What is Memory Care?
Key Takeaways
- A memory care facility provides specialized residential care for people living with Alzheimer’s disease and other forms of dementia.
- To be eligible for memory care, older adults must have a diagnosis of dementia and a need for around-the-clock supervision.
- Most memory care facilities offer dementia-specific care and activities, including gardening, exercise, and cognitive games and therapies.
- The cost of memory care can reach six figures per year. You can pay with private savings and assets or long-term care insurance. In some cases, Medicaid will help to cover the cost of memory care for eligible older adults.
The first cognitive symptoms of Alzheimer’s and other forms of dementia are mild and may resemble normal signs of aging. At this point, searching for a memory care facility might seem unnecessary. But symptoms associated with the disease’s progression, like wandering outside the home and changing sleep patterns, can make it difficult to care for someone living with dementia.
An older adult with problematic symptoms of dementia will require professional care. If you’re unable to provide this in your home or in the home of someone you care for, it might be time to look for a memory care community where a person living with dementia can engage with others and receive personal care in a safe setting.
Our Local Care Reviews Team team has provided a comprehensive guide to finding, selecting, and paying for a memory care facility.
Why you can trust our expert review
Our Local Care Reviews Team works hard to provide clear, transparent information to older adults and their caregivers seeking senior living and home care. To provide you with the best possible information, we have spent more than 250 hours:
- Consulting with our advisory board, which consists of a certified care manager, a board-certified geropyschologist ⓘA geropyschologist is a professional psychologist who specializes in the needs and well-being of older adults., and a geriatric nurse practitioner
- Analyzing and synthesizing nationwide data from the Centers for Medicare & Medicaid Services and the National Investment Center for Seniors Housing & Care
- Analyzing and synthesizing state-specific data from government health regulatory agencies
- Surveying 1,000 older adults and their caregivers about their search for senior living and home care options
- Conducting a focus group with caregivers helping older adults find local care
- Mystery shopping dozens of brands and facilities associated with long-term care for older adults
What is memory care?
Memory care is specialized care designed for older adults living with Alzheimer’s disease or another form of dementia, such as frontotemporal dementia ⓘFrontotemporal dementia refers to a group of brain disorders affecting the frontal and temporal lobes of the brain. Symptoms include behavioral changes, speech and language problems, and motor disorders. or Lewy body dementia ⓘIn this type of dementia, protein deposits called Lewy bodies develop in the brain’s nerve cells. Symptoms include cognitive problems, visual hallucinations, and movement disorders.. Natali Edmonds, a board-certified geropsychologist and CEO of Dementia Careblazers, noted that memory care facilities are set up with attention to the behaviors and safety of people living with dementia. “For example, these facilities have locked doors to prevent the residents from wandering away. Ideally, they also have staff members with special training in dementia care,” she said.
What services are provided in memory care?
A residential memory care facility offers the same services and amenities as most assisted living facilities, including a private or shared apartment, three meals and snacks per day, housekeeping, laundry, and personal care services, such as help with activities of daily living (ADLs) ⓘActivities of daily living, also called ADLs, are activities related to necessary personal care. These include bathing, dressing, toileting, eating, walking, and transferring in and out of a bed or chair..
In addition to these basic services, a memory care facility offers specialized care for people living with dementia. A study by the National Center for Health Statistics (NCHS) reported that 91% of dementia special care units within residential facilities offered dementia-specific activities for residents, and 90% had doors with alarms to alert staff if someone left the unit. [1]Centers for Disease Control and Prevention. Dementia Special Care Units in Residential Care Communities: United States, 2010. November 2012. Found on the internet at https://www.cdc.gov/nchs/data/databriefs/db134.pdf These common features of memory care facilities are aimed at engaging residents while also keeping them safe.
How is memory care different from other senior living options?
One of the main differences between memory care and other types of residential care, Edmonds noted, is memory care will have more security. All doors are locked and, in most cases, facilities are designed so outdoor areas are also within the secured, supervised area. The NCHS found that seven out of 10 memory care units within residential care facilities had specially trained staff, enclosed courtyards, and locked exit doors. [1]Centers for Disease Control and Prevention. Dementia Special Care Units in Residential Care Communities: United States, 2010. November 2012. Found on the internet at https://www.cdc.gov/nchs/data/databriefs/db134.pdf Residents aren’t able to leave the unit without a staff or family member.
Ideally, memory care staff members should have specialized training in dementia care, such as the Hand in Hand training series, which is a requirement for nursing staff in any nursing facility that receives federal Medicare or Medicaid funding. [2]Quality, Safety & Education Portal (QSEP). CMS Hand in Hand: A Training Series for Nursing Homes. Found on the internet at https://qsep.cms.gov/pubs/HandinHand.aspx This type of training, which is not typical in other types of residential facilities for older adults, teaches staff to calm and reassure residents who exhibit dementia-related behaviors, such as anxiety and irritability. The training also clearly defines what abuse of a person with dementia looks like, as well as how to prevent it. [3]Frontiers in Neurology. Behavioral and psychological symptoms of dementia. May 7, 2012. Found on the internet at https://www.frontiersin.org/articles/10.3389/fneur.2012.00073/full
Memory care facilities may also incorporate special activities for people with memory impairment. These may include hands-on activities, like gardening, crafts, or cognitive games. Facilities may also offer therapeutic activities for residents. “Reminiscence therapy,” Edmonds said, “helps bring out long-term memories from the person’s childhood and can bring joy to people with dementia.”
What are the benefits of memory care?
It can be hard on families to move someone they care for to memory care. Caregivers may experience a sense of guilt or feel they should be the ones to care for their friend or family member with dementia. But caring for someone with dementia can be a full-time job and isn’t an option for all families. For caregivers considering memory care, it may be helpful to understand what can be gained from this type of residential care.
Benefits of memory care include:
- A secure setting, which keeps residents safe and provides peace of mind for caregivers
- Social engagement and physical exercise, both of which can help slow the progression of dementia [4]Alzheimer’s Association. Can Alzheimer’s Disease Be Prevented? Found on the internet at https://www.alz.org/alzheimers-dementia/research_progress/prevention
- Personalized care, including medication management and help with ADLs, such as bathing and dressing
- Access to health care professionals, including physical therapists and psychiatrists, who are often available for on-site visits
- Care provided by staff with specialized dementia-specific training
- Improved diet, especially if the person with dementia was previously living alone and preparing their own meals
- Elimination of day-to-day caregiving that allows family members to return to their roles as son, daughter, or spouse
Recognizing the need for memory care
Following a dementia diagnosis, older adults may continue to live at home or with family members. “Knowing when someone is ready for memory care will depend on their care needs and on your ability to care for them at home,” Edmonds said. As you evaluate the need for memory care, consult with a geriatrician or another trusted medical professional to help determine the best options.
Signs it might be time for memory care
Before an older adult can be considered for memory care, they must have a diagnosis of Alzheimer’s or another form of dementia from a health care professional. When a person is ready for memory care, they often have symptoms making it unsafe for them to live on their own. Additionally, older adults with dementia whose needs progress beyond the care assisted living facilities can offer may need to move to a memory care community. These considerations may influence your decision to choose memory care:
Safety concerns
“If the person can’t be left alone for any length of time without fear of falling, wandering, or using the stove or another appliance incorrectly, these are signs memory care may be needed, or alternatively that more care needs to be brought into the home,” Edmonds said.
Physical needs
As dementia progresses, many people will need around-the-clock help with personal care, including toileting, showering, and transferring to and from bed or a chair. [5]Alzheimer’s Association. Stages of Alzheimer’s. Found on the internet at https://www.alz.org/alzheimers-dementia/stages “Given their memory impairment,” Edmonds said, “people with dementia may not understand they need this high level of care. That’s where the specialized training of memory care staff is important.”
Caregiver needs
Being the primary caregiver for someone living with dementia can be overwhelming. By relying on memory care professionals for caregiving, people close to the person living with dementia can focus on their own mental health while also returning to their roles as supportive family members or friends.
Assessing the need for memory care
Not every person with dementia will move to memory care. But in some cases, a memory care facility is the best option for both the caregiver and the older adult with dementia.
To help determine whether someone you care for is ready for memory care, consider filling out a Cognitive Impairment Safety Assessment Checklist as a family. [6]Alzheimer’s Association. Cognitive Impairment Care Planning Toolkit. Safety Assessment Checklist. Found on the internet at https://www.alz.org/media/Documents/safety-assess-checklist.pdf If this kind of assessment is stressful for the person with dementia, ask a trusted health care professional, like a geriatrician or your family physician, to facilitate a conversation about memory care.
The earlier you start these conversations, the more time you will have to find quality memory care.
How to choose a memory care facility
If you decide it’s time for memory care for someone you care for, the next step is to find and tour facilities. Here are a few things to consider before you begin your search for a memory care facility near you:
Finances
You will need to understand the financial situation of the person in need of care. If they qualify for Medicaid, for example, it’s probably not worth your time to tour facilities that only accept private-pay residents.
Geographical area
Determine how far you and others on your caregiving team are willing to travel in order to visit the memory care facility. For example, you may decide to research facilities within a 20- or 30-mile radius. Frequent visits are important for evaluating and providing feedback on the type of care being provided in the facility.
Level of care
Determine the level of care needed. If a family member with dementia has other chronic health issues, such as diabetes or congestive heart failure, you may need to find a memory care unit within a skilled nursing facility.
Tips for choosing a memory care facility
If someone you care for is living with dementia, you want them to receive the best possible care. When touring memory care communities, it’s easy to get sidetracked by conversations with administrators and salespeople. To make sure you’re thoroughly vetting each facility you visit, bring a pen and a notepad or checklist, and don’t be afraid to ask lots of questions. You might also try making an unscheduled visit or scheduling a few visits at random times. According to Christopher Norman, a geriatric nurse practitioner in New York state, it can be a red flag if a facility only offers tours between certain times on certain days. By visiting the facility at random times, you can “get the real experience, not just the sales pitch,” he said.
Depending on the progression of a person’s dementia and the degree to which they accept the move to memory care, it may or may not be a good idea to bring them with you when touring facilities. Visiting the facility, especially talking to other residents and seeing fun features, like a movie theater or ice cream bar, might make an individual with dementia feel excited. But, as Edmonds shared, “If a person who needs memory care is not yet open to the idea of moving, it may not be a great idea to bring them and may cause more distress.”
Here are four tips for choosing a memory care facility:
1. Consider the facility layout and physical environment
When visiting memory care facilities, take note of the physical surroundings and ask yourself if the person you care for would be comfortable there. For someone who enjoys being social, inviting common areas and socially engaged residents are great features in a memory care facility. For someone who enjoys nature, a memory care facility with ample outdoor areas is ideal.
For safety reasons, any memory care facility you choose should be clean, well-lit, and have secure exits. Remember, upscale facilities with fancy amenities, like restaurant-style dining rooms and spas, don’t necessarily deliver superior care.
2. Evaluate the staff’s training and expertise
Ideally, memory care facilities will require dementia-specific training for all members of their staff, which may include certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs).
As mandated by Section 6121 of the Affordable Care Act (ACA), the Centers for Medicaid & Medicare Services (CMS) must ensure nursing staff are regularly trained on caring for residents with dementia and on preventing abuse. This is accomplished through the Hand in Hand training series, which is a requirement for staff of skilled nursing facilities. [2]Quality, Safety & Education Portal (QSEP). CMS Hand in Hand: A Training Series for Nursing Homes. Found on the internet at https://qsep.cms.gov/pubs/HandinHand.aspx
Memory care facilities regulated on the state level, such as those in assisted living facilities, have varying requirements for dementia-specific training. For example, in California, facility administrators are required to take eight hours of dementia-specific training every two years, and CNAs are required to take six hours of dementia-specific training. In Oklahoma, there are no dementia-specific training requirements for facility administrators, but CNAs must take 10 hours of dementia-specific training. [7]Justice in Aging. Training to Serve People with Dementia: Is our Health Care System Ready? August 2015. Found on the internet at http://justiceinaging.org/wp-content/uploads/2015/08/Training-to-serve-people-with-dementia-Alz3_FINAL.pdf The nature of these state-level training programs will vary depending on where you live.
No matter where you live, it’s a good idea to ask the facilities you tour about dementia-specific training for staff. Additionally, it’s important to know the staffing levels at the facility and when the RNs are present.
3. Look for a community with activities and social engagement
“All people with dementia are not the same, and not every older adult with dementia enjoys bingo or card games,” Edmonds said. “Generally speaking, the best activity for someone with dementia is an activity that pertains to their personal interests and is safe for them to do.”
When you visit memory care communities, look for staff actively engaged with residents and residents engaged with activities. Ask to see the activities calendar, and request a meeting with the activities director, if possible. While the activities calendar may look regimented to you, remember routine is often helpful and soothing for people with cognitive impairment. “People starting to lose the ability to internally organize themselves often benefit from externalized structure, which is in part what memory care facilities strive for,” Norman said.
4. Discuss the availability of continuing care
Ask the facility about the services they offer to residents. Specifically, inquire about the highest level of care offered at the facility. If a resident’s needs were to exceed that level of care, what are the next steps? All forms of dementia are progressive, and it’s best to be prepared for the changing needs of someone living with the disease.
Understanding memory care costs
The cost of memory care will vary depending on where you live. The type of facility where the memory care unit is located, such as assisted living or a nursing home, will also influence the cost of care and the methods of payment accepted by the facility. In general, memory care is expensive, and it can be challenging for families to cover the cost.
How much does memory care cost?
Dementia Care Central reported the average monthly cost of memory care in an assisted living facility in the United States is $6,160, or about $73,920 each year. As dementia progresses, nursing care may be required. The national average for a shared room in a nursing home is about $286 per day, or about $8,580 per month. [8]Dementia Care Central. Alzheimer’s/Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Updated February 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/
How to pay for memory care
You can pay for memory care using personal assets and savings, long-term care insurance, or a combination of both. In some cases, government programs, like Medicaid and veterans benefits, will help to cover the cost.
Edmonds recommended talking to an elder law attorney in your state to help structure assets in ways that will help you qualify for state or federal assistance with memory care fees. Or, you can find a social worker through your local area agency on aging to help walk through Medicaid requirements and applications.
Personal assets and savings
To pay for memory care, many people draw from personal savings. This can include pension payments, Social Security benefits, stocks, and 401(k) and IRA accounts. You can also use proceeds from the sale of your home or a personal life insurance policy to help pay for memory care. Before trading over any assets to pay for memory care, be sure you get the advice of a trusted financial advisor.
Government programs, like Medicare and Medicaid
Medicare and Medicaid benefits can help pay for the cost of some services received in assisted living. In some cases, these government benefits will cover the full cost of care.
Medicare won’t pay for any form of long-term care, including memory care. But Medicare will pay for many services people receive while living in a memory care facility, such as physical or occupational therapy, outpatient doctor visits, some prescription drugs, and durable medical equipment (DME), like shower stools or bedside commodes.
Medicaid will cover the full cost of nursing care for Medicaid-eligible individuals who are determined by a physician to need Nursing Home Level of Care (NHLOC). So, if the memory care facility is located within a nursing facility, Medicaid will cover the full cost.
If a memory care community is located within an assisted living facility, Medicaid will cover the cost of personal care services, such as help with ADLs, but not the cost of room and board. Memory care residents may also get financial help for room and board fees if they are eligible for both Medicaid and state-level Medicaid waivers to help pay for assisted living. These 1915(c) Home & Community-Based Services (HCBS) waivers have broad federal guidelines tailored by states to meet the needs of their residents. [9]Medicaid.gov. Home & Community-Based Services 1915(c). Found on the internet at https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html For example, Michigan’s Choice Waiver Program allows older adults who meet income criteria to receive Medicaid-covered services in settings other than nursing homes, such as their own home or another residential facility. [10]Michigan Health & Human Services. MI Choice Waiver Program. Found on the internet at https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/beneficiaries/programs/progbens/mi-choice-waiver-program The names of these Medicaid waivers will vary by state, and not all states have Medicaid waivers to help pay for senior care.
Long-term care insurance
Long-term care insurance will reimburse policyholders for the cost of memory care, but it’s crucial you understand the details of the policy. Many long-term care insurance policies have a 90-day period before benefits kick in. So, if the person you care for starts using the benefit the day they move into memory care, they could be responsible for thousands of dollars in out-of-pocket expenses. If possible, start using the long-term care benefits on less-expensive services, such as in-home care, before moving to memory care.
Veterans benefits
Veterans and surviving spouses of veterans in need of memory care may qualify for Veterans Aid and Attendance benefits. Though these benefits will typically not cover the cost of room and board in a memory care facility, they will pay for many other services provided to veterans, such as medication management and help with ADLs. [11]U.S. Department of Veterans Affairs. Geriatrics and Extended Care. Found on the internet at https://www.va.gov/GERIATRICS/pages/Assisted_Living.asp In addition, veterans may qualify to receive skilled nursing, adult day care, or domiciliary care though State Veterans Homes. Eligibility for admission varies by state.
To get a better understanding of what federal programs and benefits you may be eligible for and how they could help you pay for memory care, use BenefitsCheckUp.
Alternatives to memory care
If an older adult needs memory care but does not qualify for Medicaid assistance and can’t afford the cost of a facility, they may need to receive care at home. If you’re currently caring for someone living with dementia in your home, or plan to do so in the future, there are programs and resources that can help:
- In-home care: Hire companion care (also called homemaker services) or a home health aide. A companion can ease loneliness while also helping with light housekeeping, meal preparation, and technology assistance. A home health aide offers the same services as a companion, with the addition of personal care services, such as help with ADLs, like bathing and dressing. Increasingly, more states are adding programs that use Medicaid dollars to pay family members and other individuals who are caring for chronically ill or physically disabled people in the home. For example, New York’s Consumer Directed Personal Assistance Program (CDPAP) provides compensation for services that would normally be provided by a personal care aide, home health aide, or nurse. [12]New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP). Found on the internet at https://www.health.ny.gov/health_care/medicaid/program/longterm/cdpap.htm
- Adult day centers: Many communities have adult day services, which provide therapeutic, social, and some health-related services to adults needing supervised care outside of the home during the day. [13]National Adult Day Services Association. About Adult Day Services. Found on the internet at https://www.nadsa.org/about/about-adult-day-services Because most adult day centers are staffed by CNAs, they usually welcome people who require assistance with ADLs, such as toileting or walking independently.
- Respite care: For caregivers planning to travel or needing a break from caregiving, respite care offers a temporary residence to older adults living with dementia or other illnesses requiring around-the-clock care.
- Dementia support groups: People living with dementia and their caregivers can find solace, community, and resources through virtual dementia support groups. [14]Alzheimer’s Association. Support Groups. Found on the internet at https://www.alz.org/help-support/community/support-groups You may also find in-person dementia support groups through your local area agency on aging.
Bottom line
If an older adult living with Alzheimer’s disease or another form of dementia needs supervised, around-the-clock care, it might be time to consider a memory care facility. Often located within a nursing home or an assisted living facility, memory care units are locked to prevent residents from wandering. For residents who require such care, memory care facilities offer assistance with ADLs and medication management. Typically, memory care communities will provide a full calendar of activities that promote social engagement, which is beneficial to people living with dementia. The best memory care units provide their staff with dementia-specific training.
When it comes to selecting a memory care facility, you’ll need to consider budget, location, and the level of care the person you care for requires. When touring individual facilities, ask questions about the kind of care offered, from staff training requirements to the quality of planned activities. In each facility, look for staff and residents who seem content and engaged.
Covering the cost of memory care is challenging for many families. First, learn as much as you can about the financial resources available to the person you care for, including whether or not they qualify for government assistance, like Medicaid or veterans benefits. Many families use a combination of personal savings and financial assistance to help cover the cost of memory care.
A diagnosis of Alzheimer’s disease or another form of dementia is a requirement for memory care. But you don’t need to wait until dementia progresses to begin your search. The earlier you start looking for memory care communities, the more options you will have when the time comes.
Frequently asked questions
A memory care facility is a long-term care residence designed for older adults living with Alzheimer’s or another form of dementia.
People living with Alzheimer’s or another form of dementia may need a memory care facility when symptoms, like wandering outside the home or uncontrolled incontinence, require around-the-clock care and supervision. The Cognitive Impairment Safety Assessment Checklist is a tool that can help with the decision about when to seek memory care. [6]Alzheimer’s Association. Cognitive Impairment Care Planning Toolkit. Safety Assessment Checklist. Found on the internet at https://www.alz.org/media/Documents/safety-assess-checklist.pdf
According to Dementia Care Central, the average cost of memory care in an assisted living facility is around $6,106 per month. In a skilled nursing facility, the cost of memory care is about $8,580 per month. [8]Dementia Care Central. Alzheimer’s/Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Updated February 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/ If you qualify for Medicaid based on your income, it will cover the cost of memory care in a skilled nursing facility but not always in an assisted living facility.
Have questions about this article? Email us at reviewsteam@ncoa.org.
Sources
- Dementia Special Care Units in Residential Care Communities: United States, 2010. Centers for Disease Control and Prevention. November 2012. Found on the internet at https://www.cdc.gov/nchs/data/databriefs/db134.pdf.
- CMS Hand in Hand: A Training Series for Nursing Homes. Quality, Safety & Education Portal (QSEP). Found on the internet at https://qsep.cms.gov/pubs/HandinHand.aspx.
- Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology. May 7, 2012. Found on the internet at https://www.frontiersin.org/articles/10.3389/fneur.2012.00073/full
- Can Alzheimer’s Disease Be Prevented? Alzheimer’s Association. Found on the internet at https://www.alz.org/alzheimers-dementia/research_progress/prevention.
- Stages of Alzheimer’s. Alzheimer’s Association. Found on the internet at https://www.alz.org/alzheimers-dementia/stages.
- Cognitive Impairment Care Planning Toolkit. Safety Assessment Checklist. Alzheimer’s Association. Found on the internet at https://www.alz.org/media/Documents/safety-assess-checklist.pdf.
- Training to Serve People with Dementia: Is Our Health Care System Ready? Justice in Aging. August 2015. Found on the internet at http://justiceinaging.org/wp-content/uploads/2015/08/Training-to-serve-people-with-dementia-Alz3_FINAL.pdf.
- Alzheimer’s/Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Dementia Care Central. Updated February 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/.
- Home & Community-Based Services 1915(c). Medicaid.gov. Found on the internet at https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html.
- MI Choice Waiver Program. Michigan Health & Human Services. Found on the internet at https://www.michigan.gov/mdhhs/assistance-programs/medicaid/portalhome/beneficiaries/programs/progbens/mi-choice-waiver-program.
- Geriatrics and Extended Care. U.S. Department of Veterans Affairs. Found on the internet at https://www.va.gov/GERIATRICS/pages/Assisted_Living.asp.
- Consumer Directed Personal Assistance Program (CDPAP). New York State Department of Health. Found on the internet at https://www.health.ny.gov/health_care/medicaid/program/longterm/cdpap.htm.
- About Adult Day Services. National Adult Day Services Association. Found on the internet at https://www.nadsa.org/about/about-adult-day-services.
- Support Groups. Alzheimer’s Association. Found on the internet at https://www.alz.org/help-support/community/support-groups.