Memory Care in Wisconsin

Table of Contents

Memory Care in Wisconsin

Table of Contents

• The Cost of Memory Care in Wisconsin
• Wisconsin Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Wisconsin?
• More Ways To Pay for Memory Care in Wisconsin
• Memory Care Laws and Regulations in Wisconsin
• Free and Low-Cost Resources for Seniors in Wisconsin
• Wisconsin 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.

To provide the most accurate estimate, we've added 25% to the cost of assisted living found in the 2021 Genworth Cost of Care Survey when predicting what memory care will cost in the state of Wisconsin. Costs can vary based on demand, region and quality of care.

Compared with neighboring states such as Minnesota and Illinois, the cost of care in Wisconsin is more expensive. The average Illinoisan pays $5,610 per month for memory care, while Minnesotans pay $5,635. In Wisconsin, the average cost of memory care is about $5,750. It can vary widely depending on where you live. Racine has the highest average monthly cost at $6,813 per month, while Milwaukee residents pay an average of $6,655 per month. Memory care in Oshkosh costs an average of $6,446 per month. Wausau has the lowest average cost for care in the state at $5,156, and La Crosse has an average cost of $5,329 per month.

State Medicaid programs offer coverage to those who can't afford medical care as long as they can prove a medical need and meet certain income requirements. Wisconsin's Medicaid program doesn't provide direct coverage for memory care, but it does provide two waiver programs to assist people who can't afford long-term care at an assisted living facility.

IRIS Program

IRIS (Include, Respect, I Self-Direct) is a special needs program that offers assistance to seniors and adults living with disabilities. It works by giving individuals a monthly benefit they can use toward the cost of their private care. Participants use these state-backed funds to pay for skilled nursing care, adult day care services, companion services and transitions from their homes into a care facility. 

• Who Is Eligible: To be approved for the program, seniors must be eligible for Medicaid benefits in Wisconsin, be over the age of 65, have a disability or require nursing care.
• How To Apply: Applicants can get in touch with their local Aging and Disability Resource Center for information on how to apply to the program.

Family Care Waiver

The Family Care Waiver was meant specifically for individuals who are over the age of 65 and require long-term assisted care. Wisconsin considers long-term care to mean any form of care that includes assisting patients with basic needs, such as personal care, skilled nursing or memory care.

• Who Is Eligible: Residents over the age of 65 who also qualify for Medicaid can apply for the Family Care Waiver. They must also provide evidence of medical needs that meet the state's definition of long-term care.
• How To Apply: The Aging and Disability Resource Center helps Wisconsin residents find the right programs to meet their needs and can help seniors determine whether they qualify. If they do, the ADRC will help them apply.

Medicaid Eligibility for Seniors in Wisconsin

The Medicaid program helps people who can't afford to pay for medical treatment obtain the care they need. To qualify, their income must remain under an income threshold. They also must not have a lot of assets that could otherwise be used to pay for care if sold. Here are the income limits for Wisconsin residents.

2022 Medicaid Income Limits for Seniors in Wisconsin

In addition to meeting these income requirements, the following must also apply:

• Must be a citizen of the United States or a legal resident
• Must be over the age of 65 or an adult living with a disability

How To Get Help Applying for Medicaid in Wisconsin

If a senior is having trouble applying for benefits or doesn't know what programs they qualify for, they can use these resources.

aid.

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.gov
• Reverse Mortgage: A reverse mortgage allows 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 loan will need to be paid back after the sale of the home. The most commonly used type of reverse mortgage 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

In Wisconsin, assisted living facilities that are permitted to care for those with memory impairment fall under the category of community-based residential facilities (CBRFs). The Wisconsin Department of Health Bureau of Assisted Living regulates these facilities and handles licensing and registration.

As part of the licensing process for CBRFs that provide care for people with dementia, the facilities must have a detailed description of the special care services they will offer these residents. To ensure continuous quality, the licensing department conducts unannounced inspections every two years and in response to complaints.

Facility Scope of Care

CBRFs may provide care, treatment, and other assistive services beyond room and board to residents. The level of care is limited to intermediate nursing care, and no more than three hours of nursing care may be administered to an individual resident per week. CBRFs are permitted to admit and provide services to those with dementia, but not those who require around-the-clock or advanced nursing services.

Additionally, CBRFs are required to provide certain services unrelated to health care, including:

• Transportation
• Leisure-time activities, and specific activity programming for residents with dementia
• Three nutritious meals per day plus a nutritious snack that meets residents’ specific dietary needs

Admissions Requirements

CBRFs may admit a wide range of residents, but there are certain restrictions as well. 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
• Mental Health Conditions
• Developmental Disabilities
• Physical Disabilities
• AIDS
• Traumatic Brain Injuries

Residents Who May NOT Be Admitted

Those who:

• Are destructive to property and/or themselves
• Cannot get out of bed and/or evacuate on their own
• Present a risk of harm to themselves or others
• Require more than three hours of nursing care perk week
• Require intermediate nursing care for more than 30 days

Care Plan Requirements

CBRFs must assess each individual person’s abilities, physical and mental condition, and care needs prior to admission. These assessments must be completed, at minimum, once per year, or anytime a resident’s needs or abilities change.

Immediately upon admission, CBRFs must develop a temporary, individualized service plan, and a comprehensive, long-term service plan must be developed within 30 days of admission. The plan must include which services a resident will receive, and at what frequency.

Medication Management Requirements

Residents of CBRFs are permitted to administer their own medications unless they have been found incompetent to do so by their physician. When necessary, medications may be administered and/or directed by a registered nurse, nurse practitioner, or pharmacist. Certain medications, including nebulizers, injectables, and medications administered rectally or vaginally must always be administered by a nurse.

Facility Requirements

CBRFs may have both private and double-occupancy rooms with shared bathrooms. All facilities must have, at minimum, one toilet, one sink, and one tub or shower for every 10 residents.

Residents’ rooms must be clean and odor-free, and all residents who wish to do their own laundry must have access to a laundry facility.

Staffing Requirements

CBRFs must have resident care staff who are responsible for directly caring for residents, as well as an administrator, who oversees the resident care staff and the day-to-day operation of the facility. There are no minimum staff ratios, but facilities must have enough employees present to meet residents’ needs on a 24-hour basis.

All resident care staff must undergo training prior to performing any job duties. The training must include, at minimum, a Department of Health approved training in medication management, first aid, fire safety, and standard precautions. Facilities must ensure additional, adequate trainings in resident rights, reporting abuse, and, for some, development of service plans and provision of personal care. All staff of CBRFs that offer memory care must undergo training in managing the physical and psychological needs of persons with dementia within 90 days of employment.

Additionally, facility administrators and resident care staff must receive 15 hours of continuing education annually.

Medicaid Policy

Standard Medicaid does not cover room and board in CBRFs. However, Wisconsin has two Medicaid waiver programs- Family Care and IRIS- which people with dementia may use to cover the cost of certain memory care services that they receive while living in a CBRF.

Reporting Abuse

Anyone with a concern or complaint about the quality of care or treatment of residents in a CBRF should contact the Office of the Long-Term Care Ombudsman. The ombudsman may also be reached by phone at 800-815-0015.

In addition to state and federal programs, many charitable organizations and public programs provide support services for little to no cost. From early diagnosis to support groups that help caregivers adjust to the realities that come with caring for a loved one with cognitive decline, the following organizations offer vital resources.

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.