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Our facility kept telling us they will give us the price after they are assessed. We keep asking for a price. They have been there almost a month and we got a huge bill. They are charging points because Dad had a fall last week. If he does not fall for 3 months they will not charge in the future. They are penalized for falls? My dad's behavior is very strong willed and he gives them a hard time when they are dealing with my mom. They are charging us 4 points for his behavior. This sounds ridiculous! Has anyone experienced this?

My 85yo mother was in a private pay Memory Care facility. They used the point system when determining cost. When I first sat with their director to talk about costs, she said that for the first month or so the bill will be higher than I should expect to pay because the facility is still determining what my mother's needs will be. The director made it clear that they wanted to keep my mother in Level 2 to keep the costs low for our family, since it was private pay. I let this go for two months at this higher rate (Level 4), then reached out to the director about cost when I got the bill for the third month. I was told that my mother really did require all the care that she came into the facility needing (surprise! surprise!), and that she really should be at Level 5 (really?). Their point system included such determinates as -- assisting with dressing, assisting with bathing (both of which my mother needed), and this one, that I thought was ridiculous: being told to go to breakfast, lunch, dinner. Hello! It's a memory care facility! My mother required very little assisting, as far as I could tell -- she walked around the gardens, ate when she was supposed to, mostly handled her own bathroom needs. Caring for the elderly is an industry...
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Reply to ArtMom58
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In our experience, with both my parents and my husband's mom in ALFs, we have found that whatever they quote you up front is not to be counted upon as a final number. They may assess your loved one differently after a fall or other incident that requires extra care; they can even just change their method of charging (that happened to us with our parents' care, but they were given an "allowance" discount for having lived there for a while to soften the blow). And yes, if they have to deal with a reluctant or belligerent resident, they may charge more. (We've experienced that as well!) Good luck, this is the way it is, by and large.
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Reply to HelperMom
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Oh, it's so complicated! AL is theoretically designed for people who need some assistance with some Activities of Daily Living. There's an underlying assumption that they can manage their own affairs. This is not always the case.

State regulations factor into how they charge, too.

At least in my state, Kansas, the looser regulation means that Assisted Living homes have flexibility in how much support they can offer. This can translate to the same charge for all residents... or a point system. Someone said in a previous reply - time is money. That's what it boils down to. If someone needs more help, then they need more staff available. Is it fair for a relatively independent person to pay the same rate as someone who needs cueing, reminders, or physical assistance with just about everything? It doesn't really seem fair.

Additionally, family members tend to see their loved one as how they used to be, or how they behave on their best day. A loved one may act very differently when family is not around. It's hard for a family to understand increased charges for care if they don't see the behavior on a daily basis. Yes, the administration (usually nurse or social worker) should definitely have a conversation with the family about their assessment and explain why charges are the way they are. You should be able to request a care plan review meeting to have that conversation. When requesting, realize that these staff members are very busy and it may take some time to get it on their calendars.
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Reply to LaurenBond
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wi57twin Aug 30, 2018
When my dad moved into his AL 4 years ago he was the first male and like the 4th or 5th resident. Most of the first wave of residents were mobile meaning no wheelchairs and few walkers. This changed quite a bit over the years as it’s almost the opposite. I saw my dad 5 times/week so I witnessed his decline along with others.
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Sadly, yes, this is the world of assisted living.All kinds of unexpected charges. We paid for level 4 care which included management of Mom's medications, help with bathing and dressing, and transport in her wheelchair to activities. When they transported her to the hair salon, in the independent living building across the parking lot, that was an extra charge. Things started to look fishy to me when she asked me to set her alarm clock for 4:00am because she said it too her that long to get dressed for breakfast at 7. So, they hadn't been helping her dress in the morning, and since she fell forward into her closet trying to get her shoes, they wanted to charge for the extra fall risk. She stopped going to activities because the staff was too busy to take her back to her room when she got tired and wanted to return, yet we were still paying those fees for transport. They also said that a severe case of diarrhea was not enough of a reason to ask for no charge tray service to her room rather than going to the dining room. 7 to 9 bucks each meal brought to her room. They will raise the rent about 5% every year, as well. Ripoff.
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Reply to kwyattearp
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health2018 Sep 1, 2018
Any chance responders talking about experiences with facilities would name the places they are referring to? I'm writing down some questions to ask based on what individuals are saying, but I would really like to know the names of facilities. I think this could be of some help to everyone looking for places to take care of their LOs. If we want change that is meaningful we all could use this information.
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This info should have been part of the rental agreement. AL facilities usually have different care levels and each level should have a set price. Before they actually charge for an increase in care level, an assessment should be done by a LVN or RN who is in charge of the caregivers and medical technicians. They should call in the resident’s appointed family member or POA/medical POA to review and discuss the changes. For instance are these changes due to a temporary condition or long term. You or the responsible party should be asked to sign off on this increase in payment for care. Once you’ve sign off they’ll usually go back to the date the increase care began and then be part of their new monthly rate. But the AL should always review this info with the responsible party first.

Might be be a good idea to review the rental/lease agreement before you call a meeting to better prepare yourself.
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Reply to jellybean18095
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wi57twin Aug 30, 2018
My dad’s AL did this as I was POA and had to sign off on increase. However he was on of the first residents and his contract could only have annual increases regardless of increased care. I’m sure that was modified for residents who moved in after the facility was finally full.
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Yes, this is what they do. BUT.... sit down with the administrator of the section in which your father lives. Before they act of those charges, they SHOULD have a proper assessment completed and APPROVED by the family member who is responsible for the resident. Then ask questions, such as what the new points entail. For example, toileting assistance. I found out that only meant “reminders” by the staff but the administrator told me it was”hands on assistance”. Ask for the points and costs ahead of time and then tell them you will need to get your father’s doctors to assess their assessment as well in case “there are more needs”. They will get excited but realistically you can come back and let them know the points and costs are not necessary. One thing I did for my mom is tried for a month and then went back and complained that the “points and services” were not being provided. Plus they were charging exorbitant prices for disposable underwear equaling over 20 a day. She only used 2 or 3 at the most.
Staff told me the Administration push them to upsell services and it was ridiculous. Just be on them and ask about everything that doesn’t seem right and make sure if you disagree have another option available. You are the voice for your parent and they are there to make money.
Another option is a smaller 6 bed facility where they are sometimes less expensive because they do not charge all the extra do dads AND your parent will get a lot more attention.
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Reply to ScrimbleB
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They use an assessment tool that applies points to care needs. It's the only way to be fair in charging for levels of care. Time = money. They should be willing to show you the assessment so that you can see where points are applied and have them explained to you.
Depending upon how your dad fell, they may have determined that he needs to have an assist when he's up and about. That's a lot more staff time. If that's not what they're providing, ask exactly why the fall resulted in an increase in care level.
Behavior can absolutely result in an increase in care level. If a resident won't take meds, requires extensive persuasion with personal hygiene and/or lots of intervention and assistance, that all takes time and that's what you're paying for.
It is not unusual to have an adjustment in points (up or down) in the period after move in depending upon how the resident adapts to community living. However, it seems odd to me to not give a month or so adjustment period before deciding to greatly increase the level of care assessment. It looks like your Dad's AL is 'proactive' in assessing points, so you have to be proactive in making them reassess as your Dad adjusts.
Some communities have experimented with an 'all-inclusive' care approach. Basically, the residents who need very little hands-on care subsidize the care for the more needy residents. Generally, everyone has periods of higher need or needs more care as they age, so it would seem fair. However, the range of need is so great, that the amount they'd have to charge to 'even it out' would be prohibitively high for the resident who needs very little hands on care.
Not knowing the details of the fall nor the behaviors, I can't really give an opinion, but I would say that the AL's quickness in applying extra points would cause me to be diligent in making sure his assessment is always accurate.
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Reply to IsntEasy
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The facility I used, and the one I changed to, will give an "estimated care cost" upon initial assessment, and have a 30 day review upon first moving in, then an assessment will be done every 6 months. If your parents have dementia those care costs will skyrocket every assessment. I found it almost impossible to get detailed information from the management about what my costs covered. Your best bet is to get to know the aides, the people actually providing the care. They will tell you what is really going on. I found that out too late, and finally moved my mom out as her needs increased and I was tired of fighting with the management which was really in the apartment rental business not the care business.
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Reply to sarmar
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I think ALs that are loosey-goosey about fees need to be pushed hard for written contracts, I know of one where every resident seems to be paying something different depending on how well they negotiate and how willing they are to walk away.
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Reply to cwillie
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My dad’s AL used a point system and he was assessed before moving in so I knew the cost. Also his AL in the contract I signed could only increase price once/year. This was a newly opened facility and I’m sure this probably changed. As dad’s dementia increased and needed more assistance in is activities of daily living his cost also increased. In the 4 years he resided there is cost increased about 30% mainly the last 18 months.
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Reply to wi57twin
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What have you signed?

Here's the thing. In theory, according to basic principles of contract, not only would the facility have to inform you of the price but you would have to agree to it. But obviously in terms of care services there has to be some flexibility, and so what normally happens is:

care needs are assessed
the level of services required is estimated
there is some kind of price banding according to the support required
these are adjusted as time goes on and needs increase.

But in principle it seems bonkers that the facility has said something like "let's see how they get on" and then sent you this kind of itemised bill. So to repeat - who agreed to what (and signed for it) when your parents moved in?

If the facility refused to carry out a needs assessment before your parents were admitted, I think they were pulling a bit of a fast one - not to mention potentially exposing your parents to risk. If, on the other hand, all parties agreed to a probationary period to fine-tune their care plan, that's different. Would you like to say a little more about the background?
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Reply to Countrymouse
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I just think this is ridiculous.  I would find another ALF that does not charge this way.  I would be broke.  My Mom is out of control, rude, ignorant, does nothing for herself.  It is just a horrible situation.
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Reply to Stanledm
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My mom is in a NH so I do not have any personal experience with AL.  There are different ways that Assisted Living determines their fees for care.  I have listed a few websites that you can "Copy and Paste to your browser" for more information. 

payingforseniorcare.com/assisted-living/pricing-models.html
"Fee Structures and Pricing Models in Assisted Living and Alzheimer's Care"

seniorhomes.com/p/assisted-living-cost/

caring.com/articles/how-assisted-living-facilities-determine-levels-of-care
"How Levels of Care Affect Assisted Living Cost"
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Reply to DeeAnna
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This is ridiculous. How can you budget their money when things change this much. My Moms care was based on 1 thru 4 steps. 4 being the most care. Which was Mom. She needed to be showered, toileted and dressed. They had to make sure she got to the dining room to eat.
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Reply to JoAnn29
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My dad's AL/MC has a point system that determines whether there are any extra costs but they provide a list of point items and how many points trigger given amounts of extra costs - nothing hidden just not known until there's some actual experience with the person. I was given a minimum and maximum monthly cost at the time Dad entered their care.

Base care levels are included in the "base" cost. Base care includes giving medication 4 times a day - with meals and at bedtime; for medication more often or on a different schedule, there's a extra charge. Base care includes 6 toileting assists a day and 1 incontinence event; more than that costs extra. Basically people that need more care need more staff and/or supplies. The extra charges are used to fund appropriate staffing levels. I have found the system to be mostly fair with some months having more extra charges than others.
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Reply to TNtechie
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realtime Aug 30, 2018
Two of the ALs I visited when I was looking for a place for my mother gave me printed rate sheets, showing the extra monthly cost for additional elements of care. I take a printed rate sheet to reflect a good level of professionalism.
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