While Missouri’s southern climate is part of what attracts retirees to its assisted living communities, this state also has a very low cost of living, and more than 95% of Missouri is rural land. Unlike many majoritively rural states, Missouri’s major urban centers of St. Louis and Kansas City offer world class healthcare options and a notable contemporary art scene. Seniors in this state can enjoy a peaceful way of life without living in isolation.
Paying For Assisted Living in Missouri
The Cost of Assisted Living
The monthly median expense of assisted living in Missouri is over $1,000 less than the national average, and in 2018, Missouri remains the nation’s least expensive state for assisted living. According to Genworth’s 2018 Cost of Care Survey, the state’s average costs are significantly lower than expenses in most other states.
Prices can vary significantly from city to city, and they are often higher in more populous areas. Columbia, home to the University of Missouri, is the state’s most expensive region for assisted living. If Missouri’s most populous cities are excluded, the average cost for ALF residence in the state’s remaining counties comes to only $2,650.
The type of care that is needed will significantly affect elder care costs, but Missouri’s assisted living facilities represent one of the state’s least costly care options. Both assisted and independent living are likely to cost less than $3,000 per month. As is the case in most states, Missouri nursing home expenses will be dramatically higher.
Financial Assistance for Assisted Living in Missouri
Home- and Community-Based Personal Care Services
Missouri residents of assisted living and residential care facilities may be eligible for Medicaid reimbursement for their personal care expenses. Personal care services include assistance with activities of daily living, like bathing, dressing, and walking around. Missouri’s Medicaid program also offers to cover advanced activities of daily living which are more nursing-oriented activities, most of them involving medical maintenance.
For eligible recipients, this program will cover personal care needs that exceed the minimum of assistance that is offered at their facility. A monthly RN visit is also covered so that the needs of recipients can be re-evaluated every 30 days. Covered service amounts cannot exceed 60% of the average statewide cost of care in a nursing facility, excluding costs for RN appointments.
Who is Eligible?
Aside from meeting basic Medicaid eligibility requirements, recipients of personal care coverage must also be:
- People 18 years of age and older
- Individuals who are nursing home eligible
- Active Medicaid recipients with an appropriate Medicaid Eligibility code
How to Apply
In order to apply for personal care coverage, prospective recipients must have a referral from their physician to receive Home- and Community-Based Services. Applications for Missouri’s Medicaid program for the elderly, administered through MO HealthNet, can be initiated online or on the phone, and a sample referral form for personal care services can be found online as well. To find a downloadable paper application for Medicaid or to apply online, visit MyDSS.MO.gov. To apply for Medicaid by phone or in person, use the table in this guide to locate your regional Area Agency on Aging.
Supplemental Nursing Care
Medicaid recipients who live in assisted living, residential care, or a skilled nursing facility may be eligible to receive a grant to mitigate their monthly costs of care. These grants are intended to cover the difference between a resident’s countable monthly income and their monthly costs at a facility if those costs are greater. Only a facility’s base rates for resident care are considered, excluding additional charges for personal expenses, clothing, etc.
The maximum grant that applicants may receive will be based on how their income compares to their basic monthly facility costs, and on what type of facility they inhabit.
- Assisted living facility residents may receive up to $292.50 monthly.
- Residential care facility residents may receive up to $156 monthly.
- Skilled nursing facility residents may receive up to $390 monthly.
Who is Eligible?
Only people who are living in a facility at the time of application can receive skilled nursing care supplements. Applicants should also be:
- Nursing home-eligible
- Eligible for Medicaid
- In need of skilled nursing care
- Getting a monthly income that is less than their facility’s basic monthly cost
How to Apply
Applicants should connect with an eligibility specialist at the DHS Division of Senior and Disability Services by first locating their regional Area Agency on Aging in the table below. A state eligibility manual for skilled nursing care can be found online at DDS.MO.gov.
Applications for Missouri’s Medicaid program for the elderly, administered through MO HealthNet, can be initiated online or on the phone. To find a downloadable paper application or to apply online, visit MyDSS.MO.gov. To apply for Medicaid by phone or in person, use the table in this guide to locate your regional Area Agency on Aging.
Missouri’s Program of All-Inclusive Care for the Elderly is administered by the Centers for Medicare and Medicaid. PACE is intended to cover all medical expenses for especially frail seniors who are at immediate risk of institutionalization. The program can support a limited number of recipients, and most programs can take between 150 and 300 active participants. Assisted living residents may be reimbursed for services provided at facilities as long as a family member or friend is available to provide oversight during brief interims of respite. For people who are not Medicaid eligible, PACE may be available for a monthly fee.
Who is Eligible?
Eligibility for PACE participation requires applicants to be 55 or older, and coverage in Missouri is only available to people living in the St. Louis area. Medical eligibility requires that PACE recipients be nursing home-eligible with at least 21 points on the nursing home level of care assessment, which is administered by a Medicaid caseworker.
How to Apply
To find out if you’re eligible and learn about what PACE offers, contact your local HHS office by dialing 2-1-1. You can also consult your local Area Agency on Aging for more details and application assistance. To learn more about PACE, visit NPAOnline.org.
More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:
- Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.
- Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov
- Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.
- Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.
Free Assisted Living Resources in Missouri
United Way 211
In July of 2000, the FCC reserved a phone number, 2-1-1, to be a nationwide community information and referral service. The United Way of Missouri now maintains a 24-hour hotline at this number, providing callers with information and access to social services for everyday needs and crisis aid.
To contact the United Way resource centers, simply dial 2-1-1, or find out more online at 211Helps.org.
Missouri’s Aging & Disability Resource Centers
Aging & Disability Resource Centers are senior support organizations selected by the state government of Missouri. These centers are often housed in the same offices as the Area Agencies on Aging, serving as a single point of contact with the long-term services and supports (LTSS) system for older adults across the state.
For more information, consult the table in this guide to find your local Area Agency on Aging, or go online to consult Missouri’s Administration of Community Living.
The Long-Term Care Ombudsman Program
Missouri maintains a Long-Term Care Ombudsman program to protect the best interests of seniors across the state. The Office of the Ombudsman coordinates a network of volunteers who visit with ALF residents to provide advocacy and field any complaints they may have of their long-term care environment. An Ombudsman’s main goal is to help maintain or improve the quality of life for ALF residents by ensuring that their rights are respected.
Although the state ombudsman is located in Jefferson City, volunteers also work out of the regional Area Agencies on Aging offices located in nine Missouri cities. To connect with an ombudsman, contact your local Area Agency on Aging by consulting the directory below, or call the Office of the Ombudsman at (800) 309-3282.
The Area Agencies on Aging
In the state of Missouri, there are ten Area Agencies on Aging. With the passing of the 1973 Older Americans Act, the AAA was created for the purpose of implementing support programs at the local level. With state-endorsed locations serving every county in Missouri, the AAA works to reduce confusion for seekers of long-term care services, and to facilitate access to care. Anyone over the age of 60 is welcome to use the agency’s services free of charge.
|Area Agency on Aging||Address||Phone Number|
1735 S. Fort Avenue
Springfield, MO 65807
1078 Wolverine Road, Suite 1
Cape Girardeau, MO 63701
106 W. Young Street
P.O. Box 1078
Warrensburg, MO 64093
809 N. 13th Street
P.O. Box 265
Albany, MO 64402
815 N. Osteopathy
Kirksville, MO 63501
1121 Business Loop 70 E., Suite 2A
Columbia, MO 65201
600 Broadway, Suite 200
Kansas City, MO 64105
14535 Manchester Road
St. Louis, MO 63011
1520 Market Street
4th floor, Room 4065
St. Louis, MO 63103
531 E. 15th Street
Joplin, MO 64804
The VA has one Regional Benefit Office in the state of Missouri which is available to help veterans who are seeking residential care determine their financing options. The Veterans Benefits Administration (VBA) is responsible for administering programs which provide assistance to veterans, their dependents, and survivors.
Veterans’ benefits may include:
- Veterans’ compensation
- Survivor’s benefits
- Rehabilitation and employment assistance
- Education financing
- Home loan guarantees
- Life insurance coverage
For more information, visit the VA Regional Benefit office at 9700 Page Avenue, St. Louis, MO 63132, or call (800) 827-1000. The Veterans’ Crisis Hotline can be reached by calling (800) 273-8255 (Press 1), and a complete VA contact directory is available online at VA.gov.
Social Security Offices
The federal government maintains a central website for the Social Security Administration at SSA.gov. Many Social Security-related tasks can be completed online, including:
- Applying for Social Security Benefits
- Requesting replacement Social Security cards
- Making sure you qualify for benefits
- Estimating your benefits
- Receiving Social Security statements electronically or by mail
For further assistance, contact or visit the SSA office in your locale. Refer to the alphabetically sorted table below to find your nearest location.
|Social Security Office||Address||Phone Number|
2245 Cape Centre Drive
1105 S. Mitchell Avenue
803 Gray Oak Drive
Columbia, MO 65201
1215 Fern Ridge Parkway
Creve Coeur, MO 63141
650 Gravois Bluffs
Fenton, MO 63026
11753 W. Florissant
Florissant, MO 63033
155 Forrest Drive
Hannibal, MO 63066
3520 S. Noland Road, Suite C
Independence, MO 64055
129 Scott Station Road
Jefferson CIty, MO 65109
4102 S. Arizona Avenue
Joplin, MO 64804
Kansas City, MO 64132
2021 Independence Avenue
Kansas City, MO 64124
8620 North Green Hills Road
Kansas City, MO 64154
800 South Bypass
Kennett, MO 63857
1305 Crown Drive
Kirksville, MO 63501
2456 South Jefferson
Lebanon, MO 65536
518 W South Hills Drive
Maryville, MO 64468
120 S. Commerce Drive
Nevada, MO 64772
507 East Main Street
Park Hills, MO 63601
2600 Kanell Boulevard
Poplar Bluff, MO 63901
1813 E 10th Street
Rolla, MO 65401
1402 N. Woodbine Road
Saint Joseph, MO 64506
3404 W. 10th
Sedalia, MO 63801
711 York Drive
Sikeston, MO 63801
1570 W. Battlefield Street
Springfield, MO 65807
717 N. 16th Street
St. Louis, MO 63103
5669 Delmar Boulevard
St. Louis, MO 63112
8800 Watson Road
Saint Louis, MO 63119
4800 Executive Center Parkway
St. Peters, MO 63376
43 Prairie Dell Plaza Drive
Union, MO 63084
1612 Imperial Drive
West Plains, MO 65775
Assisted Living Laws and Regulations in Missouri
The Department of Health and Senior Services licenses and regulates long-term care facilities in Missouri. Assisted living facilities (ALFs) and residential care facilities (RCFs) are permitted to offer long-term care in many of the same ways, though divisions exist in the laws that regulate each type of facility. The following are pertinent regulations governing both ALFs and RCFs.
Assisted Living Service Plans
On moving into a long-term care facility, residents must meet with facility staff for an interview to establish the new resident’s needs and manage their expectations of what the facility can provide. At this time, a residential agreement will also be drafted which demonstrates that residents have been informed of their rights and of all costs for service.
In assisted living facilities, part of the overall agreement must include provisions for any resident who is incapable of safely self-evacuating in cases of emergency. As part of the service agreement, these individuals or their representatives must be consulted to form an individualized evacuation plan.
Assisted Living Admission Requirements
Assisted living facilities can admit applicants who can confirm their need of assisted living services, such as assistance with activities of daily living, like bathing or mobility. People who are more incapacitated due to mental or physical decline may also be accommodated, but only by facilities that are sufficiently licensed and staffed to meet all of such residents’ needs. Some ALFs can provide skilled nursing care and assistance with medical maintenance tasks, and all are required to be capable of assisting residents to safety in an emergency.
Residential care facilities have the same admission requirements as ALFs, except where the ability to self-evacuate in cases of emergency is concerned. RCF residents must be capable of getting to safety without assistance within five minutes of being notified of an emergency situation. In some, temporary cases of incapacity, such as during a period of convalescence, incapacitated residents are allowed to remain as tenants in an RCF. However, prolonged immobility puts these residents at risk of transference to another care setting.
ALFs and RCFs have some limitations for acceptance. Neither type of facility can house people who exhibit the following:
- Tendencies toward self-harm or harm to others
- The requirement of physical or chemical restraints
- Skilled nursing requirements exceeding the facility’s offered services
- Need for assistance by more than one person (except in bathing or transference)
Assisted Living Scope of Care
ALF Scope of Care: Assisted living facilities must provide 24-hour care and protective oversight, including assistance with dressing, bathing, transferring, medication management, dietary services, social/physical activities, and food sanitation. There are additional requirements for ALFs that specialize in memory care and dementia. Assisted living facilities are intended to provide medical oversight and assistance in a home-like setting.
RCF Scope of Care: Residential care facilities must provide 24-hour care, shelter, board, and protective oversight, including assistance with storage, distribution, and/or administration of medications, dietary services, and food sanitation. Care can be provided to those with a short-term illness and during periods of recuperation.
Assisted Living Medicaid Policy
Unlike many states, Missouri does not allow Medicaid waiver coverage to be used in long-term care facilities for people with greater medical needs. However, for eligible Medicaid recipients who need a greater level of care than their facility is able to provide, the state does reimburse for personal care services, and also for advanced personal care services to aid residents with medical maintenance tasks. For people in need of skilled nursing care who have an income that is less than the monthly charge of their facility, the state may offer a cash grant to cover the difference.
Assisted Living Facility Requirements
Both ALFs and RCFs in Missouri may provide either apartment-style lodging or single- to double-occupancy bedrooms with a maximum of four residents per room. Assisted living facilities have the added requirement that they must be “home-like” environments, with living and communal spaces that provide the psychosocial experience of a typical family home. Both residential care and assisted living facilities must provide at least 70 square feet of usable living space per resident. For every six people in residence, facilities must provide at least one bathroom, and for every 20 residents there must be at least one bath or shower.
Medication Management Regulations
ALFs and RCFs keep each resident’s medication regimen on file, and depending on the type of facility one lives in, their regimen will be reassessed every two to three months by a physician or registered nurse. Any staff authorized to administer or assist residents with their medications must be licensed as a Medication Aide (MA) by the Missouri Assisted Living Association, and there are different levels of MA certification that are based on the type of medicines to be administered, including various types of injections. A registered nurse will be on staff at all facilities for at least eight hours a week to coordinate and oversee medication management operations.
Both assisted living and residential care facilities are required to hire at least one administrator or manager, as well as a team of direct care staff who are capable of providing care to the facility’s most medically needy residents. ALFs must also have a registered nurse on staff who will be present for at least eight hours per week, or more if the facility’s population is over 30 people.
Both facility types have staff to resident ratio requirements in place to make sure that there is always sufficient staff on hand to meet residents’ needs, including throughout the night. Fewer staff members are required to be available in residential care facilities, with only one staff member needed on the grounds at any given time for every 40 people in residence.
Staff Training Requirements
Administrators of assisted living and residential care facilities must be certified by the Board of Nursing Home Administrators, and they may be certified as nursing home or ALF/RCF administrators. Staff at assisted living facilities are given two hours of orientation training before they begin work, and residential care staff only need one hour of orientation. However, staff of both facility types must receive 20 hours of in-service training on a yearly basis, and administrators must complete 40 hours of biennial continued education coursework.
Assisted living facilities differ from residential care facilities by the amount of social interaction training they are given. However, all long-term care facility staff, administrators, and managers will have CPR and first-aid certification and will be trained in fire safety as well as methods for physically transferring residents. Procedures concerning abuse, neglect, and exploitation are also taught to all employees.
Background Checks for Assisted Living
All facilities must check the online registry of employees before they are able to provide direct care to residents. The online registry is maintained by the state of Missouri and allows facilities to see if a prospective employee’s license is current or inactive, and whether they have a Federal Indicator Status. No person with past convictions or substantiated accusations of abuse, neglect, or exploitation may be hired at a Missouri long-term care facility.
The state of Missouri provides different means of assistance with complaints of elder abuse and complaints lodged against a long-term care facility failing to honor a contract or state regulation.
Before reporting a long-term care facility, the DHS recommends first trying to resolve the issue by contacting a facility administrator. To lodge a formal complaint of a facility, injured parties may contact the state Ombudsman at (573) 526-0727 or (800) 309-3282, and should file a report online at Health.MO.gov.
Allegations of elder abuse are investigated by the Missouri Department of Health and Senior Services (DHSS). Abuse can include neglect, exploitation, abandonment, physical or emotional abuse, and theft. To confidentially report a suspected act of elder abuse, call the Missouri Adult Abuse and Neglect Hotline at (800) 392-0210, or use the online complaint form at Health.MO.gov.