# What to look for in new AL/MC facility and "the Fine Print"



## Wild1 (Jun 12, 2019)

As alluded to in another message, I think that we are going to be looking for a new home for Grandma (92)soon. 

At this point, she needs more frequent care due to frequent falls. Normally she is cognitively "pretty good"  but she has had a hard run lately with UTI's, falls, and now some problematic delerium type symptoms and paranoid ideation. 

What should I be lookig for in the literature and services? And in the fine print for the agreement at the new place? I know this is a broad question, but I am interested in learning anything from what to look for as far as the financial aspects of what is included and how the costs are itemized, to any contractual stuff (what if she doesn't like it and doesn't do well and doesn't want to stay?), as well as the legal type stuff that could have an impact on the staff's responsibility for patient care, patient rights, stuff like that. 

Also, is there a kind of "in between" community based care that is somewhat like more supervision like memory care, but where there are other people who are still able to be social and offer company? One thing I fear (and a staff person sort of confined this to me) is that without the other residents, my grandma will not have much social opportunity in memory care. She has been doing pretty well socially (except on a few bad days) with others, they make sure she gets out, and are wonderful for her. 

But, my grandma has fallen a lot. There's not like a "balance care" version we can put her in?


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## Lethe200 (Jun 13, 2019)

There is no standardization for senior facility care. Unlike Canada and other countries with nationalized healthcare, the U.S. does only basic inspections and has mostly minimal regulations, most of which are merely to conform to Medicare/Medicaid, or avoid being sued. 

It is, therefore, _*the Wild Wild West of seniorcare.*_ Pretty much anybody can offer anything, and outside of minimum building safety standards and lax staffing regulations, anything goes. There are some very good organizations in the seniorcare field, and a lot of greedy ones, as well as a few really really bad ones (the kind that get shut down under one corp name and just reopen under another; lather rinse repeat).

You should not keep asking on a public forum because state regulations rule when it comes to seniorcare and elder law. 

In general terms, one of your first and best sources is:
- One of the few national resources: your local office of the *Area Agency on Aging*. They can help you find the professional help you need, one of which is probably:
- *An attorney who specializes in elder law*. We used one for my MIL and it is absolutely worth it. You need to know what her rights are, what your rights are, and who pays for what.

I wish you the very best in what is a difficult time ahead. It can be a rough road, but when you "get the ducks in a row", it really, really helps make it a little easier.

Good luck, and keep us posted on your progress!


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## Wild1 (Jun 13, 2019)

thanks for your response - but i am not sure what is so wrong about asking on a public forum? I guess I am confused what I am doing wrong? 

I guess my question was a bit vague, and maybe I'm not so much talking about the "FINE" "fine print" but more of the medium print. The kind of stuff that can mean the difference between what the brochure conveys, before the contract is signed, and the reality that hits the pocketbook unexpectedly or negatively impacts quality of care/quality of life for the resident? 

I guess im having a hard time articulating what my question exactly is - so... Maybe a better way for me to have put my question is: 
-What do you wish you would have asked, but didn't, when finding an AL/MC facility? 
-What was a reality of the contract/billing that affected you/your loved one, that you wish you would have understood, before you chose that facility? 
-what is a policy that had unexpected negative consequences (contrary to your expectations). 
-if you could do it all over again (not that you would) what would you do differently? 
-Is there a certain thing that costs a lot that
-what are some cost structure type things to look out for? (Like a large up front payment; or a low base cost and high itemized costs, can you find these out ahead of time?
-where do they (the greedy business) "getcha?" 
-how do you find out really if it is a good place, and not a crappy one? 
-is there anything contractually that you have to watch out for that basically spells out their right to (insert sketchy practice here). 
.....
Etc.,.,this is an open-ended question.


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## Aunt Bea (Jun 13, 2019)

When my mother went into assisted living approx. thirteen years ago we didn't have any issues with fine print.

The assisted living facility month to month lease included the room rent, meals, assistance with administering meds, laundry, etc...

The only thing included other than those basics was a roll of toilet paper and a bar of soap.  We took care of everything else including health insurance premiums, telephone, cable television, transportation to medical appointments, etc...

When my mother died the facility prorated the last month's rent for the days that her belongings remained in the room and refunded the rent for the remaining days.  The business manager strongly hinted that we should consider making the refund a donation to the facility in memory of our mother but we didn't take the bait, at the time the cost was approx. fifty thousand per year and the facility had never felt the need to cut us any slack.

I suppose that it varies from facility to facility and from state to state.  Most states have some sort of database online that lists serious violations.

The only advice I can give is to be involved, visit often, take an active role in your loved ones care, have low expectations, don't assume anything and ask lots of questions.

Good luck.


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## Lethe200 (Jun 15, 2019)

My DH and I have visited 10 facilities (8 for MIL a few years ago; 2 for us and ongoing), and NONE of them are identical. All of them have different "gotchas"; all of them very different social/cultural atmospheres; all of them say the same things but differ in what they offer.

- Some have a big buy in. Some don't.
- Some have good food. Many don't.
- Some are willing to be flexible with residents; many are not.
- Some offer laundry; some don't. Some give residents a "meal allowance"; others are 3 meals daily/7 days week; others have different plans to pick from. 
- Some have kitchens. Some don't.
- Some are full-service; others specialize in one or two segments of the industry.

A good facility has a low turnover ratio. Virtually no one will give you hard figures. In our state it's on the state's website as a year-to-year percentage. 

Some facilities are one price all the way (Type A contracts); most are 'come in at one price, but changes are charged market rate' (Type B/C contracts).

Memory Care/Skilled Care (nursing) were the same prices at almost every facility.

EVERYTHING costs a lot, because good care is so labor-intensive. In 2013, at my MIL's full-care non-profit facility, the basic rent for a tiny studio, no kitchen, was $3400 for Independent Lvg. But Level 1 assistance - giving her 3 pills in the morning, and helping her bathe or shower 1x/week, was $800/mo. additional. Level 2 assistant added $900/mo. over that, and going to Level 3 puts the resident on the same cost as MC/SC (it means the resident doesn't have to move to a new unit, however).

All facilities we've talked to set their own individual levels of pricing for assistance in AL. AND, it is the facility who decides what level a new resident comes in at. You can negotiate it with them (we did) but once in, your negotiating power is pretty much nil, because.....

....virtually all facility contracts tie you to arbitration when it comes to conflicts. They will not accept the risk of being sued. It can be done, but you need to have deep pockets, especially against a for-profit corporation.

Personally we would do nothing differently. We spent a lot of time researching, an enormous amount of time visiting, eliminating most and then revisiting the 2nd round group AGAIN, winnowing it down to 2 facilties, and then DH picked the one he thought his mom would like best. We took her 3x to the facility before she moved in, to be absolutely certain she would like it. 

It turned out to be the best thing for her and she loved it there. There is no substitute for research *plus *visiting in person. The more places you visit, the more context you have for making a good decision.

That's why I'm not big on asking a lot of general questions on the Web. On paper all these places look like. Research and feature comparisons enable you to sort places into "apples here; oranges there" but after that, feet on the ground is essential, IMHO.


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## Wild1 (Jun 17, 2019)

Lethe200^ that gave me some additional context.
Very helpful post, I will share with mom. And maybe get her on here! 
Anyway, I like your approach to looking at many places. It reminds me of when I went through looking at colleges. I rememer being encouraged to look at ones I didn't think I was even seriously interested in (for whatever reason, location, majors, cost etc) and looking anyway. That experience allowed me a better view into what to expect and what kind of questions to answer! 

As someone who is working still, and well, in the first half of that life for sure, I probably won't be the one conducting most of the visits and doing the boots on the ground work. 

I think what you have described regarding the price/assistance level thing is similar to what you have described, 
and at this point we have become more comfortable with the smaller unit, no kitchen, maybe even no phone, etc. 

Glad to know there is a SC option for people like her who aren't (always) "batpoo" crazy but need the extra help. 
i am really sad for her. Finally coming to terms with what is happening and she is "embarrassed to tears" (her words) 

The thing I am more scared for her is losing her friends. They say it's hard for an old dog to learn new tricks. What about new friends?" She handled it nicely last time but obviously was in a better situation before. Bummed for her, but confident now there are better options ahead.

Thank you all


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