Memory Care in Rhode Island

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.

Genworth Financial’s 2019 Cost of Care Survey shows that the average cost of assisted living in Rhode Island is $5,199 per month. While this is considerably more expensive than the U.S. median of $4,051, it is near the lower end of the price spectrum in neighboring states, which ranges from a high of $7,021 in New Hampshire to a low of $4,630 in New York. In Connecticut, assisted living costs an average of $4,880, while rates in Massachusetts average $5,640 per month. Adding 25% to the average for assisted living in Rhode Island puts the expected cost of memory care at $6,498 per month.

The monthly cost of assisted living in Rhode Island’s largest city, Providence, is on par with the state average. This is about midrange between the costs in neighboring Boston, Massachusetts, and Norwich, Connecticut, where the monthly averages for assisted living are $6,442 and $4,247, respectively. Bearing in mind that the $5,199 monthly average mentioned previously is for standard assisted living only, and seniors seeking memory care in Rhode Island may pay up to $675 more per month.

Rhode Island Medicaid Programs for Memory Care

Global Consumer Choice Compact Waiver

The Rhode Island Medicaid Global Consumer Choice Compact Waiver offers funding to help seniors who need memory care remain in a community setting, such as an assisted living facility. The waiver provides a number of benefits, including case management, assistance with activities of daily living, personal care, medication management and physical therapy. Approved participants are responsible for paying their room and board fees, which are not covered by this program.

• Who Is Eligible: Adults with disabilities and seniors aged 65 and older are eligible for coverage under the GCCC Waiver if they meet the program’s functional criteria and qualify financially for the state’s Medicaid program.
• How to Apply: Those who wish to apply should contact the Rhode Island Department of Elderly Affairs at 401-462-3000.

Non-Medicaid Financial Assistance Programs for Memory Care in Rhode Island

SSI Enhanced Assisted Living Program

The Department of Elderly Affairs administers the SSI Enhanced Assisted Living program to help cover assisted living room and board costs for eligible Rhode Island residents, including those receiving memory care. This program augments the monthly amount of Supplemental Security Income an individual receives, and it also provides an allowance for personal needs.

• Who Is Eligible: This program is available to seniors aged 65 and older, and disabled adults aged 64 and younger, who qualify for SSI benefits through the Social Security Administration. Applicants must meet the program’s current income and asset criteria and have limited medical needs. Those who require the level of care provided in a nursing facility do not qualify.
• How to Apply: Interested individuals can call the Rhode Island Aging and Disability Resource Center at 401-462-4444 to begin the application process. Those who have not done so already should apply for the SSI program at their local SSA office.

Home and Community Care Co-Pay Program

The Rhode Island Department of Human Services manages the Home and Community Care Co-Pay program. This non-Medicaid program provides eligible seniors with funds to offset the cost of assisted living and memory care, so they can avoid placement in a nursing home. The amount of assistance a participant receives is based on their income, which also determines the amount of the co-pay they must contribute each month.

• Who Is Eligible: To qualify for the HCC Co-Pay program, Rhode Island residents must be aged 65 and older and ineligible for Medicaid coverage. They must also have difficulty leaving home without assistance and need help with daily living activities. The income of individual applicants is limited to 200% of the federal poverty level.
• How to Apply: Seniors can complete an application online or call the department at 401-462-3000 for more information and assistance applying.

Medicare Advantage Plans

Rhode Island residents currently enrolled in Original Medicare Parts A and B may choose to switch to a Medicare Advantage plan to recoup some of the expenses incurred in a memory care facility. Also referred to as Medicare Part C, these plans are offered by private insurance companies under contract with the Centers for Medicare and Medicaid Services. The CMS requires that MA plans cover all the basic services provided by Medicare Part A and B, and many also include Part C prescription drug coverage. MA plans may also offer a range of extra benefits, which can include vision and dental services, personal emergency response systems, wellness programs, personal care assistance and nonmedical transportation.

Due to recent CMS rule changes, the coverage options for MA have expanded to include certain services provided in assisted living facilities, and seniors may now use the facility where they receive memory care as their address of record with an MA insurer. This makes it possible for enrollees to be reimbursed for eligible memory care-related expenses through specific plans, such as the United Healthcare assisted living plan. Coverage varies between plans and providers in Rhode Island, so seniors should verify that a particular plan meets their needs before they enroll.

• Who Is Eligible: To sign up for an MA plan, seniors must already be enrolled in Original Medicare Parts A and B. In addition to paying any costs associated with the new plan, enrollees are still responsible for paying their monthly Medicare Part B premiums.
• How to Apply: Seniors can use the Medicare plan finder tool to compare the coverage and cost of plans available in their area of Rhode Island. MA enrollment is only allowed during certain periods each year. To learn when and how to enroll, seniors can call Medicare at 800-633-4227 or contact a plan provider directly.

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

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:

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.