer regulations than basic care facilities. Additionally, basic care facilities must provide residents with meals, while ALFs are not required to do so. Neither type of facility has specific regulations related to providing memory care, although certain basic care facilities are specifically permitted to provide care for those with dementia.

Facility Scope of Care

Assisted living facilities provide individualized care to five or more residents in a building with five or more living units. Residents may receive assistance with activities of daily living (ADLs) and independent activities of daily living (IADLs), and they are only required to pay for the services they receive based on request or need. Home health agencies may contract with residents to provide additional services.

Basic care facilities have living quarters for five or more residents who receive meals, personal care, social support and health care. Services include assistance with ADLs and IADLS, medical care arrangements, transportation, assistive devices and living unit maintenance. Third-party home health and hospice agencies may contract with the facility for nursing and end of life care.

Admission Requirements

Residents Who May Be Admitted

Older adults and people with:

• Alzheimer’s or other forms of dementia
• A need for assistance with ADLs or IADLs
• Physical impairments
• Cognitive Impairments
• Traumatic Brain Injuries
• Needs that can be met by the facility’s available services

Residents Who May NOT Be Admitted

Those who:

• Pose an immediate or potentially high risk of danger to other residents
• Require frequent medical or nursing care
• Are incapable of self-preservation (Basic Care Facility)
• Are unable to comply with National Fire Protection Association (NFPA) 101 Life Safety Code requirements (Basic Care Facility)

Care Plan Requirements

Applicants at assisted living facilities must be evaluated to ensure they qualify for admission according to the facility’s requirements. For every admitted resident, facilities must maintain ongoing records of specific services provided.

Basic care facilities must assess residents in areas of need relating to personal care, nutrition, health, socializing and more. Assessments must be completed within the first two weeks of a resident’s move-in date and then at least once per quarter. The facility should formulate a care plan resulting from resident consultations and the assessments.

Medication Management Requirements

Unlicensed staff in assisted living and basic care facilities may only administer drugs that are controlled and prescribed on an as-needed basis if they are specifically trained to do so and a registered nurse monitors the administration. Other medications may be administered by unlicensed staff.

In assisted living and in basic care facilities, unlicensed staff members may administer medication, except for controlled prescription drugs taken on an as-needed basis. Personnel acting in this capacity must have specific training and be monitored by a registered nurse.

Facility Requirements

While most basic care facilities have semiprivate units, which must provide each resident with at least 80 square feet, private units must be at least 100 square feet. The facility may have shared bathrooms. Up to 15 residents may share a bathtub or shower, and up to four residents may share a toilet.

In an assisted living facility, each unit must include a lockable entry door, a private full bathroom and a sleeping area. A maximum of two people may occupy one bedroom.

Staffing Requirements

Basic care facilities specifically licensed to provide memory care must require staff to undergo specialized training. This includes:

• At least eight hours of related, specified training in the first three months of employment
• At least four hours of additional training annually
• An annual competency evaluation

There are no specific staffing ratios that assisted living or basic care facilities are required to maintain, but each must have staff available 24 hours per day. All staff in both types of facilities must complete training in residents’ rights, infection control, residents’ mental and physical health needs, fire and safety procedures and behavioral problems and prevention.

Medicaid Policy

Basic care facilities that serve residents with dementia or a brain injury can have services covered by a home and community-based Medicaid waiver. Personal care services are also covered by state-funded Medicaid in licensed basic care facilities.

Reporting Abuse

Assisted living facilities must provide a written notice to residents explaining how they can file complaints against the facility. Residents of both types of facilities may file complaints by emailing dhsagingombud@nd.gov, completing an online form at the Department of Human Services’ Long-Term Care Ombudsman Program website or by calling 701-328-4617 or 855-462-5465 and selecting option 3.

There are many free and low-cost resources for North Dakota seniors at various stages of their memory loss journeys. This list includes organizations that can help those affected prepare for a future with dementia, get the most from their health insurance, resolve issues with care providers and use music and dance to alleviate the impact of memory loss.

Note: The following information was compiled and most recently updated on 2/13/2022. 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.