Assisted Living Services and Sarah’s Surprise: Paying $14,400 to $28,000 a Month

Several times a week, I counsel adult children who are taking care of their loved ones. What I see trending is an unexpected feeling of sticker shock that sometimes results in a panic. This is when expenses in assisted living facilities unexpectedly become astronomical. What is astronomical, you ask? How about $28,000 a month? No joke, no exaggeration, just reality.

Why? Well, assisted living facilities also known as ALF’s offer some excellent services to care for loved ones, but they do have limitations with the level of caregiving they can provide. This is not commonly known or discussed before a family signs up and moves their loved one into the ALF.

Sarah is 79 years old and has mild cognitive impairment, which usually means she may be a little forgetful and not be able to remember old routines on her own. She may need some prompting when trying to tell a story because she doesn’t have the same mastery of language. Sometimes judgment may also be impaired.

Here is what the Alzheimer’s Association says about it:
Mild cognitive impairment (MCI) causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. A person with MCI is at an increased risk of developing Alzheimer’s or another dementia.

How does that translate with 79 year old Sarah? Well, in an ALF environment she may do very well for quite a while. However, as her symptoms become more noticeable and affect her functional ability, certain things may occur that will require more hands on caregiving assistance than an ALF is able to provide. They typically do not provide 24 hour personal one on one caregiving services.

I’ll give you two possible and typical scenarios for Sarah. The first is when she gets to a point where she is a significant fall risk, because she is unsteady on her feet or needs to use a walker, but won’t use one because she can’t remember to use one. Caregiving needs will change. Sarah’s family may be asked to hire extra caregivers to make sure that she does use her walker so that she does not fall and injure herself. This is called stand-by assistance. This will usually be during the day when she is most active.

The second is when Sarah’s dementia progresses to the point that she needs to move into the memory care section of the ALF. Those areas are usually smaller, quieter and have staff closer at hand to assist residents. But, when Sarah’s behavior changes and she often becomes agitated, angry and sometimes violent, her family may be asked to hire extra caregivers to re-direct her and to prevent anything untoward happening to other residents or Sarah.

You may not think either of these scenarios would warrant a dramatic increase in expenses. But they often do.

What does Sarah’s family do if they don’t agree with the requirement or can’t afford the extra expenses? Why can’t they just keep her there only hiring minimal assistance?

If the situation becomes unsuitable in the eyes of the ALF, Sarah’s family must comply to their request. What families don’t realize is that the ALF’s have a special license under which they operate and while Sarah is under their roof and license, they make the rules and Sarah and her family must comply or exit.

Let’s look at potential costs. For scenario one, (in Northern California) let’s say that her family must hire caregivers for 8 hours a day. Using $30 an hour it is an additional $240 a day or $7,200 a month. If Sarah was paying $7,200 a month for the ALF and their services she is now looking at $14,400 a month. Not what she or her family expected coming through the front door.

For scenario two, (in Northern California) the family must hire caregivers for 24 hours a day at the hourly rate of $30. Depending on how it is staffed they are looking at $720 a day (at the low end) or $21,600 a month. Sarah is paying $7,200 a month for the ALF and their services and she is now looking at $28,800. That is definitely sticker shock, which sometimes translates to “panic”.

There is much more to be discussed and learned about situations like this and I hope this provides you some helpful information on your journey in caring for your aging relatives.