Memory Care in Wisconsin

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 Wisconsin, the average monthly cost of assisted living is $4,350. This is several hundred dollars more than the national monthly average of $4,051. Assuming that memory care will cost, on average, 25% more than assisted living, one can expect to pay approximately $5,437 per month for residential memory care in Wisconsin.

Within the state, the cost can vary significantly. In the Madison area, for example, assisted living costs an average of $3,950 per month. In Milwaukee, one can expect to pay an average of $4,485. And in the Oshkosh area, the cost soars to an average of $5,471 per month. 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.

Wisconsin Medicaid Programs for Memory Care

Family Care Waiver

The Family Care Medicaid Waiver is intended to assist adults over the age of 65 who need help with their activities of daily living pay for long-term care. The state defines “long-term care” as any service or support that one needs to complete activities of daily living and other basic tasks, like paying bills, so beneficiaries have some autonomy over the services received. The benefit may be used to pay for in-home memory care as well as care in a residential facility, though the program is intended to prevent unnecessary moves to a residential care facility.

• Who is Eligible: To qualify for Family Care, one must be age 65 or older and be financially eligible for Wisconsin Medicaid. In 2019, the income limit is $16,612 for a single person and $22,491 for a two-person household. Additionally, Family Care participants must have proven long-term care needs.
• How to Apply: Those interested in Family Care should contact their local Aging and Disability Resource Center (ADRC). The ADRC will work with the individual to determine eligibility, and if eligibility for the program is confirmed, the ADRC will contact the person to start the enrollment process.

IRIS Program

IRIS stands for Include, Respect, I Self-Direct. This Medicaid program assists frail elders and other adults with disabilities pay for long-term care. Program participants receive a monthly stipend from the state, and are free to use those funds to completely self-direct their care. This may include nursing services, adult day care, home modifications, and more.

• Who is Eligible: To be eligible for IRIS, one must be eligible for Wisconsin Medicaid, be a frail elder or have a qualifying disability, and require the same level of care as one would receive in a nursing home.
• How to Apply: Those interested in enrolling in IRIS should contact their local ADRC to apply.

Non-Medicaid Financial Assistance Programs for Memory Care in Wisconsin

The Alzheimer’s Family and Caregiver Support Program

The Alzheimer’s Family and Caregiver Support Program (AFCSP) provides those with Alzheimer’s and related disorders with financial assistance to pay for services associated with Alzheimer’s. The program is designed to benefit those with dementia as well as their families. Funds from the program may be used to pay for services including in-home care, adult day care, respite care, and transportation services. Certain goods, including delivered meals, medical alert systems, and nutrition supplements, may also be paid for with funds from the AFCSP.

The size of the benefit that one receives varies from person-to-person. Each county and tribe in Wisconsin is given a set amount of money to distribute to qualifying residents. Up to $4,000 may be allocated per person.

• Who is Eligible: To be eligible for AFCSP, a couple may not have an income exceeding $48,000. However, Alzheimer’s-related expenses may be subtracted from gross income, so in some cases, an income above $48,000 is permissible. The benefit amount is based on one’s ability to pay for care, so those with higher incomes will be expected to pay for a larger portion of their care. Additionally, applicants must have verification from a physician of their diagnosis of Alzheimer’s or another irreversible dementia.
• How to Apply: This program is coordinated by the ADRC, but since it operates on a county level, those interested should contact their local country and tribal aging office to apply.

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

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.

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.