What the Average Monthly Cost of Memory Care Covers

When families search for the average monthly cost of memory care, they get a national number and a state table. Neither tells you what the number buys, and that is the part that decides whether a placement works. I have toured the memory care programs on Long Island and in Queens, 47 of them by my count, and the fee covers more than most families expect and less than a few of them assume.

The direct answer: the monthly memory care fee bundles a secured apartment or room, meals, around the clock aides at a higher ratio than assisted living, personal care, medication management and a structured program of activities. It does not cover physicians, rehab or hospice. I do not publish dollar figures because they change every year and vary by building; ask me for current numbers for the communities you are considering.

Why memory care costs more than assisted living

Memory care costs more than assisted living in the same building for three reasons: more staff, more training and a secured design. Everything else, the apartment, the meals, the housekeeping, is roughly the same. My guide to what a nursing home costs sets all three settings side by side.

Staffing is the biggest line. A memory care neighborhood runs more aides per resident on every shift, including overnight, because residents need cueing to eat and bathe, not just a hand with the physical task. Those aides complete dementia specific training on top of the basic requirements for New York special needs units, and good programs refresh it regularly. Then there is the building itself: secured doors, a safe outdoor courtyard, circular hallways that let a restless resident keep walking, and lighting and contrast chosen for aging eyes. All of that is built into the fee.

I explain the model in my memory care guide. What matters for the budget is this: you are paying for people and time, so the questions that protect your family are about staffing, not square footage.

What the monthly fee includes

Here is what sits inside the monthly fee at nearly every memory care program I tour on Long Island, and what sits outside it. The exact lines vary by community, which is why I read every rate sheet with the family.

Usually inside the monthly fee	Usually outside it
A private or shared room in a secured neighborhood	Physician and specialist visits
Aides around the clock at a higher ratio than assisted living	Rehab after a hospital stay, which happens in a skilled nursing facility
Help with bathing, dressing, toileting, eating and walking	Hospice, provided by an outside agency
Three meals, snacks and hydration rounds with cueing at the table	Private one on one companions
Structured activities: music, movement, sensory and reminiscence programs	Incontinence supplies, in many buildings
Housekeeping, laundry and linens	Salon, phone, cable upgrades, guest meals
Nurse oversight and care planning	Medication management, where it is priced as an add on
Secured outdoor space and emergency response	Transportation to appointments beyond a set radius

Notice that medication management and incontinence care appear on both sides depending on the building. Those two lines are where the biggest surprises live, so ask about them specifically.

The add ons: incontinence care, medication management, escorts and level changes

The add ons are the difference between the rate you were quoted and the rate on the invoice. Most memory care programs on Long Island use one of two structures: an all inclusive rate with very few extras, or a base rate plus a care level set by the nurse’s assessment. The second is more common, and the care level is where the add ons hide.

The lines that move the bill

• Incontinence care: priced as part of a care level in some buildings and as a separate charge in others, often with supplies billed on top.
• Medication management: nearly every memory care resident needs it, so treat it as part of the real rate even when it is listed separately.
• Escorts and cueing: help getting to meals and activities, which a resident with dementia needs more as the disease progresses.
• Two person transfers and lifts: a jump in the care level and, in some buildings, a question of whether the license allows it.
• Level changes: the reassessment that moves a resident from one tier to the next, sometimes with little notice.

Ask how often the assessment is repeated, how much notice the family gets before a level change and whether a level can go down after a hospital stay. In my experience the honest communities answer in a sentence and the others change the subject.

Inside an assisted living community vs a free standing building

Of the roughly 47 memory care programs on Long Island and in Queens, 42 are neighborhoods inside a larger assisted living community and 5 are free standing buildings devoted to dementia care. The pricing structure follows the building.

Inside an assisted living community, memory care is usually priced as the assisted living base rate plus a memory care premium plus the care level, and the premium covers the secured neighborhood and the extra staff. A free standing program more often quotes a single all inclusive rate, because every resident in the building needs the same secured setting and a similar level of help. Neither model is cheaper across the board; it depends on your parent’s care level today and where it will be at month 24.

Nassau, Suffolk and Queens

Location moves the rent portion more than the care portion. Newer buildings on the Nassau North Shore and along the Queens border sit at the top of the range, central Suffolk sits in the middle, and the care premium is similar everywhere because dementia staffing costs the same in every town. I keep lists on my Nassau County memory care and Suffolk County memory care pages.

How Long Island communities set the care level

The care level is set by the community’s nurse at an assessment before move in, and it is reassessed on a schedule or whenever something changes. The nurse scores help with bathing, dressing, toileting, transfers and eating, plus medication needs, cueing, supervision and behaviors such as wandering or agitation. In memory care the behavioral lines carry more weight than in assisted living.

Three things to understand about the assessment. First, it is a clinical judgment, so two communities can place the same person at different levels. Second, the level is tied to the staffing the community plans to provide, which is why I take the assessment as a sign of how closely they looked at your parent. Third, the level will rise. I plan 18 to 24 months ahead with every family because the fee at move in is rarely the fee at month 18, and a budget that only works at the first level is not a budget.

Talk to the doctor about the stage of the disease before the assessment. A clear picture of where your parent is on the curve lets me tell you which community’s level structure will treat your family fairly as needs change.

Questions to ask before signing

Ask these before you sign anything, and write down the answers building by building. They are the questions I ask on every memory care tour.

1. Is the rate all inclusive, or base rate plus care level, and can I see the full rate sheet?
2. What care level would my parent start at, based on the assessment, and what is the next level up?
3. Are medication management and incontinence care inside the rate or added on?
4. How often is the assessment repeated and how much notice do we get before a change?
5. What is the community fee, and is any of it refundable?
6. What was last year’s annual rate increase?
7. What happens to the rate and the room if my parent goes to the hospital or rehab?
8. What would cause you to ask my parent to leave, and how much notice would we get?
9. How many aides are on this neighborhood on each shift, and how long have they worked here?

The last question is the most important one, because the fee is paying for those aides. A stable staff is worth more than any amenity on the tour.

Ways families pay

Medicare does not pay for memory care rent, and I say that in every first call because someone has usually told the family otherwise. Families on Long Island pay for memory care from a mix of sources, usually in this order:

• Savings, pensions, Social Security and the sale of the house.
• Long term care insurance, which often covers memory care when a doctor documents cognitive impairment; read the policy for the elimination period and daily limit. I explain this in my post on paying for assisted living and memory care with long term care insurance.
• VA Aid and Attendance for eligible wartime veterans and surviving spouses, covered in my post on VA Aid and Attendance.
• Life insurance, through a conversion or an accelerated benefit, which I describe in my post on using life insurance to cover senior living costs.
• Medicaid, only through the Assisted Living Program, where beds are limited and not every provider serves a secured memory care unit; confirm the current rules.

Talk to an elder law attorney before moving money, because Medicaid look back rules apply to transfers and the house.

Ways to keep the cost down without cutting the care

You cannot negotiate the aides, and you should not try. What you can do is control the lines around them.

• Choose a shared room if your parent tolerates company; in memory care, a roommate is sometimes a comfort rather than a compromise.
• Compare all inclusive against tiered pricing over 24 months, not over the first month.
• Ask whether a move in during a slower season comes with a reduced community fee or a rate hold; it sometimes does.
• Use the community’s included transportation and programs before paying for private companions.
• Start a long term care insurance claim the day the doctor documents the diagnosis, since elimination periods only run once a claim is open.
• Pick a community that holds the licenses to keep your parent through rising needs, because a second move costs more than any discount.

The biggest savings I see come from placing a parent in the right level the first time. A year in assisted living that should have been memory care means falls, hospital stays and a second community fee.

How I compare two offers side by side, free to families

When a family has two offers, I put them on one page: same room type, same care level as assessed, the add ons each building would actually bill for my client, the community fee and last year’s increase, and then the same picture at month 24 one level higher. The cheaper quote is the more expensive offer more often than you would think. That comparison is part of what a senior living advisor does, and my help is free to families; communities compensate the advisor when a family moves in.

I hold a dementia care certification and I have toured more than 90 communities across Nassau, Suffolk and Queens. Assisted Living Locators of Long Island is at 42 Prospect Ave, Glen Cove, NY 11542. Ask me for a side by side comparison, and I will give you current numbers for the programs you are considering.

Questions readers ask

Read next

• How Much Assisted Living Costs on Long Island, Line by Line
• What a Nursing Home Costs on Long Island vs Assisted Living
• What Memory Care Actually Includes (and What It Does Not)