Hidden Costs of Assisted Living


The strong suit for in-home care agencies is their flexibility. During my years of caregiving for multiple elders, I used the services of two different in-home care agencies in the traditional manner, which was to fill the gaps in home care that I couldn't provide for my loved ones.

One of the reasons that assisted living centers are appealing to many people is that they offer a relatively high level of independence. If your parent is in good health and doesn't require much assistance with everyday tasks, assisted living is a terrific option. In fact, residing in an assisted living center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that trained staff is on hand to help your loved one when necessary.

However, assisted living centers are not all cut out of the same mold. Depending on what part of the country you live in, what you get at assisted living may cost more.

Assisted living facilities provide a safe environment with convenient meals and social opportunities in their "base package." They are generally set up so that an elder can obtain help if he or she falls or has another emergency. Many also offer transportation by bus or other means for group outings or to specific locations.

But what about the basics of personal care: help with dressing, bathing, keeping track of prescription refills, setting up daily doses, injecting medications such as insulin, and a companion for trips to doctor appointments? Many assisted living facilities don't provide it in the "base" package. The services are add-on pricing.

So make sure you understand what services they do and don't offer per the contract, and what services may be available, but would cost extra. You might get some services you are expecting, but not all.

It works differently at different communities. At Emeritus Senior Living in Bonita Springs, FL the base rent is for what is called independent living. Any room could become an assisted room if the resident has a health care need. A caregiver goes to the room to help with showering, medication management and more. But, there's a fee for that.

When my mom was considering assisted living, we looked at several facilities, one of which was extremely expensive. It was interesting to look it over, even though we knew the cost was prohibitive. They offered gourmet meals besides the option of a kitchenette in her room. They had a spa, a gym, many group activities and the surroundings were deluxe. However, after reading the contract, I realized that we'd be paying for beauty, but no more hands-on help than she had in her current apartment – which amounted to the help I provided. In other words, we would have to pay extra for basic services like help with bathing and dressing – or hire a home health agency to do it.

The facility she could afford to live in was okay, though not fancy. They, too, offered no real help within her unit other than a call light in the bathroom for help if she fell. I would have had to continue to provide her personal care unless we hired a separate agency for her personal needs.

Carefully read the assisted living contract

It's very possible that the assisted living community will provide the hands-on services your elder requires, but it could be an added cost. Some facilities have their own staff for this, while others contract with an in-home care agency for this additional care. Going with the facility's choice of caregivers may be cheaper, since the agency would provide care for many elders in the facility, however most assisted living contracts would let you hire independently if you choose.

Read the facility's contract thoroughly. You might find that much of the care you're looking for – that which you have been providing for your elder is not included in the base price. Then it's up to you to decide if you want to continue giving daily hands-on care, let the facility provide the needed care through their channels and pay extra, or whether you'd prefer hiring your own helpers through an independent in-home care agency. Figure the price both ways – what the facility would charge and what an independent in-home care agency would charge. Quality is even more important than cost. If you prefer one agency over another, you should have that choice.

Take advantage of the flexibility of in-home care agencies if your loved one needs more care than the facility provides in the basic contract. The combination of the facility for safe living and the in-home care agency for personal care can free you up to be the spouse, daughter or son again instead of the person involved in all of the physical care. This could be a huge benefit for you and your loved one.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

Minding Our Elders

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Seahawk, recent post discussing a lot of these issues . https://www.agingcare.com/Questions/how-calculate-the-cost-for-caregiver-185299.htm. 24x365=8760 hours of potential caregiving per year. Constant availability - potentially no relief under your scenario (try getting last minute agency help in that a narcissistic elder will accept). And if a small stipend is given, the person is an employee. Which makes them subject to labor laws, payroll taxes, vacation time off even if not paid, time off or overtime wages.
As glad points out (from 4 years in the trenches with 2 frail elders and whackadoodle siblings), this type of arrangement would need a LOT of support, planning and planned relief for the live-in that frankly many families are not willing to provide or elders to pay for.
Siblings definitely don't understand, unless they have been the hands-on caregiver. I sent mine the glossy brochures from various ALF's, and all they looked at was how much was the rent per month (as printed in the brochures). The sibs never read the fine print. Also the sibs failed to consider multiple items that costs lots of bucks--which would add $15- $20,000 per year, in Depends, prescriptions, eyeglasses, orthopedic shoes, doctor bills, cell phone, meals not included in the ALF meal plan, etc. When I informed the sibs about this, they claimed I was inflating the costs. And even my mom could not understand -- the rent WOULD increase every year, and could even increase with only 30 days' notice. As I consider my own senior years I am very determined to avoid any facility. They are designed to appeal to a very urgent and "capstone" of Life need.....but their motivation is money, it has to be. Nobody would ever just build an ALF for the fun of it!
I have a friend that thought one of these care homes would be the perfect solution for grandma. They moved grandma three times trying to find a care home that would work. Grandma ended up in a nursing home because of the meds needed to control her behaviors. A whopping 10K a month and three moves later!