Memory Care in Vermont

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.

In Vermont, the average monthly cost of assisted living is $5,338. This is nearly $1,300 more than the national monthly average of $4,051. Assuming that memory care costs, on average, 25% more than assisted living, seniors can expect to pay approximately $6,673 per month for residential memory care in Vermont.

Assisted living in the Burlington area averages $5,113 per month, which is slightly less expensive than other areas in Vermont. Because Vermont is a small state, the costs between regions don’t vary significantly. Assisted living in neighboring New Hampshire is significantly more expensive at over $7,000. Vermont’s nearby areas in New York, such as Glens Falls and Albany, are more affordable, within the $4,000 range. Pittsfield, Massachusetts, is even cheaper at $3,013. Keep in mind that these prices are for standard assisted living, and memory care may cost $1,000-$2,000 more per month, depending on the area and specific facility.

Vermont Medicaid Programs for Memory Care

Medicaid for the Blind, Aging and Disabled

Medicaid for the Blind, Aging and Disabled benefits low-income senior Vermonters with free or low-cost coverage for an array of health care services. Vermont Medicaid (Green Mountain Care) has dedicated long-term care programs that may provide financial assistance for MABD-eligible seniors in need of health care and supportive services in memory care facilities.

• Who Is Eligible: Qualified MABD beneficiaries must be Vermonters 65 or older and meet the criteria for maximum income and countable resources. As of 2020, the income limit is $1,175 for Chittenden County residents and $1,091 for citizens in all other Vermont counties. These financial criteria apply to individual applicants in one- and two-person households as well as to elderly couples. The maximum countable resources for single applicants is $2,000, and $3,000 for couples.
• How to Apply: Applicants should print and fill out the 205ALLMED application form, which can be obtained online from the Green Mountain Care website. The completed and signed form should be mailed to Green Mountain Care Application and Document Processing Center. Alternatively, a physical copy of the form may be requested by calling 1-855-899-9600.

Choices for Care Program

Choices for Care is the main long-term care program of Vermont Medicaid through the Global Commitment to Health 1115 waiver. It allows qualified seniors and disabled adults to receive supportive services in their long-term care settings of choice. This program may provide financial coverage for health care and other supportive services in the client’s home and in adult family care homes, adult day care centers and licensed facilities such as nursing homes, assisted living residences and residential care facilities.

• Who Is Eligible: Eligibility for Choices for Care is based on the same requirements as MABD. Additionally, seniors must meet the clinical criteria for receiving a nursing home level of care. Green Mountain Care determines the applicant’s financial eligibility, while the Department of Disabilities, Aging and Independent Living assesses clinical qualifications.
• How to Apply: Applicants may print and fill out the 202LTC application form, available online via the Green Mountain Care website. The completed and signed form should be mailed to Green Mountain Care Application and Document Processing Center. Alternatively, a physical copy of the form may be requested by calling 1-855-479-6151. Assistance may be obtained via the Senior Helpline at 1-800-642-5119 or through a local Area Agency on Aging.

Enhanced Residential Care

Enhanced Residential Care is a daily bundled package of services provided in participating assisted living residences and Level III residential care homes. This Choices for Care option benefits eligible Vermonters requiring memory services, and the fees for the ERC services they receive are covered by Medicaid through provider reimbursement. Covered services include assistance with daily living activities, 24-hour supervision, nursing overview and medication management. Case management, recreational activities and laundry and housekeeping costs may also be reimbursed by participating ERC providers. Room-and-board costs aren’t covered and are paid directly to the facility by the resident.

• Who Is Eligible: ERC services can only be provided by participating long-term care facilities to those who are eligible for the Choices for Care program.
• How to Apply: The applicant’s chosen ALR or RCH must be a certified ERC provider. Seniors may contact their local Area Agencies on Aging for assistance in applying for the Choices for Care program with the ERC option.

Assistive Community Care Services

Part of Vermont’s Medicaid State Plan, Assistive Community Care covers the costs of supportive services provided in participating assisted living residences and residential care homes. Medicaid reimburses these participating ACCS facilities on the costs of long-term care services, including personal care, medication assistance, on-site assistive therapy and restorative nursing. Nursing assessment and case management services are also covered. Because ACCS doesn’t cover room and board, qualified residents pay for them directly. Eligible seniors may also qualify for both ACCS and ERC if their residential facilities participate in both programs.

• Who Is Eligible: ACCS may only be provided by participating long-term care facilities to those Vermonters 65 and older and eligible to receive SSI and Medicaid benefits.
• How to Apply: The applicant’s chosen ALR or RCH must be a licensed ASSC provider. Seniors may contact their local Area Agencies on Aging for assistance in applying for SSI or Medicaid and in finding qualified facilities.

Non-Medicaid Financial Assistance Programs for Memory Care in Vermont

Dementia Respite Grant

The Dementia Respite Grant program provides financial support to Vermonters with Alzheimer’s or dementia, allowing them to continue receiving care while their unpaid caregivers are taking a break. Strictly for respite purposes, the funds may be used for in-home care, brief institutional or community-based respite, adult day care services and other eligible activities that provide rest for a participant’s caregiver.

• Who Is Eligible: The care recipient must be diagnosed with Alzheimer’s or irreversible dementia by a physician and be a permanent resident of Vermont who lives at home. Respite grants may not be given to anyone participating in Choices for Care, Veteran-Directed Care, Attendant Care and National Family Caregiver programs.
• How to Apply: This program operates on a county level, and applicants may contact their local Area Agencies on Aging for assistance from counselors or case managers.

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

For older Vermonters, assisted living residences and residential care homes offer residential options for memory care. Several of these facilities are licensed to provide memory care services through special care units. They are regulated by the Division of Licensing and Protection of the Vermont Department of Disabilities, Aging Independent Living.

Through Survey and Certification operation, the DLP ensures that these long-term care facilities are in compliance with state and federal regulations. In addition to unannounced surveys for initial licensing and on a recurring basis, the S&C also conducts surprise investigations based on facility-related complaints.

Facility Scope of Care

Generally, ALRs and RCHs in Vermont should be able to provide room and board and personal care services in supportive homelike settings. While ALR residents may receive appropriate nursing services for them to age in place, nursing care arrangements in RCHs are limited to:

• Fewer than three times per week, or
• Up to seven days per week for no more than 60 days where the resident’s condition is improving

ALRs should also be able to provide social services such as referrals and coordination of home health, hospice, transportation and other necessary services for aging in place. In addition, a daily program of activities should be offered to ALR residents.

Admissions Requirements

ALRs and RCHs may admit a wide range of residents, but there are certain restrictions. The below table gives an overview of who may or may not be admitted.

Care Plan Requirements

A written care plan should be developed by an ALR or RCH in cooperation with the resident or the client’s legal representative. It should describe the care and services necessary to support a resident’s needs, choices, independence and well-being. Care plans must be reviewed at least annually and whenever warranted due to changes in a resident’s condition or circumstances.

Using an assessment instrument provided by the DLP, an ALR or RCH should complete resident assessments within 14 days of a client’s admission. Residents requiring nursing care must be assessed by a registered nurse. Assessments must be consistent with a physician’s diagnosis and orders, and they should be done annually or as necessary due to changes in a resident’s physical or mental condition.

Medication Management Requirements

Medication administration by ALR and RCH staff must be under the delegation and supervision of a licensed nurse. Registered nurses are responsible for providing appropriate training to unlicensed staff and for designating specific staff members to specific residents. Sufficient monitoring and documentation are required for every resident’s prescription and over-the-counter medications, whether self-administered or with a caregiver’s assistance.

PRN medications may be administered by non-RN staff who are educated about the desired and side effects of such medications. Residents may receive insulin injections from staff members who have received additional training and are designated by a registered nurse.

Facility Requirements

All ALR residential units must have floor spaces of at least 225 square feet, excluding bathroom and closet areas. Each unit should be ADA-compliant and for private occupancy unless a resident voluntarily prefers unit sharing. Other required installations include individual temperature controls, an emergency response system and at least one telephone jack for every unit. An ALR should have at least two common areas, including one that’s available for residents’ use at any time.

RCHs can have private and double-occupancy rooms with standard-size full and twin beds that should be at least 6 inches thick. There should be at least one bathroom for every eight residents per floor, not counting those who have rooms with private bathrooms.

Staffing Requirements

There are no minimum staff-to-resident ratios for ALRs and RCHs, but a sufficient number of qualified personnel must be available at all times to provide appropriate care services and emergency response. Each facility should have at least one on-duty staff in charge at all times, wherein a manager may delegate authority to a competent staff member. Facilities with more than 15 residents should have at least one awake staff at all times.

Every staff member providing direct care must have at least 12 hours of training each year. Training should be documented and must cover specific matters such as residents’ rights, fire safety and evacuation, emergency response procedures and general supervision and care. Additional qualification screenings, orientation and specialized training on Alzheimer’s and dementia should be conducted in facilities with memory care units.

Medicaid Policy

Vermont’s Medicaid programs don’t cover room-and-board fees in ALRs and RCHs. However, seniors who qualify for ERC or ACCS may benefit from financial coverage on a certain bundle of supportive services, including memory care. Many of these licensed long-term care facilities participate in one or both of these Medicaid programs and can receive both ERC and ACCS reimbursements for the same resident.

Reporting Abuse

An ALR or RCH staff, resident, loved one or any concerted citizen can report any case of suspected abuse, neglect or exploitation to the Adult Protective Services, a program within the Division of Licensing and Protection of the DAIL. An online report may be submitted directly, and APS may also be contacted by toll-free phone at 1-800-564-1612.

Reports should be made to APS within 48 hours of learning of the suspected or alleged incident. Depending on the nature of the abuse, investigations may be performed by representatives of APS, the Office of the Long-Term Care Ombudsman or Vermont Protection and Advocacy, Inc.