Memory Care Endorsement or Alzheimer's Unit? What Omaha's Roster Shows, Area by Area

Why Nebraska has two dementia designations

Nebraska has no separate memory care license. Dementia care happens inside a licensed ALF or nursing home. Since 2007 the ALF rules have included requirements for any facility or unit that specializes in Alzheimer's disease or dementia, and the roster flags those buildings as having an “Alzheimers Unit.” In 2016, LB698 added a second, optional layer: the memory care endorsement, which DHHS awards to ALFs that document qualifications beyond the base rule.

The result is that two Omaha buildings both advertising memory care may stand in quite different places legally. One may simply meet the dementia-unit rule. Another may hold the endorsement too. A third may market memory care without either designation on the roster.

What the Alzheimer's unit rule requires

Under 175 NAC 4-006.11E, the facility must give the resident or representative its written criteria for admission, discharge, transfer and resident conduct before admission. It must keep enough trained direct care staff awake, fully dressed and available in the unit at all times. The administrator and direct care staff must be trained in the unit's philosophy, the disease process, and how to care for and redirect residents who cannot manage daily activities or who wander.

The rule also bars a dementia unit from keeping a resident who is a danger to self or others, or who needs complex nursing interventions, unless the ALF's general three-part exception is met. There is no numeric staffing ratio. That is the single most important gap for families to probe on a tour.

What the endorsement adds

The statute, Neb. Rev. Stat. 71-472, tells DHHS to set endorsement qualifications specific to residents with cognitive impairment, covering staffing enhancements, staff training, dedicated memory care programming, cultural competencies, facility requirements and security. A facility applies with proof and pays a fee. On the roster, “Memory Care Endorsement” appears as a separate code.

We treat it as a useful filter, not a verdict. Ask an endorsed building what it changed to qualify, then ask a non-endorsed building how it handles the same things. The answers are usually more revealing than the label.

Where each designation sits

Source: Nebraska DHHS Assisted Living Facility Roster, October 15, 2026. Omaha areas are ZIP-code groups; communities outside Omaha are listed by postal city. Cass, Saunders and Washington counties are covered on their county pages.

Questions that separate one dementia unit from another

Whatever the designation, the same handful of questions tells you most of what you need to know. How many residents live on the unit, and how many direct care staff are awake there at 2 a.m.? Do those staff also cover assisted living apartments elsewhere in the building? How many hours of dementia training do new staff get before working alone, and how many each year after? What happens when a resident tries to leave, refuses a shower, or strikes out? How often do families meet with staff to review the service agreement?

Ask, too, what would end a stay. Nebraska's dementia-unit rule bars keeping a resident who is a danger to self or others unless the general exception is met, and every ALF must give 30 days' written notice before an involuntary discharge, except for safety. The written discharge criteria the unit must give you before admission are the document that answers this in advance.

When a nursing home special care unit is the better fit

Some people with dementia also need daily skilled nursing: complex wound care, frequent changes in condition, or help from two staff for every transfer. Nebraska ALF staff may not perform complex nursing interventions, so those residents are often better served in a nursing home with an Alzheimer's or special care unit, which the long-term care roster lists. Those homes are certified by CMS, which means their inspections, staffing and quality measures, including the use of antipsychotic medications, are public on Care Compare and on our facility pages.

Small memory care homes are part of the picture

13 of the designated ALFs in the five counties have 16 or fewer licensed beds, many of them in Elkhorn and west Omaha. Small residences can feel more like a household, with the same few caregivers every day, which suits some people with dementia better than a large building. They also have fewer staff to cover a bad night, so the overnight staffing question matters even more.

Whatever the size, ask every dementia unit for its Alzheimer's special care disclosure. Nebraska's disclosure act requires it to cover philosophy, placement and discharge, care planning, staff training, the physical environment, activities, family involvement and costs, which makes side-by-side comparison much easier.