Does your assisted living facility have a point system for how they charge? Are they required to tell you up front what the cost is?

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.

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.

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.

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.

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?

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.

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.

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.

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.

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.