Nursing Homes in Vermont

Vermont is the country’s second least populous state with a total population of more than 620,000, yet it has a significant senior population, with 20% of its residents 65 and older. The Green Mountain State projects an increase in this age group by 2030, when over one out of four Vermonters are expected to be seniors. Thankfully, Vermont is among the highest ranking states when it comes to health care access, and a large majority of its long-term care facilities accept Medicaid. Likewise, a majority of Vermont’s nursing home residents are Medicaid recipients.

Nursing facilities accommodate individuals who may need 24-hour nursing services in an institutional setting. Based on Genworth Financial’s 2020 Cost of Care Survey, Vermont’s average monthly cost for nursing home care in a semiprivate room costs $9,779, while the private-room option averages $10,311 per month.

This guide offers helpful information about nursing home care in Vermont, its associated costs, available financial support programs and licensing regulations. A list of free statewide resources is also provided.

The Cost of Nursing Home Care in Vermont

Compared to most states in the American Northeast, Vermont is on the moderate side with an average nursing home care cost of $9,779 per month. According to the Genworth Financial’s 2020 Cost of Care Survey, this amount is about $2,000 more than the national average of $7,756. However, Vermont’s neighboring states are significantly more expensive. New Hampshire’s average cost of $10,646 is nearly $900 more expensive than the Green Mountain State, while New York, at $12,319, costs over $2,500 more. Massachusetts is the most expensive bordering state at $12,623, costing seniors approximately $2,800 more per month than Vermont. Maine is less expensive at $9,642, which is only about $130 less. 

Burlington, which is Vermont’s largest city, is more expensive than most areas in the state with an average monthly nursing home care cost of $10,737. This is slightly greater than the average cost of New Hampshire’s Manchester area at $10,646. The nearby New York areas are even more expensive. Glens Falls and Albany, both in New York’s Capital District, have respective nursing home care costs of $14,068 and $12,973. In neighboring Massachusetts, Pittsfield and Springfield have costs of more than $11,100 per month. Seniors opting for Maine can expect to pay $10,220 monthly in the Portland area.

Several noninstitutional care options in Vermont may be considered based on budget and the required level of care. Assisted living at $5,310 costs slightly lower than in-home care and home health care, which cost $5,434 and $5,529, respectively. The costs for these three types of care are somewhat comparable, but assisted living includes monthly accommodations, meals and most utilities. Adult day care at $2,979 is the cheapest option and may be amenable to homebound seniors who need intermittent nursing or moderate levels of medical care instead of 24-hour skilled care.

Financial Assistance for Nursing Home Care in Vermont

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 Vermont.

Vermont’s Medicaid Program

There are over 166,000 Vermonters enrolled in Medicaid (Green Mountain Care) as of September 2020, roughly 26% of the state’s population. A study by KFF shows that about 23% of the enrollees are elderly and disabled, and that five out of eight nursing home residents in Vermont are Medicaid beneficiaries. The Green Mountain State expects that, despite a continued increase in the 65-84 age group population by 2030, the estimated number of Medicaid long-term care recipients in 2030 may still be similar to the current count. This may be due to factors including positive changes in economic and health conditions which may decrease the demand for publicly funded long-term care.

Choices for Care is Vermont’s dedicated Medicaid program for long-term care. This program grants a tailored package of long-term services and supports to eligible recipients in their settings of choice. A CFC participant may choose to receive long-term care at home, a licensed residential care facility or nursing home. Covered services in nursing facilities may include 24-hour skilled nursing, therapies, meals, activities and social services. Some of these services may also be provided in traditional homes and community-based adult care facilities. As of 2021, Vermont is home to 37 licensed nursing homes.

Medicaid Eligibility in Vermont

Seniors aged 65 and older must be current Vermont residents and meet the financial criteria for Medicaid for the Aged, Blind and Disabled. The maximum eligible countable assets is $2,000 for individual applicants and $3,000 for couples, while the income limit is up to 400% of the federal poverty level. MABD recipients must need a nursing level facility to be eligible for Choices for Care.

MABD applications may be handled online through Vermont Help Connect. Seniors and their families may also contact their local Area Agency on Aging or call Vermont’s Senior Helpline at 1-800-642-5119 for assistance with Choices for Care applications.

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 Vermont

Older Vermonters have access to statewide resources that can help them obtain assistance with nursing home care costs. Resources for alternative care options and other benefits are also available and may help them remain at home or thrive in community-based facilities.

Resource	Contact	Service
DAIL Adult Services Division	(802) 241-0294	The Adult Services Division of the Vermont Department of Disabilities, Aging and Independent Living partners with various organizations in providing Medicaid-funded long-term services and supports, and it oversees core programs by Vermont’s Area Agencies on Aging. Its organized website provides detailed information on its managed programs, as well as valuable resources such as brochures, reports, application forms, a field contact directory and inquiry forms.
Vermont Area Agencies on Aging	(800) 642-5119	Vermont’s five AAAs implements OAA and state-funded programs that serve seniors in all 14 counties. Services include free information, a referral helpline, options counseling, case management and care coordination, Meals on Wheels and health promotion programs. These agencies also provide Medicare counseling under SHIP (State Health Insurance Program) and collaborate with designated mental health agencies for the Eldercare Clinician program.
Community of Vermont Elders	(802) 229-4731	COVE is a nonprofit advocacy and education organization that protects and promotes the welfare of older Vermonters. In addition to its Vermont Senior Medicare Patrol program, COVE’s unique programs include Building Bridges scam and fraud prevention, COVEcast and Vermont SMP podcasts, and entertaining Savvy Seniors educational skit presentations. This agency also maintains an annual senior resource guide and directory.
Vermont Office of Veteran Affairs	(802) 828-3379	VT OVA provides assistance with applications for VA disability benefits. Its dedicated long-term care programs support eligible veterans in their homes or care facilities of choice. Eligible vets with disabilities that are 70% service-connected may qualify for subsidized care in VA-operated and approved regular nursing homes. The 177-bed Vermont Veterans Home in Bennington also accommodates qualified vets, their spouses and Gold Star parents. Alternatively, veterans aged 75+ who are clinically eligible and enrolled in the White River Junction VA health system may qualify for the Veterans Directed Care program.
Vermont Assistive Technology Program	(800) 750-6355	VATP offers information, hands-on experiences and loaned equipment to Vermonters with disabilities and aging-related needs. Assistive technology equipment includes mobility aids such as walkers and wheelchairs, and automated devices such as voice recognition devices and screen readers. VATP maintains an online inventory and the AT Exchange marketplace for used equipment where Vermonters can find free or discounted devices for permanent use after they finish the 30-day loan program. VATP also has a funding guide to local and national resources for purchasing AT devices and tools.
Vermont Long-Term Care Ombudsman	(802) 383-2227	Vermont Legal Aid partners with DAIL for LTCOP, which advocates for older Vermonters living in nursing homes and other residential care facilities. This program also supports Choices for Care enrollees to ensure that they receive quality long-term care. In addition to resolving individual complaints, LTCOP educates seniors on their rights and works to influence administrative and legislative decisions for the best interests and welfare of the elderly.
Adult High Technology Services	(802) 241-0294	The Adult High Technology services program benefits Medicaid-eligible and medical technology-dependent adults with skilled nursing care in home-based settings. Services covered include coordinating treatments and advanced medical equipment/supplies provided by approved home health agencies.

Nursing Home Laws and Regulations in Vermont

Licensing Requirements	All nursing homes must be licensed by the State of Vermont prior to operation. These licenses must be renewed annually as they expire one year after their dates of issuance.
Staffing Requirements	A nursing home must appoint an administrator who is licensed by the State of Vermont. A physician is designated as the medical director, and a registered nurse must serve as a full-time director of nursing. Sufficient nursing staff is required to provide 24-hour care in accordance to the residents’ care plans. The director of nursing may function as a charge nurse only if the nursing home has an average daily resident occupancy of 60 or less.
Staff Training Requirements	Nursing homes must employ nurse aides who are competent and included in the Vermont Nurse Aide Registry. Nurse aides with less than 4 months of experience prior to employment must demonstrate competence based on their performance in state-approved training and evaluation programs. Hired nurse aides receive performance reviews once every 12 months and at least 12 hours of regular in-service training/education annually.
Admission Restrictions	Anyone seeking nursing home placement must receive options counseling from an authorized agency prior to initial admission or within three working days after direct transfer from hospital discharge, unless it is a readmission, emergency admission or short-term stay no longer than 21 days. A nursing home may only admit clients beyond its licensed capacity for emergency reasons if approval for temporary authorization by the licensing agency is obtained.
Care Planning Requirements	A comprehensive care plan for each resident should describe the services to be provided to maintain or improve the client’s physical, mental and psychosocial well-being. The resident and/or family/legal representative may participate in developing a care plan, in cooperation with an interdisciplinary team consisting of the client’s attending physician, responsible registered nurse and other appropriate staff. Periodical reviews and revisions must be done based on routine and necessary assessments.
Dietary and Nutritional Services Requirements	A nursing facility must employ a qualified full-time dietitian or designate a director of food service who works frequently with a part-time or consultant dietitian. Nourishing and palatable meals should be offered based on well-balanced diets that meet the daily nutritional and special dietary needs of each resident. Individual therapeutic diets must be prescribed by the resident’s attending physician. Assistive utensils and special eating equipment are provided when needed.
Specialized Rehabilitative Services	Physical, occupational and speech therapy, as well as mental health and other specialized rehabilitative services, must be provided, based on the residents’ care plans and written orders by physicians/qualified staff. These services may also be obtained from outside providers.
Medication and Pharmaceutical Services	Each resident’s medication regimen must be free from unnecessary drugs and reviewed by a licensed pharmacist at least once a month. A resident may self-administer medications if determined safe by the interdisciplinary care team. Nursing facilities must prevent medication error rates of 5% or greater.
Activities Requirements	An ongoing program of activities is required to support the personal interests and physical, mental and psychosocial well-being of residents, in accordance with their comprehensive assessments. The activities program must be directed by a qualified therapeutic recreation specialist or licensed/registered/certified activities professional.
Infection Control Requirements	A nursing facility’s infection control program should include investigations and spread prevention, isolation procedures, recording of incidents and corrective actions. Handwashing is required for all employees after direct contact with each resident. Employees with communicable diseases and infected skin lesions are prohibited from direct contact with residents and their food.
Medicaid Coverage	The Choices for Care program of Green Mountain Care (Vermont Medicaid) pays for long-term care services provided in approved nursing homes, as well as in other residential care facilities and the private homes of recipients eligible for nursing facility level of care.