Memory Care in Rhode Island

Table of Contents

Memory Care in Rhode Island

Table of Contents

• The Cost of Memory Care in Rhode Island
• Rhode Island Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Rhode Island?
• More Ways To Pay for Memory Care in Rhode Island
• Memory Care Laws and Regulations in Rhode Island
• Free and Low-Cost Resources for Seniors in Rhode Island
• Rhode Island 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.

We added 25% to the assisted living costs reported in the Genworth Financial 2021 Cost of Care Survey to estimate monthly rates for memory care in Rhode Island and elsewhere. With an average price of $8,533 per month for memory care, Rhode Island is the least affordable state in the region.

The average cost for memory care in the U.S. as a whole is $5,625 per month, $2,908 lower than Rhode Island's median. New Hampshire residents also save around $1,000 per month. Memory care in Massachusetts is priced at just $408 per month lower than in Rhode Island. Connecticut and New York each offer considerable savings of $2,122 and $2,808 per month, respectively.  

Seniors in Providence save almost $1,000 per month compared to the state average, but the survey found insufficient data to determine the cost in other RI cities. Memory care in Norwich, CT averages $5,375, and in Worcester, MA, it costs $7,106. 

Low-income seniors and others in Rhode Island may qualify for memory care via Medicaid, but the state doesn't provide coverage for this or assisted living services by default. Medicaid coverage for these services — collectively referred to as Long-term Services and Supports (LTSS) — may be provided based on additional program criteria. As this guide focuses on the elderly and people with disabilities who need memory care services, the Medicaid requirements detailed throughout this guide are for the Aged, Blind or Disabled (ABD) category of eligibility.

• Who Is Eligible: Aged 65+ or blind or disabled, with income and assets at or below the limits outlined below.
• How To Apply: Visit the HealthSource RI website to apply for Medicaid or contact the closest DHS office. Help in the application process is also available from the resources noted further down in this guide.

Medicaid Long-term Services and Supports (LTSS)

In Rhode Island, the Medicaid LTSS program opens up a wide range of options for Medicaid recipients to get the care they need. Much of the program focuses on seniors and people with disabilities who live independently in the community, such as meal delivery, transport, and social opportunities. Memory care services in residential care communities may also be covered for eligible residents.

• Who Is Eligible: Applicants for LTSS must be receiving or eligible for Medicaid and evaluated as to their need for the requested services. Services may be provided in a community-based environment, such as a memory care program, assisted living or private residence.
• How to Apply: Visit or call a nearby DHS office or contact the statewide helpline at 1-855-697-4347. Application forms can also be downloaded and printed. Current Medicaid recipients should contact their case manager or call the DHS.

Medicaid Eligibility for Seniors in Rhode Island

Income and asset limits for Medicaid are determined by the applicant's living arrangements, source(s) of income, medical needs and expected costs. In Rhode Island, aged, blind and/or disabled (ABD) residents are eligible with income up to 300% of the federal benefit rate (FBR). This sets a maximum annual income of $30,276 for a single applicant as of 2022 and is subject to change alongside the FBR. The maximum value of countable assets is $4,000.

For two-person households, income and asset limits are significantly different and wide-ranging due to spousal impoverishment rules. These rules allow a non-applicant spouse living in the community to retain a higher value of assets.

2022 Medicaid Income Limits for Seniors in Rhode Island

In addition to the financial criteria, people who need memory care service coverage must meet the following requirements.

• State residency (currently living at an address in Rhode Island)
• U.S. citizen, national or other satisfactory immigration status
• Level of care assessed at "high" or above (evaluation focuses on the applicant's current diagnosis, functional activity, cognitive status and any ongoing treatments)

Applicants may also be asked to provide financial records, other documents and proof as needed during the enrollment.

How To Get Help Applying for Medicaid in Rhode Island

Due to the complex nature of eligibility requirements and Medicaid coverage in general, help is freely available from various sources throughout Rhode Island. In-person and telephone assistance for all Medicaid-related concerns is provided by the DHS. Other sources of help include the Office of Healthy Aging and certified application counselors.

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

Rhode Island assisted living facilities are licensed and regulated by the state's Department of Health, Center for Health Facility Regulation. The type of license a facility requires is based on the following fire code and medication administration classifications:

• F1: Facilities with residents who cannot self-preserve in the event of an emergency
• F2: Facilities with residents who can self-evacuate in an emergency situation
• M1: Facilities that provide central storage and administration of medications
• M2: Facilities that only offer assistance with self-administration of medications

Assisted living facilities that provide dementia care must have an F1-M1 license. Facilities must also obtain a dementia special care unit license if:

• One or more residents have dementia symptoms that affect their functional abilities
• The facility advertises that it offers dementia services
• Residents with memory impairment are housed in a separate, secured area

The CHFR inspects all licensed facilities annually to ensure compliance with state regulations and investigates complaints.

Facility Scope of Care

The care services provided in Rhode Island assisted living facilities and dementia special care units should include:

• Administration of medications or assistance with self-administration
• Assistance arranging support services
• Monitoring of health and well-being
• Housekeeping and laundry services
• Therapeutic, recreational and social activities
• Personal care assistance
• Transportation services
• Access to nursing and skilled therapy services
• Three balanced meals each day that meet residents' medical regimens

Admissions Requirements

Rhode Island assisted living facilities and dementia special care units may admit adults and seniors with various care requirements and conditions, including Alzheimer's disease and related disorders. The following table provides an overview of the criteria that affects admittance to an assisted living facility, according to state regulations:

Residents Who May Be Admitted and Retained By ALFs and Dementia Special Care Units

Seniors and adults who:

• Require meals, lodging, personal care and medication management assistance
• Require no more than 45 days of therapy or skilled nursing services
• Are receiving hospice care and are bedbound or need ambulation assistance

Residents Who May NOT Be Admitted or Must Be Discharged:

Individuals who:

• Require skilled nursing or medical care on an ongoing basis
• Are chronically bedbound or require help with ambulation from more than one person
• Do not meet the facility's residency agreement criteria
• Pose a danger to themselves or other residents

Care Plan Requirements

Each new resident admitted to assisted living facilities and dementia special care units must be evaluated by a registered nurse to determine the individual's health, social, physical, cognitive and functional needs. The written evaluation must be completed using the DOH's Assisted Living Resident Assessment form and signed by the RN conducting the evaluation. A care plan must be developed for each resident based on their assessment within a reasonable period after admission.

Medication Management Requirements

In M1 facilities that provide memory care, registered nurses, licensed practical nurses and registered medication aides may administer topical and oral medications and monitor related health indicators. Unlicensed staff members must complete four hours of RN-administered training and pass an exam to be registered as medication aides. Schedule II medications may only be administered by licensed staff.

Facility Requirements

Assisted living facilities that offer memory care and dementia special care units must have security features to ensure resident safety and quality of life, such as locking mechanisms and secured perimeters. Facilities may offer single rooms and shared rooms that accommodate no more than two residents. Single rooms must be at least 100 square feet in size, and shared rooms must provide at least 160 square feet of usable space. Rooms must have lockable storage areas for the safekeeping of residents' personal possessions. Facilities are required to have at least one toilet for every eight beds and a shower or tub for every 10 beds, at a minimum.

Staffing Requirements

Licensed facilities must employ a DOH-certified administrator who is responsible for its proper and safe operation. There are no mandated staff ratios, but facilities are required to have sufficient staff on duty to provide the necessary care and ensure the physical and mental well-being of residents. Dementia special care units must have trained and experienced registered nurses on staff to manage residents' dementia-related health and behavioral issues.

Direct care staff members who work with residents with dementia must receive four hours of initial training on relevant topics and two hours of ongoing training annually. New staff in dementia care units must complete 12-hours of orientation and training that covers understanding the various types of dementia, effective communication and behavior management.

Medicaid Policy

The Rhode Island Medicaid program does not cover memory care or assisted living services as entitlements. However, it does offer the Global Consumer Choice Compact Waiver, which may provide financial aid for eligible seniors who receive memory care in an assisted living facility.

Reporting Abuse

Concerned parties can report suspected resident neglect or abuse in an assisted living facility or dementia special care unit by contacting the Department of Elderly Affairs Protective Services Unit at 401-462-0555.

General aging-related concerns, questions and requests for assistance can be handled via these nonprofits, government agencies and the connections made with local service providers. Assistance and most services are provided at no cost to eligible residents.

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.

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.