My 88 year old mother is in a memory care ward of an assisted care facility. Recently she had a fall, was hospitalized with a punctured lung and 10 broken ribs. She returned to her facility in hospice, which has been providing personalized attention.

The care facility, re-evaluated care provided to mom and along with an increase in overall monthly costs have increased fees by 50%. Since my mother's return to her facility we have hired 24/7 caregivers to supplement care provided by the assisted living facility. Our monthly costs have increased 300%, of which only 25% is covered under a long-term care policy.

How do I know that the facility is providing the service they are supposed to be providing, and what suggestions do you have to negotiate lower fees? The increase in monthly rates as well as the addition of 24/7 caregivers is financially devastating to our family.

Thank you for any insight you may have.

I am very sorry about your situation, but I am afraid your experience is more common than not. We were only able to find out that my mother's assisted living residence was charging us $900/month for the extra care we had signed up for, but NOT providing that care, when my mother's private caregiver told us. My mother is now in memory care at another facility, on hospice, and still has private care. In a great many instances the residences are just residences and dining halls. The reason for this is that these are all businesses owned by corporations. They exist to make as much money as possible while giving as little service as possible. This is a sad, but true, fact of aging in America. All you can do is be alert and ask your private caregiver what kind of services the facility is continuing to provide if he/she feels comfortable sharing information. We are extremely lucky that my mother is financially comfortable with a great long term care policy.
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Reply to horticulturist

Ascot21071: YOU do not use your financials for any of this. Your mother pays for her care. 24/7 care aides are superfluous since she is in hospice care in a memory care ward of an assisted living facility.
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Reply to Llamalover47

This reminds me of our family's experience with an assisted living facility that has been voted "best in state" for multiple years running. Both parents were assessed as requiring the highest level of care offered by the facility. At the end of the day the facility did not meet their contractual obligation to provide the services that my parents required. Showers, housekeeping, transport to the dining room, and in-room meal service were hit-or-miss. We realized after move-in that the apartment actually was not ADA compliant. The rooms were tight, and it was difficult to manuveur with a walker or wheelchair for toilet access. Call-button response time was regularly 20 minutes or more.

Instead of rolling the dice on another facility, we modified their condo to make it more accessible for them, and hired in-home help. My math showed that we could cover in-home help for 12 hours per day for the same cost as assisted living. A family member lives with them, ensuring that that someone is there overnight.

Since then, Mom has had a bad fall that resulted in several broken vertebrae, and Dad entered hospice. She is in a rehab facility for another two weeks, and we expect to have home health when she gets out. The hospice nurse comes out 3x per week to perform wound care for Dad, but that is the same schedule he was on with home health before he went into hospice. We are not using the shower aides from the hospice agency because their schedule is not consistent and we never knew when they were going to show up.

I don't really know if this plan is going to be sustainable, but it is as good as we can manage at this point.
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Reply to elcee499

I would say either move her to a nursing home or take her home with the private care. Both are expensive in their own right but paying a facility, which did not do a good job of caring for her in the first place—tho I do understand not all falls can be prevented, but some sure can—does not seem the best choice. It will depend on the care needed but smaller group homes are more affordable and provide better one on one bc there are less residents. That could be another option. This place does not sound like a patient centered facility. Sorry for this heartbreak and hardship. But this arrangement is not sustainable.
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Reply to WendyElaine

When I looked at facilities for my mom they had a base rate and then care levels added on extra cost. Sounds like your mom's level went up and that's the 50% increase?

Typically there's a sheet you can look at that shows you the extra services they provide at those respective levels. Does it seem right to you? If so, maybe you'll have to bring a good reading book or tablet and sit a full day with your mom and see if she's getting what you're paying for. You negotiate for lower fees when you document they're not providing them.

You also hired 24/7 caregivers. What do they offer that the MC unit cannot provide?
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Reply to Sha1911
strugglinson May 23, 2024
agree. if the MC staff are now doing zero since you got your own 24/7 people in, then they should drop their facility care level down to the lowest, so actually then the facility should be charging less than before.
make sense?
the facility cant try to have it both ways, dont let them
See 1 more reply
I think you need to sit down with the care manager at the facility and discuss it
What were the services they provided before? What has changed now to lead to an increase in 50%? Make them list out the exact services they are providing that have increased, and make sure the staff are actually doing those.

why did you feel the need to get additional 24/7 caregivers? Does she truly need constant monitoring?

One thing I have found that is a downside to getting additional outside caregivers in, is that then the facility staff do even less, thinking your private caregiver is doing it all! IF the facility care staff are doing nothing, then they should drop the facility care charges way lower. You should argue this out.
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Reply to strugglinson

If your mother has become a ward of the care facility she lives in, her family is not responsible for anything anymore. You also do not legally make her decisions anymore. It is not your place to hire outside help when the care facility is legally in charge of your mother.

Why keep her in a care facility if you are already paying for private, 24-hour care?

Save about $10,000 to $15,000 or more a month that's being paid to the care facility for nothing by putting a hospital bed in a room of your house and move your mother there. Why pay them if you have to hire 24-hour care for her?
Helpful Answer (2)
Reply to BurntCaregiver

I am assuming an aid is 24/7?
Why is this required, or being done?

Your family should not be paying this cost.
If your elder has no funds left it is time for application for Medicaid.
This will likely mean a transfer to in facility hospice or to a nursing home as most MC are private pay.
I would ask for a breakdown in the billing for exactly what you are paying for here, and why.

My friend went home on Hospice but had to pay for 24/7 caretakers. Even at the CHEAP rate of 20.00 an hour it was terribly expensive when you add it up. She had to have someone with you, but as your elder is in a MC already and on the "good meds" through hospice, I don't know why a dedicated 24/7 aid is needed here. To be honest any one of you could take her home with 24/7 care at this point with less expense.
Helpful Answer (3)
Reply to AlvaDeer
BurntCaregiver May 23, 2024

They should just move a hospital bed into their home and take the mother back. If they're already paying for 24-hour care, why pay a care facility to do nothing?
See 1 more reply
Your the secon person to ask this question. Hospice is provided by Medicare. They pay for an aide a couple of times a weekbto bath and a Nurse that comesvout 1x a week. Whatvare the facility aids doing extra for thet much increase.
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Reply to JoAnn29

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