Source: https://www.aarp.org/caregiving/financial-legal/unexpected-costs-assisted-living.html
1. The Problem of Hidden Costs
Many families are surprised to learn that assisted living base rates often exclude significant expenses. Over 1 million older Americans in assisted living face unexpected charges that can quickly drain retirement savings or force relocation.
- Lack of Transparency: Brochures often suggest all-inclusive pricing, but many services are billed à la carte.
- Surprise Bills: Families may receive unexpected charges without clear explanations.
- Unprepared Families: Many do not know what questions to ask to fully understand what is not included.
Examples:
- Medication Management: One family paid $100 extra monthly when daily pills increased from 5 to 6 because of tiered pricing, even for simple items like vitamins.
- Overnight Aide Fees: Another family faced a surprise $5,000 charge for overnight care that was never clearly disclosed.
2. Common Hidden Fees
The article identifies many services often excluded from base rates:
- Higher Levels of Care: Extra charges for help with dressing, bathing, eating, dementia care.
- Goods and Services: Hygiene products, household supplies, incontinence supplies, personal laundry, meal delivery to room, salon services, cable TV.
- Medical-Related Costs: Medication management (often tiered), therapy co-pays, transportation, visitor meals.
3. Pricing Models and Care Levels
- Tiered Pricing: Facilities start with a base rate and add charges based on assessments of activities of daily living (ADLs).
- Assessment-Driven Costs: Levels of care are determined by staff, with no formal appeals process like in health insurance.
- Cognitive Impairment Costs: Memory care or dementia often pushes residents into higher fee categories.
4. Limited Public Funding
- Primarily Private Pay: Most assisted living is paid out-of-pocket.
- Medicaid and Medicare Limitations: Very few facilities accept Medicaid; Medicare typically does not cover assisted living.
- Planning Ahead: Families cannot rely on public programs for long-term assisted living costs.
5. Strategies to Avoid Unexpected Costs
- Read Contracts Carefully: Review every charge, and have professionals like elder-law attorneys or aging care specialists review agreements.
- Request Full Cost Breakdowns: Ask for written details on fees for medication management, transportation, therapy, and care level increases.
- Clarify Pricing Policies: Understand who determines care level changes, how often rates increase, and whether private caregivers are allowed.
- Know State Regulations: Since disclosure laws vary by state, families should check with local regulators.
- Ask Probing Questions: Understand fully what’s included in the base rate and what triggers additional charges.
- Consider Private Caregivers: For limited assistance, private aides may save money, but extensive private care often costs more.
- Cost-Management Tips:
- Do personal laundry at home (save $50–$100 weekly).
- Buy incontinence supplies in bulk (Amazon, Walmart, Costco).
- Provide toiletries to avoid facility markups.
Emotional Toll: Financial strain is often compounded by the emotional burden of caregiving, causing families to overlook details in their desire to ensure loved ones' comfort.
