Memory Care in Tennessee

Table of Contents

Memory Care in Tennessee

Table of Contents

• The Cost of Memory Care in Tennessee
• Tennessee Medicaid Programs for Memory Care
• Can You Use Medicare to Pay for Memory Care in Tennessee?
• More Ways to Pay for Memory Care in Tennessee
• Memory Care Laws and Regulations in Tennessee
• Free Memory Care Resources in Tennessee
• Tennessee 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.

Because of this difference, we added 25% to the cost of assisted living as reported in the 2021 Genworth Cost of Care Survey to calculate the cost of memory care.

The monthly cost of memory care in Tennessee is $5,131, which is less than the national average of $5,625 but more than what memory care residents pay in many neighboring states, such as North Carolina ($5,013), Georgia ($4,419), Alabama ($4,379) and Kentucky ($4,310).

Though the statewide average cost of memory care in Tennessee is slightly more than $5,000 per month, it can vary depending on where the facility is located in the state. Among Tennessee's largest cities, Chattanooga has the highest monthly costs at $5,275, followed by Memphis at $5,250 and Nashville at $5,125. Knoxville has the lowest memory care costs in Tennessee, coming in several hundred dollars below the state average at $4,779 per month.

While Medicaid itself doesn't pay for memory care services in Tennessee, TennCare Medicaid recipients aged 65 and up who've been diagnosed with Alzheimer's or another form of dementia may be eligible for help with memory care costs through TennCare CHOICES, a waiver program.

TennCare CHOICES

TennCare CHOICES can help cover a variety of costs for Tennesseans with Alzheimer's or other forms of dementia who require memory care services, such as personal care services, medication management, assistive technology, personal emergency response systems, adult day care, and respite care.

It's important to note that TennCare CHOICES does not cover room and board for memory care facilities. However, many of the costs of care incurred inside the facility, such as those listed above, are covered in part or in full by the program.

• Who is Eligible: Seniors aged 65 and older who meet the qualifications for the specific group of services they're applying for. To qualify for Group 1 or 2, a senior must be nursing home eligible and meet all Medicaid requirements. To qualify for Group 3, a senior must be at risk of needing nursing care and currently receiving Supplemental Security Income (SSI). Applicants must have a monthly income of no more than $2,523 and total assets of no more than $2,000.
• How to Apply: Seniors can apply for TennCare CHOICES by contacting their local Area Agency on Aging and Disability or by calling (877) 224-0219. 

Medicaid Eligibility for Seniors in Tennessee

TennCare has strict eligibility requirements. To receive benefits, you must have a household income and total assets that fall below certain limits. Single individuals can make up to $30,276 per year and have up to $2,000 in assets. A single applicant in a two-person household can also make up to $30,276 and have $2,000 in assets, while the non-applicant in the household is limited to $137,400 in assets. A two-person household with both members applying can make up to $60,552 in annual household income and have up to $4,000 in total assets.

2022 Medicaid Income Limits for Seniors in Tennessee

In addition to these income limits, TennCare applicants must meet additional requirements pertaining to their age, citizenship or residency status and income from previous years:

• Must be 65 or older, blind or have a permanent disability
• Must be a U.S. citizen, permanent resident or legal alien
• Must be a full-time Tennessee resident
• Must not have had a household income exceeding $30,276 for any of the previous five years (if filing individually)

How to Get Help Applying for Medicaid in Tennessee

Tennesseans who need help applying for Medicaid via TennCare can receive assistance in several ways. Multiple government and nonprofit organizations exist to help Tennesseans with questions about Medicaid eligibility or benefits or who need assistance with the application process.

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

The Tennessee Department of Health Board for Licensing Health Care Facilities handles all licensing for assisted care living facilities (ACLF), including those locations with a secure unit. To obtain a license, a facility must submit a completed application that includes financial documents, the application fee and undergo an inspection to ensure compliance with all health and safety regulations.

For those ACLF locations offering memory or dementia care, a secured unit is typically required for resident safety. Operating a secure unit means reporting to the Department of Health annually with resident assessments generated by multidisciplinary teams, along with the number of deaths, hospitalizations and incidents that occurred within the unit. Staffing patterns, ratios and training must also be included in the report, along with information about daily group activities.

Facility Scope of Care

An ACLF in Tennessee must provide services such as protective care, interventions during a crisis, assistance with activities of daily living, laundry services and dietary services. In addition, facilities may offer medical services such as medication administration, intermittent nursing care, various therapies, podiatry and hospice services, among others. ACLFs with a secure unit must have a staff member on hand, 24/7/365 to respond to resident needs and emergencies, along with a calendar of events and activities appropriate for residents in the secure wing and attendance records.

Admissions Requirements

Not all Alzheimer’s patients need a secure wing in an ACLF and some many not be good candidates. Below is a brief list of reasons why a senior may be denied admission and who is eligible:

Residents Who May Be Admitted

Those who:

• Have been examined by an interdisciplinary team consisting of at least a physician, social worker, registered nurse and a family member, or patient care advocate, and approved for admittance
• Require assistance with ADLs and IADLs, but are ambulatory or capable of self-transfer from a bed to a wheelchair or similar device

Residents Who May NOT Be Admitted

Those who:

• Require treatment for stage III or IV decubitus ulcers or those with exfoliative dermatitis
• Require continuous nursing care, with an exception for treatment consisting of nasopharyngeal or tracheotomy aspiration, nasogastric feedings, gastrostomy feedings, intravenous therapy or intravenous feedings necessary for no more than three, 21-day periods or has been granted a waiver
• Cannot evacuate the facility within 13 minutes
• Have an active, infectious and reportable disease in a communicable state that requires contact isolation
• Exhibit verbal or physically aggressive behavior that may result in harm to the resident or others, even without a diagnosis
• Require physical or chemical restraints
• Have needs that the ACLF can not safely meet

Care Plan Requirements

When admitting a new resident, an ACLF must create a plan of care for that resident within 72 hours. The plan of care is developed in conjunction with the care staff, treating physician and the resident or their legal representative. The ACLF must create the care plan within five days of admission. Each care plan must include how much care a resident will require and information about who will be providing needed assistance, how often and when. It will also list transportation/visitation planning for medical appointments, along with information about dietary needs. The care plan should also include a list of recreational and social activities that the resident enjoys.

Care plans must be reviewed and amended as often as a resident’s needs change. If there are no specific reasons to make changes, the care plan should be reviewed at least twice per year.

Medication Management Requirements

ACLF staff can help residents self-administer medications. Assistance may include:

• Reading labels
• Opening dosage packages
• Reminding residents to take medications
• Observing residents while they take medications

For medications not delivered orally, a licensed health care professional can administer medications at an ACLF, provided it is within their scope of practice. For example, a nurse may administer intravenous medications when prescribed by a doctor on an intermittent basis.

Facility Requirements

All ACLFs must meet building code requirements in effect at the time of construction. Any major changes to existing facilities are subject to approval from the Tennessee Board of Health. All planned construction must submit two sets of plans for approval. Plans must be complete and include sections for architectural, structural, mechanical, electrical and sprinkler systems.

Staffing Requirements

An ACLF must employ an administrator who is at least 18 years of age, responsible and able to maintain and manage the financial obligations of the facility, including resident personal services and room and board. There must be at least one attendant awake and alert at all times, along with sufficient staff to meet the needs of the residents, including providing prescribed medical services. A licensed nurse must be available on an as-needed basis, along with a dietitian. No one listed on the abuse registry — available through the Department of Health — is eligible to work at an ACLF. All staff must train annually on fire safety, disaster preparedness and general emergency procedures.

Staff working in the secure unit must participate in annual service training on topics such as:

• Basic facts about the causes, progression and management of Alzheimer’s disease
• Dealing with dysfunctional behavior and catastrophic reactions
• Identifying and mitigating safety risks to residents
• How to assist with ADLs
• Communicating with family and friends of a resident

ACLF administrators must obtain certification and recertify every two years. This certification requires 24-hours of approved continuing education on topics such as:

• State rules and regulations
• Health care management
• Nutrition and food service
• Financial management
• Healthy lifestyles

Medicaid Policy

In Tennessee, Medicaid and its waiver programs do not cover the cost of room and board for seniors. Seniors enrolled in the CHOICES program do not get direct assistance with room and board costs, but Medicaid limits the charges to no more than 80% of the maximum personal needs allowance. In 2019, the maximum allowable monthly charges for room and board were $1,850.40.

Reporting Abuse

To report suspected abuse, concerned individuals should call Adult Protective Services at 888-277-8366. For seniors in an assisted care living facility or a nursing home, lapses in care or other concerns should be reported to the Tennessee Long-Term Care Ombudsman by calling 877-236-0013.

Several free and low-cost resources are available in Tennessee to help individuals with Alzheimer's and dementia, as well as their families and caregivers. These resources include support groups, free legal aid and advocacy services.

Note: The following information was compiled and most recently updated on 2/15/2022. 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.