Nebraska Assisted Living
Home to almost 2 million people, approximately 16.2% of Nebraska’s population comprises people aged 65 and over. On average, Nebraska’s climate is more comfortable than in many other states, and locals enjoy around 223 sunny days each year. The lower-than-average overall cost of living can help to offset the state’s high taxes.
This guide provides information about assisted living in Nebraska. It covers various options for long-term care and how much they cost, how to pay for senior care, regulation of assisted living communities, and legal resources for older adults.
The typical resident population in Nebraska's assisted living communities is 70% female. Overall, 87% of residents are ages 75 and older, with 35% of residents ages 75 to 84 and 52% ages 85 and older.
The Nebraska Department of Health and Human Services, Department of Licensure and Regulation of the Division of Public Health licenses assisted living facilities in the state. Assisted living facilities (ALFs) provide shelter, food, and care to four or more residents who require or request services due to age or physical disabilities. The care that ALFs provide includes a minimum amount of supervision and assistance with personal care, activities of daily living (ADLs), health maintenance, and other supportive services.
Adult foster care is a family home that assists people who cannot live independently but can function with minimal supervision and protection. These homes can house up to three adults aged 19 or older. Their services include room and board, household supplies, and laundry service.
The resident agreement with residents must be based on an assessment of the abilities and care necessary for the prospective resident. The agreement specifies the rights and responsibilities of both the resident and the facility, the cost of services to be provided, and the terms of payment and conditions of continued occupancy in the facility.
The facility must provide information to residents that include a description of the services provided and the available staff to provide them, move-out criteria, and any updates to the resident services agreement. The disclosure also includes the charges for the services, whether Medicaid payments are accepted for those services, and limitations to those payments.
For any ALF that markets itself as having a special care unit for residents with dementia, including Alzheimer’s disease, a written statement of the mission and philosophy of the facility must be included. The special care unit disclosure must include admission, discharge, transfer criteria, resident assessment policies, staffing, activities, and family involvement policies.
In order to be admitted to an ALF, a person must either need or want to have food, shelter, assistance with ADLs, supervision, or assistance with personal care. People cannot be admitted or retained in an ALF if they have an unstable or unpredictable condition or require complex nursing care unless the following conditions are met:
ALFs may provide an array of services to their residents including assistance with personal care, ADLs, and instrumental activities of daily living (IADLs) as well as health maintenance activities. Facilities may also provide supportive services like transportation, laundry, housekeeping, behavioral management, case management, financial assistance and management, shopping, and spiritual services.
Each resident is assessed to determine the level of care they need, either from the facility or some other source. The assessment is used to develop a care plan that specifies the services required, how often and when they are required, and who will deliver the service, including any services for residents with special needs. The service plan is updated when necessary.
Residents may assume the responsibility for arranging care through a licensed home health or hospice agency.
ALFs in Nebraska must provide food service to residents and may offer meals for special diets as requested by residents. The meals must be appropriate for the resident’s needs and meet daily nutritional requirements. Residents must be monitored for potential nutritional deficiencies based on changes in weight.
Each ALF must have an administrator responsible for the operations of the facility and must designate a substitute if they are absent. The direct care staff is responsible for helping residents with their personal care needs. Trained medication aides may administer medications, and the facility must have access to an RN to review all medication policies, procedures, and the training of medication aides.
There are no minimum staffing ratios, but the facility must maintain adequate staffing and training to support the needs of the residents according to their care plans. At least one staff member must be on-site and always awake.
Apartment units are not required in Nebraska. Units can either be a bedroom or a private apartment. If apartments are provided, they must include a private bathroom, a sleeping area, and a kitchen area. For facilities constructed before April 2007, a maximum of four residents are allowed per unit. One toilet and sink must be available for every six licensed beds, and one bathing facility is required for every 16 residents.
After April 2007, a maximum of two residents are permitted per unit. One toilet and sink are required for every four licensed beds, and one bathing facility must be provided for every eight residents. In new construction, one toilet room adjoining each resident’s bedroom is required.
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 Nebraska, 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 55% of communities providing skilled nursing. Many have health care specialists and on-site services, with 71% of communities offering dental care. In addition, 80% 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 Nebraska, 79% of communities conduct depression screenings, and 61% 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 necessary resources.
Some assisted living residents live with various medical conditions. In Nebraska, 39% have Alzheimer's disease or another form of dementia. In addition, 47% have high blood pressure, 32% have heart disease, 33% have depression, and 17% have diabetes.
Nebraska Department of Health and Human Services, Division of Behavioral Health Services, operates programs to support and maintain mental health. Available 24/7, the toll-free 211 Nebraska hotline provides free, confidential information about local services. Alternatively, individuals can use the live chat service during business hours, complete an online contact form, or contact via the mobile app. The nonprofit Mental Health Association of Nebraska (MHA-NE) provides peer-to-peer support for people experiencing mental health challenges. The National Alliance of Mental Health (NAMI) has a branch in Omaha.
Veterans can access programs, information, and counseling via the Nebraska Department of Veterans Affairs. The national 24-hour Veterans Crisis Line and Roger, which is part of Stop Soldier Suicide, provide crisis intervention for former members of the U.S. Armed Forces.
Residents capable of self-administering medications can do so with or without supervision by facility staff. Licensed health care professionals may administer medications as long as the scope of their practice includes medication administration. Medication aides who are trained, have demonstrated competency, and are appropriately directed and monitored are allowed to administer medications.
Medication administration policies must be reviewed and documented by an RN at least annually and must provide or oversee training of medication aides.
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 Nebraska’s assisted living facilities often receive help with their ADLs. In Nebraska, 14% of residents need help eating. Other commonly used services include bed transfer (29%), toileting (31%), and walking (50%). Caregivers in ALFs help 43% of residents dress, and 70% need help bathing.
The average cost of assisted living care in Nebraska is $4,076. This cost is $424 lower than the monthly national average of $4,500 per month. The cost of living in Nebraska is less than the national average by 6.3%, with health care costs more than the national average by 0.8% and housing costs less than the national average by 13.4%.
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 $2,906 in the Grand Island area to a high of $4,715 per month in the Lincoln area of Nebraska.
If you live close to Nebraska’s borders, you may find assisted living in a neighboring state is an affordable option. Two neighboring states have lower average monthly assisted living costs than Nebraska: South Dakota’s average is $3,350 per month, and Missouri’s is $3,000. Colorado, Kansas, Iowa, and Wyoming have higher average costs of assisted living at $4,750, $4,580, $4,367, and $4,169, respectively. Though Wyoming’s monthly average cost is slightly higher than Nebraska’s, it has the most comparable to Nebraska’s.
How to Pay for Assisted Living
The Department of Licensure and Regulation of the Nebraska Division of Public Health oversees Nebraska’s assisted living communities. To ensure regulatory and legal compliance, the department can make on-the-spot visits to any community and random sampling visits throughout the year. Nebraska’s Long-Term Care Ombudsman program investigates complaints against assisted living facilities, nursing homes, and other senior residential care providers. Ombudsmen also educate older adults about their rights related to long-term care and help people resolve issues concerning the quality of care.
Individuals can contact the Medicaid and Long-Term Care team of DHHS for assistance related to funding, social service, and medical support.
Under the Nebraska Administrative Code, Title 473, Chapter 6, assisted living communities must have a license from the Department of Licensure and Regulation. Communities must adhere to standards related to health, safety, and quality. Communities comply by having robust emergency procedures in place, following fire safety and food hygiene regulations, having documented operational procedures, obeying building layout and amenities requirements, adhering to staffing requirements, and training employees.
Community staff must also pass criminal background checks. Before hiring staff, communities must check against the sex offender registry, nurse aide registry, adult central registry of abuse and neglect, and the central child registry of abuse and neglect. They cannot hire anyone in a direct care position who has a negative result on the nurse aide registry. Discretion is allowed in cases of adverse findings on other registries or criminal background checks. Still, communities must clearly document their reasons for employing an individual. Where results indicate abuse, theft from residents, or exploitation, communities must also show that their hiring decision won’t pose any risk to residents.
Administrators must hold a valid hospital or nursing home license or complete 30 hours of initial training followed by 12 hours of ongoing training. Direct care staff must complete orientation training and at least 12 hours of job-specific training each year. Staff members who provide care to residents with dementia must have additional training. Only licensed health care professionals or trained medication aides can administer medications.
While there are no set staffing ratios, assisted living communities must have sufficiently trained staff available at all times to provide resident care. And at least one staff member must be on-site and awake at all times.
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.
In Nebraska, Adult Protective Services operates a hotline for reporting abuse against older adults. The State Unit on Aging, Long-Term Care Ombudsman, Office of the Attorney General, and local Area Agencies on Aging can also help people facing elder abuse, fraud, or exploitation. The Senior Medicare Patrol, administered by Nebraska SHIP, provides help related to Medicare scams, fraud, and abuse.
Nebraska’s eight Area Agencies on Aging can help older adults access free or affordable legal services. Agencies partner with Legal Aid of Nebraska to offer the Legal Assistance program. People aged 60 and over can call the Legal Aid of Nebraska’s ElderAccessLine for free civil legal advice and assistance in areas including public benefits, health insurance, debt, consumer matters, wills, powers of attorney, and advance directives.
This guide provides information about assisted living in Nebraska. It covers various options for long-term care and how much they cost, how to pay for senior care, regulation of assisted living communities, and legal resources for older adults.
The typical resident population in Nebraska's assisted living communities is 70% female. Overall, 87% of residents are ages 75 and older, with 35% of residents ages 75 to 84 and 52% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Nebraska Department of Health and Human Services, Department of Licensure and Regulation of the Division of Public Health licenses assisted living facilities in the state. Assisted living facilities (ALFs) provide shelter, food, and care to four or more residents who require or request services due to age or physical disabilities. The care that ALFs provide includes a minimum amount of supervision and assistance with personal care, activities of daily living (ADLs), health maintenance, and other supportive services.
Adult foster care is a family home that assists people who cannot live independently but can function with minimal supervision and protection. These homes can house up to three adults aged 19 or older. Their services include room and board, household supplies, and laundry service.
Resident Agreements and Disclosures
The resident agreement with residents must be based on an assessment of the abilities and care necessary for the prospective resident. The agreement specifies the rights and responsibilities of both the resident and the facility, the cost of services to be provided, and the terms of payment and conditions of continued occupancy in the facility.
The facility must provide information to residents that include a description of the services provided and the available staff to provide them, move-out criteria, and any updates to the resident services agreement. The disclosure also includes the charges for the services, whether Medicaid payments are accepted for those services, and limitations to those payments.
For any ALF that markets itself as having a special care unit for residents with dementia, including Alzheimer’s disease, a written statement of the mission and philosophy of the facility must be included. The special care unit disclosure must include admission, discharge, transfer criteria, resident assessment policies, staffing, activities, and family involvement policies.
Assisted Living Admission and Retention
In order to be admitted to an ALF, a person must either need or want to have food, shelter, assistance with ADLs, supervision, or assistance with personal care. People cannot be admitted or retained in an ALF if they have an unstable or unpredictable condition or require complex nursing care unless the following conditions are met:
- The resident physician or facility RN agrees that admission or retention is appropriate.
- The resident assumes the responsibility for arranging care through licensed third parties.
- The care for the resident does not compromise the operations of the facility or create a danger to others.
Assisted Living Services and Service Planning
ALFs may provide an array of services to their residents including assistance with personal care, ADLs, and instrumental activities of daily living (IADLs) as well as health maintenance activities. Facilities may also provide supportive services like transportation, laundry, housekeeping, behavioral management, case management, financial assistance and management, shopping, and spiritual services.
Each resident is assessed to determine the level of care they need, either from the facility or some other source. The assessment is used to develop a care plan that specifies the services required, how often and when they are required, and who will deliver the service, including any services for residents with special needs. The service plan is updated when necessary.
Residents may assume the responsibility for arranging care through a licensed home health or hospice agency.
Assisted Living Food and Dietary Provisions
ALFs in Nebraska must provide food service to residents and may offer meals for special diets as requested by residents. The meals must be appropriate for the resident’s needs and meet daily nutritional requirements. Residents must be monitored for potential nutritional deficiencies based on changes in weight.
Assisted Living Staffing Requirements
Each ALF must have an administrator responsible for the operations of the facility and must designate a substitute if they are absent. The direct care staff is responsible for helping residents with their personal care needs. Trained medication aides may administer medications, and the facility must have access to an RN to review all medication policies, procedures, and the training of medication aides.
There are no minimum staffing ratios, but the facility must maintain adequate staffing and training to support the needs of the residents according to their care plans. At least one staff member must be on-site and always awake.
Assisted Living Housing Requirements
Apartment units are not required in Nebraska. Units can either be a bedroom or a private apartment. If apartments are provided, they must include a private bathroom, a sleeping area, and a kitchen area. For facilities constructed before April 2007, a maximum of four residents are allowed per unit. One toilet and sink must be available for every six licensed beds, and one bathing facility is required for every 16 residents.
After April 2007, a maximum of two residents are permitted per unit. One toilet and sink are required for every four licensed beds, and one bathing facility must be provided for every eight residents. In new construction, one toilet room adjoining each resident’s bedroom is required.
What Is Included With Assisted Living Care In Nebraska?
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 Nebraska, 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 55% of communities providing skilled nursing. Many have health care specialists and on-site services, with 71% of communities offering dental care. In addition, 80% 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 Nebraska, 79% of communities conduct depression screenings, and 61% 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 necessary resources.
Some assisted living residents live with various medical conditions. In Nebraska, 39% have Alzheimer's disease or another form of dementia. In addition, 47% have high blood pressure, 32% have heart disease, 33% have depression, and 17% have diabetes.
State Mental Health Resources
Nebraska Department of Health and Human Services, Division of Behavioral Health Services, operates programs to support and maintain mental health. Available 24/7, the toll-free 211 Nebraska hotline provides free, confidential information about local services. Alternatively, individuals can use the live chat service during business hours, complete an online contact form, or contact via the mobile app. The nonprofit Mental Health Association of Nebraska (MHA-NE) provides peer-to-peer support for people experiencing mental health challenges. The National Alliance of Mental Health (NAMI) has a branch in Omaha.
Veterans can access programs, information, and counseling via the Nebraska Department of Veterans Affairs. The national 24-hour Veterans Crisis Line and Roger, which is part of Stop Soldier Suicide, provide crisis intervention for former members of the U.S. Armed Forces.
Medication Provisions
Residents capable of self-administering medications can do so with or without supervision by facility staff. Licensed health care professionals may administer medications as long as the scope of their practice includes medication administration. Medication aides who are trained, have demonstrated competency, and are appropriately directed and monitored are allowed to administer medications.
Medication administration policies must be reviewed and documented by an RN at least annually and must provide or oversee training of medication aides.
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 Nebraska’s assisted living facilities often receive help with their ADLs. In Nebraska, 14% of residents need help eating. Other commonly used services include bed transfer (29%), toileting (31%), and walking (50%). Caregivers in ALFs help 43% of residents dress, and 70% need help bathing.
Cost Of Assisted Living Care In Nebraska
The average cost of assisted living care in Nebraska is $4,076. This cost is $424 lower than the monthly national average of $4,500 per month. The cost of living in Nebraska is less than the national average by 6.3%, with health care costs more than the national average by 0.8% and housing costs less than the national average by 13.4%.
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 $2,906 in the Grand Island area to a high of $4,715 per month in the Lincoln area of Nebraska.
How Costs Compare In Nearby States
If you live close to Nebraska’s borders, you may find assisted living in a neighboring state is an affordable option. Two neighboring states have lower average monthly assisted living costs than Nebraska: South Dakota’s average is $3,350 per month, and Missouri’s is $3,000. Colorado, Kansas, Iowa, and Wyoming have higher average costs of assisted living at $4,750, $4,580, $4,367, and $4,169, respectively. Though Wyoming’s monthly average cost is slightly higher than Nebraska’s, it has the most comparable to Nebraska’s.
How to Pay for Assisted Living
Nebraska Assisted Living Oversight
The Department of Licensure and Regulation of the Nebraska Division of Public Health oversees Nebraska’s assisted living communities. To ensure regulatory and legal compliance, the department can make on-the-spot visits to any community and random sampling visits throughout the year. Nebraska’s Long-Term Care Ombudsman program investigates complaints against assisted living facilities, nursing homes, and other senior residential care providers. Ombudsmen also educate older adults about their rights related to long-term care and help people resolve issues concerning the quality of care.
Individuals can contact the Medicaid and Long-Term Care team of DHHS for assistance related to funding, social service, and medical support.
Quality And Safety Of Assisted Living Facilities In Nebraska
Under the Nebraska Administrative Code, Title 473, Chapter 6, assisted living communities must have a license from the Department of Licensure and Regulation. Communities must adhere to standards related to health, safety, and quality. Communities comply by having robust emergency procedures in place, following fire safety and food hygiene regulations, having documented operational procedures, obeying building layout and amenities requirements, adhering to staffing requirements, and training employees.
Community staff must also pass criminal background checks. Before hiring staff, communities must check against the sex offender registry, nurse aide registry, adult central registry of abuse and neglect, and the central child registry of abuse and neglect. They cannot hire anyone in a direct care position who has a negative result on the nurse aide registry. Discretion is allowed in cases of adverse findings on other registries or criminal background checks. Still, communities must clearly document their reasons for employing an individual. Where results indicate abuse, theft from residents, or exploitation, communities must also show that their hiring decision won’t pose any risk to residents.
Administrators must hold a valid hospital or nursing home license or complete 30 hours of initial training followed by 12 hours of ongoing training. Direct care staff must complete orientation training and at least 12 hours of job-specific training each year. Staff members who provide care to residents with dementia must have additional training. Only licensed health care professionals or trained medication aides can administer medications.
While there are no set staffing ratios, assisted living communities must have sufficiently trained staff available at all times to provide resident care. And at least one staff member must be on-site and awake at all times.
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.
In Nebraska, Adult Protective Services operates a hotline for reporting abuse against older adults. The State Unit on Aging, Long-Term Care Ombudsman, Office of the Attorney General, and local Area Agencies on Aging can also help people facing elder abuse, fraud, or exploitation. The Senior Medicare Patrol, administered by Nebraska SHIP, provides help related to Medicare scams, fraud, and abuse.
Nebraska’s eight Area Agencies on Aging can help older adults access free or affordable legal services. Agencies partner with Legal Aid of Nebraska to offer the Legal Assistance program. People aged 60 and over can call the Legal Aid of Nebraska’s ElderAccessLine for free civil legal advice and assistance in areas including public benefits, health insurance, debt, consumer matters, wills, powers of attorney, and advance directives.
