As of July 2019, Alabama had more than 4.9 million residents, and seniors 65 and older made up 17.3% of the population. The Kaiser Family Foundation reports that 22,884 adults lived in Alabama’s certified nursing facilities during the same year. With more than 100 hospitals and 15,000 staffed beds throughout the state, Alabama has plenty to offer seniors who need health care. Alabama also has 228 skilled nursing facilities, ensuring that seniors have access to daily medical care and supervision when needed.

Nursing homes provide 24/7 care for seniors who are unable to live on their own due to medical or cognitive issues. Because nursing homes provide ongoing medical care, they cost more than assisted living facilities, home health services and adult day care facilities. In Alabama, nursing homes cost an average $6,540 per month for a semi-private room and $6,911 per month for a private room.

This guide provides an overview of nursing home care in Alabama, including a detailed cost breakdown and information on programs that may pay for skilled nursing. It also includes a summary of the Alabama laws governing the operation of skilled nursing facilities.

The Cost of Nursing Home Care in Alabama

When compared to nearby states, Alabama has the lowest average costs for skilled nursing care at $6,540 per month. Georgia costs slightly more at $6,722 per month, making it the only nearby state with average monthly costs under $7,000. With average costs of $8,669 per month, Florida — known for its large population of seniors — is the most expensive state in the region. Mississippi and Tennessee both have average costs just over the $7,000 mark: Mississippi averages $7,057 per month, and Tennessee averages $7,072 per month. Alabama’s nursing home costs are also well below the national average of $7,756 per month.

$6540

Alabama

$7756

The United States

$6722

Georgia

$7057

Mississippi

$7072

Tennessee

$8669

Florida

The cost of nursing home care within Alabama varies from one city to the next. Average costs depend on several factors, including the number of facilities in a region, the number of amenities offered and the type of care provided. Sitting less than 100 miles from the Alabama/Florida border, Dothan has the highest average costs ($6,996 per month). Huntsville, known as the home of the U.S. Space & Rocket Center, has monthly costs averaging $6,950. Mobile and Montgomery have average costs right in line with the state average — $6,540 per month for both states. Tuscaloosa and Birmingham have the lowest average costs at $6,235 and $6,388 per month, respectively.

$6235

Tuscaloosa

$6388

Birmingham

$6540

Mobile

$6540

Montgomery

$6950

Huntsville

$6996

Dothan

Alabama has several types of care available for seniors with varying needs. Nursing homes provide the highest level of care possible, making them the most expensive option at an average of $6,540 per month. Adult day care is a nonresidential option that focuses on socialization and companionship rather than medical care. As a result, adult day care costs an average of $655 per month in Alabama. Seniors who remain in their homes but need help with certain tasks may hire a home health aide or homemaker service, both of which cost an average of $3,432 per month. Like nursing home care, assisted living is a residential option; however, assisted living facilities don’t provide a nursing level of care. Therefore, they are less expensive than skilled nursing facilities, averaging $3,150 per month in Alabama.

$655

Adult Day Care

$3432

Home Care

$3150

Assisted Living

$6540

Nursing Home

Financial Assistance for Nursing Home Care in Alabama

Most people do not pay for skilled nursing care entirely out of pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in Alabama.

Alabama’s Medicaid Program

Medicaid for Institutional Care, also called Institutional Medicaid, is specifically for seniors in nursing homes and hospitals. The Alabama Medicaid Agency recommends applying for coverage as soon as a senior enters a skilled nursing facility. If the application is approved, Medicaid may pay for services not covered by Medicare or a long-term care insurance policy. To qualify for institutional Medicaid, a senior must require 24/7 nursing care. Seniors who don’t need this level of care aren’t eligible for institutional Medicaid; however, they may be eligible for home and community-based waivers

Alabama has 228 certified nursing facilities. Medicaid may cover services at any of these facilities, provided the facility maintains its license and remains in good standing with the Alabama Board of Health. In 2018, 15% of Medicaid funds were spent on care provided to residents of nursing homes. Approximately 25% of Alabama citizens were eligible for Medicaid coverage at some point during the year.

Medicaid Eligibility in Alabama

Alabama Medicaid is only available to residents of Alabama who are U.S. citizens or lawfully admitted immigrants who have lived in the United States for at least five years. Applicants must not have more than the maximum amount of income allowed under Medicaid guidelines. This amount changes in January of every year. Institutional Medicaid also has a resource limit of $2,000 as of the first day of the month.

Seniors can apply for coverage at the Alabama Medicaid website.

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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 skilled nursing care.
  • Reverse Mortgages: If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Alabama

Alabama has a variety of resources available to help caregivers find high-quality nursing homes for their loved ones and also to age in place at home in order to delay nursing home placement—and the cost of it—for as long as possible. 

Resource

Contact

Service

Alabama Long-Term Care Ombudsman(334) 242-5753The Alabama Long-Term Care Ombudsman ensures that residents of nursing homes and other long-term care facilities receive quality care. The agency also investigates complaints and educates residents and their family members on the rights of long-term care residents.
Alabama State Health Insurance Assistance Program(334) 242-5743Alabama SHIP has trained volunteers available to answer questions regarding long-term care, Medicare coverage and other topics of interest to seniors. Volunteers can also refer seniors to other agencies when needed.
Alabama Area Agencies on AgingVaries by regionAs part of the Older Americans Act, each state created a network of agencies designed to advocate for seniors. Trained counselors are available to provide information and referrals related to nursing home care and other topics of interest to seniors.
Health Care Facilities Directory(800) 252-1818The Alabama Department of Public Health maintains an electronic database of medical facilities throughout the state. Users can search by facility type, city name, county name or license status.
Alabama Nursing Home Association(334) 271-6214The Alabama Nursing Home Association has several helpful resources for consumers. Its search tool enables users to search for facilities capable of caring for seniors with a wide variety of special needs, including memory care and hospice services. Users can browse by city or search for a facility by name. The ANHA website also provides a useful set of statistics on Alabama nursing homes, such as the number of nursing home beds in the state.

Nursing Home Laws and Regulations in Alabama

Licensing RequirementsAll SNFs must be licensed by the Alabama Board of Health. A new facility must submit a completed application, pay a licensing fee and have a “permanent and distinctive name” to be considered for a regular license. The Alabama Board of Health doesn’t grant SNF licenses to applicants with felony convictions for fraud or abuse/neglect of a vulnerable individual. If an owner operates several facilities, a separate license application must be submitted for each facility.
Staffing RequirementsUnder state law, Alabama SNFs must meet several staffing requirements. An administrator must be appointed to oversee the general management of the facility, develop written personnel policies and maintain adequate staffing records. At minimum, every SNF must establish vaccination requirements for employees and ensure that employees with communicable diseases don’t return to work until they are symptom-free or have been cleared for duty by a medical professional.
Staff Training RequirementsEvery employee must complete an orientation that covers general policies as well as information specific to their roles. Employees must also participate in ongoing in-service training to gain new knowledge and skills. For nurse aides, a facility must provide at least 12 hours of in-service training per year. Facilities with feeding assistants must provide training on feeding techniques, infection control, safety procedures and safe ways to feed residents with dementia, among other topics.
Admission RestrictionsFacility employees may not ask new residents to waive their right to Medicaid and Medicare, nor are they allowed to require new residents to put it in writing that they will not apply for Medicaid or Medicare.
Care Planning RequirementsEvery SNF must have a comprehensive care plan for each resident. Facilities are required to complete this plan within seven days of a new resident’s arrival. The care plan must address a resident’s physical and psychosocial needs, be prepared by an interdisciplinary team of professionals and have measurable objectives.
Dietary and  Nutritional Services RequirementsSNFs must provide well-balanced meals that meet the specific dietary requirements of each resident. These meals must be nutritious and palatable. Every facility must also employ a registered dietitian in some capacity. If the SNF doesn’t have a full-time dietitian, then it must have a director of food service who frequently consults with a registered dietitian. At a minimum, a facility must provide three meals per day.
Specialized Rehabilitative ServicesIf a resident requires specialized rehabilitative services (e.g. occupational therapy or physical therapy), the facility must provide the services or hire an outside provider. Specialized rehabilitative services may only be provided if a physician orders them.
Medication and Pharmaceutical ServicesEach facility must hire a pharmacist or consult with a pharmacist to ensure medications are administered safely. The pharmacist is responsible for reviewing resident drug regimens, keeping adequate pharmacy records and monitoring drug inventory. Facilities must store all medications in locked compartments, maintain records of the storage and disposal of controlled substances, destroy medications that have expired and label medications properly.
Activities Requirements Each SNF must develop a comprehensive activities program to help residents maintain their physical, mental and social well-being. Activities must be planned at least one month in advance, and each facility must post an activities calendar in a prominent place. SNFs must keep records documenting the type of activity conducted, the person who conducted it and the number of residents who participated.
Infection Control Requirements Every facility must have a formal infection control program to prevent disease transmission and ensure that residents live in a sanitary environment.
Medicaid CoverageMedicaid for Institutional Care may cover room, board and medical care at a skilled nursing facility. Applicants must meet eligibility requirements to receive coverage.