Vermont Assisted Living
Older adults looking for rest and relaxation surrounded by beautiful landscapes away from the hustle and bustle of city life may be able to overlook the high cost of living for Vermont residents. With options to qualify for a tax exemption on Social Security payments and additional credits for those who rely on taxable income, the state offers options to assist people with their financial burdens. Those considering Vermont for their ideal assisted living communities can gain insight from the following information on the price of available options, state laws and regulations that govern these communities, and additional resources available.
The typical resident population in Vermont's assisted living communities is 74% female. Overall, 78% of residents are ages 75 and older, with 32% of residents ages 75 to 84 and 46% ages 85 and older.
Two settings are licensed to provide housing, meals, and supportive services to adults who are unable to live independently but do not require the care provided in nursing homes.
Residential care homes (RCH) serve three or more residents and are licensed as Level 3 or Level 4. Both levels provide room and board, assistance with personal care, general supervision, and medication management. Level 3 homes must provide a nursing overview to their residents.
Assisted living residences (ALRs) combine housing, health, and other services to support seniors, including aging in place. ALRs are required to offer private bedrooms, private bathrooms, living space, kitchen capacity, and a lockable door. ALRs must provide the same level of care as a Level 3 RCH.
ALR resident agreements must include the residential unit's occupancy terms and information regarding utilities, maintenance, and management services provided by the facility. In some instances, a separate lease agreement for the resident unit could be required. Information regarding payment for services, transfer, and discharge policies is required.
ALRs must disclose to residents the services the facility will provide, public programs or benefits it accepts, and the policies that can affect a resident’s ability to remain in the residence. The disclosure must also include information about the service packages, tiers, rates, and reasons for rate increases. Any facility that has a special dementia care program must provide a statement regarding the program’s philosophy and mission and how the facility can meet the needs of these residents.
RCH agreements must be provided to potential residents or their legal representatives. The agreement describes the rate to be charged, the time frame (daily, weekly, or monthly), the services included with the rate, and all applicable financial issues relating to payment and cancellation. The agreement must also specify how services are to be provided.
ALRs are permitted to admit or retain residents that meet the requirements for nursing home-level care if the facility is able to meet the needs of the individual safely. Residents are permitted to age in place if one staff person in the ALR can meet their mobility, ambulation, and transfer needs, cognitive impairment is at a moderate or lower degree of severity, and behavioral symptoms consistently respond to appropriate intervention. Residents can be involuntarily discharged if they pose a serious threat to themselves, staff, or other residents or if the resident has care needs that exceed the ALRs ability to meet those needs.
RCHs may not admit or retain a resident that meets the eligibility criteria for nursing home admission, has care needs that exceed the ability of the facility to meet those needs, or has a serious, acute illness that requires medical, surgical, or nursing care of a general or special hospital. When admitted, a resident must provide a medical diagnosis from a physician, including a psychiatric diagnosis if necessary.
The following services are not permitted in an RCH: intravenous therapy, ventilators or respirators, daily catheter irrigation, feeding tubes, or Stage 3 or 4 decubitus ulcers. Residents may be discharged if their care needs exceed those that the facility is licensed to provide.
ALRs must provide personal care and supportive services, which could include nursing services. The facility must also provide a daily activity and socialization program, social services such as hospice, home health, transportation, and other services necessary to support aging in place.
The resident, facility, and legal representative work together to develop and maintain a resident care plan that describes the assessed needs and choices of the resident. The plan must be reviewed annually and when the resident’s condition changes.
ALR residents have the right to arrange for third-party services that are not available at the facility.
RCHs provide personal care, medication management, and transportation for medical services, local community functions, laundry, and nursing overview in Level 3 homes.
An assessment must be completed for each resident in RCHs within 14 days of admission. The resident's ability regarding medication management must be assessed within 24 hours.
RCHs must provide three balanced meals a day. Residents must be provided alternatives to the planned meal upon request and offered snacks between meals and at bedtime. No more than 14 hours may lapse between the end of the evening meal and the morning meal. Therapeutic meals must be provided if a physician orders them.
ALRs must provide three meals daily and snacks but may allow residents to purchase fewer meals. ALRs must also follow RCH food and dietary provisions.
ALRs and RCHs must employ a manager who works at the facility at least 32 hours per week and is responsible for the day-to-day management and supervision of employees and residents.
The home/residence must have an RN on staff or under contract to provide any required nursing services and delegate nursing care to qualified staff. Any home/residence that provides Medicaid services must designate a staff person that is responsible for case management services.
There are no minimum staff ratios required as long as the home/residence has sufficient personnel to provide the necessary care to their residents, maintain a safe and healthy environment, and ensure prompt and appropriate action in case of injury, illness, fire, or some other emergency.
ALRs must provide private occupancy units unless a resident voluntarily chooses to share the unit. All units must include a private bathroom, private bedroom, living space, and kitchenette, adequate storage, a lockable door, and individual temperature controls, and must be equipped with an emergency response system to alert on-duty staff. Kitchenettes must include food prep and storage areas, cabinets, counter space, a refrigerator with a freezer, a sink with hot and cold running water, and a stove or microwave that can be removed or disconnected.
ALRs must have an accessible common dining space outside of residential units to accommodate residents, and there must be at least one public restroom that is convenient to the common areas.
RCHs must offer single- or double-occupancy rooms; a minimum of one bathing unit, toilet, and sink must be available for every eight residents on each floor.
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 Vermont, 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 81% of communities providing skilled nursing. Many have health care specialists and on-site services, with 75% of communities offering dental care. In addition, 68% 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 Vermont, 82% of communities conduct depression screenings, and 59% offer mental health counseling. Social work programs are also found in 64% 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 Vermont, 50% have Alzheimer's disease or another form of dementia. In addition, 55% have high blood pressure, 47% have heart disease, 46% have depression, and 21% have diabetes.
The state's Department of Mental Health within the Agency of Human Services oversees the administration of several mental health programs available to all adult Vermont residents. These services include evaluations, counseling and therapy, emergency mental health interventions, and hospitalization options when necessary. People who wish to access these programs need to contact their local Designated Agency and complete an assessment with an intake coordinator. From there, the coordinator assists in selecting the appropriate services based on needs and eligibility. Additional resources are available through the Vermont branch of the National Alliance on Mental Illness. The program's website maintains a current list of state and national crisis lines and a resource guidebook covering relevant Vermont services. Those who served in the military may also be eligible for mental health care programs and services through the state's Office of Veteran's Affairs.
The facility manager of both RCHs and ALRs is responsible that medications are handled according to the policies of the home and that designated staff are fully trained in medication policies and procedures.
Residents who are capable of medication self-administration may purchase and self-administer over-the-counter medications. The facility must make reasonable efforts to monitor and educate residents about reactions or interactions with other medications.
If a resident requires medication administration, unlicensed staff may administer medications if
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 Vermont’s assisted living facilities often receive help with their ADLs. In Vermont, 19% of residents need help eating. Other commonly used services include bed transfer (25%), toileting (37%), and walking (47%). Caregivers in ALFs help 48% of residents dress, and 64% need help bathing.
The average cost of assisted living care in Vermont is $5,250. This is $750 higher than the monthly national average of $4,500. The cost of living in Vermont is more than the national average by 17.0%, with health care costs less than the national average by 0.7% and housing costs more than the national average by 36.2%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges can be as high as $6,371, the average cost in Burlington.
If you live close to one of Vermont’s borders, you may find assisted living in a neighboring state is an affordable option. If you live near the border with New York, you may be able to find less expensive assisted living as the average cost in the state is $4,580 per month. The average cost in New Hampshire and Massachusetts is considerably higher than in Vermont at $6,053 and $6,500, respectively.
How to Pay for Assisted Living
Vermont assisted living communities receive their licensing and certifications through the Division of Licensing and Protection. This department is also responsible for managing Adult Protective Services, the agency that handles reports of suspected fraud, abuse, and exploitation of older adults in the state. People can find additional assistance through the State Long-Term Care Ombudsman Program, which investigates and resolves senior abuse, fraud, and exploitation complaints within residential care communities.
The Division of Licensing and Protection of the Agency of Human Services Department of Aging and Disabilities handles quality and safety regulations of Vermont assisted living communities. Licensed communities must develop a quality improvement program for a quality improvement committee to maintain that identifies quality issues and their solutions. This committee includes the community director, a licensed registered nurse, another staff member involved with direct care, and at least one resident. It may consist of other members as needed. The committee expects to meet quarterly and must be accessible to residents who may have grievances.
To help ensure the safety of residents, communities must check all outside vendors and providers not employed by a certified agency against the Vermont criminal and abuse registries. Any resident who poses a threat to other residents may be subject to an involuntary discharge, and all direct care employees of the community are required to complete Alzheimer's and dementia communication training.
Older adults are often primary targets for scams, abuse, exploitation, and medical and financial fraud. To help protect them and their families from these campaigns, Vermont Legal Aid provides 24/7 access to information on relevant legal topics and hosts a virtual advice clinic through scheduled 20-minute phone consultations. It encourages Vermont residents over age 60 to reach out for answers to their civil legal questions regarding topics that include health care, housing, consumer debt, and social security.
Legal Aid also offers the Elder Law Project for people who require more substantial legal assistance. Within the scope of two programs, the Medicare Advocacy Project (MAP) and the Senior Citizens Law Project (SCLP), counsel is available to advise on legal issues, review and prepare legal documents, advocate for eligible individuals, and provide full legal representation when necessary. It splits the program's qualifying legal subjects as follows:
The typical resident population in Vermont's assisted living communities is 74% female. Overall, 78% of residents are ages 75 and older, with 32% of residents ages 75 to 84 and 46% ages 85 and older.
Assisted Living Facility (ALF) Definitions
Two settings are licensed to provide housing, meals, and supportive services to adults who are unable to live independently but do not require the care provided in nursing homes.
Residential care homes (RCH) serve three or more residents and are licensed as Level 3 or Level 4. Both levels provide room and board, assistance with personal care, general supervision, and medication management. Level 3 homes must provide a nursing overview to their residents.
Assisted living residences (ALRs) combine housing, health, and other services to support seniors, including aging in place. ALRs are required to offer private bedrooms, private bathrooms, living space, kitchen capacity, and a lockable door. ALRs must provide the same level of care as a Level 3 RCH.
Resident Agreements and Disclosures
ALR resident agreements must include the residential unit's occupancy terms and information regarding utilities, maintenance, and management services provided by the facility. In some instances, a separate lease agreement for the resident unit could be required. Information regarding payment for services, transfer, and discharge policies is required.
ALRs must disclose to residents the services the facility will provide, public programs or benefits it accepts, and the policies that can affect a resident’s ability to remain in the residence. The disclosure must also include information about the service packages, tiers, rates, and reasons for rate increases. Any facility that has a special dementia care program must provide a statement regarding the program’s philosophy and mission and how the facility can meet the needs of these residents.
RCH agreements must be provided to potential residents or their legal representatives. The agreement describes the rate to be charged, the time frame (daily, weekly, or monthly), the services included with the rate, and all applicable financial issues relating to payment and cancellation. The agreement must also specify how services are to be provided.
Assisted Living Admission and Retention
ALRs are permitted to admit or retain residents that meet the requirements for nursing home-level care if the facility is able to meet the needs of the individual safely. Residents are permitted to age in place if one staff person in the ALR can meet their mobility, ambulation, and transfer needs, cognitive impairment is at a moderate or lower degree of severity, and behavioral symptoms consistently respond to appropriate intervention. Residents can be involuntarily discharged if they pose a serious threat to themselves, staff, or other residents or if the resident has care needs that exceed the ALRs ability to meet those needs.
RCHs may not admit or retain a resident that meets the eligibility criteria for nursing home admission, has care needs that exceed the ability of the facility to meet those needs, or has a serious, acute illness that requires medical, surgical, or nursing care of a general or special hospital. When admitted, a resident must provide a medical diagnosis from a physician, including a psychiatric diagnosis if necessary.
The following services are not permitted in an RCH: intravenous therapy, ventilators or respirators, daily catheter irrigation, feeding tubes, or Stage 3 or 4 decubitus ulcers. Residents may be discharged if their care needs exceed those that the facility is licensed to provide.
Assisted Living Services and Service Planning
ALRs must provide personal care and supportive services, which could include nursing services. The facility must also provide a daily activity and socialization program, social services such as hospice, home health, transportation, and other services necessary to support aging in place.
The resident, facility, and legal representative work together to develop and maintain a resident care plan that describes the assessed needs and choices of the resident. The plan must be reviewed annually and when the resident’s condition changes.
ALR residents have the right to arrange for third-party services that are not available at the facility.
RCHs provide personal care, medication management, and transportation for medical services, local community functions, laundry, and nursing overview in Level 3 homes.
An assessment must be completed for each resident in RCHs within 14 days of admission. The resident's ability regarding medication management must be assessed within 24 hours.
Assisted Living Food and Dietary Provisions
RCHs must provide three balanced meals a day. Residents must be provided alternatives to the planned meal upon request and offered snacks between meals and at bedtime. No more than 14 hours may lapse between the end of the evening meal and the morning meal. Therapeutic meals must be provided if a physician orders them.
ALRs must provide three meals daily and snacks but may allow residents to purchase fewer meals. ALRs must also follow RCH food and dietary provisions.
Assisted Living Staffing Requirements
ALRs and RCHs must employ a manager who works at the facility at least 32 hours per week and is responsible for the day-to-day management and supervision of employees and residents.
The home/residence must have an RN on staff or under contract to provide any required nursing services and delegate nursing care to qualified staff. Any home/residence that provides Medicaid services must designate a staff person that is responsible for case management services.
There are no minimum staff ratios required as long as the home/residence has sufficient personnel to provide the necessary care to their residents, maintain a safe and healthy environment, and ensure prompt and appropriate action in case of injury, illness, fire, or some other emergency.
Assisted Living Housing Requirements
ALRs must provide private occupancy units unless a resident voluntarily chooses to share the unit. All units must include a private bathroom, private bedroom, living space, and kitchenette, adequate storage, a lockable door, and individual temperature controls, and must be equipped with an emergency response system to alert on-duty staff. Kitchenettes must include food prep and storage areas, cabinets, counter space, a refrigerator with a freezer, a sink with hot and cold running water, and a stove or microwave that can be removed or disconnected.
ALRs must have an accessible common dining space outside of residential units to accommodate residents, and there must be at least one public restroom that is convenient to the common areas.
RCHs must offer single- or double-occupancy rooms; a minimum of one bathing unit, toilet, and sink must be available for every eight residents on each floor.
What Is Included With Assisted Living Care In Vermont?
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 Vermont, 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 81% of communities providing skilled nursing. Many have health care specialists and on-site services, with 75% of communities offering dental care. In addition, 68% 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 Vermont, 82% of communities conduct depression screenings, and 59% offer mental health counseling. Social work programs are also found in 64% 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 Vermont, 50% have Alzheimer's disease or another form of dementia. In addition, 55% have high blood pressure, 47% have heart disease, 46% have depression, and 21% have diabetes.
State Mental Health Resources
The state's Department of Mental Health within the Agency of Human Services oversees the administration of several mental health programs available to all adult Vermont residents. These services include evaluations, counseling and therapy, emergency mental health interventions, and hospitalization options when necessary. People who wish to access these programs need to contact their local Designated Agency and complete an assessment with an intake coordinator. From there, the coordinator assists in selecting the appropriate services based on needs and eligibility. Additional resources are available through the Vermont branch of the National Alliance on Mental Illness. The program's website maintains a current list of state and national crisis lines and a resource guidebook covering relevant Vermont services. Those who served in the military may also be eligible for mental health care programs and services through the state's Office of Veteran's Affairs.
Medication Provisions
The facility manager of both RCHs and ALRs is responsible that medications are handled according to the policies of the home and that designated staff are fully trained in medication policies and procedures.
Residents who are capable of medication self-administration may purchase and self-administer over-the-counter medications. The facility must make reasonable efforts to monitor and educate residents about reactions or interactions with other medications.
If a resident requires medication administration, unlicensed staff may administer medications if
- An RN delegates responsibility for the administration of specific medications to designated staff.
- The RN responsible, teaches designated staff proper techniques for medication administration.
- The RN establishes a routine communication process with staff on resident conditions.
- The RN monitors and evaluates the designated staff's performance.
- All medications must be administered by the person who prepared the doses.
- Psychoactive medications can be administered by non-nursing staff when the home has a written plan for their use.
- Non-nursing staff can administer insulin injections when the resident’s diabetic condition is stable, the designated staff has received additional training, the RN monitors the resident’s condition regularly.
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 Vermont’s assisted living facilities often receive help with their ADLs. In Vermont, 19% of residents need help eating. Other commonly used services include bed transfer (25%), toileting (37%), and walking (47%). Caregivers in ALFs help 48% of residents dress, and 64% need help bathing.
Cost Of Assisted Living Care In Vermont
The average cost of assisted living care in Vermont is $5,250. This is $750 higher than the monthly national average of $4,500. The cost of living in Vermont is more than the national average by 17.0%, with health care costs less than the national average by 0.7% and housing costs more than the national average by 36.2%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges can be as high as $6,371, the average cost in Burlington.
How Costs Compare In Nearby States
If you live close to one of Vermont’s borders, you may find assisted living in a neighboring state is an affordable option. If you live near the border with New York, you may be able to find less expensive assisted living as the average cost in the state is $4,580 per month. The average cost in New Hampshire and Massachusetts is considerably higher than in Vermont at $6,053 and $6,500, respectively.
How to Pay for Assisted Living
Vermont Assisted Living Oversight
Vermont assisted living communities receive their licensing and certifications through the Division of Licensing and Protection. This department is also responsible for managing Adult Protective Services, the agency that handles reports of suspected fraud, abuse, and exploitation of older adults in the state. People can find additional assistance through the State Long-Term Care Ombudsman Program, which investigates and resolves senior abuse, fraud, and exploitation complaints within residential care communities.
Quality and Safety of Assisted Living Facilities in Vermont
The Division of Licensing and Protection of the Agency of Human Services Department of Aging and Disabilities handles quality and safety regulations of Vermont assisted living communities. Licensed communities must develop a quality improvement program for a quality improvement committee to maintain that identifies quality issues and their solutions. This committee includes the community director, a licensed registered nurse, another staff member involved with direct care, and at least one resident. It may consist of other members as needed. The committee expects to meet quarterly and must be accessible to residents who may have grievances.
To help ensure the safety of residents, communities must check all outside vendors and providers not employed by a certified agency against the Vermont criminal and abuse registries. Any resident who poses a threat to other residents may be subject to an involuntary discharge, and all direct care employees of the community are required to complete Alzheimer's and dementia communication training.
Legal Resources
Older adults are often primary targets for scams, abuse, exploitation, and medical and financial fraud. To help protect them and their families from these campaigns, Vermont Legal Aid provides 24/7 access to information on relevant legal topics and hosts a virtual advice clinic through scheduled 20-minute phone consultations. It encourages Vermont residents over age 60 to reach out for answers to their civil legal questions regarding topics that include health care, housing, consumer debt, and social security.
Legal Aid also offers the Elder Law Project for people who require more substantial legal assistance. Within the scope of two programs, the Medicare Advocacy Project (MAP) and the Senior Citizens Law Project (SCLP), counsel is available to advise on legal issues, review and prepare legal documents, advocate for eligible individuals, and provide full legal representation when necessary. It splits the program's qualifying legal subjects as follows:
- Legal Aid developed MAP to work with older adults who are beneficiaries of Medicare and Medicaid. The primary focus is to hold Medicare accountable by assisting in appeals cases regarding care and service decisions, such as nursing care, home health services, prescription coverage, and durable medical equipment coverage.
- SCLP covers most civil legal topics outside of Medicare and Medicaid. People can request assistance with cases involving housing, general health care, guardianship, and government benefits. This program also interacts with the legislature to advocate for the improvement of the policies that shape the lives of older adults in Vermont.
