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My mother's assisted living facility MORE THAN DOUBLED her MONTHLY CARE FEE. She had just had an assessment done and needed no new services. Is that legal? It seems like there should be some laws as to how much these places can increase your bill- especially when no new services are needed. Most elderly people are living on a fixed income and can't afford an increase like this. I have spoken to them and they just said they had to increase their costs in order to be competitive in the market.

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It is very difficult when facilities do this. The facility my mother was in in NY had significant raises but not as drastic as you describe and there was general warning. Subsequently the other facilities she has been in in SC where we moved to along with her had smaller raises with advance notice. Again not drastic ones.

I would try to find out from other local facilities what their rate is. Generally a geographic area tends to have rates that are somewhat comparable. Rates tend to be higher in areas that are closer to more major cities with rates lower in more rural areas.

Perhaps if you choose to investigate this you ideally might find a facility with availability that has a lower rate. Of course you would have to feel positive about that place.

I moved my mother last September to a preferable place when there was an open bed. She just passed the end of April. This facility had not yet been completed when I began my search before we officially moved here. The cost was higher but not greatly so and there was a great difference in personnel, food and cleanliness both in attending to her and her clothing but also how the room was kept.

I hope you might find some solutions. I know how difficult it is in general to have someone in a facility especially when there are factors that seem unfair or prove to be a difficult fit.
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Caring4mom23: Perhaps you'll have to look at your contract or retain an elder law attorney.
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Most ALF and MC facilities are privately owned business models that are not governed by laws in the way that nursing homes are. Often the contract on admission describes the circumstances under which raises can be made in either cost of care levels or cost of room. For instance, in my brother's ALF his fees would go up with any increase in care level needs, and then at least yearly with 3 to 5% raise the norm. Add to this, raises could happen with special circumstances (rampant inflation, covid, etc.).

In most instances they can do raises as they deem appropriate and necessary, and the resident has to decide whether to stay or to move to another facility.

POA may request a meeting with administration to discuss any raises; this may help.
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Thank you for posting this question. It is yet another good reason I will be staying away from Assisted Living facilities. I've known I never want to be in a nursing home for long-term-care. (I spent 5+ years in one taking care of my mother.) I would have considered Assisted Living for myself as I age, but now I will stay put in my home. If I die or live in squalor, so be it. That is preferable to feeding the profiteers.

Aside: I am attempting to start a "caring community" in my area, where people striving to care for themselves healthfully, also strive to help each other - with information, sharing equipment, helping as they can, developing relationships with a nursing agency and other helpers, etc. I see this as a model that could be useful for many of us entering our last laps.
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taimedowne May 2023
Unfortunately, not everyone gets to make that choice for themselves. You may have needs for care that extend far beyond merely “living in squalor” and sometimes death is neither quick nor painless. I hope you will be able to continue to care for yourself but do not disparage the choices of others.
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I would agree that you need to read the contract that is currently in force to make sure this is legal.

This is a generalization, but for the most part in terms of "senior" housing/medical facilities, government regulations only come into play when the facility is accepting government funds (aka Medicare/Medicaid). This gets most ALs off the radar because they so rarely accept Medicaid and Medicare, being a health insurance, does not pay for room and board. ALs that accept Medicaid usually severely limit the number of beds they reserve for Medicaid because the Medicaid payment is so low compared to what they can get for private pay residents. So you need to be very careful listening to the marketing speech that says " oh, when your Mom runs out of money, we accept Medicaid" because what may not be said is "if we have a dedicated Medicaid bed available at that time". If they don't have the bed.... out you go!

LTCs do accept Medicare/Medicaid (federal funds) so the government at least looks at what they charge but if they can provide spreadsheets and invoices during their audits (which are not as thorough or as frequent as I would like but that is another story as the government can't get experienced accountants because the government can't match the salaries of accounting firms) they may get a bit more in Medicaid funding but it will never match private pay. Medicare is going to pay the approved sum for approved skilled nursing/rehab (also less than private pay).

In all honesty, their costs probably have increased dramatically as everything has gone up. When eggs when from $2.00 per dz. to $4.89/dz many of us simply decreased our use of eggs but you can't do that in an AL or LTC so you can imagine what that kind of increase on the level of feeding 80 people can do. Now they have (supposedly) increased the amount they pay to try to attract LPNs and RNs although in NJ ALs do not have to have an RN on site as long as they have 24 access to one but they have to pay her (or her agency) something for the access. I have yet to see them increase the amount of money they pay CNAs who do the real "grunt" work (changing diapers, feeding, doing laundry) or the kitchen staff. So yes............. they remain incredibly understaffed in some key positions because the income that doesn't flow to the owners goes to administration, marketing and maintaining the beautiful buildings. I don't deny the owners a profit.... I just would like to see the profit a bit more evenly distributed.
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ERH1234 May 2023
I just had to mention this because we are discussing wages, price increases, etc. I recently learned that the CEO of Brookdale Senior living--which I believe there are quite a few of them--makes a whopping 6-plus million dollars a year for being CEO. I know it must be a difficult position but it seems extravagant when you consider the low wages of CNAs, and lack of staffing issues. How can people in this industry who make money off the poor and ailing sleep at night knowing that so many suffer because of low wages and high costs for the elderly. (I wonder what she does with that 6 million every year?!) Just had to say something because I was flabbergasted.
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This is a big problem in our society. We are conditioned by doctors and relatives to think it is not ok to die. So we get overtreated which prolongs our lives only to end up being cared for by others.
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My cousin who is a nurse told me that when it comes time to put my dad into MC to make sure I have a one year contract to start, not month to month, to avoid this scenario. Like a rental lease, they can’t just raise the cost in the middle of the existing contract. Then when that contact expires, negotiate the next one for 2 years to lock in the rate. Worth a try.
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kahill1918 May 2023
What happens when the patient dies in the middle of the year contract?
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They have all increased their fees and it is painful for the elderly who are on a fixed income. When covid hit and took the lives of so many people, if forced everyone to take stock of their lives and stare the possibility of their own demise in the face. Vast amounts of working age people have decided that they don't want to spend what time they have left doing a job they don't like. It has crippled the work force. Healthcare facilities are having to pay people double what they used to just to get them to come to work. Nurses that used to make $30 hr are now getting $60-80 hr. A medical assistant who used to make $18 hr is now getting $28 hr. So I get why hospitals and nursing homes are having to increase what they charge for services, but that doesn't change the fact that our elderly have no way to increase their income to pay it.
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PriscillaFaye May 2023
James- No disrespect intended, but where on earth are Medical Assistants making $28/hr??
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DI'd you sign a year contract if so they can't raise there prices like that
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A new company took over my mom’s AL and was looking for ways to either move her to MC (higher price) or increase her services. I had cancelled all of her extra pay services and got her a private carer for 4 hours every day because 1. The services were not being performed -due to staffing and 2, they were not being done well or thoroughly. I got her to another place and many other people left as well. Because the private caregivers went with her, they helped her socialize and showed her the ropes. It was a better fit since her former place had no written plan to let me know what we were going to end up with. I suspected they knew but were hanging on to their residents until they didn’t need them. I specifically stated in writing what the caregiver staff were doing and that their services were not needed since I was providing them. The only thing they provided was the pills. I got my staff to do the eyedrops too.
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My dads memory care suddenly went up $1000 per month. I was shocked.
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Wow..ours went up $200 a month over past 2.5 yrs. Cost is $5000 a month. Mom is fairly independent. Needs meds/supervision due to dementia.
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They may or may not have official city, county or state rules about fees and raising fees (see my researach below although check with your county and state).
Read your initial contract you signed.

My research -

Assisted Living Facilities:

1) How are assisted living facilities regulated in the United States?
The Centers for Medicare and Medicaid Services (CMS) regulates skilled nursing facilities and rehabilitation homes that receive funds from Medicaid or Medicare. One or more state agencies regulate assisted living throughout the United States.

2) http://canhr.org/factsheets/rcfe_fs/html/rcfe_fs.overview.htm
In reading this one, please note:

Is There a Limit on How Much Facilities Can Raise Private Pay Rates?

No. Since residential care is a private business, providers will charge what the market will bear. However, facilities must issue 60–day notices to increase rates, but can raise charges for level of care changes immediately and provide notice within 2 working days. (HSC 1569.655, 1569.657; see also CANHR’s factsheet on Admission Agreements) 

Nursing Homes:

1) HHS' Centers for Medicare and Medicaid Services (CMS) has an essential, ongoing responsibility to oversee nursing homes and shares with State agencies the responsibility for ensuring that nursing homes meet Federal requirements for quality and safety.

2) The California Department of Public Health, Licensing and Certification Program (CDPH, L&C) is the California state agency that licenses and regulates health facilities such as a nursing home.

Gena / Touch Matters
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No. ALs have to compete in the market for workers and their biggest cost. They have to offer an attractive wage to get staff. And on top of that, the cost of everything else has gone up drastically too. Food. Utilities. Toilet paper. The AL isn't going to run at a loss. And if it's a good one that has a waiting list, when your mother runs out of money someone will take her place within a week. We're facing the same headwinds with my FIL. I feel your pain.
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My dad's VA home costs (he's private pay) just went up from 6K to 10K a month. So good luck on getting the government to help you. This sucks. Practically cut my dad's time before going on Medicaid in half.
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Caring4mom23 May 2023
This doesn't seem right. There should be some kind of regulation on how much a facility is allowed to increase costs per year. Otherwise there are going to be a lot of homeless elderly.
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Does anyone know if original contracts remain in effect when no new contract is given when a new company takes over an independent/assisted living/memory care community?
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geddyupgo May 2023
It may depend on how the original contract is written but in general if the contract has an expiration date or similar phrasing ("this contract will expire one year from the date of signing"), the contract remains in force until that date (unless the facility has declared bankruptcy and that is a totally different scenario). If a new company takes over and does not offer a new contract by the original contract expiration date, it is assumed in most states that the rental agreement is now month to month. You would need to check how you state/county handles month to month contracts in this case.
Having a new owner of a facility can be tricky and nerve racking. The rates most always go up because they will find something that was hidden from them during the initial buying inspection (new roof needed or industrial dish washer broke the day of signing!) or some improvements really need to be made (new kitchen and better grease traps). I would suggest new contracts (which, after COVID, will rarely go for more than 1 year) be reviewed by and certified elder care attorney.
Good Luck and keep up advised of how this works out
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If shes consuming no new or additional services, what on earth is a doubled monthly care fee FOR, exactly? The AL needs to give you a breakdown of fees each month, which are probably not all "care" related but include a rent increase too.

Check her contract, but private pay ALs can pretty much do as they please w regard to costs. My folks spent about $400k in a 7 year period which means they depleted their life savings .... nobody can manage on just a monthly fixed income in AL! Unless that income is astronomical, savings must be tapped into.
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Caring4mom23 May 2023
They have gone to an ala carte care system which is based on points- (very confusing)- but they are making the base rate (which is doubled for my mom) to include more services (which she doesn't need). This is only Care, not a rent increase. Oh yeah, she has already tapped into her life savings.
I'm surprised they can more than double care fees and there are no regulations on this. If you lived in an apartment and they told you that they were going to more than double your rent I think a lot of people would move out. Not so easy when you are dealing with the elderly population.
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What does your contract say?

Is there a provision that speaks to this?
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Caring4mom23 May 2023
Interesting question. She originally signed a contract when this facility was under a different ownership. She never signed a new contract with the company that took over, so I'm assuming her original contract is still in effect since no new contract was signed? I will check on this. Thanks!
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