Memory Care in Pennsylvania

Table of Contents

Memory Care in Pennsylvania

Table of Contents

• The Cost of Memory Care in Pennsylvania
• Pennsylvania Medicaid Programs for Memory Care
• Can You Use Medicare to Pay for Memory Care in Pennsylvania?
• More Ways to Pay for Memory Care in Pennsylvania
• Memory Care Laws and Regulations in Pennsylvania
• Free and Low-Cost Resources for Seniors in Pennsylvania
• Pennsylvania 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 calculate the cost of memory care, we added 25% to the assisted living rates reported in the 2021 Genworth Cost of Care Survey. In Pennsylvania, memory care costs an average of $5,125 per month, which is more affordable than the average in the neighboring states of New Jersey ($8,119), Maryland ($6,125), Ohio ($5,794) and New York ($5,725). It's also less than the national median of $5,625 per month.

Within Pennsylvania, the cost of memory care varies depending on location. Due to its proximity to New Jersey, Philadelphia has some of the highest costs in the state, averaging $7,106 per month. To the north in Allentown, the cost drops to $5,980. Pittsburgh is close to Ohio and West Virginia, both of which have relatively low costs of living. As a result, the cost of memory care in Pittsburgh averages just $4,063 per month. Memory care is even more affordable in Scranton, at an average of $3,594.  

In Pennsylvania, the Medicaid program is known as Medical Assistance. Although Medical Assistance doesn't directly pay for memory care services, Pennsylvania offers the Community HealthChoices Waiver to support eligible individuals who need long-term care.

• Who Is Eligible: Pennsylvania Medical Assistance is available to state residents who are U.S. citizens, lawfully admitted aliens and refugees who can provide a Social Security number and proof of identity. Applicants must also meet the program's financial eligibility requirements. In 2022, the annual income limit for regular Medicaid/Medicaid for the aged, blind and disabled is $18,075 for single applicants and $24,353 for a two-person household.
• How to Apply: To apply for general Medical Assistance, use Pennsylvania's COMPASS website or call the Consumer Service Center for Health Care Coverage at 866-550-4355.

Community HealthChoices Waiver

Pennsylvania's Community HealthChoices Waiver allows older adults and some younger people with disabilities to receive the services they need to stay in their communities. It doesn't cover the cost of room and board at an assisted living facility, but it can be used to pay for case management and services such as personal care and assistance with activities of daily living. Participants may also qualify for assistive technology to enhance their safety.

• Who Is Eligible: Applicants for the Community HealthChoices Waiver must meet all basic requirements for general Medicaid coverage, including the citizenship, residency and financial criteria. To qualify for CHC, an applicant must also be at least 65 years old or between the ages of 19 and 64 and have a physical disability. All applicants must undergo an assessment to determine if they require a nursing facility level of care.
• How to Apply: Applicants who need long-term care should contact the Independent Enrollment Broker to schedule an assessment. Otherwise, applicants should use the COMPASS website, call 866-550-4355 or visit a County Assistance office for an eligibility review.

Medicaid Eligibility for Seniors in Pennsylvania

Applicants must live in Pennsylvania and be able to provide proof of citizenship, refugee status or lawful resident status. Medical Assistance is a need-based program, so it also has strict income limits based on household size. In 2022, the income limit for applicants interested in Community HealthChoices and other waiver programs is $30,276 per year for a single applicant.

For married couples, the limit depends on whether both spouses need coverage. If both spouses are applying, the income limit is $60,552 per year, with $30,276 allowed for each spouse. If only one spouse is applying, the limit is $30,276 per year for that spouse.

Medicaid also has limits on the value of assets owned by enrollees. In 2022, the resource limit in Pennsylvania is $2,000 for single applicants. For married couples, the limit is $4,000 ($2,000 per spouse) if both spouses are applying. If only one spouse needs coverage, the resource limit is $2,000 for the applicant and $137,400 for the non-applicant.

2022 Medicaid Income Limits for Seniors in Pennsylvania

How to Get Help Applying for Medicaid in Pennsylvania

There are various resources available to assist seniors and their families with understanding and applying for Medical Assistance coverage to help with the cost of memory care.

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

In Pennsylvania, assisted living facilities have two levels of licensing. These are assisted living residences (ALRs) and personal care homes (PCHs). PCHs are not available to residents who require a nursing home level of care. Both levels of facilities are permitted to care for those with memory impairment and are licensed by the Pennsylvania Department of Human Services.

Facilities offering memory care must detail how they care for people with dementia, including their philosophy, staff training and the activities designed to meet the needs of people with Alzheimer’s disease. Facilities are inspected annually and in response to complaints.

Facility Scope of Care

Both types of facility provide services beyond room and board to residents. For residents who don’t require assistance with activities of daily living (ADLs), services include laundry and cognitive supports. Other residents receive assistance with ADLs, transportation and medication assistance.

Facilities that have a secure dementia care unit are required to provide certain services on a weekly basis, including:

• Gross motor activities and exercise
• Self-care activities
• Group and individual activities
• Sensory and memory enhancement activities
• Outdoor activities.

Resident participation in these activities must be voluntary.

Admissions Requirements

There is a wide range of residents who may be admitted into ALRs and PCHs. There are some restrictions on who can be admitted, but facilities can request an exception from the licensing agent under certain conditions. The below table gives an overview of who may or may not be admitted.

Residents Who May Be Admitted

Older adults and people with:

• Dementia
• Mental health conditions
• Physical disabilities

Residents Who May NOT Be Admitted

Those who require:

• 24-hour skilled nursing care
• Physical restraints
• Ventilator dependency
• Continuous intravenous fluids

In addition, PCHs cannot admit or retain any residents who require a nursing home level of care.

Care Plan Requirements

A medical evaluation is required prior to admission to an ALR. This must be conducted by a physician, physician’s assistant or nurse practitioner. The evaluation determines if the individual can be safely served in the facility and also helps develop a service plan. A further assessment is conducted within 30 days of admission to determine the support plan, with reassessments conducted yearly. Support plans are updated after a significant change in condition or at the Department’s request.

PCHs must also conduct an assessment prior to admission. This determines if the facility can meet the applicant’s needs. A support plan that takes into consideration the resident’s communication abilities, mobility, medication administration needs and cognitive functioning must be written and implemented within 30 days.

Both facility types must assess individuals within 72 hours of their admission to a secured dementia care unit. Memory care residents must be reassessed annually to determine if they need continuing residency.

Medication Management Requirements

Both facility types must provide assistance with self-administration of medication, if required. This assistance includes remembering medication schedules, storing medication and offering medication at the correct time. Medication administration services must be provided to residents who have been assessed as needing them and those who choose not to self-administer. These services must be provided by licensed professionals or staff that have completed and passed approved medication administration training.

Facility Requirements

Secured dementia care units in both ALRs and PCHs cannot have more than two residents occupying a living space. Facilities must also provide both indoor and outdoor exercise space. Each facility must detail how they will enhance environmental awareness, minimize stimulation and maximize independence for memory care residents. Doors equipped with locking systems may be installed with written approval from the Department.

Staffing Requirements

ALRs must have direct care staff to provide personal care assistance to residents, and there must be direct care staff awake at all times. Each mobile resident must receive at least one hour of assisted living services each day, and those with mobility needs must receive at least two hours of care daily. Administrators must also be present in the residence for an average of at least 36 hours a week. While there are no minimum staffing ratios, there must be enough staff to meet the needs detailed in residents’ care plans.

Both administration and direct care staff must complete and pass the licensing agency-approved training. Administrators must complete 24 hours of continuing education each year, and direct care staff must complete 16 hours of annual training relating to their job responsibilities. Staff working with memory care residents must complete an additional eight hours of dementia-specific training within 30 days of being hired and at least eight hours of dementia training annually.

PCHs also have no minimum staff ratios. There must be at least one direct care staff person awake whenever residents are present. In addition, the administrator must be present for an average of at least 20 hours each week. PCH administrators must have 24 hours of annual training relating to their job responsibilities, and direct care staff must complete 12 hours of annual training. Direct care staff working with memory care residents must complete at least six hours of dementia-specific training in addition to other prescribed annual training.

Medicaid Policy

Pennsylvania does not have any programs that cover residents in assisted living residences or personal care homes. However, Medicaid covers those residing in nursing home facilities.

Reporting Abuse

The Pennsylvania Department of Aging has a 24-hour hotline for the reporting of elder abuse, whether the person lives at home or in a care facility. Reporters can remain anonymous and have legal protection from retaliation. The Department of Aging can be reached by phone on 1-800-490-8505.

Memory loss is a concerning issue, but Pennsylvania residents have access to many helpful resources. The state has two universities engaged in cutting-edge research, along with nonprofit organizations that can provide information on using health insurance to cover the cost of dementia-related care. Support groups also exist to help caregivers understand more about dementia and its effects.

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.