Memory Care in Tennessee

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 cost of assisted living averages $3,900 in Tennessee, which is a savings of about $150 per month compared to the national average of $4,051. Memory care residents often pay more, so Tennessee residents can expect to pay between $4,680 and $5,070 per month, depending on the community.

In Tennessee, costs can vary dramatically based on the region. For example, the average cost of assisted living care in Cleveland is $4,420, but it is only $3,323 in Clarksville — a difference of nearly $1,100 per month. The larger the city, the higher the price tends to be in Tennessee — the cost averages $4,113 in Memphis, $4,140 in Nashville and $4,248 in Kingsport. In Chattanooga, which has a lower population, the cost averages $3,225. For memory care units, prices can run between $645 and $1,326 more expensive, on average.

Tennessee Medicaid Programs for Memory Care

TennCare CHOICES in Long-Term Services and Supports

TennCare CHOICES in Long-Term Services and Supports is a Medicaid Waiver program offered to seniors who qualify for or might otherwise be at risk of transfer to a nursing home. Services provided under CHOICES include personal care, home-delivered meals, installation of a personal emergency response system, assistive technologies, adult daycare, respite care and various other services. Residential care is also an option in senior group homes or assisted living facilities. This waiver program pays for support services, but it does not cover room and board. CHOICES enrollment offers one of three possible options:

Group 1 – Seniors in a nursing home setting.

Group 2 – Seniors who qualify for nursing home care but would rather receive care at home through assistive services.

Group 3 – Seniors who are at risk of nursing home placement but do not currently qualify may enroll in Group 3 to receive a more moderate assortment of home care services with the aim of delaying or preventing nursing home placement.

• Who Is Eligible: To qualify for the CHOICES program, a senior must be 65 or older, and meet the guidelines for the group of services applied for. Group 1 and 2 applicants must be nursing home eligible and meet all of the enrollment requirements for Medicaid long-term services and supports. Group 3 applicants must be at risk of needing nursing home placement and receiving Supplemental Security Income payments. Group 3 applicants are subject to an annual service cap of $15,000. Financial eligibility requirements limit seniors to no more than $2,349 per month in income and $2,000 or less in countable assets.
• How to Apply: To apply for the CHOICES program, seniors can contact their local Area Agency on Aging and Disability or call 877-224-0219.

Non-Medicaid Financial Assistance Programs for Memory Care in Tennessee

OPTIONS for Community Living

The OPTIONS for Community Living program is state-funded and available to all qualifying adults who meet the program guidelines. This program is designed to provide homemaker, personal care and home-delivered meals for seniors and the disabled. OPTIONS specifically includes those with cognitive disabilities such as Alzheimer’s patients. There may be a fee for service.

• Who Is Eligible: There are no financial eligibility requirements for the OPTIONS program. All adults aged 18 or older may apply if they are residents of Tennessee who meet the activities of daily living (ADL) and instrumental activities of daily living (IADL) limitation requirements. Services are provided on a sliding fee scale based on the applicant’s income.
• How to Apply: Applicants should contact their local Area Agency on Aging and Disability for information about enrolling or call the statewide information line at 866-836-6678.

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

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:

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.