Debra Drelich
Geriatric care specialist Debra R. Drelich, LMSW, ACSW, CMC, CADDCT is founder of New York Elder Care Consultants, Riverdale, New York. NYElderCareConsultants.com
Many seniors face a dilemma. They’ve developed mobility or cognitive issues that make it difficult to continue living in their own homes. Maybe they’ve fallen when getting out of the bathtub, or they are mixing up their medications. Yet, in other ways, they’re still in good health—too self-sufficient to need the constant medical attention and oversight of a nursing home.
Option to consider: Relocate to an assisted-living facility. Assisted-living facilities are residential rental buildings for older adults that allow residents to live independently in private units with their own furniture and belongings (some may come prefurnished). Assisted-living facilities offer group spaces to socialize…three meals served daily in a community dining room…and round-the-clock support services to help with bathing, toileting, dressing, housekeeping, laundry, and medication and health management. Assisted-living facilities typically do not have full-time doctors on staff, although there may be medical professionals such as geriatricians, podiatrists, psychiatrists or psychologists who come in as consultants to see the residents. Some facilities are limited in the type of medical care they can provide based on their particular level of licensure (for example, some do not administer insulin…some cannot manage feeding tubes). Residents can participate in a variety of daily programs such as art, exercise and wellness classes.
Assisted-living facilities are one of the fasted-growing areas of long-term care with about 31,000 facilities nationwide and 1.2 million licensed beds. For seniors, it removes the isolation they often feel and the burden of keeping up a household. Also: Family members no longer have to run over to Mom’s house to make sure she’s okay every time she doesn’t pick up the phone or oversee a potential revolving door of home health aides.
But there are drawbacks to assisted-living facilities: Annual costs are substantial, warns eldercare expert Debra Drelich, LMSW, ACSW, CMC. They range from $3,000 to $20,000 a month, depending on the location (think small town versus big city). That expense often necessitates significant life changes such as selling a parent’s home so he/she and the family can afford to pay for multiple years at an assisted-living facility. What’s more, assisted-living facilities vary widely when it comes to quality of care—it can take a lot of research to find the right fit.
Here are five common mistakes Drelich says people make when they are considering an assisted-living facility for a loved one…
Charges at assisted-living facilities typically are broken into two monthly components—rent and a care plan.
Rent is determined like most conventional rental apartments—by size, ranging from a small studio without a view to a luxury two-bedroom apartment with a kitchenette and a river view.
The costs of care plans, however, are far more complicated. Unexpected fees are common and make it difficult to compare facilities and establish a realistic budget.
Some assisted-living facilities offer a la carte pricing, in which you are charged for each individual service. This may be the most economical way to go if a resident doesn’t need a lot of daily assistance. But charges can pile up quickly, and the bill can vary from month to month. Example: Residents may be charged fees for daily medication reminders…help bathing…ordering medications from a pharmacy not used by the facility…and having meals delivered to their rooms instead of eating in the common area.
Other assisted-living facilities use tiered or all-in-one pricing. Residents’ needs are assessed when they first arrive, and they’re assigned a certain care level or tier. A monthly tier price is much simpler to budget for—but residents may wind up overpaying for assistance they don’t use. Before signing any contract, check the facility’s policy about reassessment of care needs in regard to adding or removing services.
Most assisted-living facilities are for-profit companies that expect residents to pay out-of-pocket. While federal laws ban nursing homes from ousting residents after they spend down their assets, assisted-living facilities have no such legal obligation.
These facilities typically don’t accept Medicaid. Medicare may cover some services that take place in the facility, such as physical and occupational therapy, and some outpatient services through visiting consultants like geriatricians, podiatrists and psychiatrists…but there is no coverage toward the main expense of room and board and hands-on care services such as bathing or dressing.
Medicaid exception: Your state may offer Medicaid assisted-living facilities or a limited waiver program. Some states might offer the option of paying for care such as bathing, dressing, etc., for those who are living in independent living facilities. Medicaid waivers are designed to prevent or delay the move into a nursing home. To check your state’s waiver programs: Visit Medicaidwaiver.org. For more information, go to Medicaid.gov.
If at some point the resident runs out of savings or retirement income to pay the rent at an assisted-living facility, some states or counties help cover the cost of housing. To find out more, contact your local Area Agency on Aging at Eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx.
Alternate payment solution: If you have long-term-care insurance, it may cover the cost of an assisted-living facility. But the policies frequently set a maximum lifetime benefit (the total dollar amount it will pay for your care) or have a finite coverage period such as five years. For more on long-term-care insurance, go to BottomLineInc.com and search for “long-term-care insurance.”
Many assisted-living facilities market themselves to potential residents with glossy brochures, elaborate tours and resort-style amenities such as indoor swimming pools. But be sure to evaluate the quality of care that residents get and whether the facility can meet the particular needs of your family member. Questions to ask…
The industry average for assisted-living facilities during busy daytime hours is 8:1, meaning eight residents to one staff member. A ratio higher than that can mean delays if a resident needs help getting dressed or toileting assistance or activates the call button in his/her room.
Some assisted-living facilities have “no-lifting” policies to avoid liability. Instead of helping a resident to his bed and assessing his condition, a fall often results in an automatic call to 911 for an ambulance…a long wait lying on the floor…and a trip to the hospital even if the resident is okay.
Many seniors can no longer drive or take an Uber on their own, or they don’t want to inconvenience family members by asking for rides. Not being able to get to the grocery store, doctors’ appointments, the pharmacy or church services can be detrimental to your loved one’s health and well-being.
This can be a deal breaker for many seniors who rely on a cat or dog for companionship. Many assisted-living facilities allow pets, but there may be size restrictions on the animal, as well as an assessment to make sure the resident can feed and care for the pet or hire a pet caretaker.
Many assisted-living facilities require an involuntary discharge if a resident needs more intensive care than the facility can provide. Find out specifically what conditions trigger these decisions and how they are made. Examples: In some cases, residents may be discharged if they are incontinent on a daily basis…unable to ambulate or maneuver their own wheelchair…or have cognitive issues that cause delusions or aggressive behavior. Also find out how long the facility will allow a resident to retain space in the community if he has to spend a prolonged period away in a hospital or rehab center.
Alternatives to consider: Some assisted-living facilities allow you to hire a part-time caregiver to provide assistance so that a resident won’t be required to leave. And many assisted-living facilities offer a designated “memory care” unit. This may be a good option for people suffering from some cognitive decline because they can transition to memory care. Note: Monthly costs for memory care are significantly higher than routine assisted-living care, often exceeding $10,000 per month.
Well-to-do individuals who worry about being uprooted from an assisted-living facility may want to consider a continuing-care retirement community (CCRC). CCRCs offer a variety of elder-living environments on one campus, including independent living, assisted living, nursing-home care and rehab care. This allows seniors to transition to higher levels of care without leaving the community. CCRC residents typically pay an entry fee of $250,000 or more, plus ongoing monthly fees. Some CCRCs, particularly not-for-profits, might say they won’t discharge a resident who runs out of funds to pay monthly fees, but it is crucial to review the contract language and ask clear questions. For more information: Go to BottomLineInc.com and search for “continuing-care retirement community.”
Several class-action lawsuits have accused assisted-living chains of failing to raise staffing levels to accommodate residents’ needs or failing to fulfill billed services. These shortcomings are particularly problematic in units where residents have memory issues and can wander away.
Assisted-living facilities are not regulated by the federal government like nursing homes are. Instead, state governments are in charge of licensing and oversight. Each state has its own guidelines and inspection requirements. To find out which agency has oversight in your state and to look up inspection violations: Go to APlaceForMom.com/caregiver-resources/articles/assisted-living-violations, or ask the director of the facility you are considering for a copy of the latest state inspection report. He/she should be willing to provide it.
Helpful: You also should check with your state’s office of long-term-care ombudsman. These federally funded advocates for residents of elder facilities serve as a resource for complaints. To find the long-term-care ombudsman in your state, go to TheConsumerVoice.org/get-help.
