Memory Care in Ohio

Table of Contents

Memory Care in Ohio

Table of Contents

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

We added 25% to the cost of assisted living reported by the 2021 Genworth Cost of Care Survey to calculate the cost of memory care. 

Memory care in Ohio costs an average of $5,794 per month, which is only slightly more than the national median of $5,625. Communities in Ohio tend to charge more than those in the surrounding states of Kentucky ($4,310), West Virginia ($5,200), Indiana ($5,354) and Pennsylvania ($5,125).

The average cost of memory care varies across Ohio, with seniors in Akron paying the highest fees of $6,241, while those in Springfield, the most affordable city in the state, pay around $4,575 per month. In the state capital of Columbus, memory care communities charge an average of $5,106 each month. Communities in the lakeside city of Cleveland charge around $6,175 per month for memory care services.

Medicaid in Ohio doesn't cover the costs of memory care in an assisted living facility or residential community. There are two waiver programs offered by Medicaid that may be able to reduce the costs of care and make it an affordable option. These two waiver programs are the MyCare Ohio Plan and the Assisted Living Waiver. 

• Who Is Eligible: To qualify for Medicaid in Ohio, applicants must be 65 years or older and meet certain financial criteria. The applicant is required to reside in Ohio.
• How To Apply: Seniors can apply through the Ohio Department of Medicaid online or by calling (800) 324-8680.

MyCare Ohio Plan

The MyCare Ohio Plan is also known as the Integrated Care Delivery System Medical Waiver. The purpose of this waiver is to provide managed care services to seniors who qualify for Medicaid and Medicare coverage. It's only offered in 29 counties, and seniors should check if their county is covered before applying. It covers some of the services provided in a memory care facility, such as behavioral health services, personal care and nonmedical transportation.

• Who Is Eligible: Seniors must reside in one of the counties covered by the program. Additionally, they must be 65 or older and qualify for Medicaid and Medicare coverage.
• How To Apply: Seniors can apply online or contact the Medicaid hotline at (800) 324-8680.

Assisted Living Waiver

The Assisted Living Waiver covers some of the care costs in an assisted living or memory care facility. The waiver doesn't cover room and board costs but can reduce monthly expenses by covering personal care, medical equipment, support services and housekeeping. 

• Who Is Eligible: Seniors over the age of 65 who require nursing home-level care and qualify for Medicaid are eligible for the waiver.
• How To Apply: Seniors can apply by contacting their local Area Agency on Aging or calling (866) 243-5678.

Medicaid Eligibility for Seniors in Ohio

Seniors in Ohio must meet certain financial and medical requirements to qualify for Medicaid coverage in Ohio. Single applicants are limited to an annual income of $30,276, while married spouses can receive a yearly income of up to $60,552. The asset limit for single applicants is $2,000, and the asset limit for couples is $3,000. It does not include any properties or vehicles the applicants may own.

2022 Medicaid Income Limits for Seniors in Ohio

Additional eligibility requirements include being a U.S. citizen or legal resident. On application, seniors should submit the following documents to show they're eligible for Medicaid:

• Birth certificate
• Proof of U.S. citizenship or legal resident status
• Bank statements for the past 60 months
• Insurance policies
• Copies of burial arrangements
• Power of attorney
• Title deeds of any property owned

How To Get Help Applying for Medicaid in Ohio

Seniors and their loved ones can contact one of the agencies or departments listed in the table below for assistance in applying for Medicaid.

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.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.

Memory Care Regulation

In Ohio, facilities that provide memory care services in an assisted living environment are known as residential care facilities (RCFs). Across the state, the terms assisted living and residential care can be used interchangeably. The Ohio Department of Health (ODH) is responsible for the licensing, inspection and certification of all RCFs throughout the state.

According to the state, to be classified as an RCF, a facility must offer accommodations for 17 or more unrelated individuals, with supervision and personal care services for at least three residents who experience limitations due to their age, physical or mental impairments. Smaller communities that provide some skilled nursing care services can also be licensed as RCFs.

These RCFs may have specialized units or an entire facility designed specifically for residents who have Alzheimer’s or another type of dementia. The ODH has specific requirements for these special care units, which must be outlined when a facility applies for their residential care license.

Facility Scope of Care

RCFs may provide residents with a variety of services, including supervision, daily personal care, medication administration, diet supervision, dressing and assistance with part-time intermittent enteral feedings. Skilled nursing services may also be provided on a part-time basis for no more than 120 days, with the exception of hospice residents and those whose physicians have recommended skilled nursing care as part of their routine.

Admissions Requirements

RCFs offer care services for a variety of residents, though they do have some restrictions on who they can admit. The table below outlines who may or may not be admitted to an RCF.

Residents Who May Be Admitted

Older adults and people with:

• Dementia
• Mental Health Conditions
• Developmental Disabilities
• Physical Disabilities
• AIDS
• Traumatic Brain Injuries
• A need for skilled nursing care for fewer than 120 days

Residents Who May NOT Be Admitted Those who:

• Are bedridden with limited potential for improvement
• Have Stage III or IV pressure ulcers
• Have a medically complex condition
• Require skilled nursing beyond the Ohio Revised Code or what the facility can provide
• Require care for more than eight hours per day or 40 hours per week
• Require chemical or physical restraints
• Have a complex medical condition that requires constant monitoring
• Are listed on the Ohio sex offender registry

Care Plan Requirements

Facilities are required to complete a residential assessment within 48 hours of a senior moving in, and after that, on a yearly basis or following any significant health changes. A licensed health professional must also determine if a senior is able to self-administer medication or requires medication administration assistance. Additional assessments may be conducted for residents with medical, psychological, developmental or intellectual impairments.

Residents are also allowed to contract with third-party providers, such as a licensed hospice agency, certified home health agency or mental health agency, if they feel they could benefit from additional services.

Medication Management Requirements

Any medications administered to residents must be done so by authorized personnel, such as physicians, registered nurses (RNs), licensed practical nurses (LPNs) or certified medication aides who have undergone special training.

Residents who are mentally alert and capable of self-administering their own medications may do so with the help of trained nonlicensed staff as required. Assistance includes reminders, observation, handing medications to the resident and verifying labels, and in the case of physically impaired residents, removing medications from containers, placing a container to the resident’s mouth and applying medication upon request.

Facility Requirements

As licensing rules do not dictate a requirement for apartment-style rooms, RCFs can have both private and shared rooms. Private units must be a minimum of 100 square feet in size and multiple-occupancy units are required to provide a minimum of 80 square feet for each resident, not including bathrooms or closet space. The maximum occupancy for an individual unit is four individuals. For every eight residents, there must be one toilet, sink and tub or shower provided. If more than four seniors of one gender are residing on a single floor, a bathroom for each gender must be provided on that floor.

The facility is required to have safety items such as sprinklers, smoke detectors and carbon monoxide alarms installed, as well as a disaster preparedness plan.

Staffing Requirements

RCFs are required to have direct care staff to provide personal care services, at least one of whom is trained in first-aid, and an administrator who oversees daily operations and is accessible at all times. If a facility offers skilled nursing services, it must have a registered nurse either on staff or under contract, and if it offers medication administration services, an RN, physician, LPN or authorized staff member must be on duty. RCFs must also have a psychologist or physician on staff if they provide memory care services.

While the state does not enforce a minimum staff ratio, sufficient numbers must be available to properly care for residents’ needs. All staff members are required to go through orientation and training to learn their responsibilities, facility procedures, emergency assistance and resident rights. Training must be conducted by a licensed nursing professional. Any staff who provide direct care to residents must complete first-aid training within 60 days of their hiring.

Staff must participate in eight hours of continuing education on an annual basis to keep up to date on personal care techniques, refine their observational skills and develop their communication skills.

Medicaid Policy

Ohio has two Medicaid waiver programs to cover the cost of services in residential care facilities: the Assisted Living Program and the Managed Care Demonstration Waiver, known as MyCare. Additionally, seniors who are eligible for Medicaid can receive monthly assistance from the state-funded Residential State Supplement (RSS) to help cover the cost of accommodations, supervision and personal care services in an RCF.

Reporting Abuse

To register a complaint about an RCF, seniors can call the Ohio Department of Health complaint department toll-free at 800-342-0553 or fill out a form online. Complainants can choose to remain anonymous. Concerns or complaints dealing with the care or treatment of residents in an RCF can also be directed to the area’s regional long-term care ombudsman program or by calling 800-282-1206.

In Ohio, seniors with Alzheimer's or dementia and their loved ones have access to numerous resources to assist and support them. 

Note: The following information was compiled and most recently updated on 2/13/2022. 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.