Understanding Assisted Living in Wisconsin: The Different Types
Before diving into eligibility, it's crucial to understand the types of assisted living available in Wisconsin, as requirements can differ based on the facility. The two main categories are:
- Community-Based Residential Facilities (CBRFs): These facilities house five or more unrelated adults and provide services beyond room and board. CBRFs are for individuals who need personal care but do not require complex, round-the-clock medical attention, though they can provide up to three hours of nursing care per week per resident. Residents must be able to evacuate the facility independently.
- Residential Care Apartment Complexes (RCACs): RCACs are for more independent seniors who live in private apartments with their own kitchens and bathrooms. Residents receive no more than 28 hours of supportive, personal, and nursing services per week. A key difference is that RCACs cannot admit individuals who are incapable of recognizing danger or making care decisions unless they live with a competent spouse or legal guardian.
Which facility is right for you?
The choice of facility type is directly tied to the level of care and independence a person needs. The initial assessment process will help determine which type of living arrangement is appropriate.
Meeting Functional Eligibility: The Wisconsin Functional Screen
To determine if an individual's care needs align with assisted living, Wisconsin utilizes a standardized tool called the Long-Term Care Functional Screen (LTCFS). This is a critical step, especially for those seeking public funding like Medicaid waivers.
What the screen assesses:
- Need for assistance with Activities of Daily Living (ADLs), such as bathing, dressing, and eating.
- Mobility, medication management, and cognitive abilities.
- Risk of institutionalization in a nursing home.
Experienced professionals, such as social workers or registered nurses, administer the screen. The result of the LTCFS determines an individual's functional eligibility for Wisconsin's long-term care programs. Completion of the screen is voluntary, but it's required for enrollment in public funding programs.
Navigating Financial Eligibility for Wisconsin Assisted Living
Financial qualifications for assisted living depend largely on how you plan to pay. Most residents use private funds, but several public options are available.
Private Pay
This is the most straightforward option, where residents or their families pay for costs out-of-pocket using personal savings, long-term care insurance, or a reverse mortgage. Facilities set their own rates, which can vary widely based on location, amenities, and level of care.
Public Funding: Medicaid Waivers
Wisconsin's Medicaid program provides waivers to help cover the cost of care services for eligible individuals. The most common program is Family Care.
To qualify for the Family Care program, you must:
- Be a Wisconsin resident and at least 18 years old.
- Be determined functionally eligible via the Long-Term Care Functional Screen.
- Meet the financial eligibility criteria for Medicaid, with income and asset limits. In 2025, for a single person, the asset limit is typically $2,000, and income is capped, though some exemptions apply, such as the primary residence.
Veterans' Benefits
Eligible veterans and their spouses may use benefits from the Department of Veterans Affairs, such as the Aid and Attendance benefit, to help cover assisted living expenses.
Key Admission Criteria for Wisconsin Assisted Living
Beyond the functional and financial aspects, specific criteria dictate who can be admitted.
- Health Stability: Residents must generally be in stable health. Assisted living is not suitable for those with extensive, continuous medical needs that require 24/7 skilled nursing.
- Cognitive Abilities: While many facilities have memory care units, certain levels of cognitive impairment may make an individual unsuitable for a general assisted living setting, especially in an RCAC.
- Safety and Evacuation: Residents in a CBRF must be able to evacuate independently in an emergency. This is a critical safety regulation.
- Facility Assessment: The facility itself conducts an assessment to determine if it can provide the required level of care and meet the resident's specific needs.
The Step-by-Step Application and Assessment Process
- Research Facilities: Identify potential assisted living facilities (CBRFs or RCACs) that meet your geographic and personal needs. Utilize resources like Aging and Disability Resource Centers (ADRCs).
- Contact and Tour: Reach out to facilities to ask questions, schedule tours, and discuss their specific admission criteria and payment options.
- Complete a Functional Screen (if needed): If you are seeking public funding, an ADRC can help you initiate the Long-Term Care Functional Screen.
- Undergo Facility Assessment: The facility's staff will conduct a health and physical assessment to create a customized care plan.
- Secure Financial Arrangements: Determine how the cost of care will be covered, whether through private funds, a Medicaid waiver, or other benefits.
- Sign Agreements: Finalize the resident agreement and service plan with the facility before the move-in date.
A Comparison of Wisconsin Assisted Living Facility Types
| Feature | Community-Based Residential Facility (CBRF) | Residential Care Apartment Complex (RCAC) |
|---|---|---|
| Living Space | Private or shared rooms; shared living areas. | Independent apartments with kitchens and lockable entrances. |
| Services Included | Room and board, supervision, support services. | Supportive, personal, and nursing services. |
| Maximum Care Hours | Up to 3 hours of nursing care per week. | Up to 28 hours of care per week. |
| Independence Level | Lower independence; for those needing more hands-on assistance. | Higher independence; for those needing only occasional support. |
| Medicaid Eligibility | Some certified CBRFs accept Medicaid waivers. | Certified RCACs can accept Medicaid waivers. |
Conclusion: Making an Informed Decision
Qualifying for assisted living in Wisconsin is a multi-step process that involves a blend of functional and financial criteria, as well as an assessment by the facility itself. By understanding the distinction between CBRFs and RCACs, navigating the state's Long-Term Care Functional Screen, and evaluating financial options, families can find the right fit. It's a journey best taken with careful research and consultation with resources like your local ADRC or the Wisconsin Department of Health Services to ensure the best possible care for your loved one.
