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Understanding Little Known Move-In Costs; Assisted Livings and Adult Family Homes

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Sylvana Rinehart, Certified Concierge Care Advisor

There are a large number of factors that go into a move and it’s understandable that families focus on several important factors when choosing a place for their loved one; appearance, feel and patient care. The order may vary but they remain of paramount importance, in addition to the financial factor. When moving into either a Retirement Community or an Adult Family Home there are certain upfront costs related to move-in that might come as a surprise.  Memory Care comes under the same umbrella as Assisted Living and therefore will not be addressed separately. This article is meant to be informative and help the reader be aware of some of the possible additional expenses that might not be a part of the initial conversation when one first queries either an Assisted Living community or an Adult Family Home. It is important to note that providers are not deliberately concealing anything; rather, monthly costs tend to be the initial primary focus.

Assisted Living:

When first visiting an Assisted Living, care fees are generally not known to the prospective resident unless there is an actual assessment completed by the community’s nurse within one or two weeks prior to move-in. Upon completion, the nurse will confer with the Sales Director and the Executive Director who has the final say regarding acceptance to the community. Most of the time, care expenses are given separately because they can vary as needs increase or decrease. The nurse then draws a care plan for the prospective resident before he/she moves in, which will be revised within the next 14 days, at which point the power of attorney will be given the opportunity to go over a Negotiated Care Plan with the nurse and care team. It is called a “Negotiated Care Plan” because it is an opportunity to discuss the care plan with the resident and or the power of attorney and for understanding what realistic expectations on the part of the provider and the resident/family are. Care plans are revised regularly or when there is a major change of condition.

When considering assisted living, we are generally given either a daily or monthly rate. There is no advantage or disadvantage to either formula. To get the monthly rate when given a daily one, just multiply by 30. Multiplying by 30.5 will give a more accurate yearly rate. The rent is generally due within the first five days of the month and will be prorated if one moves in during the month. In some cases, if a resident moves in after the 15th of the month, they will have to pay for the days of the current month and the following month. If one has Long Term Care Insurance, the insurance company will reimburse the insured person at the end of the month after having checked with the community or home as to how many days the insured has spent at the home versus the hospital.  This process might delay reimbursement directly to the insured, so one needs to be prepared to pay up front. Communities will offer to facilitate communication with the insurance company as a gesture of good will, but the insured or power of attorney is responsible for initiating and opening the file with the insurance company.

Most assisted living communities charge a Community Fee, or sometimes it is called a Move-in Fee. This is a one-time, non-reimbursable fee once the agreement is signed. It generally covers all the expenses associated with acquiring a new resident. These fees vary from organization to organization. In some cases, a deposit is required to hold a room for a limited period of time. In most cases, the deposit, which is sometimes the Community Fee, is not actually deposited and is instead held at the community until such time as the agreement is signed. Expect to sign a lengthy and detailed agreement which has generally been reviewed by their legal team. I often suggest that my client get a copy of the agreement beforehand, so that if there are questions, these can be addressed before signing.

One should expect an annual rate increase between 3% and 8% of total monthly cost. Some organizations make it effective on anniversary date, which is the move-in date, others on a calendar year.

Adult Family Homes:

Adult family homes, just like Assisted Living Communities, are licensed under the Washington State Department of Social and Health Services (DSHS). The homes are generally licensed for six residents and get the same scrutiny and annual inspections as Assisted Living Communities. Their agreements are month to month, and many will accept Medicaid after a pre-determined number of months or year of private pay. DSHS provides the agreement template. In some instances, if the agreement to be signed is different than what was discussed and approved by the owner/provider, you can make changes upon signing as long as both parties agree.

Before moving into an Adult Family Home, the prospective resident needs to be assessed by an independent Nurse Assessor. DSHS requires the assessment to be done by a trained Registered Nurse who will assess the current care needs of the senior and draw a detailed care plan for the owner and staff of the home. It is generally a 30-page report. Concierge Care Advisors will provide you with the name of an assessor and give you the pre-determined amount it will cost you, which is generally lower than getting someone outside of our pool of nurses.

Once the owner/provider of the Adult Family Home has read the assessment, he or she will be able to state a monthly rate. That rate will generally stay the same as move-in day, unless there is a major change of condition, requiring additional care giving. Some homes will require an annual increase of 1% or 2%. When a senior goes on Hospice, most homes will be obliged to increase their monthly rate due to a major increase in care giving needs.

Many homes now require an Administration or Set Up fee. Some will ask for first and last month’s rent upfront. Most will request a deposit to hold the room for a short period of time and take it off the market, applying the deposit to the first month’s rent, or to the Administration fee.

Nurse Delegation is also an initial expense. Because seniors are commonly on many medications, some with very specific instructions, DSHS requires that a Nurse Delegator go to the home and instruct the owner and staff on how to dispense the medications to the resident even if the home is owned by a nurse. There is a setup fee, which is usually a little more expensive followed by a maintenance fee every three months. In most cases this is covered by the resident.

Clarity and good upfront communication are the key to successful transition both in Assisted Living and in an Adult Family Home. In the latter model, one can rest assured that if the owner has committed to accepting Medicaid after a period of private pay, your loved one will not have to leave due to finances. Concierge Care Advisors are well equipped to help you through this process so that you can focus on your loved one and leave the details up to us!

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