Memory Care in Vermont

Table of Contents

Memory Care in Vermont

Table of Contents

• The Cost of Memory Care in Vermont
• Vermont Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Vermont?
• More Ways To Pay for Memory Care in Vermont
• Memory Care Laws and Regulations in Vermont
• Free and Low-Cost Resources for Seniors in Vermont
• Vermont 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 a 25% premium to assisted living costs as given in the 2021 Genworth Cost of Care Survey to calculate the cost of memory care.

Vermont’s statewide average memory care cost exceeds the national median by $938 per month. Rates here are on the lower end compared to neighboring states, though. New Hampshire to the east is more expensive by $1,003, and prices in Massachusetts run $1,562 over average costs in Vermont. However, in western neighbor New York, prices fall $838 lower than rates in this state.

The Genworth survey only provides senior care cost data for one Vermont city, Burlington, where seniors pay an average of $7,964. In nearby towns in other states, the prices vary widely but mostly fall below prices here. Seniors in Pittsfield, MA, pay $3,958 less than Vermont’s state average, while those in Springfield, MA, pay only $253 less. Memory care rates in Glen Falls, NY, are $1,250 below Vermont’s average price, but costs in Albany Area, NY, are about equal to Vermont’s median. In Manchester, NH, costs soar above Vermont’s average fees by $3,513.

Green Mountain Care is Vermont’s Medicaid program, administered by the Department of Vermont Health Access (DHVA). Medicaid for the Aged, Blind & Disabled (MABD) provides income-eligible older Vermonters with no- or low-cost coverage for health care services.

• Who Is Eligible: To qualify for MABD, individuals must be residents of Vermont aged 65 or older. They must also meet the criteria for income and allowable resources. As of 2022, the annual income limit is $13,992 ($1,166 per month). In Chittenden County, though, the limit is $15,192 ($1,266 per month). These criteria apply to individuals and elderly couples in one- and two-person households. For single applicants, the maximum countable resource limit is $2,000, and couples have a maximum of $3,000.

• How To Apply: Print, complete and sign the 205ALLMED application form, which is accessible from Green Mountain Care’s website. Mail the form to Green Mountain Care Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-1500. Individuals can also request a physical copy of the form by calling 855-899-9600.

Choices for Care (CFC)

Choices for Care (CFC) is the primary long-term care program offered through Vermont Medicaid’s Global Commitment to Health 1115 waiver. It enables eligible seniors and adults with disabilities to receive supportive services in their chosen long-term care setting, including assisted living and residential care facilities.

• Who Is Eligible: CFC has the same eligibility requirements as MABD, determined by Green Mountain Care. Seniors must also meet the clinical criteria for a nursing home level of care, determined by the Department of Disabilities, Aging and Independent Living.
• How To Apply: Print, fill out and sign the Application for Long-Term Care Medicaid. Mail the completed form to Green Mountain Care Application and Document Processing Center. Seniors can request a physical copy of the form by calling (800) 479-6151 or the Vermont Senior Helpline at (800) 642-5119. A local Area Agency on Aging or Home Health Agency can provide assistance as well.

Assistive Community Care Services (ACCS)

Assistive Community Care (ACCS) in Vermont’s Medicaid plan helps cover the costs of long-term care services rendered in select assisted living facilities and residential care homes. Medicaid reimburses such facilities for the costs of supportive services, including personal care, on-site assistive therapy and medication assistance.

• Who Is Eligible: ACCS may reimburse long-term care facilities serving Vermonters 65 and older who qualify for SSI and Medicaid benefits.
• How To Apply: The applicant’s chosen facility must be a licensed ACCS provider. Seniors or their caregivers can contact their local Area Agency on Aging to find qualified facilities and apply for SSI or Medicaid.

Medicaid Eligibility for Seniors in Vermont

Vermonters can apply for Medicaid at any time. Regular Medicaid and MABD count the incomes of both the applicant spouse and non-applicant spouse when determining eligibility.

2022 Medicaid Income Limits for Seniors in Vermont

To qualify for MABD, an applicant must:

• Be a Vermont resident
• Be at least 65 years of age
• Be blind or have a disability
• Meet the financial criteria for MABD

How To Get Help Applying for Medicaid in Vermont

Vermont provides many avenues for getting help with Medicaid. Seniors and caregivers can reach out to trained counselors for unbiased guidance with options and completing applications.

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

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.

Residents Who May Be Admitted

Older adults and people with:

• Dementia
• Physical disabilities
• Developmental disabilities
• Behavioral symptoms that consistently respond to appropriate intervention

Residents Who May NOT Be Admitted

Those who:

• Have serious, acute illnesses requiring the medical, surgical or nursing care provided by a general or special hospital
• Require a ventilator or respirator
• Need nasopharyngeal, oral or tracheal suctioning treatments
• Have stage III or IV decubitus ulcer
• Need two-person assistance to transfer from bed or chair

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.

Vermont seniors living with dementia and their caregivers are not alone in their journey. State and local agencies have set up programs to support these individuals and families with educational tools, counseling and financial help.

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.