July 2005
Just because the facility calls itself assisted living doesn’t mean that residents get as much help as they want--at least not without paying for it. Most facilities offer a basic service plan. Although that plan varies from one facility to another, it typically provides a 24-hour staff, weekly light housekeeping and laundry services, two to three meals a day, social activities such as bingo and movies, and help with some of the activities of daily living (ADLs), for example, bathing, dressing, and going to the bathroom. A MetLife survey showed that the average monthly basic rate ranged from $1,340 a month in Miami to $4,327 in Stamford, Conn., in 2003. Some facilities charge a flat rate, while others offer a choice of service levels or complicated à la carte pricing. Atria, the nation’s fourth-largest chain, has 18 different fees based on the required level of care (there are six) and which apartment style you select (three are available) at its Stratford, Conn., location. Prices range from $3,400 a month for a studio (which includes the room, meals, utilities, activities, daily housekeeping, weekly laundering of bed linens, and some transportation, but no assistance with ADLs) to a $6,400 two-bedroom option for residents with dementia. Most facilities also require an up-front fee, which may range from the equivalent of one month’s charges to tens of thousands of dollars; it may or may not be partially refundable if a resident leaves. Most assisted-living residences provide some health care. Small staffs run by a nurse may be in the building or on call around the clock. At some locations, there’s no nurse at all. Generally, residents consult their own doctors; but personal physicians do not necessarily communicate with staff at the facility. Medication administration may also be offered at an additional charge. The question of what and how much care residents should receive can pit seniors--and their families--against the facility. Marty Margeson, for example, has battled to make the Pioneer, a state-run assisted-living facility in Anchorage, Alaska, reinstate care for her 91-year-old father, William, who is in the later stages of dementia. Though he has been at Pioneer since 1997, in the fall of 2004, the facility cut his baths from twice to once a week and now checks his vital signs once a month instead of once a week. “The standard of care here is one bath a week and checking vitals once a month,” says David Frain, the Anchorage Pioneer’s administrator. The facility had previously offered William Margeson a higher level of care because, says Frain, “We try to bend over backwards for someone who is struggling, but at some point you have to say, it’s time to place your loved one in a nursing home.” The difference between Pioneer and a nursing home isn’t that clear, however. The chain’s Web site states, “Many residents receive a level of service that would otherwise be delivered in a nursing home.” In any case, Frain recently sent Marty Margeson a letter saying that her father would have to leave because she had not signed the required plan of care or service contract. She says she has not signed because of the reduction in care. Moreover, she doesn’t want to take her dad to a nursing home because she fears the move would be fatal. |
