Financial and Legal Facts & Figures

There are facts and figures you need to know in order to understand how senior living communities provide care, how much they cost, and how they can be paid for. You also need to have information about supports for home care. Finally, you need to understand how decisions are made when a person with dementia can no longer make their own decisions.

There are two main types of senior living communities in Connecticut.

Skilled Nursing Facilities (SNF): also known as “nursing homes,” these residences are for people who cannot live independently, need significant help with personal care and have physical or mental conditions requiring medical help SNFs provide 24-hour supervision and medical care, help with daily living activities, meals, and recreational activities. Rooms can be private or semi- private. Some SNFs may have units or are specifically for people with dementia, called “memory care.”

Because nursing homes are federally funded and assessed, Medicare offers a website that allows you to review the quality of nursing homes near you: https://www.medicare.gov/care-compare/. Select “Nursing home including rehab services” from the list of providers you can compare. You can enter a street, town, or zip code to will see the overall ratings of nursing homes within a certain distance that you select. Ratings are based on stars. Facilities receive between 1 and 5 stars, with a 1-star rating indicating the lowest rated and 5 stars indicating the highest rated. The rating system takes into account the results of a health inspection, the staffing, and quality measures such as the number of patients who develop urinary tract infections or pressure ulcers. This is the only option that offers a website to review quality ratings. Assisted Living Facilities do not have similar websites.

Assisted Living Facilities (ALF): These residences are for people who cannot live independently but do not require the same level of care or supervision as required in SNFs. In Connecticut, all ALFs offer private apartments with communal spaces and must include meals, laundry, transportation, scheduled housekeeping, chores and maintenance, and recreational activities. They also provide as-needed assistance with daily living activities, personal care, and health care. Some ALFs have units or are specifically for people with dementia, called “memory care.”

There is a third option, Continuing Care Residential Communities (CCRC). These senior living communities offer lifetime living accommodations from independent senior housing to SNF. Residents move in with the intention of needing additional care as they age, including SNF, assisted living, or memory care. They usually require a contract and sizable down payment. Some CCRCs have eligibility criteria (e.g. minimum ages; only requiring independent living services at move-in). Due to financial requirements and eligibility criteria, this may not be a viable option for everyone.

Home care services are provided by individuals who come to the patient’s home. These services consist of medical home care and non-medical home care. Medical home care services are provided through licensed agencies. Non-medical home care services are provided both through licensed agencies and private caregivers. Licensed agencies conduct background checks, provide oversight, and handle items like payroll and taxes. However, they are more expensive and less flexible than private caregivers.

Medical home care: This includes: a) skilled nursing care: medical treatments, wound care, and health monitoring, which is provided by registered nurses or licensed practical nurses; b) different forms of therapy: physical, occupational, and speech, which is provided by therapists; c) medical social services: counseling and making connections with community resources, which is provided by a social worker. Medicare-certified home care can be assessed at the same website (https://www.medicare.gov/care-compare and selecting “Home health services”), but note that this not an all-inclusive list of home care agencies.

Non-medical home care: This includes: a) personal care: assistance with daily activities, like bathing and dressing, which is provided by home health aides or personal care aides; b) companionship, which is provided by personal care aides or companions; c) transportation; d) homemaking: light housekeeping, meal preparation, and grocery shopping, which is provided by homemakers.

Adult Day Care Centers can be an alternative to or addition to homecare services. They typically offer transportation to and from the center, meals, supervision, and social activities. Some also offer personal care services, such as bathing, and many will administer medications as well. Services differ, so it is important to ask about the details of services offered, but generally Adult Day Care Centers are the most affordable option for providing either half days or full days of supervision, activities, social interaction, and meals.

Connecticut offers information on both senior living communities and home care by calling 211 (or 1-800-203-1234 if outside Connecticut) or visiting their website 211ct.org and selecting “Older Adults.”

• SNF: As of 2024, the rate for a semi-private room at a SNF in Connecticut ranges from $9,4292.17 - $21,535.00 per month, with a monthly average of $15,525.00, if paying 100% out-of-pocket. Private rooms cost more.
• ALF: According to the Connecticut’s Office of Legislative Research, the 2020 average monthly rate for a private apartment at an ALF was $6,300 if paying 100% out-of-pocket.
• Home care: With the exception of live-in care, home care services are billed by the hour. Costs by the type of services provided, with medical home care costing more than non-medical home care. The average rate for a home health aide in Connecticut in 2024 was $41 per hour. This means that care for 30 hours a week would be approximately $5,330 per month.
• Adult day care centers: The average cost in Connecticut is $114 per full day or a monthly average rate of $2,476.79 if attending 5 days per week. Many centers also offer half-day rates.

Connecticut offers a list and costs of skilled nursing facilities, home health agencies, and adult day centers within the state, along with their costs, online. This can be found by going to CT.GOV and searching “Partnership Consumer Private Pay Rates.” Once you click on the link, select “Download Cost of Care Report.” Please note that assisted living facilities are not included on this list but can be found on 211ct.org.

• Medicare & Senior Living Communities: Medicare generally does NOT cover care in a senior living community. However, Medicare will cover 20 full days and 80 partial days of SNF care per year IF a person was hospitalized for 3+ days prior to admission and the physician certified that SNF care is required. SNF placement should be directly from the hospital or within 30 days of discharge. Medicare Advantage plans may have different requirements, so it’s important to check your loved one’s plan if they have it.
• Medicare & Home Care: Similarly, Medicare only covers home care services if the physician certifies that the person is homebound and requires “skilled services.” Example of these include administration of IV antibiotics, complex wound care, or physical therapy. Most often, these services are provided for a brief period of time following a hospitalization. Medicare does not cover home care services for chronic needs such as taking medications or bathing.
• Medicaid & Senior Living Communities: Medicaid, also known as Title 19, will cover SNF care for those who are financially eligible, assuming the facilities accept Medicaid. Some Assisted Living Facilities will accept Medicaid for services provided, but will not cover fees for room and board. Connecticut has varying levels of Medicaid eligibility as well as options for “spending-down” assets to become Medicaid-eligible. We recommend speaking with an eldercare attorney to determine the best option for the person living with dementia.
• Medicaid & Home Care: Medicaid will cover home care services for both skilled and chronic needs in Connecticut, including adult day services. The amount of home care services provided is determined by a formal assessment of the patient’s care needs. You can find out more about eligibility requirements for Medicaid reimbursed services by calling the Area Agency on Aging at 1-800- 994-9422.
• Long-term care (LTC) insurance: are policies that specifically cover senior living communities, including SNFs and Assisted Living, as well as home care services. The state of Connecticut offers a 5% discount if LTC insurance is used to pay for SNF care. However, you cannot purchase a plan after a dementia diagnosis. If you currently have LTC insurance and plan to use for memory care within a senior living community, be sure that the LTC plan covers dementia care. You can learn more by going to the National Council on Aging’s website ncoa.org and searching “What is Long-Term Care Insurance?”
• Veteran Administration (VA): If your loved one is a Veteran, the VA also has programs that provide and pay for both long-term care services, as well as respite programs for their caregivers. In Connecticut, this is provided through the West Haven VA Medical Center. You can find out more about those services by calling 203- 932-5711 or navigating to their website https://www.va.gov/connecticut-health-care/.

Here are some additional considerations and resources as you think about senior living community- versus home-based care:

• If your loved one has been resistant to spending their resources on care, you may need to consider that they do not recognize all of the help that they need. This is common in dementia, and you may need to be the one to decide how their resources can best be used to provide care.
• If you have been resistant to spending their resources on care, this is the time to have an honest conversation with yourself. You need to consider what would be best for both your loved one and for you, and this may involve paying for more services.
• If you have friends or family who cannot provide physical help, reach out and see if they could help in other ways. For example, they can research and make a list of local community resources or long-term care options, or they can contact those services and supports directly to get more information for you.
• Do you have family members who are not pulling their weight in helping to support your loved one at home? If so, you may need to be more direct in asking them to participate in your loved one’s care. The Alzheimer's Association Helpline (800.272.3900) is staffed with care consultants who may be able to provide assistance in finding outside help to mediate potential family disagreements.

To get more help with any of these issues, you may want to join a support group. Caregiver support groups are offered both in-person and virtually. To find a support group, you can begin by contacting the Alzheimer’s Association at 860-406-3040 or your local Area Agency on Aging.

Elder law attorneys have specific expertise in two areas that may be helpful to you:

• Financial planning for senior living communities. If the care of your loved one will require an application to Medicaid, these attorneys can help you develop a strategy to protect your loved one’s assets.
• Creating powers of attorney, health care agents, and conservatorships. We provide a brief overview about these different ways of establishing who will be making decisions on behalf of your loved one in the next section.

When looking for an elder law attorney, here are some questions you can ask to ensure you are going to get the best possible advice:

• How many years of experience does the attorney have?
• Is the attorney a member of the National Academy of Elder Law Attorneys (NAELA) or the National Elder Law Foundation (NELF)? You can go to the websites naela.org or nelf.org to help you look for an attorney. The attorneys listed on the NELF website are all “Certified Elder Law Attorneys,” meaning that they have practiced for at least 5 years with a focus on elder law and passed a certification examination.

Be aware that the fees charged by attorneys can vary widely, so you should specifically ask about this.

Laws provide several different ways to allow one person to make decisions for another person.

• Power of Attorney (POA): A POA is a document naming someone who can act on your family member’s behalf. This usually includes accessing and managing their financial accounts. To appoint a POA, your loved one would need to sign a form identifying a person who would protect their interests, and to understand the purpose of the form. If you or your lawyer are unsure of whether your loved one has this ability, the lawyer may ask you to have a doctor assess this. The POA does not establish a health care decisionmaker. You do not need a lawyer to complete this form, but you may want to speak with one to make sure it meets your specific needs.
• Health care agent: Also known as a “health care representative”, a health care agent is a document naming someone who can make medical decisions on your family member’s behalf if a doctor determines that they cannot make their own decisions. In addition, it gives their healthcare providers permission to share their medical information. Like the POA, your loved one would need to have the capacity to sign this form. This form is easy to complete without a lawyer. You can download the form by going to CT.GOV, search “Health Care Agent,” then click the first link You will need two witnesses and the signature of a notary public.
• Conservatorship: Conservatorship (known as guardianship in other states) involves having the court assign a decision maker for a person who isn’t able to make their own decisions. The court can give a conservator the authority to make financial decisions, health care and other personal decisions, or both. One reason that a person with dementia may need a conservator is that they never established a POA and/or Health Care Agent and are now too impaired to do so. There are also situations where family members disagree about what is best for the person living with dementia or there are concerns that certain family members are exerting inappropriate influence over them. Because conservatorship offers additional safeguards, including oversight by a probate court judge, it may be the best solution.

Even as you are thinking about the best site of care for your loved one, you need to put some contingency plans in place. These plans should cover if something unexpected happens to you and you are unable to take care of your loved one. This set of plans should include:

• Having your own POA to be able to access your financial accounts. If your loved one with dementia is currently your POA, you may need to choose a different person who will be able to handle your affairs.
• Ensuring your POA knows where you keep your financial statements and other important documents, including the documents for your loved one.
• Identifying who will take care of your loved one and ensuring that person knows of this role.
• Consider preparing for the need to move your loved one to a senior living community. Take some time to get to know what the options are. Many senior living communities will allow you to complete applications ahead of time and will put your loved one’s name on a waiting list. When their name comes to the top of the list, you can either accept or defer a place for them there. Thinking about these issues now may leave you with more choices later.

You have made it to the end! You’ve taken an important step in thinking about different sites of care. You may be feeling a lot of emotions right now. That is to be expected, and you should take satisfaction knowing that you have tackled some difficult topics. You can move forward and explore options at your own pace.

Remember, you are not alone in this.