She's been in the same place for 2 years. Every 6 months they do an assessment and increase the care tier she falls under. The latest is a 350% increase from when she moved in. I don't believe she is receiving a 350% increase in care.
I know nothing about ALF but that does sound like a huge increase. Is it possible that they are increasing the costs to this degree because she actually needs to be moved to Memory care or NH? Sit with them and have them explain the increases she is receiving in services and not just dollars. Perhaps it’s time to do some comparison shopping?
Many/some ALFs have a rate sheet that gives the additional price of each service; ask for it if this ALF has it. The types of service the resident needs determine the "level" of care. Just a few things that trigger an increase are decreasing mobility, increasing incontinence, need for help in transfers from bed to wheelchair and number of helpers needed for the transfer, etc. etc. --- essentially changes in the resident's condition that require additional staff hours or additional skills. I think maybe you see this situation most often in free-standing assisted living facilities that don't have memory care or long-term nursing sections. But 350% sounds out of line. Ask for a detailed explanation and have them work the figures for you. And don't ask only for an explanation by "level" --- find out what needs and services each level requires.
sarmar, I see from your profile that your Mother has Alzheimer's/dementia. With such a disease the person sadly only gets worse, thus more care is needed.
My Dad was in Assisted Living and all the perks came with the monthly rent which was around $7k per month.
Back when Dad was in Independent Living, there was an options chart if Dad needed more things done for him. Example, his "medtech" was costing $30 per day extra for a Staff person to keep charge of his prescription meds and give him the pills required twice a day. That was an extra $10k per year. If Dad wanted his personal laundry done by the Staff, there was an extra charge. If Dad wanted his meals served in his room, that was an extra charge. There was an extra tier care option that would cost $13k per year. So, it can add up.
Assuming you are her POA you are entitled to know exactly what she is paying for. Having a conference with someone who knows what services she is getting (Director of Nursing, maybe) and someone in charge of billing should explain that huge increase.
Have rates gone up for everyone? Is some of the increase due to increasing needs and some just to rising costs? What does the contract say about rising costs?
I just looked up stats for my state (Minnesota). The average cost of assisted living in the largest metro area is $4050 a month. Memory care is about $1050 a month, on average. Even if your mother declined to the point where she needed full dementia care (except for the security feature) the increase you quote seems extremely high.
Did Mother get some kind of a special promotional deal for a few months, and now she is paying the regular rates? This is just hard to understand. It would be interesting to hear the explanation you get.
i would look around & ask them if they do that to i would not take that maybe notify the better business bureau or something ..how can they figure 350% anyway &they propbably think if you can pay if you are .i say prove it to & if they dont then you really need to shop & before you leave tell them to stick there 350% up there --you know
Many facilities have space for family to stay to visit. Check into that option to see if you could stay for a few days or even a week so you can see how mom is on a daily basis. And of course meet with the care team for a face to face explanation.
$1050 for memory care, Jeanne? That figure seems very low, no?
Sarmar, your mother may not be receiving 3 and a half times as many hours of care, but she may now need the support of much more highly trained people - with all the costs associated with that.
Factor in inflation, sector-specific cost increases, and - if we're determined to be cynical - the increased difficulty of finding anywhere better for her; and you can see where the steady ratcheting up in fees comes from.
But go through the assessment item by item and verify that she is only being charged for services she does use. There's no rule that says you can't argue!
My mom is at ALF. She is in a wheelchair all day. She needs help after she goes poop and she need somebody to be in the room when she showers. I pay 3600 a month for that. The food is crappy the help is worse and they don’t speak English. You have no choice but to pay what they ask for or move. I’ve done both and it’s a hassle.
We don't have all of the facts here - but if $4050 was increased by $1050 to a total of $5100, then it sounds like her dementia has progressed to the point where she is almost at nursing-home care or "enhanced assisted living." Five grand is pretty inexpensive for that level of care in most places in this country.
But as others have said, you need to sit down with a director and ask for an "accounting" of the various levels of care, what they entail, where your mother falls on their level chart, etc.
If the facility goes by evaluation "points" for activities of daily living, they add up quickly. Example: Toileting & incontinence - 0 points if no assistance needed, 2 for reminders, 4 for assistance required or incontinence up to 3 times daily, and a jump to 7 if assistance required... 4 or more times daily. And that is just 1 of 8 difference categories. Top level in all categories could give you 65+ points to add to charge.
You have a lot of good advice here already but I just wanted to add on about a lady I knew that decided she preferred eating alone in her room and began ordering her meals that way at a hefty extra charge for each meal. That lasted one billing cycle lol.
Maybe you could find another place where the prices are more reasonable. Wouldn't hurt to check around. When she runs out of money, she can go on medicaid.
My dad is in an AL specializing in memory care. He started around $3800/month and is at $5400/month. He was due for a $200 increase but for some reason it hadn’t changed. Hospice does his showering twice a week. He is in wheelchair and needs help with everything. He was one of the first residents to move in and his contract has a condition that his rate cannot change more than once in 12 months.
Unfortunately, the brunt of this all falls on you. When my mom was in a SNF, I got a list of expenses each month. Surprisingly enough, it was pretty easy to read for a “lay person” like me. But, I did go over it with a fine tooth comb. Years ago, my MIL showed me a summary of charges for my FIL, also in a facility. There was a charge for THREE large bottles of Colace, a stool softener, over the month. She told me that wasn’t the first time overcharges had happened. After seeing that I always asked for an explanation of any charges I didn’t understand. I didn’t do it in a snarky or accusatory way, but the facility knew I was, shall we say, “aware” of the rundown of expenses and would question anything I didn’t understand. Care Conference meetings are invaluable in a facility to find out what’s going on.
Our mother is in year 2 of MC. They did increase the rate, just calculated it to 4%. It was identified as rising costs and wage increases. Anyone out there paying 5k for MC - I am jealous!!! But there have been other postings who indicated $12-14000!!!
I do know that she has 1 hour of "personal" care build in, then we would get charged if she goes over that (I did ask, it would be around 1k+/- per month for each extra hour.) To the best of my knowledge, she still does not need help with getting around, etc. We did, for 2 months now, get an extra cleaning charge. She's had some accidents on the carpet in her room - hoping to get her to use the pads I bought and check for UTI, but she dismissed the pads at this point. She makes it to the bathroom but wets everything and has to change, which makes me suspect UTI not incontinence - secondary problem is her denial in weight gain and the need for larger clothes. The current clothes (I just dropped off some, but she A) doesn't need any more, has plenty here and at home and B) checks the tags and says oh these are large, I don't wear large!) are too tight and may be difficult to take off when she needs to go!
Anyway, what others suggested is what I would do - get fine detail on WHAT has changed, what the extra charges are covering, etc. Assumption is you have POA and arrange the payments, so they can discuss this with you. If not, bring mom along, even if she doesn't understand anything. You are just there as advocate! They should be communicating that anyway. When we got the 4% increase, they put explanation out there with the new bill without us asking about it.
Prices are so affected by location, competition, etc, that it's barely worth talking about them. However, the level of care you are being charged can be (and should be) a very transparent process. The director should be able to share with you the scoring tool used to determine care and your Mom's score. That score determines her level of care. Typically in AL, some amount of care is factored into the base rent. Then, depending upon a resident's score, levels of care are added. Those rates are published (or should be) so you can always know exactly what your Mom should be charged. The exception to this is if your Mom requires so much care that she exceeds the highest level. At that point, a 'custom' care level is created based on the assessment. The important thing here is that you ask to see Mom's assessments so you can compare the scores from when she moved in until now. You can also see how she scored in each area. You may or may not agree and those can be a points of discussion with the director.
I just thought about something my brother brought up when we were looking for a place. He lives down south, and found a place he was asking questions of who were charging 'only' $3000, less than half the rate up here. I poked around and reported what I found: this was a 'for-profit' place and the 3k was the STARTING rate, aka the room alone. Everything else was basically ala carte. Laundry? ding. Cleaning? ding. Food? ding. Assistance with ADLs? probably MULTIPLE dings, depending on what assistance is needed! THAT would easily jack up the costs, and if one jumped from a simple level to a difficult level quickly, all those costs would add up! I did not like the fact that it was 'for-profit', which tends to be inflated costs and low wages (not all places are alike, but one has to consider this!)
Our place of choice was NOT 'for-profit', was an endowed place for the elderly and decision was made to tear down the old facility and build a new one with IL/AL/MC. They opened in stages, with MC being last. It was just in time! She was the first to move in. I am guessing others think it is a very good place as it is currently full with a waiting list of 60!
So, again, you need to have an itemized bill and a face to face with someone (admin, billing, whoever it takes) to explain such a huge increase. You don't list dollar amounts , but just using $2000 (way too low I know, just needed to start somewhere) as a starting point, a 350% increase would be $7000. EVEN I would question if it went from 2-4k, but this is ridiculous, unless she went from regular AL to MC AL. THAT is what they should be providing to you WITHOUT Asking.
Each place is different. Read the contracts. I learned quick!
My da's last place couldn't get any more money in care yet raised his room rate every 6 mos (we started at $6200 and was close to 9K by the time it was over). We moved. So many new places popped up in those 2 years. Now we're in a place where it's all one fee, no matter the care, for $6300 AL/MC. This place has a wonderful chef. However the care seems less, so I used the extra money to hire private care sitters when I'm not there. It's still much less than $9K!
When I first found out about how much elders are being charged, I was really livid. There is no regulation around it, it seems.
After baby boomers, no one will have pensions and annuities and long-term health insurance to be able to afford it. The prices will have to drop....
At my Moms AL room, meals, housekeeping and laundry were one price. Her care was separate. I was able to get her in on a half price sale for her room. There was an increase on her room once a year, just like a lease. Her care amount is what would be adjusted as her needs became more.
Something is very wrong, you need to sit down with the administrator and have them explain their justification of this type of increase. Sounds like you should do some shopping around with worse case scenario as your base line.
If the ALF justifies the huge cost increase with saying that your mother needs a much higher level of care, then it is time to consider putting her into a long term care/skilled nursing facility. Of course, the ALF won't tell you that because they are for-profit & want to get as much money as possible. But when it gets to the point where she needs so much additional care, at an exorbitant cost, it's time to transfer her into full-time long term care.
Having said that, I would ask the ALF for an itemized accounting of the charges and justification for the 350% increase in cost. They may be adding on services that she doesn't really need, or adding on long term care services that suggest she is beyond their ability to provide such services.
My mother is bedridden and needs help with everything except that she can eat by herself if food has been cut up for her (and she usually does so in her room unless they put her in a wheelchair and take her to the dining room or one of the lounges). The cost is usually about $6500 per month, so I guess that is quite reasonable in this day and age. It is a for-profit business, and although it's not luxurious it's adequate for someone who couldn't take advantage of fancy amenities even if they were offered. Although there is considerable turnover in staff (particularly among the aides), there are several nurses who have been there a while. There are always some vacancies (they offer both short-term and long-term care), so it is an option that's available immediately for potential residents. They raised the rate once (from $200 to $210) during the course of over 4 years. They don't "nickle and dime" for things, so even though I sometimes feel some frustrations when it takes a long time to get something done, I figure we are fortunate to have a place this reasonable.
Have them give you an itemized list of charges. If the raise is correct, I guess you can start shopping around. I'm sorry for you both. It's so disruptive.
I too am in Minnesota. Memory care for $1050 seems extremely low. I finally came to terms with the fact I couldnt care for my mother in my home any more, her cares weren't the problem, it was trying to transfer her by myself that created the issue. Her memory care facility is just shy of $8000 a month
My Dad was in Assisted Living and all the perks came with the monthly rent which was around $7k per month.
Back when Dad was in Independent Living, there was an options chart if Dad needed more things done for him. Example, his "medtech" was costing $30 per day extra for a Staff person to keep charge of his prescription meds and give him the pills required twice a day. That was an extra $10k per year. If Dad wanted his personal laundry done by the Staff, there was an extra charge. If Dad wanted his meals served in his room, that was an extra charge. There was an extra tier care option that would cost $13k per year. So, it can add up.
Have rates gone up for everyone? Is some of the increase due to increasing needs and some just to rising costs? What does the contract say about rising costs?
Did Mother get some kind of a special promotional deal for a few months, and now she is paying the regular rates? This is just hard to understand. It would be interesting to hear the explanation you get.
Sarmar, your mother may not be receiving 3 and a half times as many hours of care, but she may now need the support of much more highly trained people - with all the costs associated with that.
Factor in inflation, sector-specific cost increases, and - if we're determined to be cynical - the increased difficulty of finding anywhere better for her; and you can see where the steady ratcheting up in fees comes from.
But go through the assessment item by item and verify that she is only being charged for services she does use. There's no rule that says you can't argue!
But as others have said, you need to sit down with a director and ask for an "accounting" of the various levels of care, what they entail, where your mother falls on their level chart, etc.
I do know that she has 1 hour of "personal" care build in, then we would get charged if she goes over that (I did ask, it would be around 1k+/- per month for each extra hour.) To the best of my knowledge, she still does not need help with getting around, etc. We did, for 2 months now, get an extra cleaning charge. She's had some accidents on the carpet in her room - hoping to get her to use the pads I bought and check for UTI, but she dismissed the pads at this point. She makes it to the bathroom but wets everything and has to change, which makes me suspect UTI not incontinence - secondary problem is her denial in weight gain and the need for larger clothes. The current clothes (I just dropped off some, but she A) doesn't need any more, has plenty here and at home and B) checks the tags and says oh these are large, I don't wear large!) are too tight and may be difficult to take off when she needs to go!
Anyway, what others suggested is what I would do - get fine detail on WHAT has changed, what the extra charges are covering, etc. Assumption is you have POA and arrange the payments, so they can discuss this with you. If not, bring mom along, even if she doesn't understand anything. You are just there as advocate! They should be communicating that anyway. When we got the 4% increase, they put explanation out there with the new bill without us asking about it.
However, the level of care you are being charged can be (and should be) a very transparent process. The director should be able to share with you the scoring tool used to determine care and your Mom's score. That score determines her level of care. Typically in AL, some amount of care is factored into the base rent. Then, depending upon a resident's score, levels of care are added. Those rates are published (or should be) so you can always know exactly what your Mom should be charged. The exception to this is if your Mom requires so much care that she exceeds the highest level. At that point, a 'custom' care level is created based on the assessment. The important thing here is that you ask to see Mom's assessments so you can compare the scores from when she moved in until now. You can also see how she scored in each area. You may or may not agree and those can be a points of discussion with the director.
Our place of choice was NOT 'for-profit', was an endowed place for the elderly and decision was made to tear down the old facility and build a new one with IL/AL/MC. They opened in stages, with MC being last. It was just in time! She was the first to move in. I am guessing others think it is a very good place as it is currently full with a waiting list of 60!
So, again, you need to have an itemized bill and a face to face with someone (admin, billing, whoever it takes) to explain such a huge increase. You don't list dollar amounts , but just using $2000 (way too low I know, just needed to start somewhere) as a starting point, a 350% increase would be $7000. EVEN I would question if it went from 2-4k, but this is ridiculous, unless she went from regular AL to MC AL. THAT is what they should be providing to you WITHOUT Asking.
My da's last place couldn't get any more money in care yet raised his room rate every 6 mos (we started at $6200 and was close to 9K by the time it was over). We moved.
So many new places popped up in those 2 years.
Now we're in a place where it's all one fee, no matter the care, for $6300 AL/MC.
This place has a wonderful chef. However the care seems less, so I used the extra money to hire private care sitters when I'm not there. It's still much less than $9K!
When I first found out about how much elders are being charged, I was really livid.
There is no regulation around it, it seems.
After baby boomers, no one will have pensions and annuities and long-term health insurance to be able to afford it. The prices will have to drop....
Let us know what happens.
Having said that, I would ask the ALF for an itemized accounting of the charges and justification for the 350% increase in cost. They may be adding on services that she doesn't really need, or adding on long term care services that suggest she is beyond their ability to provide such services.
If the raise is correct, I guess you can start shopping around. I'm sorry for you both. It's so disruptive.
a monthly fixed rate for her care. That's what I did.