Montana Assisted Living
Despite its remote location and low population density, Montana is a popular retirement destination — especially among people who appreciate natural beauty or like having access to world-class fly fishing and other types of outdoor recreation. Approximately 19.3% of the overall population of roughly 1,105,000 residents are aged 65 and over, which is almost 3% higher than the national average of 16.5%. Montana has no state sales tax, and while there is a personal state income tax, it is capped at 6.5%. The information below provides information about assisted living communities in Montana, the costs of available options, and how the state regulates these facilities.
The typical resident population in Montana's assisted living communities is 69% female. Overall, 80% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 50% ages 85 and older.
The Montana Department of Public Health and Human Services licenses assisted living facilities (ALFs). ALFs are residences for frail, elderly, or disabled persons that provide supportive health and service coordination for their residents. There are three levels of ALF in the state:
All facilities are licensed for the requirements of Category A. Additional endorsements are required for Categories B and C. ALFs coordinate personal care, health-related services, 24-hour supervision, assistance, and activities for their residents.
Adult foster care homes are private homes that are licensed to offer light personal care, custodial care, and supervision to aged or disabled adults. The residents in these homes require assistance meeting their basic needs.
All ALFs must have a written and signed contract with prospective residents prior to admission to the facility. The agreement lists all charges, refund policies, services provided, and move-out criteria. In addition, the agreement must explain the availability of skilled nursing services from a third-party provider and the residents' responsibilities as residents of the facility.
Category C facilities must provide a number of disclosures to residents. The disclosures include:
Each category of care has a set of criteria they must follow when it comes to admitting and retaining residents. ALFs are not appropriate for all individuals, particularly those who are incapable of responding to their environment or cannot demonstrate independent activity. The facility must determine whether the resident is appropriate for their environment.
Category A ALFs cannot admit or retain residents with Stage 3 or 4 pressure sores, require a gastronomy tube, require skilled nursing care continuously, require physical or chemical restraints, are dependent on assistance with four or more ADLs, or are incapable of expressing their needs.
Category B ALFs may admit and retain individuals who are reliant on assistance for four or more ADLs, require skilled nursing services for more than 30 days per episode, are not a danger to themselves and others, and do not require physical or chemical restraints.
Category C ALFs are permitted to serve residents with severe cognitive impairments that make them unable to express their needs or make basic care decisions. These ALFs may not use chemical or physical restraints on their residents.
All ALFs must either directly provide or make provisions to provide personal services like laundry, housekeeping, and local transportation, assistance with ADLs, recreational activities, assistance with self-administration of medications, 24-hour supervision, and assistance in making medical appointments.
Prior to admission, all residents must have an initial assessment to determine what needs they have. The assessment covers cognitive abilities, sensory patterns, ADL abilities, mood and behavior patterns, their social appropriateness for the facility, any health issues, weight and nutritional status, medication use, and any safety or assistive devices required.
Additional services that may be available in Category A ALFs include allowing residents to contract with a third-party provider for the administration of medications, short-term skilled nursing care, or other skilled services. Category A facilities must develop the initial service plan for each resident based on the initial needs assessment. This initial plan must be reviewed within 60 days to ensure that this initial plan meets the needs of the resident.
Category B ALFs may provide skilled nursing care or other skilled services for up to five residents. This is in addition to those residents who do not require such care.
Category C ALFs may serve residents that fall under Category A and Category B, but they also provide care to meet the needs of residents with severe cognitive impairment.
Category B and C facilities must assess the residents' needs within 21 days of admission, which will be reviewed upon a change in their condition. Category C facilities must conduct a resident certification to determine intervention techniques for resident behaviors and needs, including memory, judgment, ability to care for themselves, the ability to solve problems, mood and behavior changes, behavioral patterns, wandering, and dietary needs.
At least three meals a day must be offered at regular intervals with no more than a 14-hour span between the evening and morning meals. If a nutritious snack is provided between those meals, then a 16-hour time span is permitted. Modified diets must be prepared when ordered by a health care provider.
All ALFs must employ an administrator responsible for the facility's daily operations and ensure 24-hour supervision of the residents. When the administrator is unavailable, someone must be designated to be responsible for the facility. There must be sufficient staff to provide for the safety and well-being as well as the care of all residents according to their care plans. At least one staff member per shift must be trained in CPR if the facility offers it.
Category B facilities must have a registered nurse available to provide or supervise nursing services, including general health monitoring of residents, performing nursing assessments on residents as required, assisting with developing resident care plans, and other routine nursing tasks.
There are no set minimum staff ratios, but at least one staff member must always be present. There must be sufficient qualified staff to meet the residents' scheduled and unscheduled needs.
Category C ALFs require a staff member always to be present and awake.
Apartment-style units are not required in Montana. If the facility was licensed prior to 2004, no more than four residents can reside in a single bedroom. Facilities licensed after 2004 that serve residents with cognitive impairment must be limited to no more than two residents per room. Each resident must have access to a toilet room without entering another resident's room or the kitchen, dining, or living areas. There must be one toilet room for every four residents and one bathing or shower facility for every 12 residents.
Kitchens or kitchenettes are permitted in resident rooms if the resident’s service plan allows unrestricted use of cooking appliances.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
In Montana, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 63% of communities providing skilled nursing. Many have health care specialists and on-site services, with 44% of communities offering dental care. In addition, 62% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Montana, 84% of communities conduct depression screenings, and 44% offer mental health counseling. Social work programs are also found in 48% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In Montana, 46% have Alzheimer's disease or another form of dementia. In addition, 50% have high blood pressure, 34% have heart disease, 36% have depression, and 15% have diabetes.
The National Alliance on Mental Illness is a national organization with a chapter in Montana. The organization provides free county mental health guides for each of Montana's 56 counties. Those struggling with mental health issues can also learn about community-based resources available in their location by calling Montana 211. People can also contact the Addictive and Mental Disorders Division of the Montana Department of Public Health and Human Services or a local Area Agency on Aging.
Residents of Category A ALFs must all be capable of self-administering their medications. Residents in Category B ALFs who are capable of self-administering their medications are encouraged to do so. Any direct care staff member capable of reading medication labels may provide necessary assistance to a resident in taking their medications.
Assistance in administering medications includes the following:
Category B and C residents who are unable to self-administer their medications must have their medications administered by a licensed health care professional or a trained or licensed individual.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Montana’s assisted living facilities often receive help with their ADLs. In Montana, 23% of residents need help eating. Other commonly used services include bed transfer (26%), toileting (35%), and walking (34%). Caregivers in ALFs help 42% of residents dress, and 63% need help bathing.
The average cost of assisted living care in Montana is $4,450. This cost is $50 lower than the monthly national average of $4,500 per month. The cost of living in Montana is more than the national average by 0.7%, with health care costs more than the national average by 0.9% and housing costs more than the national average by 6.3%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $4,150 in the Great Falls area to a high of $4,650 per month in the Missoula area of Montana.
If you live close to one of Montana’s borders, you may find assisted living in a neighboring state is an affordable option. All of Montana’s neighbors have lower average monthly costs for assisted living. Idaho, South Dakota, and North Dakota all have average costs below $4,000 per month, with Idaho at $3,838, South Dakota at $3,350, and North Dakota at $3,391. Wyoming still has a lower average monthly cost of $4,169 per month.
How to Pay for Assisted Living
Montana has many requirements with which its assisted living facilities must comply in order to remain in operation. It also has legal resources for its residents, should older adults in the state need to resolve various issues.
Assisted living facilities in Montana have a state license to operate. They must also have an administrator responsible for the facility's operations. Depending on the facility’s category, it must meet certain conditions. For example, administrators must complete 16 hours of relevant continuing education per year, and facilities must have emergency and fire safety plans.
You can look up individual assisted living facilities in Montana through the Montana Department of Public Health and Human Services License/Certificate Verification Page. This will disclose the type of license a facility holds if there are administrative or disciplinary actions against it.
The term "elder law" is often associated with estate planning, trusts, and help to obtain benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.
The Montana Legal Services Developer Program provides older adults with resources such as telephone assistance, referrals to local pro bono providers, and other relevant legal services and hosts annual Legal Documents Clinics designed to help participants finalize their estate planning documents. This program works under the umbrella of Montana's Office on Aging.
Montana Legal Services Association provides free legal assistance for those who meet income eligibility requirements. This service also provides free legal forms, self-help materials, and legal information.
The typical resident population in Montana's assisted living communities is 69% female. Overall, 80% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 50% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Montana Department of Public Health and Human Services licenses assisted living facilities (ALFs). ALFs are residences for frail, elderly, or disabled persons that provide supportive health and service coordination for their residents. There are three levels of ALF in the state:
- Category A residents are capable of self-medication, are in generally good health, and need assistance with no more than three activities of daily living (ADLs).
- Category B residents may need nursing services and are consistently or completely dependent on assistance with four or more ADLs.
- Category C residents suffer from cognitive decline and cannot express needs or make basic care decisions.
All facilities are licensed for the requirements of Category A. Additional endorsements are required for Categories B and C. ALFs coordinate personal care, health-related services, 24-hour supervision, assistance, and activities for their residents.
Adult foster care homes are private homes that are licensed to offer light personal care, custodial care, and supervision to aged or disabled adults. The residents in these homes require assistance meeting their basic needs.
Resident Agreements and Disclosures
All ALFs must have a written and signed contract with prospective residents prior to admission to the facility. The agreement lists all charges, refund policies, services provided, and move-out criteria. In addition, the agreement must explain the availability of skilled nursing services from a third-party provider and the residents' responsibilities as residents of the facility.
Category C facilities must provide a number of disclosures to residents. The disclosures include:
- The overall philosophy and mission of the facility related to meeting the needs of its residents with cognitive impairment.
- The process used for resident assessment.
- The criteria for move-in, transfer and discharge.
- The frequency and type of activities.
- Any additional costs or fees.
Assisted Living Admission and Retention
Each category of care has a set of criteria they must follow when it comes to admitting and retaining residents. ALFs are not appropriate for all individuals, particularly those who are incapable of responding to their environment or cannot demonstrate independent activity. The facility must determine whether the resident is appropriate for their environment.
Category A ALFs cannot admit or retain residents with Stage 3 or 4 pressure sores, require a gastronomy tube, require skilled nursing care continuously, require physical or chemical restraints, are dependent on assistance with four or more ADLs, or are incapable of expressing their needs.
Category B ALFs may admit and retain individuals who are reliant on assistance for four or more ADLs, require skilled nursing services for more than 30 days per episode, are not a danger to themselves and others, and do not require physical or chemical restraints.
Category C ALFs are permitted to serve residents with severe cognitive impairments that make them unable to express their needs or make basic care decisions. These ALFs may not use chemical or physical restraints on their residents.
Assisted Living Services and Service Planning
All ALFs must either directly provide or make provisions to provide personal services like laundry, housekeeping, and local transportation, assistance with ADLs, recreational activities, assistance with self-administration of medications, 24-hour supervision, and assistance in making medical appointments.
Prior to admission, all residents must have an initial assessment to determine what needs they have. The assessment covers cognitive abilities, sensory patterns, ADL abilities, mood and behavior patterns, their social appropriateness for the facility, any health issues, weight and nutritional status, medication use, and any safety or assistive devices required.
Additional services that may be available in Category A ALFs include allowing residents to contract with a third-party provider for the administration of medications, short-term skilled nursing care, or other skilled services. Category A facilities must develop the initial service plan for each resident based on the initial needs assessment. This initial plan must be reviewed within 60 days to ensure that this initial plan meets the needs of the resident.
Category B ALFs may provide skilled nursing care or other skilled services for up to five residents. This is in addition to those residents who do not require such care.
Category C ALFs may serve residents that fall under Category A and Category B, but they also provide care to meet the needs of residents with severe cognitive impairment.
Category B and C facilities must assess the residents' needs within 21 days of admission, which will be reviewed upon a change in their condition. Category C facilities must conduct a resident certification to determine intervention techniques for resident behaviors and needs, including memory, judgment, ability to care for themselves, the ability to solve problems, mood and behavior changes, behavioral patterns, wandering, and dietary needs.
Assisted Living Food and Dietary Provisions
At least three meals a day must be offered at regular intervals with no more than a 14-hour span between the evening and morning meals. If a nutritious snack is provided between those meals, then a 16-hour time span is permitted. Modified diets must be prepared when ordered by a health care provider.
Assisted Living Staffing Requirements
All ALFs must employ an administrator responsible for the facility's daily operations and ensure 24-hour supervision of the residents. When the administrator is unavailable, someone must be designated to be responsible for the facility. There must be sufficient staff to provide for the safety and well-being as well as the care of all residents according to their care plans. At least one staff member per shift must be trained in CPR if the facility offers it.
Category B facilities must have a registered nurse available to provide or supervise nursing services, including general health monitoring of residents, performing nursing assessments on residents as required, assisting with developing resident care plans, and other routine nursing tasks.
There are no set minimum staff ratios, but at least one staff member must always be present. There must be sufficient qualified staff to meet the residents' scheduled and unscheduled needs.
Category C ALFs require a staff member always to be present and awake.
Assisted Living Housing Requirements
Apartment-style units are not required in Montana. If the facility was licensed prior to 2004, no more than four residents can reside in a single bedroom. Facilities licensed after 2004 that serve residents with cognitive impairment must be limited to no more than two residents per room. Each resident must have access to a toilet room without entering another resident's room or the kitchen, dining, or living areas. There must be one toilet room for every four residents and one bathing or shower facility for every 12 residents.
Kitchens or kitchenettes are permitted in resident rooms if the resident’s service plan allows unrestricted use of cooking appliances.
What Is Included With Assisted Living Care In Montana?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In Montana, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 63% of communities providing skilled nursing. Many have health care specialists and on-site services, with 44% of communities offering dental care. In addition, 62% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Montana, 84% of communities conduct depression screenings, and 44% offer mental health counseling. Social work programs are also found in 48% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In Montana, 46% have Alzheimer's disease or another form of dementia. In addition, 50% have high blood pressure, 34% have heart disease, 36% have depression, and 15% have diabetes.
Mental Health Resources
The National Alliance on Mental Illness is a national organization with a chapter in Montana. The organization provides free county mental health guides for each of Montana's 56 counties. Those struggling with mental health issues can also learn about community-based resources available in their location by calling Montana 211. People can also contact the Addictive and Mental Disorders Division of the Montana Department of Public Health and Human Services or a local Area Agency on Aging.
Medication Provisions
Residents of Category A ALFs must all be capable of self-administering their medications. Residents in Category B ALFs who are capable of self-administering their medications are encouraged to do so. Any direct care staff member capable of reading medication labels may provide necessary assistance to a resident in taking their medications.
Assistance in administering medications includes the following:
- Removing medication containers from secured storage.
- Providing verbal suggestions for the residents to self-administer their medications.
- Handing a pre-filled medication holder to the resident.
- Opening the container lid.
- Assisting in the removal of medication from a container for residents with a disability.
- Assisting the resident in drinking or guiding their hand to self-administer medication.
Category B and C residents who are unable to self-administer their medications must have their medications administered by a licensed health care professional or a trained or licensed individual.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Montana’s assisted living facilities often receive help with their ADLs. In Montana, 23% of residents need help eating. Other commonly used services include bed transfer (26%), toileting (35%), and walking (34%). Caregivers in ALFs help 42% of residents dress, and 63% need help bathing.
Cost Of Assisted Living Care In Montana
The average cost of assisted living care in Montana is $4,450. This cost is $50 lower than the monthly national average of $4,500 per month. The cost of living in Montana is more than the national average by 0.7%, with health care costs more than the national average by 0.9% and housing costs more than the national average by 6.3%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $4,150 in the Great Falls area to a high of $4,650 per month in the Missoula area of Montana.
How Costs Compare In Nearby States
If you live close to one of Montana’s borders, you may find assisted living in a neighboring state is an affordable option. All of Montana’s neighbors have lower average monthly costs for assisted living. Idaho, South Dakota, and North Dakota all have average costs below $4,000 per month, with Idaho at $3,838, South Dakota at $3,350, and North Dakota at $3,391. Wyoming still has a lower average monthly cost of $4,169 per month.
How to Pay for Assisted Living
Montana Assisted Living Oversight
Montana has many requirements with which its assisted living facilities must comply in order to remain in operation. It also has legal resources for its residents, should older adults in the state need to resolve various issues.
Quality and Safety of Assisted Living Facilities in Montana
Assisted living facilities in Montana have a state license to operate. They must also have an administrator responsible for the facility's operations. Depending on the facility’s category, it must meet certain conditions. For example, administrators must complete 16 hours of relevant continuing education per year, and facilities must have emergency and fire safety plans.
You can look up individual assisted living facilities in Montana through the Montana Department of Public Health and Human Services License/Certificate Verification Page. This will disclose the type of license a facility holds if there are administrative or disciplinary actions against it.
Legal Resources
The term "elder law" is often associated with estate planning, trusts, and help to obtain benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.
The Montana Legal Services Developer Program provides older adults with resources such as telephone assistance, referrals to local pro bono providers, and other relevant legal services and hosts annual Legal Documents Clinics designed to help participants finalize their estate planning documents. This program works under the umbrella of Montana's Office on Aging.
Montana Legal Services Association provides free legal assistance for those who meet income eligibility requirements. This service also provides free legal forms, self-help materials, and legal information.
