Part of the Transforming Life as We Age Special Report
With the boomer generation aging into their 50s, 60s and 70s and many of their parents now in their 70s, 80s and 90s, there is an increasing need for long-term care.
Most older Americans would stay in their homes if they could, but health problems and lack of assistance often make that impossible. For those who need some help, but not the intensive medical care of a nursing home, assisted living is often seen as a good choice. And as an industry, it’s growing.
But according to a story in the October issue of Consumer Reports, consumer complaints about assisted living facilities are on the rise, many of these long-term care communities face staffing shortages and the federal government does not regulate them (though some states do).
Oversight of assisted living facilities is “uneven at best,” the report says. “A good one can be an excellent choice for someone who can no longer live on his or her own. A bad one could put your loved one at risk.”
Industry surveys show high rates of satisfaction, Rachel Reeves, a spokeswoman for the National Center for Assisted Living, told Consumer Reports. Her group represents the country’s assisted living and other long-term-care communities.
4 Questions When Choosing an Assisted Living Facility
How can you tell the difference between a good and a bad place? When searching for a location for your parent, it’s best to start the hunt before you have an emergency need. But even if you can’t, try to get answers to these four key questions, Consumer Reports suggests:
1. What kind of help will your loved one need?
Assisted living communities vary greatly in the amenities, services and levels of care they provide. In general, they will help residents — whose average move-in age is 84 — with activities of daily living, such as bathing, dressing and taking medications. But some may not have a licensed nurse on staff, according to Consumer Reports, which means your parent may be sent to the emergency room for an evaluation after a fall, for instance. And some will not take residents who use a wheelchair or have multiple chronic conditions.
At some centers, residents may be able to transfer to a different section of the facility if they develop dementia.
It’s important to get a medical evaluation for your parent to make sure you are aware of current health issues at the outset. He or she may also need to be seen by a specialist if there’s been a recent illness, Consumer Reports says.
2. How good is the care?
Make sure the facility is licensed to provide assisted living. Look closely at its inspection record; depending on your state and how complete the records are, you may be able to find the inspection record at A Place for Mom’s search tool. You can also call your state’s long-term care ombudsman and ask if the facility you’re looking at has had any complaints. (To find the phone number, Google “long term care ombudsman” and your state’s name.)
The most frequent complaints reported to ombudsmen included understaffing and delays in response to residents’ calls for assistance. That’s according to a recent survey of ombudsmen for Consumer Reports by the National Consumer Voice for Quality Long-Term Care, an advocacy organization.
Most of the staff at assisted living centers are low-paid, often making just minimum wage, and may be only minimally trained, Consumer Reports says. Ask the facility how it would handle various situations like a fall, a complaint of pain or an illness.
For insights that may not be provided by staff, try talking to current residents or their relatives about the facility. Find out: Do staff respond promptly to issues? Does medication arrive on time? Visit during meal times and on weekends and observe.
3. What will you really be paying?
There’s no doubt about it: assisted living is expensive — and most costs are paid out of pocket. The median cost for a private, one-bedroom assisted living apartment in 2016 was $3,628 per month, according to a survey by Genworth, an insurance provider. And dementia care averages $4,700 per month.
Contrary to what many assume, Medicare does not pay for long-term care. Your parent may be covered by Medicaid, but that coverage “varies widely by state,” says Consumer Reports, and requires the resident exhaust his or her own savings before Medicaid kicks in.
So be sure to read the fine print of the resident contract at the assisted living facility. Some centers provide a package of services for one price; others may offer a base amount with a “menu” of additional services you can buy separately.
Ask what circumstances could trigger additional charges, Consumer Reports urges. If the staff had to drive your parent to the doctor (assuming the facility offers that service), what would that cost? Would the center let you hire a private aide if it cannot provide the care you feel is needed?
In addition, ask what it would take to lower costs if your parent was temporarily bumped up to a higher level of care after returning from the hospital, for instance. How quickly can those fees be reduced again?
4. Could your parent be kicked out?
Another frequent complaint cited in the ombudsmen survey is threatened eviction. The most common reasons are lack of payment and “care needs that exceed the facility’s capacity to provide the services,” Consumer Reports says.
A Florida woman quoted in the story said her mother was not allowed to go back to her assisted living facility after a hospital stay because she had lost her ability to walk on her own. The mother was forced to move to a nursing home.
So read the contract and ask to see the discharge terms, including how much notice the facility must give you before an eviction.
And be wary of verbal promises from a marketing director that your parent will always have a place there, the magazine says.
“The marketing and sales people are trying to fill apartments,” Amy O’Rourke tells Consumer Reports. O’Rourke is president of the board of directors of the Aging Life Care Association, an organization of aging-life-care experts, also known as geriatric-care managers. “They’ll tell you they’ll take care of you for the rest of your life,” she adds.
Other Information on Assisted Living
The Consumer Reports story also includes a graph showing how states compare on assisted living cost averages, and a list of helpful resources, such as A Place for Mom (good if you are in a hurry to find a facility) and Caring.com (a place to start your search).
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