Memory Care in Wisconsin

Table of Contents

Memory Care in Wisconsin

Table of Contents

• The Cost of Memory Care in Wisconsin
• Wisconsin Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Wisconsin?
• More Ways To Pay for Memory Care in Wisconsin
• Memory Care Laws and Regulations in Wisconsin
• Free and Low-Cost Resources for Seniors in Wisconsin
• Wisconsin COVID-19 Rules for Memory Care Facilities

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When figuring out how to pay for memory care, you first need to understand how much it will cost for your loved one to move to a quality community. As costs continue to rise, it's vital to have the latest details when planning for elderly care costs. In order to shed light on the impact of inflation on senior living costs, MemoryCare.com has gathered cost information from its network of over 75,000 senior living communities. These prices are based on the cost of Memory Care in Wisconsin and 31 other cities in Wisconsin.

How Inflation Has Impacted the Cost of Memory Care in Wisconsin

Inflation has posed a notable financial problem in the past year, driving up the costs of memory care nationwide by an average of 10.5% from 2022 to 2023, with trends suggesting another 8% rise in 2024. Care prices rose slightly less in Wisconsin, up 8.5% from the previous year. Meanwhile, some surrounding states experienced substantial jumps, such as Michigan, where costs soared by 21% and will likely grow by another 12% in 2024. Minnesota experienced a 3.5% rise, and prices jumped from $5,376 to $5,914 in Iowa. They climbed 9% higher in Illinois.

Memory Care Costs in Wisconsin's Top Cities

Differing prices across Wisconsin's major cities represent opportunities for families to save money without compromising their loved ones' care. While the state average is $6,083, care costs vary by location. In Milwaukee, the average is $6,352, which is higher than the state average, while in Green Bay it's more affordable at $5,454. Memory care is also slightly less expensive in Oshkosh at $5,700 but costs $765 more than the state norm in Kenosha. These variations show the importance of comparative research when choosing senior care options.

The Cost of Other Types of Senior Living

Monthly expenses in Wisconsin depend largely on the type of care. Memory care costs $6,083 because communities offering it require a higher staff-to-resident ratio and need to employ caregivers with specific knowledge and qualifications. Assisted living is a little cheaper at $4,992 but still provides round-the-clock care for seniors and may be suitable for individuals with early-stage memory loss. Independent living provides service for more self-reliant seniors and averages an affordable $2,760.

State Medicaid programs offer coverage to those who can't afford medical care as long as they can prove a medical need and meet certain income requirements. Wisconsin's Medicaid program doesn't provide direct coverage for memory care, but it does provide two waiver programs to assist people who can't afford long-term care at an assisted living facility.

IRIS Program

IRIS (Include, Respect, I Self-Direct) is a special needs program that offers assistance to seniors and adults living with disabilities. It works by giving individuals a monthly benefit they can use toward the cost of their private care. Participants use these state-backed funds to pay for skilled nursing care, adult day care services, companion services and transitions from their homes into a care facility. 

• Who Is Eligible: To be approved for the program, seniors must be eligible for Medicaid benefits in Wisconsin, be over the age of 65, have a disability or require nursing care.
• How To Apply: Applicants can get in touch with their local Aging and Disability Resource Center for information on how to apply to the program.

Family Care Waiver

The Family Care Waiver was meant specifically for individuals who are over the age of 65 and require long-term assisted care. Wisconsin considers long-term care to mean any form of care that includes assisting patients with basic needs, such as personal care, skilled nursing or memory care.

• Who Is Eligible: Residents over the age of 65 who also qualify for Medicaid can apply for the Family Care Waiver. They must also provide evidence of medical needs that meet the state's definition of long-term care.
• How To Apply: The Aging and Disability Resource Center helps Wisconsin residents find the right programs to meet their needs and can help seniors determine whether they qualify. If they do, the ADRC will help them apply.

Medicaid Eligibility for Seniors in Wisconsin

The Medicaid program helps people who can't afford to pay for medical treatment obtain the care they need. To qualify, their income must remain under an income threshold. They also must not have a lot of assets that could otherwise be used to pay for care if sold. Here are the income limits for Wisconsin residents.

2022 Medicaid Income Limits for Seniors in Wisconsin

In addition to meeting these income requirements, the following must also apply:

• Must be a citizen of the United States or a legal resident
• Must be over the age of 65 or an adult living with a disability

How To Get Help Applying for Medicaid in Wisconsin

If a senior is having trouble applying for benefits or doesn't know what programs they qualify for, they can use these resources.

aid.

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.gov
• Reverse Mortgage: A reverse mortgage allows 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 loan will need to be paid back after the sale of the home. The most commonly used type of reverse mortgage 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 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.

Residents Who May Be Admitted

Older adults and people with:

• Dementia
• Mental Health Conditions
• Developmental Disabilities
• Physical Disabilities
• AIDS
• Traumatic Brain Injuries

Residents Who May NOT Be Admitted

Those who:

• Are destructive to property and/or themselves
• Cannot get out of bed and/or evacuate on their own
• Present a risk of harm to themselves or others
• Require more than three hours of nursing care perk week
• Require intermediate nursing care for more than 30 days

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.

In Wisconsin, there is an abundance of resources designed to assist seniors throughout their retirement. MemoryCare.com has compiled information on a range of local organizations, programs, and agencies, categorizing them based on the care services they offer for easy browsing.

Area Agency on Aging

The Area Agency on Aging in Wisconsin is a crucial asset for retired individuals, providing advice on financial assistance, home-based care, and planning for extended care. It also connects seniors and their caregivers with local resources.

Cash Assistance Programs

Financial assistance initiatives exist in Wisconsin to help seniors with low income sustain their home living. These initiatives provide tax reductions, discounts on crucial services, and aid for home temperature regulation costs.

Financial Assistance for Senior Care and Senior Living

Elderly individuals in Wisconsin, living independently or in elderly care homes, can avail of numerous local financial support opportunities. These aid options help reduce in-home or long-term care costs and connect them to valuable community resources.

Food Assistance Programs

In Wisconsin, numerous community programs focus on enhancing the health of seniors via proper diet. These initiatives provide meal delivery, shared meals, and food bank services, guaranteeing that older citizens can obtain reasonably priced, healthy food.

Health Insurance & Prescription Drug Coverage for Seniors

Elderly residents of Wisconsin with certain income brackets have access to local aid for prescription medication expenses. They might also be eligible for health coverage and other programs providing complimentary or reduced-cost healthcare services.

Legal Resources

In Wisconsin, there are several organizations offering cost-effective or free legal aid to senior citizens. They provide advice on issues such as estate planning, living wills, and power of attorney. Some also champion the rights of the elderly in long-term care establishments.

Senior Centers

In Wisconsin, elderly individuals find a community hub in senior centers, offering a range of recreational pursuits, events, and essential resources. These centers also provide health programs, dietary advice, and support for issues related to senior living.

Senior Engagement

In Wisconsin, numerous initiatives are in place to keep seniors involved and energetic. These encompass health programs, opportunities for volunteer work, and supportive communities, all designed to promote social participation and improve the quality of life.

Social Security Offices

In the city of Wisconsin, Social Security offices are crucial resources for the elderly and those with disabilities. They provide advice on retirement perks, disability benefits, and additional security income.

Tax Assistance

In Wisconsin, a variety of tax assistance options exist for seniors and people with disabilities. These encompass possible medical cost exemptions, property tax cuts, and other tax alleviation measures.

Utility & Energy Bill Assistance

In Wisconsin, there are establishments ready to assist seniors with limited income facing challenges with home upkeep expenses, such as energy and utility bills. Emergency financial support might be available for individuals threatened with utility disconnection due to outstanding payments.

Veteran's Services

In Wisconsin, retired military personnel can find essential support through local veteran services. These organizations help veterans access their deserved benefits and offer advice on a variety of issues.

Note: The following information was compiled and most recently updated on 2/15/2022. 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.