Sources for Payment in Assisted Living

1. Sources for Payment in Assisted Living

2. Acronyms • ADL = Activities of Daily Living • ALP = Assisted Living Program • DHS = Department of Human Services • HUD = Housing and Urban Development • IADL = Instrumental Activities of Daily Living

3. Rent Board Services Three Elements of the Assisted Living Program Funding sources for each of these elements vary. However, not everyone qualifies for the funding sources. The bottom line: if you choose to live in an assisted living program, you will likely need to spend your own income and assets to pay for these three elements.

4. Three Elements of the Assisted Living Program Rent Board Services

5. Rent • Covers fixed costs: liability insurance, taxes, utilities, maintenance of common spaces and grounds, furnishings, administrative expenses, etc. • Must be paid even when tenant is absent from premises (no “bedhold” days)

6. Rent • Occupancy agreement (contract) provides a description of all fees, charges, and rates describing tenancy and basic services covered • Same contract for all tenants • Programs are allowed to add an addendum to the contract to discount rent and/or board based on a tenant’s ability to pay

7. Funding Sources for Rent • Tenant’s income • Housing Choice Voucher (HCV - Section 8) through local public housing authority • HCBS Rent Subsidy Program through Iowa Finance Authority (bridge until able to access HCV)

8. Three Elements of the Assisted Living Program Board Rent Services

9. Board • Items required in certification rules: One (1) meal, emergency response system • Other Board Package components: • Activities that take place in the common spaces • Meals and snacks • Other amenities

10. Funding Sources for Board • Tenant’s income • Congregate meal site • Home-delivered meals to apartment or common dining room (eligible for waiver if ALP is a waiver provider) • Food stamps (working with DHS and Department of Agriculture to make this an option)

11. Three Elements of the Assisted Living Program Rent Board Services

12. Services • Are delivered in the tenant’s apartment • Includes transportation • Establish staffing patterns based on projected time needed with tenants

13. Activities of Daily LivingADL • Bathing • Dressing • Walking • Eating • Toileting * “Touching” is needed to provide assistance.

14. Instrumental Activities of Daily LivingIADL • Shopping • Cleaning • Cooking • Laundry • Paying bills * “Touching” is NOT needed to provide assistance.

15. Funding Sources for Services • Tenants income • Medicaid: • Home health services provided by a Medicare-certified home health agency • Physician services, prescriptions, medical equipment & supplies • Medicaid waiver: $1,084/month maximum • In-home health related care (state supplemental assistance)

16. Medicaid Waiver • Need vs. choice: Service plan is individualized based on the tenant’s needs • The tenant chooses what services he/she wishes to receive, even if additional services are “needed” • Service Provider receives payment only after tenant receives services

17. Medicaid Waiver • Must meet financial eligibility -- (currently, income cannot exceed $1,869 / month ANDindividual assets cannot exceed $2,000) AND • Must meet medical eligibility -- (be assessed as needing nursing home level of care)

18. Level of Care Criteria Nursing • The person requires daily supervision with dressing, grooming, and personal hygiene in conjunction with another daily care need. AND/OR • The person requires limited, extensive, or total physical assistance to perform dressing, grooming and personal hygiene.

19. Waiver Cap • Elderly waiver monthly maximum is $1,084 • If service plan exceeds this amount, case manager and person will evaluate whether to cut back on the level of services or whether a lower cost provider can be hired

20. For More Information • Terri Rosonke Affordable Assisted Living Coordinator Iowa Finance Authority 515.725.4956 terri.rosonke@iowa.gov www.IowaFinanceAuthority.gov