Article - Extra Fees Drive Assisted-Living Profits

gromit

Recycles dryer sheets
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I hope my assisted living years aren't soon, but I thought this NYT article on assisted living added fees, republished with no paywall by Yahoo, might be of interest to people here. If accurate, this article is scary to think about.

https://news.yahoo.com/extra-fees-drive-assisted-living-163533841.html?ref=upstract.com

"These highly profitable facilities often charge $5,000 a month or more and then layer on extra fees at every step. Residents’ bills and price lists from a dozen facilities offer a glimpse of the charges: $12 for a blood pressure check; $50 per injection (more for insulin); $93 a month to order medications from a pharmacy not used by the facility; $315 a month for daily help with an inhaler."​
Further down the article:
"$12 a tray for meal delivery to the room; $50 a month to bill a person’s long-term care insurance plan; and $55 for a set of bed rails."​
 
My MIL is at a place with mostly all inclusive pricing. The do bill extra for some things, one being Depends. They do, however, allow my wife to bring in supplies, which she does. Just for example, they charge more than double what DW can get them for at Costco.

Thankfully, all the big stuff like meals are built into the price. It may be more likely to be all inclusive for someone like MIL who is in a memory care setting.
 
I hope my assisted living years aren't soon, but I thought this NYT article on assisted living added fees, republished with no paywall by Yahoo, might be of interest to people here. If accurate, this article is scary to think about.

https://news.yahoo.com/extra-fees-drive-assisted-living-163533841.html?ref=upstract.com

"These highly profitable facilities often charge $5,000 a month or more and then layer on extra fees at every step. Residents’ bills and price lists from a dozen facilities offer a glimpse of the charges: $12 for a blood pressure check; $50 per injection (more for insulin); $93 a month to order medications from a pharmacy not used by the facility; $315 a month for daily help with an inhaler."​
Further down the article:
"$12 a tray for meal delivery to the room; $50 a month to bill a person’s long-term care insurance plan; and $55 for a set of bed rails."​

Scary article. Capitalism at it's finest!
 
If family stays involved, you can avoid some of those charges. My wife used to investigate that monthly bill. Someone needs to do that, or, oh well.
 
This article reflects my mum’s situation right now, it’s no exaggeration. In fact, if anything, there is more.

DM has been in assisted living for 9 years. This year has been a barrage of new or higher fees that when totaled now surpasses 10% of her monthly bill. Medicine administration has sharply increased, they now charge a room service fee if the resident cannot go to the dining area for her meal. Extraneous fees at the cafe are charged that are impossible to disprove. We are fortunate that a sibling lives nearby and gets all her supplies. The ALF charges dearly for basic items.

This follows a general reduction in assisted care over the last 2-3 years, which is charged separately, and led to having to hire additional outside care. 3-4 hours per day of a private aide costs close to 1/3 of the ALF base fee. In total, all fees plus personal expenses represent more than half the cost or a basic room.

What is absent from that article is physical therapy. Many ALFs, like this one, has its own separate PT business which provides physical and occupational therapy. They have a captive audience and provide as much therapy as Medicare will cover. For my mum and most of the others in her ALF that’s around $3k-4k per month.

I’ve had numerous meetings and discussions with the ALF staff over costs and PT. It’s difficult to challenge them because the ALF makes it clear if we complain too loudly they will simply terminate her contract and ask her to leave. For most residents this would be a terrible situation, it’s difficult to find a new ALF when the patient has limitations performing ADLs.
 
We always had an option we could put into place in a month or so. In our case, CCRC costs were covered by income. But I always had in mind that a large 1st-floor room in our house could be converted for care if necesary.

Near the end we saw $10K or more monthly bills for memory care. Very scary for us, a significant income stream for CCRC.
 
MichaelB wrote : ** I’ve had numerous meetings and discussions with the ALF staff over costs and PT. It’s difficult to challenge them because the ALF makes it clear if we complain too loudly they will simply terminate her contract and ask her to leave. For most residents this would be a terrible situation, it’s difficult to find a new ALF when the patient has limitations performing ADLs. ** So I am not the only one noticing ripoffs going on in assisted living. My mom is in AL and pays approx $7,500 for residence and an extra $1,500 for 'level 1 care'. So $9,000 per month. But yes, they are adding on extra fees, which are delayed in billing by at least a month, so you have to remember back then to dispute them. My mom likes the place, but the people in charge of billing are very lowlife, and were lowlife even when she was in independent living at the same outfit. The first (of many to come?) ripoff was 'laundry aide' fees. Even though we did not request laundry to be done, they are doing it once per week at a fee of $18 per load. Tiny loads, of course. The intake person told us that we were not required to have laundry done, but once mom was in, they decided to rip her off anyway. I was there once when a laundry aide popped in to take the laundry. I said no thanks. She was very aggressive, and I had to almost yell at her to not take the tiny amount of laundry. I told her they were charging $18 per load, and the aide said no, it was included in 'level one care'. I was able to prevent that ripoff, on that day, but they later billed Mom for 4 loads at $18 each, equals $72, for that month. I have the right to do Mom's laundry myself in their machines, at no charge, which is what the intake coordinator told us. I hate confrontations with professional ripoff artists like this, but of course I had to say something after seeing the bill. The 'residential coordinator' who has an office there, said Mom needed lots of laundry since she has some bleeding from the bladder. All bs, of course, since the depends take care of it. All the staff are in on the ripoffs, unfortunately. Not an honest one amongst them, as far as I can tell. When I have disputed bill padding in the past, the person who is supposed to take care of that sort of thing says oh yes, I will look into it and get back to you, but nothing happens. This is even after going one level above that person, to complain. Mom is sort of oblivious to it all, being 100 years old, and just believing what the staff tells her. The current state of affairs with the laundry is that the 'residential coordinator' agreed to stop doing the laundry, but would not refund any of the $72. We'll see. I expect to see another $72 laundry fee, and I guess I'll have to escalate to some third party, like a state ombudsman of some sort. What a huge PITA all because of greedy little people who think they can get away with it. My sister and I are trying to get a long term care policy to kick in, and we need the cooperation of the 'business manager' to prepare bills a certain way, and send them to my sister so she can forward them to the ltc company. This 'business manager' (an ass, of course) is the person we have to complain to about the overcharging. What a cluster.
 
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Didn't peruse much of the article but I have to wonder if some of the increased fees have their roots in personnel shortages. I was in a hospital bed for two weeks following surgery and saw first hand what appeared to be staff shortages. Nurses handling as many as 6-rooms (single bed rooms) while the techs (Certified Nursing Assistants...the same certification found in many/most/all assisted living and nursing homes, depending on your state's requirements) were juggling as many as 11 or 12-rooms. BTW, they all provided me with excellent care.
 
Better call Saul!
 

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I verified with the residential coordinator that they are no longer doing Mom's laundry (Mom is doing her own). She acted innocent, even though she had just lied to me and tried to rip off my mom a few weeks ago. Sociopath, typical of the billing people at this place. But Mom doesn't want to move. Maybe I have prevented future ripoff attempts by busting this one up. Hope so, because I hate the drama. Cue Saul.
 
My dad was in a place like this, but they were very upfront with the charges when he signed up, no surprises.
 
Fortunately we got my mom into a small memory care facility that had one price for all services... she did not need them all but it was easy to know what you were paying...


Now, we did have to pay for the extras such as medication and depends etc... but it was not an outrageous price...


One of the things that I noticed (and so did a BIL) is that one facility had HORRIBLE staff... they did not follow the diet suggested for my mom, sometimes not giving her what she wanted... and one of my sisters said it tasted bad... this was a Brookstone facility...


The memory care was much better and had staff that actually took care of the people.. but even there staff turnover was high... I was a bit surprised to see it close down a couple of years ago... not sure if it was due to Covid or not as my mom passed before it hit...
 
I looked into switching AL facilities for my mother at one point. The deal was that you pay a $1500 move in fee and the monthly fee and then they assess to see what the other charges will be. Mom had casually mentioned to an optometrist that her eyes seemed dry and he recommended saline eye drops 4 times a day. They told me that they would keep the "medication" at the nurses station and give it to her to use. Four times a day put her on level three. Essentially paying an extra $1500/month for non-prescription eye drops. Fortunately we found a price inclusive small place.

As a separate issue, MIL's CCRC now has very high charges for any assistance. Mush s this used to be free. There isn't much choice. You either pay up and stay independent or claim your semi-private room in the nursing home.
 
I have lined up phone numbers and web sites of government agencies to contact (file a complaint) in case I decide to go that route. The next few monthly bills, and the staff's response to my possible questioning of the charges, will give me a better idea of what to do.
 
The icing on the cake is that I have confirmed that someone is stealing my mom's depends. What lowlifes.
 
The icing on the cake is that I have confirmed that someone is stealing my mom's depends. What lowlifes.


Probably staff.... happened to my mom a few times... and my mom got something from someone else at least once...


If it happens a lot I would bring it up with staff... they knew where things wold go if missing... not the depends but other things... my mom was in memory care so others might think something is theirs and just take it...
 
If it happens a lot I would bring it up with staff... they knew where things wold go if missing... not the depends but other things... my mom was in memory care so others might think something is theirs and just take it...

Some staff refer to residents "going shopping." Seriously, it can be a problem. Residents go shopping in other rooms.
 
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