A rant about some Memory Care facilities.. Nickel and diming...

Jerome Likes Pie

The more I look into Memory Care facilities, the more I find that many are not transparent about their pricing "schemes."  

Several of the nicer Memory Care facilities that I have evaluated include a certain number of hours per month of "individual services" in the monthly rent.  These services can include escorting your LO to the dining area, making sure your LO is taking the appropriate meds, brushing your LO's hair, bringing them a Kleenex, etc.  If your LO goes over the allotted hours of "individual service," the facility charges you for an additional monthly "care package."  

A couple facilities that I have evaluated have literally hundreds of these "individual services" with associated minutes for each.  I am guessing these services can add up quickly, so on top of the monthly rent, the resident is also paying for additional monthly "care packages" down the road that can be quite expensive.  It seems like this nickel and diming could add up quickly; not surprisingly, some facilities are not upfront about them.  If fact, I have witnessed facilities changing their pricing "schemes" during our due diligence.

Shouldn't the care givers be caring for the residents rather than spending time recording all the services they are providing?  It just seems that an all-inclusive facility would be a much better business model, and certainly better for budgeting!  While many people can afford paying thousands more for these packages, it doesn't mean you have to.  Do your homework.

Oh, and make sure the care givers can bring meals to your LO's room at no extra charge.  One facility that I evaluated charges $10 for each time they deliver a meal to a room.  I had to read this myself in the Handbook. 

Pie

Fairyland

I agree Pie.  It’s wrong to have obscure and hidden charges. Bringing them a Kleenex? Gosh.

The AL my mom is in gives included a couple of meals delivered to rooms a week if needed (as in not feeling well enough to go to dining room, the only time she used this). Then they charge but it’s not that much, at least last time I looked. For mine, toddling off to 3 meals a day and sitting with her “table” is her main and consistent activity and social time, so I don’t want her to be demanding meals in her room. Luckily (?) she forgets this is an option.

You are kind of stuck once you are in a place, so good to really dig in and think around the possible scenarios.

SusanB-dil

Wow - good to know.  I would not have realized that.

harshedbuzz

I am fortunate to live in an area well-served by such facilities. When we placed dad, I drove past over a dozen places on the drive to the one we eventually chose. I also toured a dozen places- a state-operated veterans home, a community-owned place, fancy corporate places, large CCRC MCUs both religiously-affiliated and corporate. Their pricing schemes were all over the place, but most (the state vets' home and community-run place were exceptions and significantly less expensive) worked out to about the same price for a PWD who took medications and required incontinence care.

All of the places I toured were very up-front about their pricing tiers. I could see where a business model where families pay for only what they need could make sense especially in the case of a PWD like my aunt who moved in earlier than many given that she was a widow with no children who mostly needed help with IADLs for a few years before her disease progressed. 

At the place that was mom's first choice, pricing tiers were set up in such a way that actual documentation daily was unnecessary- they knew how many meds and how many times of day they were distributed and whether a person needed incontinence care. With the shortage of staff available and the remaining demanding better pay I can understand how pricing would be very fluid right now.

May flowers

That’s crazy! They really are nickel and diming residents. The MC my FIL was at had three tiers of set pricing, plus an activity fee which was nominal. The first tier was for residents that were mobile and could do ADLs with reminding. The second, needed assistance with ADLs but still mobile. The third was when a resident needed everything plus two person transfers. All levels provided taking to activities and meals and administering meds.

But… if a person needed one on one 24/7 supervision, like after surgery, you had to hire for that on your own dime.

Beachfan

Try investigating facilities that are “stand alone” and solely dedicated to Alzheimer’s/Dementia.  My DH resides in one such facility.  Private pay only, costs are all inclusive (no tiers or enhanced services); I provide incontinence briefs and wipes.  Residents can age in place; staff are highly trained and when I interviewed them, they could not cite any instance of turning away a resident or requesting that a resident leave.  Arden Courts, operated by Pro-Medica Corp. operates facilities around the country.  DH has been in placement since November and so far all has been satisfactory.  (I am in NE PA; cost is just under 6K/month.) Good luck; I did a lot of legwork before narrowing a choice of facilities down to 2.  Both were Arden Courts facilities.

Rescue mom

Seems like most MCs in my area (all I could find and talk to that seemed decent) charge a flat fee, which is significantly higher than most other places.

I say “most places” because some facilities offer up to six tiers/levels of care, depending on how much service/attention  the individual needs. At the highest level(s) they were very similar to MCs in service and cost EXCEPT not well secured against residents trying to “escape” or get away. 

You had to study the various service levels/tiers carefully, but they were spelled out and more or less reasonable IME—no charge for delivering a tissue. But yes, charges for med management, escorting to meals/events, getting dressed, hourly toilet checks, etc. Having food delivered to rooms occasionally cost about $8 extra, if I remember right.

Another way of putting it is, IME, that residents who could ask for help—who knew they needed help and would ask— paid less. If they had to be checked on—if aides had to check/change their depends, or tell them to dress or eat.,—that’s when costs go up fast. The services are available, but you pay. But in MC—which already has the higher costs—much of that is included.

People seem to like these types of facilities because the PWD stays in one place, often started at lowest tier, then more services added when needed. The deal-breaker is wandering away, escaping, “going home.”

And, I expect that no matter what style facility, some staff members do better “checks” or spend more time with a resident, than others. Another thing families have to watch out—especially now when so many places are short-staffed.

 I often think about the families who are far away, and don’t really know exactly how well their LO is being attended to on a daily basis. I think that’s why so many hire their own private  aide in addition to the facility staff.

MN Chickadee

The dozens of facilities I toured, and then the two we utilized, did not have a la carte pricing. It was usually three tiers, which added approximately $200 - 400 per month per tier, and you got moved up on the tiers based on a handful of thresholds (number of medications you took was a big one, as was bathing/toileting and self feeding.)  Only one place did not have this arrangement, they had only one price for everyone, no add-ons. It was also the most expensive I toured. Is this an assisted living or true memory care? In my experience AL was far more likely to have small fees for this and that which would add up fast. Most considered about half the monthly payment to be "rent" and the other half was "care" which is the one that would increase. So perhaps you are seeing the initial "rent" price and at the end of the day it's the same price as the other places that do not add on fees for every little thing?

RobinNicole

It is very frustrating and scary to see how they can rack up the charges.  My mom’s facility is two levels of AL and then MC   She is in the second tier of AL ( but resides on MC due to her initial respite placement ( and never changed it)). She gets prompts / cues and escorted off locked MC floor to be able to roam and participate.  Like others have noted -within AL there are “levels” of additional services which add considerable charges.  But the AL “ comes with points to cover some services “ but if needs increase that is when they will add that to the plan ( and bill).   MC is all inclusive.  

When we were touring I brought my SIL who is a nurse in SNF in another state to review these in detail.  We quickly saw those extras and were very vocal where she currently was - and didn’t need those ( help w showering etc).   When we had to urgently place her they assessed her and agreed she needed no extra services

My SIL said typically once she was placed the nurses would need to do a new assessment to change the care plan ( and add those services).   I keep an eye on her room, her attire ( if she is showering, changing clothes) so I can hopefully stay ahead of things - and quite frankly head off little things I don’t want to pay extra for ( choice of attire not weather appropriate )

We never upgraded her to a one bedroom unit - she likes her room and figure the savings will eventually go to services, and hoping to keep the base as long as possible   

BlackCat1

The cost at our SNF keeps going up dramatically.  We are now being charged 25 percent more MONTHLY that we were 10 months ago.  We are paying thousands MORE every month. Nickel and diming is an understatement!