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?

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.

$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.

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.

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?
IDK.
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.

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.

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.

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.

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......

Hello, my name is Diane from Florida...is your mom affiliated with the V.A.? Was your dad a Veteran by chance? If so, then please contact me......you can also go to the supermarket and jot down the names and phone numbers of all the different briefs and contact the company who sends you samples which is only a temporary help...you can also contact your local fire department where families drop off boxes of unused new briefs. I look forward to your email. Diane

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!!

You might want to find out what her fluid intake is just before bed time. Sometimes limiting fluid intake in the evening lessens the need to urinate during the night. Also some nursing homes allow you purchase mail order supplies and have them sent directly to the home.

We pay a flat rate of $300 a month for incontinence care. Covers diapers or pull-ups, wipes, gloves, pads, changes etc. The last AL my Mom lived at charged $1100 per month. I assumed it was because there is much more laundry and housekeeping involved with incontinent residents. This was more of an independent living facility.

You can call it what you want; AL, skilled nursing, health care center, what have you. All have some staff with careless or mindless attitudes toward the money that's spent. I've been billed for diapers when my dad wore depends; medication which I personally provided the charge nurse on his entry to the facility; and bed linens for linens I had to provide because the facility didn't have any clean ones when he wanted to go to bed. I kept good and copious records of everything...and got a bit of revenge on the bed linens because they were flowered with red, which created pink linens for everyone for quite a while. I only dealt with the director level which was an interesting experience. Then I looked for another facility and removed my dad from this one. In the new one I gave them a list of what I would provide, his average use of supplies and the schedule on which I would do an accounting and refreshing of his needs. It worked a bit better, but the best was just bringing him home and hiring fulltime help. A bit less expensive and I had control of what he was given, how he was kept clean, and medicated. The cost for the facility per week was around $2500 for the week; the cost for home care is about $1900 some per week. Of course that means I picked up a lot of extra work and lost most of my free time. Worth it. At least I know how he's being treated and how his money is being spent.

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...

It may be a new employee who is charging multiple clients usage to your mother's account, because they don't understand the process. Please discuss with billing-$560 for briefs would be your mother being changed every hour. Ridiculous-I don't think the Admin would allow this because it is a definite overcharge. Do NOT pay it.

These suggestions are great. Yes, Rainmom, I over exaggerated on the 30 - 40 a day - I thank you for the idea of the varying brands and costs. Even so, at 18 a day there is no possible way they change her almost every hour. If fact, when I'm there for at 4 hours at a time, she is in the same diaper with a small amount of leakage. She makes it to the toilet.
You can't imagine how much I appreciate all of your advice and sharing of your similar situations. I realize this is unacceptable and since my mom really dislikes drinking water and has a rather low fluid input it shouldn't be such a ridiculous fee.
I am going to puchase myself now but.... sorry to sound needy here.... What brand(s) are recommended? She wears 24/7 mainly for leaking and overnights. I will purchase the pads as suggested as well as wipes and write her name on every package ( or every pad or diaper for that matter) .
Thank you again. I'm surely going to go in on Monday armed and ready. 😊

I have used the basic Depends- bought them for my mom, my dad and it's what Rainman currently wears. They were/are fine for my dad - with a pad insert and without the insert for Rainman. For my mom - she always had a tendency to leak with or without a pad and regardless of the brand so I just continued with Depends as that was what Costco sold and where I by them for Rainman.

I do use an "overnight" for Rainman but often wonder why I do - if Rainman has an overnight accident he somehow manages to soak his sheets, comforter and sometimes even the pillows become casualties. Its truely amazing how he manages it - as the diaper is miraculously dry. One of the many mysteries of Autism?

Try opening the diaper boxes, then take a purple or other noticeable colour - then draw a line or even write 'for Mary' across the fold side of them so that each gets a bit of the writing on it - also use a different brand than in house brand

Then do an accounting each time you visit so that you write date & time & number on box top or in a note book so that you are 'monitoring for her replacements' - let them see you do this a few times - end of story on overcharging I would think



I don't pay for my mom's as it is included so set fee for all that stuff

I buy my Mom's at BJs and bring just a couple of the pkgs at a time. I was leaving the whole box and they were disappearing awful fast. When I questioned them they didn't have a good answer other than she was using them. She only used a few a day before going in AL 80 were gone in 2 weeks. I also put them in a dresser drawer instead of the bathroom which seemed too convenient for staff to grab them. Seems to not be as bad now that I questioned them.
We pay enough $$$ for them to live there and then they steal from the residents!!!

It sounds like they are not very helpful in problem solving. If she's just hiding them they should be able to find them easily enough and they'd be overflowing by now. Try putting them on a higher shelf or in a cabinet. A polite sign for her use only since you're paying for them. Talk to others and see if they are also seeing an increase in consumable charges (facility is padding) or talk to staff. Maybe an aid is using your mom's for other residents not realizing you are being charged/thinking it doesn't matter.Caution is if she's not changed enough it could lead to rashes and UTIs, so be thankful to staff for keeping her dry (but I've never seen 10/shift either).

I learn so much from this board! Some questions:

1. If an elder is in the NH w/Medicaid, who pays for the diapers?
2. If an elder in in the NH private pay (or with LTC insurance), the diapers are always a separate charge?

If Medicaid pays for diapers (as part of the pay't to the NH, and I don't know at all if this is the case, then what would stop the NH from saving some money by taking diapers from the private pay patients (as appears might be happening to some in this thread) to use on the Medicaid patients (or anyone else who runs out of diapers; could be another private pay patient)? I could see an unscrupulous NH doing this, hoping the person who pays the bills doesn't notice the extra charges (although I don't know how hundreds of extra dollars could get by unnoticed)?

If my mother ever ends up in a NH, she will be private pay (the LTC insurance checks are made out to her, not the NH). And now I find out I will have to be on the alert for diaper theft?

When my mother was in a skilled care facility for rehab a few years ago, the diapers were included in the per diem charge. If fact, when she was dismissed, the staff told me the take the rest of the opened package because they could not use them on another patient. In AL and memory care I have always purchased the Depends and Poise. I buy them whenever they are on sale and use coupons when I have them. I learned one lesson - Depends come in two absorbencies, Moderate and Maximum. I bought Moderate once because they had a couple more in the package, but learned that it was a big mistake. She wears size large, Maximum absorbency which come 17 to a package. I can almost always get them on sale at Walgreens or my grocery store for $11.99 per package. Mom uses two packages each week (5 per day) along with one package of Poise pads. The cost is about $150 per month. Is it possible that the facility undercharged you in the past when the bill was low and they are now trying to make up the difference?

I think it would be a good idea to tell them you will supply the diapers yourself. I purchased from HDIS . They delivered the diapers on a regular basis. They are a great company to do business with. They carry all brands and I found the Tena best for my husband. Just type in HDIS in your browser and you will find them. Good luck.

Yep. I agree with ALL the above. It's excessive price for the diapers, and you get flack/lies when you question $ from staff and directors and supervisors. I got so fed up with this, no response, prices fluctuating way high, and things/excuses that made no "common" sense (that many diapers would not fit in trash can) or they could/would not explain. It's because the companies are almost all about money and staff didn't want to lose their jobs. When I brought all the complaints "un-addressed by staff and supervisors after 8 wks", 3 pages WRITTEN to the "Administrator", he acted shocked, but said, to make me feel better, they had some lazy ones and were about to make some changes. ex. the 1st medicine bill $600, never been over $50, nurse said she did, but did NOT send the insurance card to pharmacy, because I called them and sent it myself, they never got her hair washed with baths unless I told them to, staff losing and stepping on hearing aid (cost $1750) didn't reimburse me when I even called several nights in a row 12 midnight to "remind them" to get that hearing aid out and lock it up for safety, eating without her dentures, wearing someone else' glasses. Price went up $500/mo. than quoted by administer, while signing all the papers, because corporate said nothing was in writing. It goes on and on and this was only 5 months at a moderate priced nice "looking" place. I stayed a few nights, all night and saw and heard things, I was ready to bring her back home no matter how exhausted I was. She ran out of money, had to leave - (18mos private pay $5500/mo. before Medicaid could be filed.) So you WILL be taken advantage of, and loved one lacking care you or they are paying for if you don't go in there WELL prepared. I lucked out, got a not as nice physically, facility $2,000/mo. less and the care was 100% better. Keep looking for other places and check with family members as you visit. It's tough on the patient, 3 mos. transition time, but if you and family are there often it'll be easier on you both. Oh, and the diapers they supply are awful and way too big - the ones Medicaid supplies. PLEASE stand up for you and her! It was a bad experience for us and she even had family visit everyday and was a very sweet patient. I "caught" them in so many lies! I'm really an easy going person, not a complainer, thinking it's just transition/learning curve, getting to know them, benefit of the doubt,...but it didn't get better except the day I met with admin. Good luck!

Sounds like you are getting ripped off. Put your complaint in writing to the Administration and sent it by certified mail. Get a signature that your letter was received. Have a copy with the receipts for mailing and signature you get back from the P.O. Also what could be effective but may have limitations as to a legal threshold is e-mail. You would have record. Next, buy the paper panties yourself. If you know how many are on hand, you have a day to day idea of how many they are using. It is easier to catch them using 50 paper panties a day if you are stocking her bathroom. That would be medically alarming. I don't think that they would want to deal with that if they are just ripping you off.

I paid for Moms diapers. You say ur Mom can go by herself? When my Mom lived with me she used 1to 2 a day. I buy the large bags of 30ea bag and they last a month at least. Mom is now incontinent. I buy mine from Walgreens and use their brand. They usually have a coupon or buy one get the second half price.
Two bags not on sale only cost me $35. If your Mom plays with them then have them put them up high enough for her not to play with.

Seriously, after seeing what others are paying - I still recommend Costco - if you have one in your area. I paid $48 for a case of 4 packages that were 20 each. 80 maximum absorbency for $48 - that's .60 cents each. They do come in the light peach color - but my mom liked that. Made her feel more like she was wearing a panty instead of a diaper.

Hello all,
Just an update. I went in with my neatly arranged binder and asked about the concerning charge as compared to the past charges. At first I was told by the director it was for gloves, wipes, chucks, and diapers. I told her the numbers still don't make sense and my mom does not have 2 of those items in her room as I supply the wipes. Then I showed her the print outs of the various diaper companies (retail) with quantity and how that compares with her daily use of anywhere between 16 - 24 and it still does not come close to their charges. She agreed with me something wasn't right.
After she reviewed the facility caregivers product distribution report she found my mom was given 30 chucks (bed pads for night) every 2 days, 7 packs of wipes every 4 days, and 4 packs of diapers every 4 days. WHAT?
She was as shocked as I. So now all the memory care residents are going to be reviewed for careless product distribution and I am off the hook for the incontinence bill for the month.
So a huge thank you to all on this site for helping me understand this huge concern and arm me with the right info to deal with this.

my Mom was switched to full briefs the kind that had a plastic backing and looks like a diaper with Velcro tabs on the side because we were told they were more absorbent and they seem to be. The Nursing Home sticks these in multiple sizes and there is never any additional charges for supplies everything is included in the monthly payment. This is a Nursing home in Upstate NY - perhaps it varies in other states.