Memory Care in Oregon

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.

While the national monthly average cost of assisted living is $4,051, Oregon residents pay nearly $450 more per month, for an average rate of $4,499. This is in line with average costs in Oregon’s neighboring state of California, but over $1,000 more per month than costs in nearby Nevada. In Washington, however, assisted living costs are even higher at $5,500 per month. Residents should also note that with the expected 25% addition in costs for memory care in any state, Oregonians receiving memory care can anticipate paying around $5,624 per month.

However, the cost of assisted living differs greatly throughout the state, even in the largest cities. In Portland, by far the state’s most populous city, assisted living rates are much higher than the state average, at $4,998 per month. Approximately 50 miles to the south in nearby Salem, monthly costs are significantly lower at $4,275, and further south in Eugene, residents pay an average of $4,325. With the additional costs associated with specialized memory care, residents with Alzheimer’s disease or dementia can expect to pay 20-30% more depending on the area where they live and the specific facility they choose.

Oregon Medicaid Programs for Memory Care

Oregon K Plan

The Oregon K Plan is a Medicaid program permitting the state to provide home and community-based services to Medicaid-enrolled seniors and residents with disabilities. Also known as the Affordable Care Act’s Community First Choice (CFC) Option, the program helps Oregon residents who need long-term care and who would otherwise be placed in an institutional setting to remain living in their homes or their local community of choice. Services include help with tasks that fall under the umbrella of activities of daily living and instrumental activities of daily living, such as bathing, dressing, feeding, cooking, housekeeping and memory care. Other supports may include respite care, home modifications and transportation services.

• Who is Eligible: To be eligible for the K Plan, Oregon residents must qualify for Medicaid and require an institutional level of care. To meet the state’s Medicaid financial criteria, residents may earn no more than 300% more than the Federal Poverty Level (FPL), which equates to an income of $2,349 per month for individuals and $3,471 for married couples. Additionally, assets may not exceed $2,000 for an individual and $3,000 for a married couple, not including exempt items, such as an individual’s home, vehicle and personal belongings.
• How to Apply: Oregon’s residents can apply for the state’s Medicaid program, also termed the Oregon Health Plan (OHP), by completing an application online or contacting a local agency for help. Once enrolled in Medicaid, individuals interested in the K Plan undergo a functional needs assessment, so a service coordinator can develop an individualized annual plan of care.

The Aged and Physically Disabled Waiver

Through the Aged and Physically Disabled (APD) waiver, qualified Oregon residents may receive transition services to help them move from an institutional facility, such as a nursing home, back into their own home or a community setting. The waiver is available to adults aged 18-64 with a disability and seniors aged 65 and older. Participants may be enrolled in both the Oregon K Plan and the APD waiver as long as they do not receive overlapping services.

• Who is Eligible: To qualify for the waiver, adults aged 18-64 must have a physical disability. Seniors aged 65 and older may qualify if they require a nursing home level of care, regardless of whether or not they have a disability. Individuals must also meet financial criteria, which includes a maximum monthly income of $2,349 and having no more than $2,000 in nonexempt assets.
• How to Apply: To apply, interested Oregon residents should contact their local Seniors & People With Disabilities office.

The Oregon Spousal Pay Program

The Spousal Pay Program is a unique program that pays spouses to care for their own partners, as long as both spouses meet eligibility requirements and the spouse being cared for requires assistance with at least four activities of daily living. Through the program, the caregiver spouse becomes an official Homecare Worker and paying member of the Homecare Union, enabling the spouse to receive a salary and unemployment insurance.

• Who is Eligible: To qualify, spouses must be legally married, be Oregon residents and live in their private home. The spouse who receives care must need a nursing home level of care, require assistance with at least four activities of daily living and be diagnosed with a progressive, debilitating condition. Participants must also meet Medicaid financial criteria.
• How to Apply: Those interested in applying should contact their local Seniors & People with Disabilities office. They can also call the Oregon Department of Human Services at 503-945-5600.

Non-Medicaid Financial Assistance Programs for Memory Care in Oregon

Oregon Project Independence

Oregon Project Independence (OPI) is a state-funded program available to individuals of any age with Alzheimer’s disease or dementia-related impairments and seniors aged 60 and older. Program benefits include in-home care, assistance with activities of daily living, respite, skilled nursing and adult day care. Additionally, participants may direct their care by choosing their care provider.

• Who is Eligible: OPI recipients must be at least 60 years old or have a diagnosed form of dementia or cognition-impairing condition. They must be Oregon residents, not eligible for Medicaid, live at home and require nursing home-level care. Individuals with income at or below 150% of the FPL receive services at no cost, while those with income between 150-400% of the FPL pay for services based on a sliding scale.
• How to Apply: Interested individuals may apply through their local Area Agency on Aging or by calling 800-282-8096.

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 Oregon, memory care is provided in communities licensed through the Oregon Department of Human Services. These mostly include residential care facilities but can also include assisted living and nursing facilities. Each licensed facility must meet state requirements, serve individuals displaying behavioral symptoms and ensure each staff member is trained in dementia care. Licenses expire every two years, and department staff members conduct facility inspections at least once in a two year period to ensure facilities adhere to all regulations and in response to complaints. All facilities providing memory care for residents with dementia must obtain an official endorsement on its license.

Facility Scope of Care

In Oregon, there are no overarching restrictions to the levels of care residential care and assisted living facilities may offer. Facilities must provide residents with the following services:

• Three nutritious meals per day served from preprepared menus that allow for resident input and offer modified special diets and meal substitutions
• Assistance with activities of daily living
• Housekeeping and laundry services
• Medication administration
• Daily recreational programming and activities
• Transportation and ancillary services, whether provided directly or arranged, for medical and other supportive services
• Printed information provided by the Long-Term Care Ombudsman

Admissions Requirements

Prior to admitting a new resident, a facility must perform an initial screening process to identify the potential resident’s preferences and needs and confirm their ability to meet those needs. Facilities may admit individuals with all levels of needs but may also request that residents move out for certain reasons.

Care Plan Requirements

Facilities endorsed as a memory care community must provide residents with individualized nutritional and activity plans. Before a resident’s admission, these communities must provide residents and their family members with a state-designated uniform disclosure statement that details their policies along with their philosophy of care, information on how they provide services, staff training information, the number of direct care staff working each shift and the facility’s admission, transfer and discharge procedures.

Medication Management Requirements

Specially trained facility staff members over 18 years old may administer medication. All facility-administered medications must be reviewed by a registered nurse or pharmacist every 90 days. Antipsychotic medications have additional administration requirements:

• Prescribing physicians must consult with a resident’s primary care doctor.
• The facility must perform an assessment to show any potential nonpharmacological interventions they could administer to lessen the need for antipsychotic medications.
• The facility must demonstrate that it employed the determined interventions before the antipsychotic prescription and will continue to employ the interventions while administering the prescribed medication.

Facility Requirements

Assisted living facilities must meet the following requirements:

• Not including the bathroom, private resident units in newly constructed buildings must be at least 220 square feet and include a kitchen and a bathroom. Units in renovated buildings must be at least 160 square feet, not including the bathroom.
• Shared units may only exist for couples or individuals who wish to cohabitate.

Units in residential care facilities must:

• Be at least 80 square feet, not including closets and bathrooms, and permit at least 3 feet between beds.
• Open to a temperature-controlled hallway or common area if a bedroom unit.
• House a maximum of two residents per unit.
• Have at least one toilet for every six residents without a private toilet in their own unit.

Additionally, all facility buildings must have smoke detectors, automatic sprinkler systems and manual and automatic fire alarms. Endorsed memory care communities should meet specific occupancy and lighting requirements and have a secure, enclosed space for outdoor recreation.

Staffing Requirements

Endorsed memory care communities must adhere to licensing requirements and sufficiently meet residents’ scheduled and unscheduled needs. All staff members must be trained in dementia-specific topics within 30 days of hire and before providing any resident services. Annually, staff must also obtain 12 hours of training to meet licensing requirements and four hours of dementia-specific service training. Administrators must obtain 20 hours of continuing education annually, 10 of which must be dementia-specific.

All facilities must have an employed, full-time administrator on-site 40 or more hours per week. They must also have a defined system in place to ensure the number of staff on-site and available is sufficient to meet residents’ needs at all times.

Medicaid Policy

Through the Oregon K Plan, or Community First Choice, Medicaid covers assisted living and residential care services through a tiered reimbursement system.

Reporting Abuse

Complaints against facilities or suspicions of abuse should be reported to Adult Protective Services via the abuse reporting hotline at 1-855-503-7233. Suspicions that a facility is violating state regulations may be reported to the Community-Based Care Licensing Complaint Unit at 1-844-503-4773.