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Advice & More September 2013

Dollar Sense

Tips for Choosing an Affordable Assisted Living Facility

By Teresa Ambord

Whatever you decide to do, you shouldn’t feel like you are compromising quality of care in the interest of money, but obviously any arrangement you make must be affordable. So how do you balance cost and care? Do some serious homework.

Assisted living communities can be a beautiful answer for those who need it. Gorgeous new assisted living facilities have cropped up everywhere, as senior care has become a huge industry. Unfortunately as with most things worthwhile, it’s not cheap. A MetLife survey in 2012 said the average cost of a one bedroom apartment in assisted living rose to $3,550 per month, and depending on where you live, the price can soar much higher. In some areas, the monthly cost is closer to $9,000.

Too often the families of seniors who are not well off place their hopes on some kind of financial help, like Medicaid. But the rules for Medicaid qualification are strict and complex. Often a senior ends up between the rock (can’t afford to pay for private care) and the hard place (too financially stable to qualify for help).

Whatever you decide to do, you shouldn’t feel like you are compromising quality of care in the interest of money, but obviously any arrangement you make must be affordable. So how do you balance cost and care? Do some serious homework.

  •  Contact your state’s Area Agency on Aging office and ask to talk to an advisor.

There are various places online to try, and name of the website will vary by state. Try these: Area Agency on Aging, Department of Aging, Department of Senior Services, Long‑term Care Ombudsman, and always add your state name. To avoid commercialized sites, look for one that includes GOV in the link. These offices know or can guide you to information about the reputation of a facility within their region. They know the complaints, if there are any. They may be aware of some available help such as through veteran programs and other affiliations.

  • Consider an assisted living facility outside your area.

It’s generally advisable to place your loved ones in facilities which are convenient for you to visit. But this could mean paying a great deal more. Driving 20 minutes to a suburb where there is a more affordable facility might be an easy trade off of convenience for price.

  • Consider a smaller living space.

Obviously the larger apartments will cost more. My aunt was in an assisted living facility which offered various sizes of apartments. Hers was tiny, yet more than enough for her. She had a small bedroom, a good‑sized bathroom, a partial kitchen (all meals were provided), and a more than adequate living room/dining room area. She had a small front porch when she wanted to be outside, and her backdoor opened into a communal area where it was a short walk to the dining room and all kinds of activities.

If your loved one does qualify for Medicaid, this will likely mean he or she must share living space with another Medicaid recipient.

  • Ask about move‑in incentives.

Often assisted living facilities will offer special deals to potential residents. Don’t be too proud to ask. They need to keep their occupancy high to be able to afford the quality personnel they require. So ask about discounts, such as lower rent, a waiver on the entry fee, the possibility of freezing the rent for a time. Don’t be afraid to negotiate.

  • Resist pressure.

Keep this in mind. A facility which is most concerned about quality of care for your loved one will not try to pressure you. They will want you and allow you to take the time you need to make the best choice. If you are told there is a limited time offer for a certain price, beware. If you are told only one unit left! or this special rate is only available to the end of the month, beware.

  • Look for a not‑for‑profit facility.

This won’t necessarily be easy, since NPR reports 82 percent of residential care facilities are private for‑profit organizations. A study of the last several years price changes showed the profit margin of for‑profit facilities jumped significantly, while at the same time, the payroll expense fell. Does this mean you should avoid for‑profit homes? Not necessarily, but keep in mind there is likely to be pressure from the admissions staff to make a quick decision. And check with people who live there or have loved ones there to make sure the staff is adequate.

  • Check inspection reports.

Don’t judge this book by its cover. It may have terrific curb appeal to attract new residents, while cutting costs on personnel and other expenses. On the flip side, a facility which looks like it needs a facelift may offer the best care in the area. How can you know? Take a look at inspection reports available through your long‑term care ombudsman. Or contact a local senior center and ask how to reach the ombudsman.

While you are checking on the quality of care, check on the financial stability of a facility you are considering. Ask to see a copy of the annual report. Go online and find out if there have been any
negative financial reports on the facility.

  • You might also ask if there is a waiting list and if there is a probationary period.
  • Ask the facility for a list of references.
  • In addition to checking inspection reports, do your own investigation.

Visit, visit, visit, and don’t always call first.

If you’ve zeroed in on a facility, make many visits and go at various times of day. Also make at least one unannounced visit on an evening or weekend, or both. Visit during at least one meal and ask to taste the food.


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Eliminate the Surprise Costs in an Assisted Living Facility

While you are talking price, be sure you eliminate as many surprises as you can. There may be no intent to deceive, but prices do change and the residents themselves change, possibly requiring them to have more care, and that could cost a bundle. If you move your mom into an assisted living and a few months later find the billing has gone up, you will no doubt be distressed, even angry. Before you commit:

  • Ask about upfront fees, such as for assessment and community fees.
  • Ask what services are included in the basic rate.
  • More important, ask what will cost extra. Suppose you are in the middle of a work meeting and get a call saying your mom has a cold and wants to have her meals brought to her room till she feels better. No problem, you say. But don’t forget to ask if this costs extra? If the facility is calling to get your permission, this is a sign you’ll pay more. A cold can last for weeks and you may get a bill significantly higher than you expect. To avoid nasty surprises, know in advance what will cost extra.
  • Ask if the facility will give you a costs and payment schedule before you sign.
  • Ask if you will be given a copy of the admission agreement to take home and study before you decide.

Ask what the cost will be if something significant changes. For example, your elderly dad is comfy in his new digs. But a year later he begins showing signs of dementia. At some point, he will require different treatment and there’s a good chance he will have to move to a dementia unit. Know in advance how much this will cost and how the need for dementia care will be determined. It is possible the facility does not even provide such things as dementia care, which would mean another move.


Teresa Ambord is a former accountant and Enrolled Agent with the IRS. Now she writes full time from her home, mostly for business, and about family when the inspiration strikes.

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