Memory Care: Services Offered, Costs, and How to Pay for It

Memory care is a common term for a specialized type of care provided to seniors suffering from cognitive impairment associated with Alzheimer’s or other types of dementia.  Memory care units are sometimes referred to as dementia care units or simply special care units. Memory care units are commonly a type of special care unit found in nursing homes. However, memory care units may also be found in assisted living communities. Finally, many seniors with Alzheimer’s or other dementias living at home or in independent living communities obtain home healthcare from home health agencies that specialize in providing care for patients with cognitive impairment. To understand this type of care and the senior living options available to these seniors, it is first critical to understand the underlying disease and its progressions.

Stages Of Alzheimer's Disease

Alzheimer’s is a progressive disease that often slowly erodes a person’s mental and physical abilities over a long period of time, often spanning five to 20 years. Alzheimer’s is a type of dementia, but there are many other types of dementia that are caused by Parkinson’s disease, stroke or other diseases. Generally, seniors with these other forms of dementia have shorter life expectancies (typically four to eight years) than seniors with Alzheimer’s. Aside from that these other forms of dementia have similar symptoms so for purposes of this article, we will address Alzheimer’s, but seniors suffering from other dementias will often have similar symptoms^[1]. 

According to the Alzheimer’s Association, more than 5.8 million Americans suffer from Alzheimer’s disease and one in three seniors will have some form of Alzheimer’s or dementia when they die. Tragically, there is no known cure or proven treatment for Alzheimer’s or other dementias. As a result, seniors who have Alzheimer’s by age 70 are twice as likely to die by age 80 as other seniors^[2].  As you will see, as the disease progresses seniors will exhibit a wide range of symptoms, which will vary significantly both over time and from person to person.

In the early stages of Alzheimer’s, symptoms may include confusion, short-term memory loss, struggling with routine tasks, poor decision making and mood swings. As the disease progresses, the senior’s communication skills decline and confusion worsens, leaving them struggling to recognize even close relatives at times. Due to the confusion, the senior may begin getting lost or putting themselves in dangerous situations. At this point, some seniors will also begin to deteriorate physically with loss of motor functions. By the time the senior reaches late stage Alzheimer’s, the loss of function can be truly tragic, with the loss of continence and basic bodily functions, as well as complete loss of cognitive function^[3]. 

The critical thing to understand is that each person with Alzheimer’s is going to progress differently and exhibit a different combination of the symptoms listed above. It is important that the care is tailored to the individual so that they are safe, comfortable and maintain as much quality of life as possible.

Home Healthcare Options for Seniors With Alzheimer's

In the early stages of the disease, some seniors may be able to live completely independently without any assistance. At this point, they may simply find it desirable to minimize the burdens of housekeeping and maintenance and opt for an independent living community or a retirement community. For these folks, home healthcare may be sufficient. Over time, their needs will evolve and they will begin to require assistance with activities of daily living and other personal care. 

Whether the senior is still living at home, in an independent or assisted living community or a retirement community, many seniors suffering from Alzheimer’s will enlist the services of a home health care agency. These agencies can help with a wide range of services, including assistance with bathing, dressing, meal preparation, medication management and a variety of other services. Often the most important service seniors require at this stage of the disease is simply supervision to ensure they don’t injure themselves from a fall, a period of confusion or a lapse in judgement. Due to the high cost of 24/7 care, it is usually best if a spouse or other family members can provide the senior with companionship that seconds as supervision.

It may be helpful to find a home health care agency that either is certified to care for patients with Alzheimer’s or at minimum can demonstrate that they have experience in dealing with such patients. If you are moving to an independent living community or retirement community, you should confirm that they permit home health care aides to enter the community. Generally, this is not an issue and many of these communities even offer their own network of home health agencies and other services. 

For seniors with Alzheimer’s who decide to stay in their homes, it is best to renovate the home as necessary to accommodate the person’s needs. Homes can be made safer by locking or even childproofing exterior doors and cabinets that contain sharp objects or other dangerous items, as well as reducing the temperature settings on faucets. Lighting and color schemes can be adjusted to better illuminate dangerous areas and minimize displeasing color tones and shadows. Finally, there are a wide variety of monitors and alarm systems available to notify family or other caregivers when a senior is getting into danger^[4]. In the unfortunate scenario that a senior with Alzheimer’s wanders away and gets lost, police departments and the Alzheimer’s Association have protocols in place to locate them as soon as possible. 

Often, the biggest consideration in choosing home healthcare over assisted living or nursing home care for early stage Alzheimer’s patients is the reduced cost. However, the cost of these services really starts to add up as the senior’s level of need and frequency of services increases. Initially, adult day care can be a lower cost option to supplement home healthcare services. Eventually, once the senior requires services around the clock, the costs will exceed residential care in an assisted living community or nursing home. The other major consideration is safety. Seniors and their families need to be realistic about whether it is still safe for them to live independently in light of their physical and mental condition and the degree of care required.

Residential Care For Seniors with Alzheimer's

As Alzheimer’s symptoms advance to the middle and late stages of the disease, home healthcare may become both unsafe and expensive due to the extensive amount of supervision and services required.  At this point in time, many seniors with Alzheimer’s will end up in residential care. The timing of this transition may vary based on the individual’s symptoms and the availability of family members to supplement their care. 

For seniors with milder symptoms, assisted living may be an option. As their care demands increase, they may also need to explore hiring home health aides to supplement care provided by the community. Eventually, many seniors with Alzheimer’s end up requiring 24/7 supervision and personal care. When the disease reaches this advanced stage, a nursing home is usually the best option. 

In selecting a nursing home, you should ensure that the facility has experience caring for residents with Alzheimer’s. These residents will often require extensive care and supervision, although they won’t necessarily require the skilled nursing care and medical care that these facilities, offer.  For seniors with Alzheimer’s, the design of the facility and safety and security measures may be more important than the levels of nursing care available.

In fact, many nursing homes have developed special care units, known as memory care units, designed specifically to care for seniors with Alzheimer’s and other dementias. Equipped with security alarms and monitoring equipment and often having lower staff to resident ratios, many of these units are able to provide excellent care for cognitively impaired residents. These units also may offer memory classes and special activities designed for residents with Alzheimer’s^[5].

Since memory care units specialize in caring for residents with Alzheimer’s, the staff may also be more comfortable in dealing with these individuals and their behavior. In many cases, this may enable them to provide better care. Their increased comfort levels may also make the staff less likely to overreact to unusual behavior by restraining the resident (either physically or chemically).

Nevertheless, you should not jump to the conclusion that a facility is great at caring for Alzheimer’s patients merely because it offers memory care, nor should you rule out a facility merely because it doesn’t. Many nursing homes without memory care units do an excellent job caring for residents with Alzheimer’s due to the experience and attentiveness of their staff. We would advise you to assess each nursing home fairly based on the level of care it is providing to its residents with Alzheimer’s. 

Memory Care Services

In general, memory care units provide similar services to other units in assisted living or nursing homes, with a special emphasis on the care and safety needs of residents who are cognitively impaired. Services offered may include the following:

• Personal Care
• Medical Care
• Skilled Nursing
• Medication Management
• 24/7 Nursing and Staffing
• Security and Alarm Systems
• Meals
• Transportation
• Social Activities
• Housekeeping

As mentioned above, some memory care units will also offer games, classes and specialized activities specifically designed for residents with Alzheimer’s. Some facilities also provide closed-in courtyards that allow seniors to spend time outside without the usual hazards associated with leaving the facility.

Costs and How to Pay for Memory Care

Costs for caring for seniors with Alzheimer’s vary dramatically due to the wide range of life expectancy and the different levels of care available. According to the Alzheimer’s Association, seniors with Alzheimer’s are more likely to be hospitalized, visit a skilled nursing facility or suffer from other chronic conditions (including heart disease and diabetes) than other seniors. The average senior with Alzheimer’s will incur over $350,000 in long-term care costs over the course of their life, including home healthcare and residential care costs^[6].

Early on with the disease, home healthcare services will generally cost around $20 per hour, although more skilled nursing care and physical therapy may cost up to $100 per hour. Adult day care is an excellent way to supplement home healthcare and it typically costs only about $70 per day on average. 

As the disease progresses, the necessary care will become more expensive. Assisted living communities may cost $4,000 per month while nursing homes may cost $8,000 per month under ordinary circumstances. We would expect assisted living communities and nursing homes offering memory care to cost roughly $1,000 more per month than those baseline estimates above. 

Care provided for seniors with Alzheimer’s is rarely covered by insurance. That includes assisted living, home healthcare and most nursing home costs. Alzheimer’s is a chronic condition that requires primarily personal care and supervision, which are not viewed as covered healthcare costs. For this reason, Medicare generally does not provide any coverage for the care discussed in this guide. As a result, most seniors are required to private pay for memory care and related services. If your resources are depleted, you may be able to qualify for Medicaid long-term care coverage which does cover home healthcare, assisted living and nursing home care, including memory care. If you anticipate running out of resources after entering an assisted living community or nursing home, you should confirm that the facility accepts Medicaid so that your care may continue after you run out of funds to private pay. Finally, veterans with low incomes or service-connected disabilities may also qualify for residential care paid for by the VA, as well as other subsidies and pension benefits. You can find more information on paying for long-term care here.