Mom's AL bill for incontinence care varies drastically each month. I pay her bill, but when I voice my concerns, I keep getting excuses. Any ideas on how to deal with the facility supervisor about this?


The bill for the supplies, which is only for diapers, runs from $30 one month to $70 for another, then it would jump to $100. Now it went from $200 last month, to $560. My mom is able to walk and use the bathroom by herself. The diapers are used for leaks and I know from checking trash in her room that she is NOT using 30+ a day. She uses about 5-6 in a 24-hour period, which I know by being there two days in a row on many occasions without trash being taken out during that time period and being able to see what was still in the trash. At nighttime she gets up 2x and asks for assistance to walk to toilet.
I did verify the charges are for supplies only and voiced my concerns for the varying costs each month in the past, but I just got lip service stating my mom hides them in her room by the caregiver in charge of distribution. I still can't find any "hidden" in her room. She does hide other things, but I've never come across a diaper.
I would love ideas and suggestions on how to deal with her facility supervisor with this ongoing billing issue and where to perhaps purchase these on my own for her.

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I have worked in facilities for assisted and total care. The ratio for caregivers to residents are at many times 20 to 1. Even if it was 12 to 1, there is no way a caregiver can change your mother 10 times on her 12 hour shift (I say 10 times because in a whole 24 hour day, two shifts, would be 20 Depends). Nope, take the other advices and act concerned for your mom's kidney/output and get it itemized. I am positive the caregivers are probably using your mom's Depends on other residents because it may be easier and closer than going to the other side of the building to the supply room. Sometimes when a client complains and shows they are aware of the care of their loved ones, the resident gets better treatment. I have seen this countless times in these facilities also.
Helpful Answer (11)

A few years ago I reported here that my mother (in a nursing home) was being charge an "incontinence fee" of $15 per change, and it added up to several hundred dollars a month. After a couple months of this I questioned it, and was told it was for the supplies. We made an agreement that we would provide the diapers, and not only did they quit charging, they even credited the charges for the previous couple months. Particularly since this was a nursing home (as opposed to assisted living) in which she was private pay, I mentioned that it seemed ridiculous to charge for this as the residents are there BECAUSE they have needs. This was supposedly a non-profit home, too!

Bottom line--it PAYS to say something because they'll take advantage of you otherwise!!
Helpful Answer (9)

It's your right to ask for itemized billing. Ask them - no - tell them you'll purchase diapers elsewhere. Consider buying super plus adult booster pads from Amazon and tell the staff that they must insert one one into her diaper at bedtime to reduce the need for changing her diapers multiple times during the night. Unless she has a medical condition or a medicine that causes frequent urination or requires her to drink a lot of water, she shouldn't be urinating more than 12 to 16 cups of urine overnight. How much water is drinking daily? It's your right to get this info from the staff. Right after you wake-up, you have to pee, right? Take a plastic Dixie cup to catch your urine - the first urine of the day - this will give you an idea of much urine you hold overnight. If your mother is an average drinker of water, like 8 to 10 glasses a day, then her urine output will not be much different than your urine output if you don't have a medical condition that causes excessive urination.

It shouldn't take more than 10 min to change your mother's diapers so they shouldn't be charging an excessive hourly rate for this. My mother is bedridden and has a medical condition that causes excessive urinary incontinence. I change her diapers frequently during the day, like every 1.5 hour to 2 hours. Each time is less than 5 min. At bedtime I insert a super plus booster pad (purchased from Amazon) into her super plus diaper (which holds 24 oz of urine, also purchased from Amazon); the booster pad holds an additional 12 to 16 oz of urine. Her overnight urine out is...3 liters...yes...3 liters! She doesn't wake-up in the middle of the night. She has a kidney condition that causes excessive urination. She can't tolerate a catheter because it causes ongoing UTIs. I would love to save money on diapers - but the catheter disrupts her quality of life so I won't allow this for her.

Unfortunately, overcharging is common in nursing homes/assisted living.
Helpful Answer (8)

$560 in one month is a whole helluva lot of Depends! Something isn't right.

I know the price can vary by brand but on average adult diapers come in packs of 20 that can range typically from $10-$20 a pack. Doing the math that's roughly 18 diapers a day for the $560 month. Seriously?

I think I would arm myself with some figures and talk to whomever is in charge. Tell them you want a breakdown by day for a couple of months. Maybe look all wide eyed and innocent and say "Gosh! If mom is using 18 diapers a day I really out to get her to a urologist. Could you keep track how many she uses a day for a month so I know what to tell the doctor?"

Or better yet - buy and take in your moms supplies. Costco sells a box of Depends - 4pk for a total of 80 diapers for about $48.
Helpful Answer (7)

Scrimble- be careful about over estimating the per diaper cost and therefore the number of diapers - when you go to your meeting. Unless you are going off a price per diaper given to you by the facility. I'd say 30-40 is a high number per day that you're getting from the $560 figure. Even if the facility was getting the diapers wholesale- they are going to charge retail. Hope that makes sense. I just don't want you to go into a meeting with an unrealistic figure as that will make it easier for the facility to not take you seriously.

I don't know if you know the brand name of what the facility uses - but go on line and do some comp shopping. Even big brands like Depends make a variety of diapers that range in price - roughly $14 for their basic in a 18-20 pack up to over $1.00 per brief for their high-end fancier briefs.

Someone else mentioned the pad inserts. Do you know if these are currently being used? If so, that can up the price per, by half again as much.

If they have given you a price per diaper - this is all a mute point. But if they haven't - do your homework! If you can go into a meeting and cite price per diaper from a few different brands and then quality level within brands - to put it simple - they'll be less likely to "eff" with you once they realize you know exactly what your talking about.

Of final note - wipes. Is the price of wipes being factored? I mean $560 is completely insane, but the cost of wipes will slightly raise a per change price.

So go into this prepared and know your facts. Also bring in a complete incontinence billing history. And here's a tip: if you don't already have one - make up a big binder to take to the meeting. Fill it with paper and section dividers. Have it clearly labeled on the front and spin - something like "Mom - Brookside Nursing Home". Of course use the actual facility name. Put the bills and some notes under one divider. The other dividers can hold blank paper - for all they will know. They will take you more seriously if they believe you are documenting everything.
Helpful Answer (7)

I worked in an assisted living facility for 17 years and when a resident runs out of Depends they "borrow" from another resident. A $560 bill for undergarments is outrageous! I also did billing for nursing supplies and this amount is really excessive. I would start by buying your own and bringing them into the facility yourself. Go to the big box stores or buy on Amazon. Question the Director of Nursing and see if mom has medical issues that would warrant this amount of use. Best of luck......
Helpful Answer (7)

I always bought such products and brang them to the memory care facility where had my Mom --- for just this reason. If you are a fairly frequent visitor, you can oversee the supply yourself. You can buy them in any drug store, big box store or online.
Helpful Answer (6)

Who are you talking to at the facility? I would deal directly with the director; ask for a meeting and sit down with the bills.
Helpful Answer (6)

Thank you for your answers. I inially spoke last month with the Memory Care Director who brought in the caregiver in charge of distribution. She explained the increase in use from $70 to $200 was because my mom apparently gets up a lot in the night and needs help changing as well as hiding the diapers around her room. I felt I couldn't argue for the sake of of my mom and fearing it would cause them to be annoyed towards my mom. So I acted surprised and stated to her although that seems like a big increase in use but I believed what she said.
So the very next month's bill comes and it's $560! So I am thinking maybe the caregiver got upset that she was "fronted" off?
I received some great ideas here and I'm going to go in and "innocently" ask about the high amount charged compared to the others and then show the breakdown that it would mean my mom is going through 30 - 40 diapers a day and either she has a medical condition the med staff has not been made aware of or me for that sake and her room's trash cans are so small they couldn't possibly hold that quantity. They only dump trash once a day.
I'm venting here too. Sorry. I'm just thinking of other facts I can present to them during our conversation next week. Any suggestions would be great.
Helpful Answer (5)

I had a sort of similar issue - but on a much, much smaller expense scale, with baby wipes. I remembered it when a couple of posts mentioned the "borrowing".

I always got my moms incontinence supplies at Costco. Depends, Poise Pads and baby wipes. The deposable pads for sitting/laying on I did have to buy at a regular grocery store.

Anyhoo - the baby wipes came nine packs to a box, 100 wipes per pack. One day I went to visit and found a note from the paid caregiver who spent a day with my mom once a week. Seems she had to go buy baby wipes for my mom as she was completely out. WTH? I had just recently brought in a case. Maybe I had my timeline messed up? Off to Costco for another case of wipes. Then it happens again - running out of wipes. So I go talk to the person in charge.
"Oh yes, Mrs. Rainmom - your mother has had a few bouts of diarrhea." Me- "But Mr. Director, my receipt shows I just bought these wipes x days ago. That means your staff - on average - is using 124 wipes a day on my mother. That's seems like a lot".

Now, myself? I am not trying to save the environment when it comes to cleaning up a poopy mess. So yes, it can take a lot of wipes. But no - not 124 a day. And not with Costco wipes which are 2" larger than the average and hands down the best wipes I've ever used.

So, I started writing my moms name on every package of wipes with a Sharpie. Problem solved. I think because my mom was always well stocked in supplies- she became the no-pay convenience store. I realize that isn't practical- putting a name of each diaper - but do what you can do to show the staff your monitoring the situation- I really believe it helps. They know you know...
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