Opening New Doors Senior Placement

What is the difference between assisted living and memory care?

Assisted living is for someone who needs a helping hand with daily life — bathing, dressing, medications, meals, laundry — but who can still make informed decisions about their own safety. Memory care is designed specifically for people with memory impairment. Alzheimer’s is the most prevalent but there are many forms of dementia. Memory Care programs are within secured settings, have more caregivers per resident, dementia-trained staff and daily routines built around memory loss rather than physical need. In New Hampshire, a memory care community does not have to have a separate license on top of their Assisted Living license.

How do I know when it’s time for assisted living?

The most important question to consider when deciding if your loved one should move into assisted living “is home still safe with the support we have in place today”. Whether it be family pulling together to provide care and oversight or services of home care, is this person safe. Also, just as important, are they still thriving in their home environment. When assessing if a senior is safe at home, you should take into consideration physical challenges and how medically and cognitively challenged they are.

When is assisted living no longer enough, and memory care is needed?

All residents within an assisted living program need to be oriented to time and place and need to show the ability to appropriately use a call pendant and/or reach out to staff when help is needed. A few key factors a community will consider when deciding if an assisted living program or memory care program is most appropriate: Can a resident leave the community and find their way back, are they getting lost in familiar hallways, are they experiencing sun downing and are they maintaining hygiene and/or resistant to staff assistance to upkeep hygiene.

What is the difference between assisted living and a nursing home?

Assisted is the key word when talking about assisted living services: staff assists with meals, activities, personal care and medication support. Often the setting is a home like environment compared to a sterile medical setting like that of a nursing home. A nursing home provides around-the-clock licensed nursing care for people with complex medical needs, and it’s regulated much more like a healthcare facility. Many families hear the words long term care or 24/7 care and assume a nursing home is the only option after a hospital stay, when assisted living may have been a better, less restrictive option. In New Hampshire there is little difference from the services of nursing home compared to an assisted living community that has been licensed through the state as a Supported Residential Healthcare Facility.

Assisted Living

What is the difference between residential care and supported residential health care in New Hampshire?

New Hampshire has two licenses that distinguish the level of care offered within an assisted living and/or memory care program. They are residential care and supported residential health care. A residential care community provides personal care and medication administration. A supported residential health care community is licensed for a higher level of need — licensed nursing oversight, medication delegation, mechanical transfer assistance, and residents who would otherwise qualify for a nursing home. For some families, that single distinction is what allows a parent to stay in assisted living instead of moving to a nursing home. Not all states allow supported residential health care within an assisted living community. This is a valuable distinction between assisted living care in New Hampshire compared to other states.

Is assisted living in New Hampshire different from Massachusetts?

Yes, Massachusetts assisted living residences are certified rather than licensed as healthcare facilities, and they can’t provide nursing directly — those services have to come from an outside home health or hospice agency. New Hampshire’s licensed model, particularly supported residential health care, allows more nursing capability within the community itself. Families in the Merrimack Valley are often surprised to learn that a New Hampshire community just over the line can support a level of care their Massachusetts options simply aren’t permitted to provide.

Memory Care

How much does assisted living cost in New Hampshire

The total monthly cost of assisted living in New Hampshire depends on a few factors: Whether it is licensed as a residential care or supported residential health care, the amount of hands on care and nursing services a resident will need and the type of accommodations( apartment, suite, bedroom or shared accommodations).
Because there are so many factors, there is a big range when talking about monthly cost of assisted living in New Hampshire. The most inexpensive, minimal hands-on care within shared accommodations starts at $4,000 month. A person who is receiving minimal hands-on care within a studio apartment in a supported residential health may start at $8500. For those in a memory care program, a family should plan on a minimum of $10,000 per month. There are very few communities who offer all inclusive rates. Most communities will adjust rent based on the amount of hands-on care and medication oversight a resident requires- often referred to as Care Plans. Most communities also charge a one time move-in fee, sometimes called a community fee, in the amount anywhere between $4000-$8500.

What does the monthly rent in Assisted Living Include?

The rent in ALL New Hampshire Assisted Living and Memory Care Communities covers 24/7 oversight, meals, housekeeping, activities and some type of medication oversight. Some may include a base level of personal care and transportation to Md appointments, local stores or events out in the community. A community that charges more may put more money into entertainment coming into the building and offer a more robust engagement calendar and amenities for their residents.

Why does memory care cost more than assisted living?

The primary reason Memory care communities cost more is they keep more caregivers on the floor per resident compared to Assisted Living Communities. Many have some level of care included in their base rate. An example would be, cuing and reminders. Staff spends a significant time cuing and reminders, typically already included in the base rate- therefore with a base rate that is higher than in assisted living programs. They also spend more time on dementia-specific training and maintaining a safe and secured neighborhood with its own activities. In New Hampshire, plan on roughly $10,000 a month and up. In the past many memory care communities offered all-inclusive pricing but now that is rare.

Does Medicare pay for assisted living or memory care?

Medicare does not cover the cost of assisted living. Medicare does not pay for custodial care in any setting: assisted living, memory care, nursing home. It is confusing to many that although it does not cover the monthly rent, medicare continues to cover the same care/services as when you were at home. Doctor visits, hospital stays, medication and a limited period of skilled nursing or rehabilitation following a qualifying hospital admission. ( dependent on the Medicare Plan and any supplemental plans).

If Medicare doesn’t pay, how do families afford Senior Living ?

Most assisted living communities in New Hampshire are private pay and do not accept Medicaid. There are less than a handful of memory care communities in all of New Hampshire, outside of a nursing home environment, that accept medicaid as the payer source. People must depend on monthly income ( usually Social Security and/or Pensions) retirement income, savings, or proceeds from selling a home. Some are fortunate and have a Long-term Care Policy that covers the monthly rent, including the cost of care. For Veterans who have served during active war time, they should explore the VA Aid and Attendance benefit which can contribute monies towards the cost of care within Assisted Living.

Rehab says Medicare coverage is ending. What do we do now?

First, take a breath — you have more options than it feels like. You’ll receive a written Notice of Medicare Non-Coverage, often with only a day or two of warning, and it explains your right to a fast appeal. Whether or not you appeal, use those days to build a plan in parallel. Discharge planners genuinely want to help, but they’re managing many cases at once and usually work from a general list. The communities that accept direct admissions from rehab and can meet your loved one’s care level are a much shorter list than it appears.

How quickly can someone move into assisted living or memory care?

Faster than most families expect, when the pieces are lined up. A community typically needs a nurse assessment, a physician’s order or medical form, a TB screening, completed financial paperwork, and an available apartment at the right care level. When all of that comes together, a move can happen within a few days. When one piece is missing — usually the medical form, or an assessment that can’t be scheduled until next week — everything stalls. Knowing which communities have both an opening and the license for the care needed is what saves those days.

Can a community turn my parent down, or ask them to leave later?

Yes to both, and it’s worth planning for rather than being surprised by. New Hampshire communities may only admit and retain residents whose needs they can genuinely meet, which is why that nurse assessment carries so much weight. Common reasons for a decline include two-person transfers, exit-seeking behavior in an unsecured setting, complex wound care, or aggression toward staff or residents. The same standards apply after move-in, so a resident whose needs outgrow the license can be asked to move. Ask what would trigger a move-out before you sign anything — it can spare your family a second transition.

What should we ask when we tour a community?

Go beyond the tour script. What’s the caregiver-to-resident ratio on evenings and weekends? How are care levels assessed, and how often do they change? How much did rates increase last year? What’s the turnover among aides? Who’s here overnight, and is a nurse on site or on call? For memory care, ask what dementia training staff receive — New Hampshire requires it both at hire and every year — and ask to spend time in the secured neighborhood. Warm, specific answers are a good sign. Vague ones tell you a great deal too.

My parent refuses to move. What can we do?

You are in very good company — this is one of the hardest and most common places families get stuck, and pushing harder usually backfires. What tends to help: narrowing the decision instead of opening it wider, bringing the physician into the conversation, framing the move around a problem your parent already acknowledges, and visiting one community rather than five. Sometimes a short respite stay accomplishes what months of conversation couldn’t. And sometimes the loving thing is simply to have a plan ready for the day the situation decides for you.

Financial Resources

Aren’t senior living referral services free? Why would we pay for guidance?

Most national referral services are free to you because participating communities pay them a fee when you move in. That means your contact information becomes the product, and communities that don’t pay may never appear on your list at all. Many families describe a flood of calls within hours of filling out a form. Opening New Doors works for your family, keeps your information confidential, and recommends communities based on fit — not on who pays us.

What does working with Opening New Doors actually look like?

It starts with a conversation about your situation, at no cost and with no obligation. From there: understanding the level of care truly needed, a short and honest list of communities that can meet it, help preparing for tours and often joining you on them, support through the assessment and admission paperwork, advocacy during the move itself, and a check-in once your loved one is settled. Locally owned, independent, and in person when it matters most — helping New Hampshire families since 2010.