Tennessee Memory Care 2026, Costs, Funding, and How to Choose

If you are reading this, there is a good chance you are somewhere in the hardest stretch of caregiving, the long stretch where the home plan that was working six months ago is no longer working. Wandering. Sundowning. Medication confusion. Getting lost on a familiar street. A grandchild who is afraid. The exhaustion that comes from sleeping with one eye open.

Memory care is the level of care between assisted living and a nursing home, designed specifically for people with moderate-to-late-stage dementia. In Tennessee in 2026 it typically runs $5,500 to $7,000 per month for purpose-built dementia communities, with several distinct paths to help cover the cost. This guide walks through what memory care actually is in Tennessee, what it costs, how TennCare CHOICES and VA Aid & Attendance help pay, the three stages of dementia and the care setting that fits each, the legal-prep package every Tennessee family should put in place early, and how to evaluate a memory-care facility before you sign a contract.

By Brevy Care Team · Last verified May 3, 2026

What Memory Care Is, and What It Isn't

Memory care in Tennessee is delivered in secured units within ACLFs, RHAs, or nursing facilities that meet additional dementia-care standards. Tennessee does not have a separate memory care license; the underlying facility is always one of the three license types, with the secured unit licensed as a special-services component.

What memory care typically includes:

• Secured environment. Locked or alarmed doors, secured outdoor courtyards, electronic monitoring of unit egress with required emergency procedures.
• 24/7 supervision by staff with documented annual dementia in-service training (basic disease facts, behavioral management, communication strategies).
• Lower staff-to-resident ratios in the secured unit than the rest of the facility, typical is 1:5 to 1:6 during the day, 1:8 to 1:10 overnight, though TN does not mandate a specific ratio. Always ask shift by shift.
• Structured programming tailored to cognitive level, music therapy, reminiscence, sensory activities, gentle exercise, simple games.
• Medication management with licensed nurse oversight (in ACLFs and nursing facilities) or external nurse coordination (in RHAs, which cannot administer medications themselves).
• Assistance with all ADLs, bathing, dressing, toileting, transferring, eating.
• Wandering precautions and incident response.
• Simplified environment design, clear sightlines, color-coded doors, reduced sensory overload, dementia-friendly signage.
• Required interdisciplinary team review for the secured unit: physician with dementia experience, social worker, registered nurse, and a family member or patient advocate, with annual reporting submitted to the Tennessee Health Facilities Commission.

What memory care typically is NOT:

• A nursing home. Memory care residents who develop complex medical needs (PEG-tube nutrition, frequent IV antibiotics, advanced wound care, ventilator support) usually transition to a skilled nursing facility, sometimes one with its own secured unit.
• The same as standard assisted living. Standard AL is generally not equipped to safely manage wandering, late-stage resistance to care, or significant behavioral changes.
• A replacement for medical care. Residents still need primary care, neurology follow-up, and specialist visits.
• A guarantee of staffing or quality. TN does not mandate a fixed resident-to-direct-care-staff ratio for ACLFs or RHAs; ratios vary widely and must be asked about directly.

What 2026 Memory Care Costs in Tennessee

The 2026 cost of memory care in Tennessee depends on the underlying license type and the metro market. Three reference points:

Two cost notes that catch families off guard:

1. Memory care almost always costs less than a nursing home. A purpose-built memory care community generally runs $5,500–$7,000/month; a nursing home with a secured dementia unit runs roughly $9,500–$11,000/month private-pay (TN statewide median is about $9,700 semi-private and $10,500 private; Nashville runs higher). The trade-off is that nursing facilities accept TennCare for both room and board, while memory care in an ACLF/RHA accepts CHOICES only for services, never for R&B.

2. The "memory care premium" is real and consistent. Communities charge an extra $850 to $1,150/month above standard AL rates for the secured unit, the dementia-trained staffing, and the structured programming. If a community quotes you the same price for AL and memory care, ask carefully what the secured unit actually includes, there is real cost behind real memory care, and a too-low price is often a flag for a memory-care label without the underlying staffing or design.

For full TN AL cost data, by metro and floor plan, see the Tennessee Assisted Living guide. For the nursing-home option, see the Tennessee Nursing Homes guide.

The Three Stages of Dementia and What Each Typically Needs

Matching care setting to disease stage matters. The stages overlap, the boundaries are not crisp, and every dementia journey is different, but the framework helps families plan.

Early stage (typically 1 to 3 years after diagnosis)

The person can usually still live at home with the right supports. Independence with ADLs is largely intact; short-term memory is impaired and judgment is starting to slip. Driving, medication, and finances are the early failure points.

What typically works at this stage:

• Living at home with daily check-ins, medication management (locked dosette, automated dispenser, or visiting caregiver), and removal of driving privileges before an incident forces it.
• TennCare CHOICES Group 3 ("At Risk") may apply for households at imminent risk of nursing-facility placement; Group 2 may apply for households already meeting Nursing Facility Level of Care. See the TennCare CHOICES guide.
• Adult day programs supplement social connection and provide caregiver respite; see the Tennessee respite care guide.
• The Family-Directed Respite Voucher ($2,500/year through DDA and the AAADs) can fund early-stage in-home respite for the family caregiver.
• The federal Alzheimer's Disease Program Initiative (ADPI) Dementia Navigators through the Tennessee Department of Disability and Aging are a no-cost first call for families newly facing a diagnosis.

What you must do at this stage (see the legal-prep section below): get the legal package signed, file VA benefits if applicable, establish a neurologist relationship if you don't have one, and have the difficult driving and money-management conversations.

Middle stage (typically 2 to 5 years)

Safety concerns grow. Wandering may begin. Medication errors compound. Kitchen and stove hazards are real. Sundowning, agitation in the late afternoon and evening, emerges. Resistance to bathing or dressing is common. Recognizing close family members may falter.

What typically works at this stage:

• 24/7 supervision is generally necessary. The home option is intensive in-home care (private-pay home aide hours plus respite), which is rarely sustainable past a few months in middle stage.
• Memory care in an ACLF or RHA secured unit typically becomes the right option, especially when wandering or behavior changes are routine.
• TennCare CHOICES Group 2, for those who qualify, funds AL/memory-care services in a participating community.
• VA Aid & Attendance for veterans and surviving spouses fills a critical gap in monthly income.

Late stage

Total ADL dependence. Swallowing difficulties. Bedbound stages. Increased medical complexity. Often a transition to skilled nursing care, possibly with a hospice overlay.

What typically works at this stage:

• Memory care in a nursing facility's secured unit, where licensed nurses are on-site and skilled needs are addressed, often becomes the right level. See the Tennessee Nursing Homes guide and the Tennessee Medicaid Nursing Home guide for funding mechanics.
• Hospice (Medicare Hospice Benefit) is appropriate when the prognosis is six months or less without curative intent. The hospice team adds an RN, social worker, chaplain, aide, and on-call clinician layered onto the existing facility care. Most TN hospice agencies have specific dementia and end-of-life expertise.

How TennCare CHOICES Helps Pay

TennCare's CHOICES program is the single largest funding source for long-term care in Tennessee. Two CHOICES groups apply to memory care, with very different mechanics:

• CHOICES Group 1 (nursing facility entitlement): Pays the nursing-facility memory-care bed entirely, with patient liability. The resident keeps a Personal Needs Allowance of $70/month; the rest of monthly income goes to the facility, after deductions for Medicare premiums, Minimum Monthly Maintenance Needs Allowance for the community spouse ($2,643.75–$4,066.50/month), and certain other obligations.
• CHOICES Group 2 (HCBS, including AL/MC): Pays for services delivered in an ACLF, RHA, or Critical Adult Care Home, never for room and board. Group 2 is enrollment-capped (~12,500 historical slots) with a waitlist, and not all TN memory-care communities participate; participation requires a negotiated contract with one of the three TennCare MCOs (BlueCare, UnitedHealthcare Community Plan, Wellpoint).

Either way, the underlying eligibility tests are the same:

• Functional eligibility (NF Level of Care): A score of 9 or more points on the TennCare PAE Acuity Scale. Mid-to-late-stage dementia with significant ADL impact and safety concerns typically qualifies; early-stage dementia with intact ADLs usually does not.
• Income: Up to $2,982/month (300% of the 2026 SSI Federal Benefit Rate). Applicants over the limit can establish a Qualified Income Trust (TN's equivalent of a Miller Trust) to redirect excess income.
• Assets: Up to $2,000 for an individual or $3,000 for a married couple where both spouses apply. Home equity exclusion up to $752,000.
• Spousal protections: Community Spouse Resource Allowance up to $162,660; minimum protected resource standard $32,532.

Practical worked example for a Group 2 memory-care placement at $6,500/month:

• Resident's Social Security = $1,800/month
• Group 2 services covered by TennCare CHOICES = approximately $1,800 to $2,400/month
• Remaining R&B owed by the resident from income/savings/family contribution = approximately $4,100 to $4,700/month

Most TN families pair Group 2 with VA Aid & Attendance and family contribution to close the R&B gap. See the TennCare CHOICES guide for the full program mechanics.

How VA Aid & Attendance Helps

For qualifying wartime veterans and surviving spouses, VA Aid & Attendance (A&A) is a non-service-connected pension benefit that adds substantial monthly income usable for memory care. Approximate 2026 maximum monthly amounts (verify current figures at va.gov/pension/veterans-pension-rates):

For a veteran couple with $2,400/month in Social Security and pension income plus $2,795/month in A&A, that is $5,195/month, enough to cover most TN memory-care R&B in the lower half of the cost range.

Eligibility (simplified): wartime service of at least 90 days with at least one day during a defined wartime period, honorable discharge, age 65+ or permanent disability, plus a clinically demonstrated need for assistance with ADLs (which dementia at the middle stage almost always meets). The application is paperwork-heavy; avoid paid pension-poaching middlemen, many are not Veterans Service Officers and may steer families toward inappropriate trusts. Use a free, accredited VSO through the Tennessee Department of Veterans Services (county VSOs are free and accredited).

A full Tennessee VA Aid & Attendance guide is on the worklist; in the meantime see the Tennessee Caregiver Programs hub for VA caregiver-program connections and the three TN VA Medical Centers (Memphis, Mountain Home/Tri-Cities, Nashville/Tennessee Valley).

Long-Term Care Insurance

If your loved one purchased an LTC policy before cognitive decline started, file the claim immediately. Most policies pay a daily or monthly memory-care benefit, either as a fixed indemnity amount or as reimbursement of actual costs; check the schedule of benefits and the elimination period.

Critical points:

• File now, not later. Most policies require both current ADL limitations AND cognitive impairment. Waiting to file delays benefits.
• Ask about waiver of premium. Many policies stop premium collection once a claim begins.
• Document cognitive impairment formally, a primary-care or neurology assessment is usually required.
• Tennessee Long-Term Care Partnership Program policies protect assets equal to benefits paid out from later TennCare spend-down. If your loved one has a partnership-qualified TN policy, the asset protection follows even if benefits eventually run out and they need TennCare.

The Tennessee Legal-Prep Package

Tennessee has its own statutory framework for the documents that matter most when dementia progresses. Get this package signed early, while legal capacity is intact.

• Tennessee Durable Power of Attorney for finances under the Tennessee Power of Attorney for Finances and Property Act. Gives the agent authority to handle banking, bills, taxes, real estate, insurance, and other financial matters.
• Advance Directive for Health Care under the Tennessee Health Care Decisions Act. Combines healthcare proxy designation with treatment preferences (life-sustaining treatment, artificial nutrition, hospice, etc.). Tennessee has its own statutory form; do not substitute an out-of-state form.
• Last Will and Testament with TN-specific witnessing requirements.
• HIPAA release designating the family members who can receive medical information.
• Tennessee Transfer-on-Death (TOD) Deed. Tennessee allows real property to pass directly to a designated beneficiary at death without probate via a TOD deed. Tennessee does not use Lady Bird (enhanced life estate) deeds; the TOD deed is the closest functional equivalent and is helpful for keeping a home out of probate and out of TennCare estate recovery (which is probate-only in Tennessee).
• Living trust (revocable trust). For some TN families, especially with multiple properties or out-of-state assets, a living trust may be a better tool than a TOD deed. Whether trust assets are reachable by TennCare estate recovery is contested in TN; conservative planning treats them as probate-only-style (out of reach of TennCare recovery), but families should not rely on this without elder-law counsel.

A Tennessee elder-law attorney typically prepares this package as a flat-fee bundle. Find one through your county bar association lawyer referral service or the National Academy of Elder Law Attorneys (NAELA) TN directory. Memphis Area Legal Services and West Tennessee Legal Services have programs that help low-income seniors with these documents at no cost.

If moderate dementia is already established and capacity is gone, the family will likely need a conservatorship, a court-supervised process that costs several thousand dollars and takes weeks to months to complete. Avoiding conservatorship is the single most protective thing a family can do for a loved one with a recent dementia diagnosis.

How to Tour a Tennessee Memory Care Facility

Tour multiple memory-care communities. Visit at different times of day. Visit at 4 PM (when sundowning is visible) and on a weekend (when staffing patterns differ from weekdays). Bring a family member or trusted friend. The right tour is roughly 90 minutes to 2 hours.

Before the tour

• Pull the facility's HFC license record at internet.health.tn.gov/facilitylistings, confirm the license type (ACLF, RHA, or nursing facility), bed count, and date of most recent state survey.
• Read state survey reports (statements of deficiency and plans of correction) by public-records request to the facility or to the HFC.
• For nursing-facility memory care, also pull the CMS Nursing Home Compare Five-Star rating.
• Call the Tennessee Long-Term Care Ombudsman at 877-236-0013, they have jurisdiction over ACLFs, RHAs, and nursing facilities, and ask whether the facility has had recent complaint patterns.
• Read online reviews skeptically; treat them as anecdote, not evidence.

Green flags

• Staff greet residents by name and can describe each resident's history, preferences, and triggers.
• Activities are happening visibly during your tour, not just posted on a calendar.
• Residents are appropriately dressed, clean, well-groomed, and engaged with each other or with staff.
• Secured-unit doors are attended; wandering behavior is redirected warmly, not restrained.
• Families are welcomed at any reasonable time; no overly restrictive visiting hours.
• Staff knock before entering resident rooms.
• The facility has a relationship with a palliative-care or hospice provider for end-of-life transitions.
• The administrator and director of nursing or director of resident services have been in their roles more than a year.
• Staff are willing to walk you through the secured unit's most recent annual interdisciplinary-team report.

Red flags

• Residents in the common area dozing, slumped, or unengaged throughout your visit.
• Obvious use of physical or chemical restraints.
• Very high staff turnover (ask about the ratio of permanent to agency staff; over 70% nurse-aide turnover annually is concerning).
• The same complaints repeated across online reviews.
• Pressure to move in quickly, sign large deposits, or skip due diligence.
• Staff who can't answer specific questions about dementia care approaches.
• Refusal to share the most recent state survey or the secured unit's annual report.
• New administrator or director of nursing in the last six months.

Questions to ask on a memory-care tour

• "How do you handle a resident who resists a bath or shower?"
• "Walk me through how your staff respond to sundowning."
• "What is your plan if my mother wanders at 2 AM? What's the staffing on overnight, and how is wandering documented?"
• "How do you adapt activities to different cognitive levels within the same secured unit?"
• "How do you communicate with families when there is a behavior change or a fall?"
• "What happens if her care needs exceed what your unit can provide? What is the transition plan?"
• "May I see the most recent annual interdisciplinary-team report for the secured unit?"
• "What is the current resident-to-direct-care-staff ratio on the day, evening, and overnight shifts?"
• "Is the medical director on-site, and how often is the resident reviewed?"
• "What is your policy on using antipsychotics for behavioral management?" (Best practice in 2026 is non-pharmacological first; appropriate use is narrowly defined under federal Nursing Home Reform Act and state regulation.)

Tennessee Dementia Resources

Memory care is one piece of a larger support system. Tennessee has strong (if uneven) statewide dementia resources.

The two Tennessee dementia organizations, they are NOT the same

This bears repeating because the confusion costs families hours:

Alzheimer's Association, Tennessee Chapter (national affiliate, alz.org/tn). Offices in Nashville, Knoxville, Memphis, and Chattanooga. The national 24/7 Alzheimer's Association Helpline is 1-800-272-3900 (English plus 200+ languages). The TN Chapter offers free care consultations, support groups, education programs, and policy advocacy. The historic "Mid South Chapter" branding for Memphis has been folded into the TN Chapter.

Alzheimer's Tennessee, Inc. (alztennessee.org). An independent state nonprofit founded in 1983, headquartered in Knoxville. NOT affiliated with the national Alzheimer's Association. Independent helpline: 1-888-326-9888. Operates the Howard Circle of Friends Adult Day Services in Knoxville (1807 Dandridge Ave) and runs caregiver education and support programs.

Both are real organizations. Use whichever fits your geography and program needs.

Tennessee Department of Disability and Aging (DDA)

• Statewide Dementia Coordinator: Keita Cole, keita.cole@tn.gov, 615-347-6890.
• Alzheimer's Disease Program Initiative (ADPI) Dementia Navigators, a federally funded cooperative grant currently active through September 2026, providing no-cost referral specialists for families newly facing a diagnosis. The program also funds professional dementia training and certifications across TN.

Family-Directed Respite Voucher

Up to $2,500/year per care recipient, administered through the TN Caregiver Coalition / DDA / AAADs. The caregiver chooses the provider, in-home aide, adult day, or a short facility respite stay. For full TN respite options see the Tennessee Respite Care guide.

MedicAlert + Safe Return

The historic Alzheimer's Association co-branded "Safe Return" wandering-response program ended around 2020. Enrollment is now through the MedicAlert Foundation directly at medicalert.org. Worth doing as soon as wandering becomes plausible.

TN Area Agencies on Aging and Disability (AAADs)

Nine AAADs cover all 95 counties and serve as the local intake for the Family-Directed Respite Voucher, NFCSP grants, and many other dementia-relevant programs. Find your AAAD through the DDA or via the Tennessee Caregiver Programs hub.

Common Misconceptions

"Medicare will pay for memory care." It will not. Medicare pays only for medically skilled care, short-term, after a qualifying hospital admission. It does not pay for custodial memory care. Medicare hospice may pay for specific end-of-life services in the final months.

"TennCare CHOICES will pay the whole memory-care cost." CHOICES Group 2 pays for services in an ACLF, RHA, or CACH, never for room and board. CHOICES Group 1 will pay an entire nursing-facility stay, including R&B, but the resident pays patient liability from monthly income. The R&B bill remains the family's responsibility in AL/MC settings.

"A dementia diagnosis means we need memory care today." Early-stage dementia is often safely managed at home with daily supports, adult day, and respite. Memory care is typically a middle-stage decision.

"I can wait to set up legal documents until things get worse." By the time memory care is appropriate, the person may no longer have legal capacity to sign, at which point a court conservatorship is the only path. Tennessee elder-law attorneys consistently identify this as the single biggest preventable mistake families make.

"Memory care is always more expensive than a nursing home." Memory care in an ACLF or RHA is typically less expensive than a nursing home ($5,500–$7,000/month vs. roughly $9,500–$11,000/month private pay for nursing-home care). The trade-off is that nursing homes accept TennCare for room and board; memory care in AL settings does not.

"Lady Bird deeds work in Tennessee." They do not. Tennessee uses the Uniform Real Property Transfer on Death Act (TOD deeds) and living trusts as the equivalent estate-planning tools. Use a TN elder-law attorney to choose the right instrument; do not download an out-of-state form.

Related Terms

• Activities of Daily Living (ADLs): Functional measures used in TN's PAE Acuity Scale and CHOICES eligibility.
• Nursing Facility Level of Care (NFLOC): The clinical threshold (9+ on TN's PAE) for CHOICES Group 1 and Group 2.
• HCBS Waiver: TennCare CHOICES Group 2 is the primary HCBS pathway for AL/memory-care funding.

Learn More

• Tennessee Assisted Living
• Tennessee Nursing Homes
• TennCare CHOICES
• Tennessee Medicaid Nursing Home Coverage
• Tennessee Caregiver Programs
• Tennessee Respite Care
• How to Get Paid as a Family Caregiver in Tennessee

Find personalized help choosing a Tennessee memory-care facility at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, medical, or financial advice. Memory-care regulations, costs, facility quality, and program eligibility change frequently. Always verify with the facility, the Tennessee Health Facilities Commission, the Tennessee Long-Term Care Ombudsman (877-236-0013), the VA, and a Tennessee elder-law attorney. Brevy is not a law firm, financial advisor, or healthcare provider.