Memory Care in Pennsylvania

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.

The average monthly cost of assisted living in Pennsylvania is $3,913, almost $140 less than the national monthly average of $4,051. This means that the approximate cost of memory care in the state is $4,891. This figure assumes that memory care will cost an average of 25% more than assisted living.

Costs can vary significantly throughout the state. In the Philadelphia area, the cost of assisted living averages $4,875 a month, but in Pittsburgh, seniors can expect to pay $3,265. Lancaster has the highest assisted living in Pennsylvania at $5,097 a month, and the Scranton Area is the most affordable at just $2,546. These are prices for assisted living, and memory care costs can be $1,000-$2,000 more each month, depending on the area and facility.

Pennsylvania Medicaid Programs for Memory Care

Community HealthChoices Waiver

The Community HealthChoices Waiver provides support to older adults and people over 21 who have a physical disability. The program is specifically aimed at helping eligible adults remain in their homes. CHC provides medical coverage and long-term support services such as assistive technology, home modifications and service coordination to increase the independence of participants. Nursing care and assistance with activities of daily living can also be provided. The benefit may be used to pay for in-home memory care and nursing home care; however, it does not cover residence in an assisted living facility. The program replaced the Pennsylvania Department of Aging Medicaid Waiver, and people living in assisted living facilities under the old program may be able to keep their benefits in the new system.

• Who Is Eligible: To be eligible for Community HealthChoices, applicants must be financially eligible for Pennsylvania Medicaid. In 2019, the income limit for Medicaid is $16,612 for singles and $22,491 for a two-person household. Applicants must also be either receiving Medicare or require a nursing home level of care.
• How to Apply: Applicants who require long-term services and support must apply through an Independent Enrollment Broker, who will schedule an in-person assessment. Those who don’t require long-term care can apply online, via mail or by visiting a county assistance office.

Non-Medicaid Financial Assistance Programs for Memory Care in Pennsylvania

Living Independence for the Elderly

The Living Independence for the Elderly (LIFE) program is a managed care program that helps older Pennsylvanians receive the services and support they need to live independently. The program provides a comprehensive and all-inclusive suite of medical and supportive services that includes nursing care, personal care and physical, speech and occupational therapies. The program provides in-home supportive care, which may include memory care services, but can only be provided to people who are able to be safely served in the community.

• Who Is Eligible: Participants of the LIFE program must be aged 55 years or older and require a nursing home or special rehabilitation facility level of care. They must also reside in an area served by a LIFE provider and be able to live safely in the community with the help of services provided by LIFE. There are financial eligibility requirements that are determined by the local County Assistance Office or participants can pay privately.
• How to Apply: People interested in the program should contact a local LIFE provider.

PA Domiciliary Care Program

The PA Domiciliary Care Program is more commonly known as Dom Care and operates similarly to adult foster care. It is an alternative to assisted living that lets the person in need of care move into the home of a caregiver. Caregivers, called Dom Care Providers, must meet background checks and other requirements. Participants receive personal care and assistance with activities of daily living and providers are also responsible for other services including transport, medication management and recreational activities. Providers cannot be related to their residents, but elderly people can move into the home of a friend, as long as the friend meets the other provider criteria.

• Who Is Eligible: Dom Care is available to people over 18 years of age who cannot live alone because they need help with activities of daily living. Clients must also be independently mobile or semi-mobile. The program is not available to people who require skilled or intermediate nursing care. Dom Care is available to private payers; however, people eligible for the Supplemental Security Income are eligible for a financial supplement. In 2019, this equates to an income of less than $771 for singles and $1,157 a month for married couples entering Dom Care together.
• How to Apply: Program participants need to receive final approval from their local Area Agency on Aging, which also coordinates applications.

OPTIONS Program

The OPTIONS Program lets older adults receive support and services in their homes. A wide range of benefits are available to individuals, including personal assistance, home modifications and transportation. Support can also be provided to caregivers, such as adult day care and respite services. Participants in the program are assessed to determine their health and physical abilities, and the funding and services available to them are based on this assessment. Some services are self-directed, so participants can choose their provider. OPTIONS is not an entitlement, so waiting lists may apply. Participants are also expected to pay for a share of the services based on their income.

• Who Is Eligible: To be eligible for the OPTIONS program, participants must be Pennsylvania residents aged 60 or older. They must also be experiencing a degree of frailty that impacts their daily functioning. OPTIONS is not available to people enrolled in Medicaid-based programs or those residing in assisted living facilities, nursing homes or other residential facilities. Those in Dom Care may be able to receive some assistance through the program.
• How to Apply: The program is run on a county basis, so those interested should contact their local Area Agency on Aging to 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 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.

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.