Caring for a loved one with dementia can be emotionally taxing. It can be expensive too.
Especially if your loved one requires memory care — such as room and board at a memory care facility — their treatment can rack up a hefty health care bill. And while health insurance like Medicare may fund some memory-related medical needs, Medicare doesn’t pay for people to stay at a memory care facility.
Lisa Gibbs, chief of geriatric medicine and gerontology at UC Irvine in Orange, California, says the high cost of living at a memory care facility is a “major barrier” for those who need to transition from independent living. And yet, at times she adds it’s necessary to cross cost barriers to preserve your loved one’s health — or your own.
Gibbs explains that you may want to consider a memory care facility for your loved one if caregiving is placing a burden on your health and wellness, and you find yourself neglecting your own needs to take care of your loved one.
If you’re unsure how to fund your loved one’s memory care, it can help to start thinking about their specific needs and familiarizing yourself with Medicare’s coverage for memory care.
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What Is Memory Care?
Memory care refers to a type of senior care setting that provides specialized care for people with Alzheimer’s and other forms of dementia. Some memory care facilities are connected to nursing homes, personal care homes or assisted living facilities, and some hospitals or rehabs have a memory care floor.
At a memory care facility, your loved one will receive various interventions to support their well-being. Many memory care interventions are seen as custodial services, not medical treatments — they are geared toward improving the person’s overall quality of life and ability to safely participate in activities of daily living, as opposed to curing an injury or disease.
Care people might receive in memory care includes:
— Housing and housekeeping
— Meals and snacks
— Case management
— Help with dressing themselves, feeding, using the bathroom and bathing/showering
— Safety supports, such as handrails, proper locks on doors and staff supervision
— Social supports, such as social activities or community areas
— Sensory input supports, like playing music
— Occupational therapy treatments
— Physical therapy and speech therapy treatments
Marissa de Chaves, lead occupational therapist at The Riverside Rehabilitation Center, a skilled nursing facility in New York, says that OT’s who work on memory care floors or facilities are educated on dementia types, stages and physiology, which enables them to best help patients navigate the diagnosis.
“The importance of memory care is to help dementia patients live the rest of their lives as safely and independently as they can,” de Chaves says. Reducing a family’s caregiver burden is another huge benefit, she adds.
“A lot of times I see a patient with dementia that has progressed so quickly their family members are rearranging their whole lives to care for their loved one,” de Chaves says. “It’s important to have a place with skilled staff who are trained in memory care where they can safely live out the rest of their lives.”
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Does Medicare Cover Memory Care?
The short answer is no, Medicare does not cover memory care. The longer answer is that although Medicare does not cover memory care, it may cover some dementia-related or adjacent treatments, depending on your loved one’s circumstances.
Here are memory care-related services that Medicare may cover:
Medicare Part A coverage
Medicare Part A covers some inpatient stays and skilled nursing treatments for dementia, under specific circumstances. This includes coverage for stays at a skilled nursing facility for 100 days or less, if this is after a qualifying three-day inpatient stay at a hospital.
Medicare may temporarily cover skilled nursing treatments for an acute injury. Medicare also covers inpatient occupational therapy for the treatment of an acute injury. Come billing time, however, OT interventions specifically for memory care don’t always fit this description.
“If a Medicare member was admitted to a skilled nursing facility under Part A for an acute or rehabilitation need, such as gait instability and the need for ongoing physical therapy, then that member would be eligible for occupational therapy under Part A as well,” explains Dr. Ali Khan, chief medical officer of Medicare at Aetna. However, Khan notes that this admission would be in support of their “global functioning,” and not solely for treatment of their dementia.
“Dementia and memory issues by themselves do not qualify as skilled nursing-eligible diagnoses,” Khan says.
Additionally, Medicare will not pay for custodial care at a nursing home if this is the only type of care a person is receiving. This can be frustrating to deal with if your loved one is in need of memory care, which largely involves custodial-type services.
Medicare Part B coverage
Medicare Part B offers some outpatient financial support for dementia diagnoses and prevention treatments, which could help you and your loved one better plan for — or avoid — going to a memory care facility. These include cognitive testing for people who do not already have dementia, care planning for people who do have dementia, and drug coverage — albeit with a copay — for some dementia-related medications.
Medicare B also helps cover outpatient treatments like occupational therapy, which may be able to salvage your loved one’s ability to take care of themselves, keep themselves safe and improve quality of life for some time. Patients at memory care facilities can be eligible for Medicare-funded outpatient OT, if they have a supporting diagnosis.
[READ: 8 Health Problems That Can Mimic Dementia]
Memory Care Under Medicare Advantage
Like its name implies, Medicare Advantage — also known as Medicare Part C — may provide a few extra advantages when it comes to paying for memory care. Medicare Advantage covers the same services as Medicare Part A and Medicare B, plus a few more, depending on the plan.
Extra coverage under Medicare Advantage plans is most concentrated in the dementia-prevention stages. While these will not pay for your loved one to stay at a memory care facility, they may help fund drugs or treatments that slow dementia’s progress or decrease the likelihood that your loved one will need to go to a memory care facility in the future.
Khan says that two mainstays of dementia prevention that Medicare Advantage can fund are annual vision and hearing screenings.
“One of the most efficacious things we can do to prevent dementia onset in the first place is annual vision and annual hearing screens,” Khan says. Certain vision problems that people can develop in their thirties to fifties have been shown to dramatically increase the risk of dementia downstream, he says, and dementia, in its worse forms, is what leads to these memory care settings.
Other Ways to Pay for Memory Care
While Medicare won’t be able to cover your loved one’s stay at a memory care facility, there may be other ways you can find funding. One of these is to see if your loved one qualifies for Medicaid — and sign them up.
Medicaid is the largest payer for nursing home facility care and can at times be used to pay for memory care. There are some stipulations around Medicaid coverage, however, including that you must ensure the facility you are using is Medicaid-certified. Additionally, to qualify for Medicaid funding for memory care your loved one must have an income at or below Medicaid’s yearly income threshold and must be meet some medical qualifications to prove their need for this kind of care.
In addition to Medicaid, some other ways people pay for memory care include:
— Personal savings
— Retirement funds
— Social security benefits
— Other types of insurance, like long-term care insurance or converted benefits from life insurance
— Donations and funding from nonprofits
[READ What Is Medicaid Spend Down? Everything You Need to Know]
Cost of Memory Care
According to Dementia Care Central, as of February 2023 the average monthly cost of memory care in the U.S. was $6,160, or about $1,200 more than the average monthly cost of an assisted living facility.
However, fees can vary widely based on the facility’s location. According to reports from Brookdale Senior Living, the largest senior housing provider in the U.S., the average monthly cost of memory care in the U.S. ranges from $3,395 to $12,560. For example, the 2024 average monthly cost of assisted living with memory care was lower than $4,000 in Grand Island, Nebraska, but more than $7,500 in New York City.
In addition to location, memory care amenities — such as if residents have a roommate or a single room or if community amenities like swimming pools or beauty salons are available — can skew prices from the average.
How to Know If Your Loved One Needs Memory Care
If your loved one is in need of memory care, their dementia will have progressed far enough that they are not able to properly take care of themselves or live a high quality of life at their current home.
Talking to your loved one’s doctor can also help you understand if memory care is in their future. Doctors don’t “order” memory care for a patient, but may recommend memory care for a patient if their caregiving needs exceed what their at-home caregivers can give, “or if the benefits of memory care are deemed important for the person with dementia,” Gibbs says.
Some signs that your loved one would benefit from a memory care setting include:
— They cannot care for themselves in basic ways.
— They require help using the toilet.
— They require help dressing themselves.
— They require help eating.
It may also be worth looking into memory care if, in addition to everyday challenges, your loved one appears lonely within their diagnosis.
Gibbs explains that “isolation and loneliness worsen health conditions for everyone, but especially for the person with dementia, who will benefit (from) an environment that is specialized for dementia care.”
Memory care facilities can offer your loved one a sense of community by providing them a safe environment in which to socialize with staff and other residents.
“Staff in memory care facilities are often skilled and experienced in working with persons with dementia and promote a positive and friendly environment,” Gibbs says.
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Does Medicare Cover Memory Care? originally appeared on usnews.com
