I feel like my mother's AL facility is gouging me. How can I know for sure what her care needs are?

Nope, planning is what my husband and I have done personally. I totally understand and understood what you were saying. 1 to 35 is from personal experience with a SNF, 28 rooms with 2 patients each.and 1 CNA on the wing with 1 rotating around 3 wings. It took forever for anything to get addressed. My dad sat with feces in a pull up for 3 days, regardless of who I complained to. It took a transfer to a new facility to get his azz wiped. The government comment was meant to say, granted not very well, that they need to stop the for profit facilities, they are already hugely involved. They pay for a huge number of residents, so over site of tax payers dollars would be nice, however, we all know that will never happen. There is no accountability for any government employee, thereby making it nothing but a fraud. When special committees need to be formed for everything, that is the proof that it is systemic problem, no one already familiar with and getting paid for a job would say crap if they had a mouthful about any problems. But I still believe you can not compare home to facility, to many variables.

My point about the "for profit" place my brother found - yes, bottom line is to increase shareholder profit, which is one major reason I said no. That was the point I was making. The place we ended up choosing was not for profit. Despite no shareholders, it costs money to run a place like this. Due to variability in cost of living, some areas of the country (think NY city area or CA) are much more expensive just to live in, never mind provide a care facility. The place our mother is at now was endowed (two women long ago left their funds/buildings to provide a home for the elderly.) The year before we moved our mother I was seeking out places and this one was top on my list - unfortunately when I called they had just moved out the last resident, with intent to tear down the old (really old) buildings and build new. The timing really came out perfect as they opened in stages (IL, then AL, finally MC) - it was a little less expensive than the others, and again, not for profit.

I don't know what kind of facility has a 1/35 staff/resident rate, but that is either a poorly run place or more likely just AL (even that rate sounds ridiculous - do you have actual stats/facts for that? I would think no one would choose a place like that!) Our mother is in AL/MC, I believe the max #residents is 18 (only that many rooms) and when I am there I generally see AT LEAST 4 staff members. The majority of the MC residents are still mobile, some with walkers, some not, so it is not like a nursing home where one might need almost constant hands-on care all day. If it was not enough staff for those who need more help, such as with bathing, etc, they would have to hire more and then increase our rate. She has been there over a year and so far only one small increase (think YOUR pay raises yearly when you are/were working!) I do not know what the ratio is in the AL section, but obviously it would be less/person than MC (however consider that some AL residents DO need more hands-on care sometimes than someone in MC.) Again, I am not saying the price is right, it is a huge cost, and will become even MORE of a problem for those soon to retire who have no pensions and/or little savings. I was only pointing out that the entire cost of facility care is NOT what mom or pop is getting personally. Also the home care estimate was already MORE than facility and did not take into account off-shift, weekend, holiday pay, nor did it account for needing multiple people to do the ADLs, which often happens. I also am NOT implying one is better than the other, just pointing out WHY it costs so much! My main point was also that I do not see how insurance plays any part in the associated costs. Insurance does NOT pay for these places (exception is LTC plans, Medicaid, Medicare, but in general medical insurance does not cover these costs therefore do not impact the costs.)

Also, that cost estimate for home care I quoted was for 1 person/shift and only 20$/hour - it might be more or less in other areas of the country. Consider that oftentimes it takes more than one to move a resident - I watched THREE move one resident from the couch to her wheelchair (she was mostly asleep, but even awake has difficulty now with mobility.) The next night (mom suddenly ramped up anxiety in the last few days) I was there and with most residents in their rooms, some sleeping already, three people assisted another resident with bandaging his arm (he keeps scratching at it and rips off the bandages sometimes.) One to distract him (he is one who tends to be difficult to work with), one to hold his arm, one to bandage.

As for the government taking over, please let us not go there! They cannot even balance a budget or manage the programs they have or new ones they come up with!!! There is NO WAY it would cost less to have the government involved in this!!! Just to point this out, think Medicare and Medicaid - both are very much mismanaged and abused. Doctors AND insurance have found MANY ways to bilk Medicare - instead of working to stop this, you have those who want to dismantle it! Medicaid is experiencing many cuts, while cost and some need is increasing. FIX THE PROGRAMS GOVERNMENT!?!? Meanwhile, don't hold your breath.

These places are profit machines, you can not compare in home 1 on 1 care with a facility. In bulk everything is cheaper for them to provide and you are lucky if you get 1 caregiver for 10 people, more like 1 for 35. Yes, it costs to run these facilities but they are huge corps with shareholders and that is the main problem. When our government figures out how to pay for quality people and stop the profit making side it will decrease costs and improve care. We all need to pray it will happen soon, like before we need one of these facilities. I am not talking about 55+ communities for active adults.

disgustedtoo, excellent point about cost overhead just to run an Assisted Living facility.

Imagine the capital expenditure. When someone moves out, usually the carpet is torn up and replaced with new carpeting and padding. Plus the walls are painted. Repairs and/or updates to baths and kitchens.

And in the middle of winter, if there are any empty units they tend not to get rented during a blizzard, so those units aren't generating any income. The facility gave a really good discount to entice my Dad to move in while it was snowing.

I suspect part of the solution in the future will be the use of robots where possible. I recall seeing YouTube videos showing such use in Japan. This will help to lower some of the expenses in NH and other facilities, and perhaps in home care, too.

I've seen others comment here and elsewhere on the exorbitant cost of AL/MC and some, like here, mention the insurance industry. I am curious to know why people think the insurance industry has anything to do with this? A true nursing home or rehab, with funds coming from Medicaid and/or Medicare, perhaps, but AL/MC? Many of these are private pay facilities - there is no insurance involved. Although some people have those LTC policies, they don't dictate the price of a place you go to, they just (hopefully) pay out for what you bargained/paid for!

While I agree it is such a huge cost, you really need to understand that the fee being paid is NOT just for the care provided. It is for everything - building costs (maintenance, repairs, appliances, etc), property taxes, utilities (electric, heat, A/C, water), food, food prep, admin staff, MC staff, cleaning supplies, TV often running in common area, and I am sure there is some kind of insurance policy, likely not cheap!, etc, etc, etc... if you break it down, it can be seen as an average, where not everything will cost this "average" but it will make a little more sense:

$11,000/month = about $367.00/day (30 days) = about $15.00/hour (24 hour day).
(The monthly cost varies, depending on where the facility is located/cost of living; I just used doublefire's number for this example.) FWIW both my brothers were astounded at the cost quoted at the first place we looked at. Older brother later checked a place local to him (NC) and said they only charge $3k, WTF?? No, I looked into the place online - THAT was just the cost of the room, everything else was ala carte (care, cleaning, meals, laundry, etc etc.) I also said NO because it was a "for profit" place, so you know they are going to penny-pinch wherever they can to make a profit!

While for the most part night time is likely quiet, and costs would be less, you still must have staff (including a nurse), heat, electric, water, A/C and a skeleton crew for the facility itself. I'm sure there are residents who are up and about, as some have no sense of day/time. Daytime would require even more staff and resources. At our mother's place, they bring in entertainment of some kind periodically as well, which isn't free! The place is almost like a sauna to me, they keep the heat up for all the "cold" ladies!!

Many have commented on other threads on how expensive it is to bring in-home care-givers. Just using $20/hour which we paid for a short period, that would be $14,400 for 24/7 care for a month. Add in those other costs (rent/mtg/re tax, utils, repairs/yard work) and you can see that it is WAY more expensive to stay in the home, as comfy as home may be. Also, that $20/hour only applies to a 'normal' work day - nights, overnights and weekends (we never got there, but were given option to cover holidays at more money/hour) are going to be even more expensive.

So, like I said the cost of MC was a large sum to swallow, but put in perspective, one can perhaps understand why it is so expensive. We don't have to like it though! On the flip side, you KNOW the hands on staff are not making the big bucks, yet they have the most difficult job (oh wait, just like we peons were/are working for some big company!)

jeannegibbs that is a low number. My mother is in memory care in the Twin Cities area of Minnesota and we pay $7925/month now ($5091 for rent& basic care, $2834 for personal Service Rate). Mother can get around fine using a walker, when she remembers, but needs help with dressing, bathing, toileting (is incontinent), and they wake her every night to toilet. This was done at my request because she was getting up in the night and had several falls at that time, some harmful to her body. She never did break any bones though-she's one tough cookie. That extra night check increased her cost by $310 so it all adds up. Check her service plan and make sure she is getting the care she needs.

OP has not been back since she posted.

doublefire--I believe you are correct. The insurance industry has essentially become a big "parasite" that eats up a lot of our healthcare dollars, and thus drives up prices for the actual, legitimate medical services.

My mother lives in skilled nursing in Southern CA and has advanced stage 4 dementia. Her bill runs between $10,000 - 11,000 per month for room, board, and all the additional care pieces others have mentioned. I too struggle with believing that she receives $11,000 of care value each month but unfortunately it is what it is. I think senior care costs have also been greatly inflated because of insurance. I don't have any answers for you but I share with you in your frustration.

i wish when i was working i got a raise like that .!!how do they figure at 350 % that is like if you run 10 miles a hour & you say i need to run 350% ..only can do 100% not no 350% ..like i said go look for a new nest & ask them if they do that

AL facility gouging? quelle surprise! that's their business!

Wow. I didn't make my earlier statement very clear. I'm sorry I haven't been back on this thread to correct it. The $1,050 is an additional charge on top of $4,050. That is, on average Memory Care is $1,050 more than regular ALF in Minnesota.

Even if Samar's Mother now needs a lot more help I wouldn't think the cost would be so much more as to exceed what Memory Care would cost.

I own an adult foster care and have for 28 years. I have never even charged my 5% annual cost of living raise. I have never seen a raise that high in the 35 years I have been an RN in a skilled nursing home, alf, memory care and foster care. I charge between 5500-6500 per month including everything. Skilled facilities charge anywhere from 300-600 per day. Some ALF's will charge 300-600 per day but usually at the beginning. Some do point system like so much per day per point and some are flat rates. 350% is inexcusable. It should have been disclosed up front. I would talk to the state licensing agency on the increase. Sounds like if her care hasn't changed that drastically it is a come on to get you in the door. You need justification or refuse and take her out. They also have to give you a 30 day notice in most cases. Hope this helps some

Savitaa says:
"...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...."

I won't disagree that the costs, which range considerably, are distasteful. They are, but considering what is needed and looking at it more realistically, it can be perhaps considered "fair." Some areas in the country charge much different amounts (without doing extensive research, I have not a clue why this is other than cost of living varies so widely across the country. NY City or CA areas seem to charge more than say NC. Income, assets and costs are way higher in NYC and much of CA than NC, so this would reflect in how much a care place charges.)

When we visited the first place to consider, it was $8000/month "all inclusive." They told us that this would cover all needs, right to the end - we did not get to discuss if/when/how much increases might be, but as with any place, you know there will be. Their costs go up just like ours do. That said, I tried to explain to my older brother, the one who found a place that "only" charged $3000 (discussed this in a previous post - it was room fee only) this way:

She would be getting 24/7 care. Starting with $8000/month, that would be $96,000 for the year. Yikes! Agreed that anyone, never mind future elders with no pensions, who does not have significant savings or retirement income is SOL!!!

Now, divide that by 365 days/year = $263/day. At a measly $20/hour, that only gets you 13 hours of private care-givers in the home, IF you can find decent ones for that price. You still have to pay the usual utilities, food, property taxes or rent, etc, and have another 11 hours/day to cover. Don't forget you do need to factor in EVERYTHING, not just the cost of the care-givers!

If you divide that amount by 24 hours/day, the result is about $11/hour. Sure, the residents sleep (most anyway!) at night, but there still has to be staff on hand for whatever arises at night. The heat or A/C has to run, the water has to be on, etc.

Although that is an average for everything, consider the various costs involved besides just wages for the care-givers: laundry, cleaning, food and food prep, snacks, drinks, entertainment (they do bring in people who provide some at mom's place), heat (most of them there want the heat up beyond my comfort zone!), water, A/C, nurses, administrative staff, maintenance, repairs, etc, etc... This other "stuff" adds up! If you do not factor in the other stuff, it does sound exorbitant, but really I don't see any way for those costs to be reduced, much as we would like them to be reduced, unless you qualify for Medicaid and use a Medicaid facility, or you want to live in a drafty barn with no amenities at all.

I am not saying I am happy with this cost, just pointing out why it costs so much to provide for someone in a Memory Care place. AL is less expensive, as there is less (generally) care to provide, thus fewer care-givers per person, however it also includes all the costs for that "other" stuff, so it won't be 'cheap' either. Yes, you can shop around and perhaps find one less expensive that may not provide as much, but it is never going to be within many people's reach, even with some decent savings. Without good retirement income, pensions and savings, we are all in deep doo doo!

jeannegibbs said: "...The average cost of assisted living in the largest metro area is $4050 a month. Memory care is about $1050 a month, on average...."

She has not been back yet to update this, but given that MC is ALWAYS more than just AL, this has to be a typo. We can only guess that what she meant was $1050 more than AL OR it should have been $10500. It doesn't seem like MC would be that much more, so I would guess it was $1050 more/month.

sarmar: That's a huge increase. Sit down for the ombudsman.

This is true. $6k to $7k monthly is average for dementia care, especially with complications. The best thing to do is to enjoy your mom in her last years. Blessings to you for taking care of her.

Same thing happened to me.I hired a part time outside caregiver from 7am-9am,arranged outside PT/OT 9-10am,PACE bus picked her up@1015am for senior day care til 5-6pm. She got back in time for dinner,2hrs of TV in dining room then they helped her to bed.Medicare covered all of the outside care including day care.I paid 4a part time weekend care giver &I spent the night at the AL 4-5 nights a wk.Assisted Living CNAs spent less than 40hrs a wk w/mom.They tried 3 fee increase's in 90days! NO added
service's or support.We left. They weren't licensed for any dementia which they were supposed to provide,did not perform contract services and still tried to almost triple the services fees in 90 days.Fight increase,get Medicare help,do more yourself..unless you can afford more&more increases. Finally moved mom to nursing home with dementia care that involved all of patients&made them feel productive.She was happier.I continued senior day care because she enjoyed it& they took good care of her.

if it's like the place where we are I understand. We have gone thru the same thing but we are in Assisted living. If they are giving meds delivered by their pharmacy, there's a chrge They call them points in a computer system. If they are taking her to meals, bathing or assisting dressing , there's a charge Whatever they are doing, it goes into a computer. Ask for a printout of what they are doing Then you have a better idea of what they are doing. If they are scheduling dr appts etc-charge Best bet is to ask so you can see. Here they different level "care pkgs" with an assigned charge. You can also ask for a meeting with them

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

Go to a nursing home that does not charge al la carte fees, but will give you
a monthly fixed rate for her care. That's what I did.

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.

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.

What state is your mother in

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.

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.

Let us know what happens.

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.

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....

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.