Nickel and Diming Assisted Living

Money is an interesting thing. It can be manipulated, laundered and rationalized like crazy.

Since I’ve been in assisted living, I’ve seen many different ways different assisted living businesses charge for their services.

I received a phone call several days ago that absolutely shocked me.

A lady wanted to move her husband out of the facility where he was staying. When I asked why, she said they put her husband on Hospice. That didn’t seem so weird.

Until she asked me if I billed extra for someone on Hospice. I told her I didn’t. She proceeded to tell me the facility added on an additional charge per month of $12,000 for Hospice services.

That’s insane. I told her to contact a lawyer.

Hospice is a free service offered by the government through Medicare and Medicaid programs. There is no charge to an assisted living facility for the service. In fact, in many cases, Hospice is a wonderful addition to our caregivers. They bring over a whole staff of people to help us with the residents care.

I can see why she wants to move her husband out.

That’s about the most outrageous charge I have seen. Nevertheless, I see a lot of other assisted living facilities charge for every little thing they do.

• Medical checks like blood pressure and blood sugar (usually required in the care plan)

• Drug administration - more for injections but they can charge just to make sure residents take their pills

• Charges to order new medications - especially if you don’t use their preferred pharmacy

• Help with activities of daily living such as bathing

• Staff “check ins”

• Food deliveries to their room

• Billing long-term care insurance (a process that takes me all of 5 minutes a month)

For the record I don’t charge any extra for these services in my homes.

I do see some interesting behavior though. We have an extra charge of about $45 every 3-12 months depending on the resident’s level of care (high level means every 3 months, low level 12 months). The charge is for a nurse to initiate or update the residents care plan. This is a service mandated by the state of Arizona and is most likely in every facility in Arizona.

When I tell some families about this charge, they become angry. They say I’m already charging them several thousand dollars a month to stay there and now I’m trying to nickel and dime them.

So I just make the rent $50 higher each month, don’t charge them for the service plan, and they don’t complain at all. Even though they would only have to pay the $45 charge once every 3 months, 6 months or 12 months a la carte. Weird.

If you feel like your loved one is being overcharged in a facility, challenge the charges. If they won’t relent, find another facility. Ever think that if they can charge all these extras, they have an incentive to make your Mom or Dad worse so they can charge more?

Or better yet. Work with your family to make Mom and Dad as healthy as possible. Then maybe they can avoid all these charges by just living at home the rest of their lives.