This fall, my father sat down for a semi-annual assessment with staff members at his assisted living facility in Tinton Falls, N.J. They decided his condition — at 72, he has advancing Parkinson’s disease — necessitated an upgrade to the next level of care.
The meeting yielded an upgraded bill, too: a nearly 18 percent bump, about $12,000 a year.
Most assisted living residents foot the bill on their own or with help from family. Cost increases typically come in two forms: annual upticks to cover rising expenses, and more significant hikes accompanying a move to the next tier of care, such as help with bathing or dressing.
The annual rises can be daunting enough. The MetLife Mature Market Institute recently reported that assisted-living costs climbed 5.2 percent from 2009 to 2010, to a national monthly average of $3,293, outpacing both inflation and the interest earned on savings and bonds — a problem for the elderly on fixed incomes.
But add a more expensive service package, and the bill can become prohibitive. And as the costs soar, relations between families and the facilities caring for elderly relatives can sour, said Miriam Oliensis-Torres, who runs a geriatric care management firm, Geriatric Support/Pathway Care, in Milwaukee.
Sometimes the reasons for the new status can be apparent, as when a resident becomes incontinent. But the decision can also seem arbitrary. If they disagree with it, residents and their families have to work at maintaining quality care while simultaneously challenging the policies of the institution providing that care. It’s a tricky balance.
The institutions often urge families to approach assisted living a bit more realistically. “It’s important for people to remember that their loved one is moving into assisted living because they need services,” said David Kyllo, executive director of the National Center for Assisted Living. “They’re not moving in because of a change in address. It’s needs-driven.”
Those needs can change quickly. Residents average just 28 months in assisted-living facilities, and their health almost always declines.
Such deterioration may shock the family; the consequences don’t have to. Families should know ahead of time what will happen, and when, as a resident progresses through care levels.
“In my experience, families at the time of admission are pretty stressed,” said Ms. Oliensis-Torres. “It’s really worth their while to step back and say, ‘Explain this contract in plain English.’ ” Lawyers often prove helpful by reviewing a contract prior to moving in, she added.
Still, even due diligence won’t prevent genuine dissent over appropriate care. When the effort of managing an elder’s care threatens to overwhelm a family, professional expertise, though expensive, can pay off. An external review of the new price structure by a geriatric-care manager may lead to a money-saving solution.
Typically, a geriatric-care manager gathers information about the resident’s needs and abilities and the types of changes he or she is experiencing. Hourly rates range from $80 to $200, varying by geographic location and service type, said Linda Fodrini-Johnson, board president of the National Association of Professional Geriatric Care Managers. Ms. Oliensis-Torres estimated that a review typically requires three to five hours.
Don Heape turned to a geriatric-care manager for help with his eldest sibling, Marcella Festner, after she entered assisted living more than two years ago. (She died this summer.) Ms. Festner, 80 at the time, lived in Laguna Woods, Calif.; Mr. Heape lives hundreds of miles north. With another brother and sister helping, the family found a place that looked nice (the dining room had a maître d’) and fit their budget.
“When they first sign people up, it’s affordable, it’s doable,” said Mr. Heape. The rent started around $2,200 a month. After a few months, however, the facility upgraded Ms. Festner’s care level, and the rates reached $4,000. Her health had declined, he conceded, but he felt the facility was aggressive in its care assessments and billing.
One issue particularly rankled: The facility insisted on having staff members supervise Ms. Festner’s insulin injections, which added to her tab. Yet Ms. Festner, a diabetic for 30 years, had given herself thousands of injections.
“It was such a subjective approach,” said Mr. Heape. “But you’re dealing with a corporation, and their assessments are weighted in favor of the company.” With a geriatric-care manager, he succeeded in appealing one price increase.
While a reputable geriatric-care manager can bring a wealth of experience to the table, not everyone can afford one. As an alternative, Ms. Oliensis-Torres suggested getting in touch with a state ombudsman for long-term care.
She also recommended bringing a friend or family member, especially one who’s been through a similar situation, to meetings at the facility. “When people are under stress, they don’t always hear all the questions or process the answers,” said Ms. Oliensis-Torres.
It’s vital, she added, that family members attend regular care planning meetings (my father normally has two per year), especially in the aftermath of a setback. “After a blip in health status, you should ask for a care conference every two weeks to see if you can ratchet the fees back down,” said Ms. Fodrini-Johnson.
In my father’s situation, we disagreed with the facility’s new assessment. We prepared our argument and appealed on our own (my sister is a social worker, and her skills proved invaluable). The chief nurse listened, in the end reversing the decision. With $12,000 at stake, we had plenty of reasons to make the case.