Memory care facility is adding on $450 a month for incontinence fee but mom goes to the bathroom by herself. What to do?

I'm still a little bit confused about their charge. Its if for services only (assisting to the toilet, assisting with wiping) or does the charge include the Depends also? Are they saying they have determined that she needs the toileting service simply because she gets up at night to toilet herself (and unless they are monitoring, how would they know?) If they are supplying the Depends that might kick the fee up but it still seems a rather large kick. Be aware that if the MC is part of an AL, their rates are going to be a bit higher on a lot of things to cover the "assist" than you might find in a LTC.

Update: I found the contract, and the first part of it lists Basic Personal Assistance included with the monthly fee and it lists 15 items, # 14 being "Assistance with toileting activities as needed". Then about 10 pages later under Additional and Optional Services it has a note at the bottom of the page that says *Fees for incontinence care are not optional and will be required once the facility (I omitted the name of the place) determines these services are required. It seems that they can require it whether or not it's "wiping assistance" or just an occasional reminder that she needs to get up and go to the bathroom.

How many times a day is she going thru them? 450 a month ÷ by 30 days is 15 bucks a day. I looked up on Amazon. 17 of them is $33. So if you look at it that way it's not much. But of course another charge is a lot on top of other care charges. It all adds up.
Id check around to see what other NH charge. Is that fee included, or is this something new just to jack up the overall price?
Im sure with economy they need to offset costs. Like bulk delivery of food,and bulk items like briefs/pads that go under resident if they still use them. It costs more gas to delivery these bulk items. So maybe they are charging more unfortunately to offset these costs?
You can always look around to see if there is a cheaper home and if they have a similar charge.
Is she removing the brief every time and getting a new one, or only when soiled? How many is she going thru a day? That I'd also good to know if you can. Does she put them in bathroom trash can? Maybe staff saw them piling up, and decided to start charging. Things to concider. Good luck.

Have you checked with the state agency that monitors the facility. Elder attorneys may help but a local agency may have some helpful advise...Best wishes and prayers.

Seems ridiculously expensive!

My mom's AL is charging $4.50 to deliver meals to their rooms if they don't want to go to the dining room. Nothing compared to $450 but they do tend to try to make as much money as possible.

I know my mom will run out of money, if she lives long enough. At that point I know she will need to go into a Medicaid nursing home. Don't bring her home. It would be impossible.

IneedPeace: Perhaps the charge is for overnight incontinence care. Also, what is stated in her Care Plan? Maybe it's best not to complain to the facility without knowing twenty-four scenarios.

The other thought... was we have twice a year Care Plan reviews. In those reviews are detailed day to day activities, bathing, ADL, anything that the facility and family agree upon. Then a " point" system is applied and there is a Tier System called Packages.... Basic... Deluxe... Premium

I understand your distress. I would too like to see the specific breakdown of those incontinence "care" items/services(?) I haven't been dealing with incontinence care since my mom passed 2022. She was going through at least three (4?) depends a day. I would purchase at least $20.00 of pull-ups a week trying to stay ahead and build a supply. I would include extra long sanitary pads (plastic bottom slit and the adhesive rubbed off) to slip inside the pull-up. When she was mobile and with it, she was able to notice a urine soiled pad while toileting herself. Furiously rip it out (lol) throw it in the trash. (hopefully NOT the toilet). She would then yank up the pull-up and still have it do it's duty till the next trip. Once when traveled into the realm of fecal incontinence, it was a whole new routine aggravated by a nasty cycle of constipation, diarrhea and UTI's. As for Medicaid places, they are as nice as you can be available to monitor them on a regular basis and be agreeable to working with staff to meet your mother's needs. As is posted many times: focus on the goal & wisely choose your confrontations.

You should have a printed, signed care plan for your mother. This should have been done prior to her moving in. If you don’t have it, ask for it. It will/should detail all services and help your mother receives. Charges for “UTI Care” is too generic. Everything must be detailed. My mother is in ASL and I review her care plan quarterly. They do make mistakes and sometimes add “services” that are not necessary, not actually performed and have not been asked for. Discuss this with the Director, not staff. Generally speaking your County should have a Long Term Care Ombudsman or Council on Aging. The information and contact number should be posted at several locations throughout the facility. These people will act as an advocate for your mother. It’s a great resource and it’s free.

"when her funds run out...." That's where Medicaid should kick in, right?"

Gotta get with an Elder Law Attorney to strategize HER funding.

This is horrible. I hate this for you. I have worked in the healthcare field my whole life so I knew what I was getting into when placing my Mom in an ALF just 2 months ago. As much as I like the one I found for her, I’m afraid all facilities have some “broken” rules. I would kindly ask for their printed legal forms of what the pricing is for each level of care before going into attack mode just yet. Often they make up their own rules along the way and families are so busy or overwhelmed they just pay what is asked. Make them show you where this price is printed and THEN dispute the fact that she in fact uses the restroom on her own. I have found they will bow down when questioned by family/guardians, but 90% of the time no one cares or questions their rates and they know that. Terrible. Your Mom is lucky to have you! Good luck!

INeedPeace,
Would love an update from you if you talked to the administration here.
I agree with Jem that this seems arbitrary and perhaps abusive.

If this is an arbitrary, unnecessary charge, then it is financial abuse. If so, this is a battle that is worth taking on. But choose your battles carefully. First, before you fight this, are you absolutely certain that your mother is toileting herself adequately and that there is not some change to her ability that has prompted the facility to add this charge? Do some extra visitation with your mother at different times a day to observe what is going on with her ability to manage that by herself. Bring a second person if you can as a witness. If you are certain this is an unnecessary charge, put your objection in writing and send by certified mail it to the facility director with a copy count to your mother’s attorney if she has one. Ask for a meeting with the Director to discuss this charge. Bring a witness with you for the discussion. Take notes. If the facility Director will not bend ask him/her to put their reasons in writing and send to you. If the reasons are not valid, contact your state consumer protection and an elder law attorney for advice. It is simply not legal for the facility to arbitrarily charge residents for services they don’t need. But make sure you are on solid ground on this. If you are, I would expect the facility to see the light on this.

A Plan that might give you peace, if indeed, you are worried about the nice facility your Mom is in, BUT: you fear her funds may run out and her current nice facility has no Medicaid beds:
1) Do some actual 'real visits' to Medicaid facilities in your area, to check out "which would be the best of the lot", in case you were to precede her in death. Are there other caring families members that the "new Medicaid facility" should be near?
2) If Mom runs out of funds while you personally are alive, please do not have her move in with you, as it's evidently that your health would crash. So, be firm in your mind and heart that Mom is not to live with you. You will already have "checked out" WHICH of the nearby Medicaid facilities near your is the most acceptable and Mom would be moved to that facility by you.
3) If you own a home, or have assets such as IRA, CD, etc., you could set up a Special Needs Trust with an Elder Law Attorney, that would direct a "selected Trustee" to sell your home and liquidate your assets. From those funds (sale of home, investments, etc) the Trustee could continue to pay the monthly fee that your Mom would be charged, if all her own money was depleted.
4) If you have no assets, please designate a family member who could be trusted to follow your Directives, were you to precede Mom in passing: It would direct the "Guardian" of Mom to move her to that "best choice" of all the Medicaid bed facilities you would have visited.
Maybe just having a 'Proposed Plan' in place, with graduated steps, will give you more peace of mind.

The best thing we did was installing a Ring camera in my MIL apartment ( the camera is in the living room). It has given us great insight on mom's ACTUAL activities both during the day and night. And it let us know WHO was coming in at what times during the night. Of course her private areas, the bedroom is not viewed. But you can see who is going in and out of their rooms and at what times. It has been so educational for us. It was useful for us because my MIL has been getting up and " walking" the apartment during the wee hours of the morning. Would have never known this without the Ring camera. ( The facility approved the camera and posted signs).

You don't know if mom wets the bed at night and staff has to change her bed linens frequently. An incontinent person tends to have accidents that you wouldn't see visiting several times a week.

What does getting a UTI have to do with being charged an extra fee for incontinence care, I don't understand?

Memory Care Assisted Living is expensive and incontinence issues never improve, they only worsen. My mother's incontinence care was included in her monthly rent, which was higher than average. One way or another, you're going to pay for it, unfortunately.

OMG! I've never heard of this!

Sadly MC facilities and ALF have their own rules. On admission most will give you a clearly enumerated packet (I swear my brother's was about two inches thick) or alllllll the many rules and regulations. Within this, for ALF for instance, there will be listed (usually four) levels of care. It will tell what qualifies to "land you" in these levels and what the bump up in cost is. Incontinence is one of the big ones. Certain to bump you to a higher level. And this is because of the great increase needed in staff for residents receiving this care. For the additional problems with cost of products, skin care needs, chances of infection, and on and on and on.

If you have concerns they should be taken up with the administration at your own facility. I would stress in your case that this is "age related stress urgency and frequency" and not really total incontinence in which the person needs total care. But it may make a difference and it may not. The problem is that this is a private business making its own rules.

Wishing you luck. After you arrange a visit with administration I hope you'll update us. This DOES seem quite unfair if it is the only thing being taken into consideration.

Ineedpeace, when your mom's money runs out, she will go to a Medicaid-paid NH with a dementia unit, unless her current facility accept Medicaid patients after a certain period of private pay.