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Assisted Living in Iowa
Iowa has long been known as a senior-friendly state, so it’s easy to see why it ranked 7th on our 2024 Senior Living Report. Between the relatively low median assisted living rates and the lack of state income tax on Social Security benefits, the Hawkeye State is ideal for retirees looking for a welcoming, affordable place to settle down.
Iowa is home to just under 3.2 million people, and seniors aged 65 and older make up about 17.5% of the state’s population. Not only does Iowa lead the nation in corn and pork production, but it also has excellent health care facilities. The University of Iowa Hospitals and Clinics are nationally ranked in four specialties including cancer care, and MercyOne in Des Moines offers comprehensive cardiac, neurological and outpatient services.
This guide provides an overview of assisted living in Iowa, including the average care costs and information on financial aid programs for seniors who require long-term care. We also summarized Iowa’s assisted living regulations, and included a number of free resources for seniors, such as legal services and veterans’ aid programs.
The Cost of Assisted Living in Iowa
When trying to decide how to pay for assisted living, one of the first questions that comes up is "How much does it cost?" With the impact of inflation, it's more important than ever to have up-to-date information when making a financial plan for senior living. To help shed light on real senior living prices, Caring.com has compiled proprietary cost data from its network of over 75,000 senior living providers to offer insight into the average cost of assisted living in Iowa and its 25 cities.
The Genworth 2021 Cost of Care Survey shows that the statewide average rate for assisted living care in Iowa is $4,367, which is just below the nationwide median of $4,500. Monthly rates in neighboring states range from just $3,000 in Missouri to $4,508 in Minnesota. The average cost is $4,076 in Nebraska, and $4,488 per month in Illinois.
The Cost of Assisted Living in Iowa's Top Cities
The average cost of assisted living in Iowa is $4,879, but prices vary dramatically between cities. In Fredericksburg, communities charge as little as $2,669 for assisted living, while in Norwalk, typical fees are around $4,100 per month. In Ankeny, assisted living fees average around $5,112, while the cost is far higher in Denison, with communities charging as much as $6,900 monthly.
Iowa
$4,879
Fredericksburg
$2,669
Denison
$6,900
Ankeny
$5,112
Norwalk
$4,100
Inflation's Impact on the Cost of Assisted Living in Iowa
Between 2022 and 2024, inflation has driven up Iowa's assisted living cost by 4.9%. Compared to the US average increase of 17.9%, this is a relatively small increase. However, in nearby Missouri, assisted living prices have actually fallen by 3% over the same period. Seniors in other neighboring states are less fortunate, with fees having increased by 4.8% in South Dakota, 7% in Illinois and over 31% in Wisconsin.
| Location | 2022 Cost (Historical) | 2023 Cost (Current) | 2024 Cost (Estimated) |
|---|---|---|---|
| Iowa | $4,770 | $4,879 | $5,006 |
| U.S. Average | $4,070 | $4,459 | $4,802 |
| Wisconsin | $4,269 | $4,992 | $5,606 |
| Missouri | $4,488 | $4,217 | $4,318 |
| Illinois | $4,959 | $4,742 | $5,313 |
| South Dakota | $4,514 | $4,443 | $4,732 |
The Costs of Other Types of Senior Living
Seniors who do not require help with the activities of daily living may find independent living communities more suitable for their needs, and these communities charge far less for accommodation, typically costing $2,483 per month, compared to $4,879 for assisted living. Memory care communities cost around $5,914 but offer additional supervision and care for those who are living with the effects of dementia.
Assisted Living
$4,879
Memory Care
$5,914
Independent Living
$2,483
Does Medicaid Cover Assisted Living in Iowa?
Iowa’s Medicaid program doesn’t cover assisted living services directly, but instead offers the Elderly Waiver, a Home and Community Based Services Waiver. Enrollment in this waiver program is capped, so Medicaid beneficiaries who meet the enrollment criteria can expect to be placed on a waitlist for services. It’s also important to note that services funded through this waiver must be provided in an approved assisted living facility.
What Assisted Living Services Are Covered by Medicaid in Iowa?
Iowa’s Medicaid program only covers assisted living services through the Elderly Services Waiver. Assisted living residents who aren’t enrolled in this waiver qualify for all standard Medicaid-funded benefits, including:
- Occupational, speech and physical therapy
- Home health care
- Primary physician services
- Hearing services
- Hospice care
- Transportation to Medicaid-funded appointments and programs
Assisted Living Waiver Programs in Iowa
Iowa’s Elderly Services Waiver, also known as HCBS Elderly, funds non medical and medical services for Medicaid beneficiaries who are at risk of placement in a nursing home. Waiver services are assigned based on the needs of each beneficiary, and may include:
- Assisted living care
- Adult day health care
- Case management
- Emergency response device
- Home-delivered meals
- Home health aide and skilled nursing services
- Homemaker and companion services
- Nonemergency medical transportation
- Mental health counseling
- Home accessibility modifications and assistive devices
To qualify for enrollment in the HCBS Elderly Services Waiver, seniors must:
- Be aged 65 or older
- Be an Iowa resident and either a U.S. citizen or legal resident
- Be assessed by Iowa’s Medical Services Unit as needing the level of care normally provided in a nursing home
- Meet the financial eligibility requirements for Medicaid benefits
How To Know If You’re Eligible for Medicaid in Iowa
In Iowa, individuals who are qualified to receive Supplemental Security Income (SSI) benefits are automatically eligible for Medicaid. Those aged 65 and older who don’t qualify for SSI must be approved by the Iowa Department of Human Services.
All Medicaid applicants must:
- Be at least 65 years of age, or
- Be blind or meet Medicaid’s permanent disability criteria, and
- Meet current income and asset limits that are adjusted on an annual basis
As of 2023, single applicants can earn a maximum pre-tax annual income of $32,904 and have no more than $2,000 in countable assets. Couples who are both applying may earn up to $65,808 combined and have up to $3,000 in assets. If only one spouse applies, the maximum income remains the same, and the applicant can have $2,000 in assets. The non-applicant may be entitled to a portion of the applicant’s income as a minimum monthly maintenance needs allowance. They may also be able to keep up to $148,620 in jointly owned assets.
| Household Size | Number of Applicants | Income Limits Per Year | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | $32,904 | $2,000 | |
| Two People | 1 | $32,904* | $2,000 | $148,620 |
| Two People | 2 | $65,808** | $3,000*** |
*Income limit is for applicant only.
**Income is limited to $2,742 per month per spouse.
***After six months of Medicaid eligibility, the rules for married couples change. They can then can choose to be considered as single applicants, which would change the asset limit to $2,000 each spouse.
How To Apply for Medicaid in Iowa
Individuals can apply for Medicaid using the digital DHS Services Portal. Alternatively, applicants can call Iowa Medicaid Member Services at (800) 338-8366 to request a paper application.
Information You Will Need
In order to apply for Medicaid, seniors must provide the following:
- Government-issued proof of age
- Verification of residency in Iowa
- Proof of being either a U.S. citizen or national; a legal permanent resident or a qualified alien
- Current statements from all bank accounts, investments and sources of income, including government benefits and wages
- Documentation related to all insurance policies held by the applicant, including life insurance and Medicare
- Social Security number
How To Get Help Applying for Medicaid
Seniors who need help completing their Medicaid application and navigating their health insurance options can contact one of the following resources for assistance.
| Program | Contact | Services provided |
|---|---|---|
| Managed Care Ombudsman Program | (866) 236-1430 | The Managed Care Ombudsman Program advocates for Medicaid managed care members and applicants who reside in long-term care facilities. Seniors who need information about managed care services, have complaints about their Medicaid-funded care or have been declined coverage can contact the ombudsman program for assistance. |
| Department of Human Services Appeals Section | (515) 281-3094 | Individuals who wish to appeal a decision made by Iowa's Department of Human Services can request a hearing adjudicated by an administrative law judge through the Appeals Section. There's no cost to file an appeal. |
| Area Agency on Aging | (866) 468-7887 | Iowa seniors can access free health insurance counseling services through their local Area Agency on Aging. The state has six AAAs serving specific regions of the state. Seniors can locate the AAA serving their area through the Iowa Department of Aging website, or by calling the Department's toll-free number. |
Does Medicare Cover Assisted Living in Iowa?
The short answer is that no, Medicare does not cover the cost of assisted living in Iowa. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Iowa.
Paying for Assisted Living Facilities in Iowa
Medicaid is a joint state and federal program that provides health coverage for low-income seniors. Medicaid pays for nursing home care, but for those who prefer to live in an assisted living facility, Medicaid sometimes pays for assisted living if the care can be acquired at a lower cost than in a nursing home. This is done through the Medicaid 1915 (c) Elderly Waiver program.
To be eligible, applicants must:
- Be at least 65 years old
- Resident of Iowa
- Citizen of the United States
- Be determined by the Iowa Medicaid Enterprise to need nursing or skilled nursing level of care.
There are also income and asset limits that must be met.
To learn more about eligibility requirements, a senior should contact their county's Iowa Department of Human Services office.
Other Financial Assistance Options for Assisted Living in Iowa
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
| Name | How to Apply | How It Works |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in Iowa
There are many resources in Iowa that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Department on Aging | 866-468-7887 | Across Iowa, six Area Agencies on Aging provide supportive services for older adults to improve their overall quality of life. These agencies can connect seniors with local transportation services, nutritional programs, community support groups and other local aid. Additionally, low-income seniors can benefit from a variety of cost-saving programs, including home weatherization, heating and cooling bill support and help paying for medical care. AAAs also advocate for senior wellness by intervening in suspected cases of Medicare fraud or abuse. |
Cash Assistance Programs
Cash assistance programs in Iowa provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help Iowa seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Department on Aging Meal Services | 866-468-7887 | The Iowa Department on Aging provides comprehensive meal services and nutrition resources for senior citizens in Iowa — focusing on health, well-being and socialization. Services include meal programs for those aged 60 or older, nutrition counseling with registered dietitians and nutritional education resources. It partners with local food establishments through The Iowa Cafe program to offer services more efficiently. |
| Iowa Meals on Wheels | Iowa Meals on Wheels offers hot, home-delivered meals to seniors aged 60 and older and military veterans of all ages. Eligible seniors must have difficulty shopping or preparing food on their own. Volunteers deliver nutritious, ready-to-eat meals Monday through Friday, with three menu options available. Seniors who meet income eligibility guidelines qualify for free meals. Otherwise, meals are available for purchase. | |
| Iowa Supplemental Nutrition Assistance Program (SNAP) | 800-972-2017 | The Iowa Supplemental Nutrition Program offers food benefits for individuals who need additional funds to purchase food. Many seniors in the state qualify for SNAP, and they can apply online through the Health and Human Services website. Through SNAP, seniors can supplement their food budgets to add more healthy foods to their diets. |
Financial Assistance for Senior Care and Senior Living
Whether living in their own home or in a senior living community, Iowa seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Home and Community-Based Services (HCBS) Elderly Waiver | 800-338-8366 | Seniors requiring nursing home care and can safely remain in their own homes, or in an assisted living community, can apply for the Home and Community-Based Services (HCBS) Elderly Waiver. The level of financial assistance provided is decided on an individual basis. Beneficiaries take an annual assessment that determines the required coverage and level of services. Coverage may include assistance with paying the costs associated with assisted living, adult day care, home health aides, emergency response systems and home-delivered meals. |
Free Used Medical Equipment
Due to the high cost of purchasing new medical equipment, several organizations in Iowa collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.
| Program Name | Phone Number | Description |
|---|---|---|
| Habitat for Humanity Quad Cities | 563-349-7339 | Habitat for Humanity Quad Cities sells donated medical equipment at affordable prices. All equipment is new or lightly used and inspected for safety. |
| Iowa Easterseals | 866-866-8782 | DME is loaned for a nominal charge and can be used for any length of time. The organization also manages the Iowa Assistive Technology Exchange Program. The website connects seniors with providers across Iowa who have equipment available for loan or sale. |
| Iowa Exceptional Persons, Inc. | 319-232-6671 | EPI offers free loans on a variety of used medical equipment to seniors. Equipment, such as crutches, walkers, bath chairs and commodes, can be borrowed for any length of time. |
Home Repair and Modifications
Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in Iowa have different eligibility criteria and often assist retirees by providing grants or loans.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Rural Development State Office | 515-284-4663 | The program provides grants of up to $10,000 which older adults can use to remove health and safety hazards from their property. Seniors can visit the U.S. Department of Agriculture website to check if their home is eligible for the program. |
Legal Resources
Many organizations offer free or low-cost legal services to Iowa seniors. Older adults can access advice on issues such as estate planning, living wills and power of attorney. Some firms also act as long-term care ombudsmen, advocating for the rights of seniors in senior living communities.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Long-Term Care Ombudsman Program | The Long-Term Care Ombudsman program protects seniors against abuse and neglect in assisted living and other care facilities. Seniors can reach out to request intervention if they suspect abuse. The ombudsman works with the senior and the facility to resolve the concern and ensure adequate care. | |
| Iowa Office of the Public Guardian | 515-725-3333 | Iowa seniors who can't make their own legal, financial or health care decisions may be assisted by a guardian through the Office of the Public Guardian. To qualify for these services, a senior must be unable to pay for a substitute decision-maker, and/or have no suitable relative or other responsible individual who can act on their behalf. |
| Iowa Office of the State Long-Term Care Ombudsman | 641-420-9850 | The Long-Term Care Ombudsman is an advocate for the rights of seniors in residential care communities. Financed by the state, the ombudsman doesn't charge for its services, which include investigating complaints about facilities by their residents, or their families, and third parties. The ombudsman pursues solutions with care providers on behalf of residents and doesn't charge for any of its services. Additional services include providing copies of inspection reports to families comparing memory care communities for their loved ones. |
Senior Centers
Senior centers in Iowa bring together residents through recreational activities and events. Many also offer advice and support on senior issues, run wellness and nutrition programs, and connect older adults with other resources in the local area.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa 211 | An initiative of the United Way, 211 Iowa is an information and referral service that can help connect seniors and caregivers with resources in their communities. Individuals can call the organization to speak with trained experts who can provide information and help direct them to services that suit their individual needs and circumstances. The service is free, confidential and available 24/7. | |
| Iowa Care Planning Council | 800-989-8137 | The Iowa Care Planning Council is organized by the National Care Planning Council, a nationwide nonprofit organization that provides comprehensive information on issues that affect older adults. Through this resource, seniors can find information on paying for memory care services, including taking out reverse mortgage loans, applying for veterans' benefits and purchasing long-term care insurance. The council also has an updated list of memory care facilities in Iowa. |
Senior Engagement
Senior engagement resources and programs in Iowa help older adults remain active and ensure they contribute to the community. Resources include wellness programs, volunteer opportunities, support groups and organizations that help residents connect with the community to live fulfilling lives.
| Program Name | Phone Number | Description |
|---|---|---|
| Alzheimer's Association Greater Iowa Chapter | 515-440-2722 | The Greater Iowa Chapter of the Alzheimer's Association provides localized support for seniors dealing with cognitive decline and families caring for those with dementia. Help comes in several forms, such as support groups facilitated by trained association members that enable seniors with Alzheimer's to converse with others with the condition and for caregivers to build collective strength with other Waterloo residents caring for their loved ones. There are also care consultations, where counselors help seniors and their families develop road maps for care that prepare for a life with Alzheimer's. |
Social Security Offices
Social Security offices in Iowa help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several Iowa resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Homestead Tax Credit and Exemption | 800-367-3388 | Homeowners aged 65 and older who meet certain financial criteria can make a claim for tax relief under the state's Homestead tax laws. Iowa seniors who live in rental properties could be entitled to rent reimbursement. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. Iowa retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa Low Income Home Energy Assistance Program (LIHEAP) | 515-242-5655 | The Low Income Home Energy Assistance Program (LIHEAP) helps low-income seniors pay their home energy bills. This federally-funded program provides a one-off payment toward a resident's residential heating utility. |
Veteran's Services
Iowa retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| Iowa VA Benefits and Health Care | Iowa VA Benefits and Health Care helps ensure Iowa's senior veterans receive the care and benefits they've earned. With services ranging from health care and pension programs to disability benefits and housing assistance, veterans' needs are catered to accordingly. For veterans to be eligible for these programs, they need appropriate service records and Iowa residency requirements. To further show its commitment to Iowa's senior veterans, the organization offers dignified burials. |
Assisted Living Laws and Regulations in Iowa
Assisted living facilities in Iowa must comply with state rules and regulations related to staffing, services and facility maintenance. Staff members from Iowa’s Department of Inspections and Appeals conduct regular and surprise inspections of licensed facilities throughout the state.
| Topic | Rule |
|---|---|
| Assisted Living Service Plan Requirements | Assisted living facilities must assess each resident's physical and cognitive functioning on a regular basis in collaboration with the resident and their care team, and develop personalized service plans based on these assessments. In some cases, a legal risk management agreement is negotiated between the facility and the resident. This states that the resident or responsible person shares responsibility with the facility to identify changes in care needs. |
| Assisted Living Admission Requirements | Assisted living facilities may admit and retain residents who require assistance with three or fewer activities of daily living. Individuals who need total assistance with four or more ADLs for more than 21 consecutive days, or who have an unmanaged mental illness or substance use issue, or who display aggression towards others can't be admitted or retained by an ALF. Nor can those with ongoing, unmanaged incontinence. |
| Assisted Living Scope of Care | Assisted living facilities provide accommodations and at least one hot meal daily, that meets the National Academy of Science's Food and Nutrition Board guidelines. ALFs must provide personal care services, organized social and recreational programming, and medication management to three or more residents. Residents need access to an emergency response system that's monitored on a 24/7 basis. |
| Assisted Living Medicaid Policy | Assisted living services at participating facilities are covered under the Elderly Waiver, a Medicaid Home and Community-Based Services Waiver program administered by Iowa's Department of Health and Social Services. |
| Assisted Living Facility Requirements | In Iowa, assisted living accommodations may consist of a single- or double-occupancy room with an en suite bathroom equipped with a toilet, sink and bathtub or shower. Units are not required to have kitchens. |
| Assisted Living Medication Management | Residents may self-administer their prescription or over-the-counter medications. Licensed nurses employed by the facility may delegate medication management duties to unlicensed facility staff, and these duties can include assisting with self-administration. ALF staff may only administer medications under the direct supervision of a registered nurse. Residents who receive medications directly from a facility staff member must be monitored for adverse reactions by an RN for at least 90 days following the start of the course of medication, or whenever the resident experiences a major change in their physical health. |
| Staffing Requirements | All licensed ALFs need to have a full-time manager who's responsible for the day-to-day operation of the facility. If medications are administered, or health-related services are offered, there must be a registered nurse on staff. There are no state-mandated minimum staffing ratios for Iowa ALFs. Facility managers are required to ensure that enough awake staff members are on-site at all times to meet the needs of residents. |
| Staff Training Requirements | ALF managers hired after January 1, 2010 and their delegates must complete an approved assisted living management or nursing course within 6 months of their hire date. Unlicensed caregivers may be hired, however, all ALF direct care staff need to be trained in the facility’s fire safety and emergency procedures. |
| Background Checks for Assisted Living | AFL managers need to request a Department of Public Safety criminal record check, and a Department of Human Services child and dependent adult abuse record check on all prospective employees. Candidates with a record on either registry may only be hired with the approval of the DHS. |
| Requirements for Reporting Abuse | Everyone employed in an Iowa assisted living facility is deemed a mandated reporter who is legally obligated to report any concerns related to the abuse, neglect or mistreatment of a resident. Allegations must be reported to the Iowa Department of Inspections and Appeals, Health Facilities Division or to the Iowa Office of the Long-Term Care Ombudsman. |
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