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Do you know, I have been visiting ALFs on my mother's behalf for a few years now, and it was only last week that I found out about all the add-ons they charge! They must deliberately withhold that information to avoid scaring you off at the beginning of the discussion. I was shocked at the amount of the fees at this particular facility --- $66 to take a resident to her doctor, $552 a month to manage medications, $266 a month to escort them to and from room and common areas, etc. Wow! Are these fairly standard prices? This was a nice facility but not luxurious. Another one in the same area didn't give me a price sheet, but said the average resident paid $500 over and above the basic fee. (In both facilities the room, board and activities fee was about $4,000. Both had a one-time "set-up" fee of $2,500.) What is your parent paying?

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On the other hand, one charming, very small "continuing care" operation had an all-in-one price for everything except transportation. It looks as if this will have to be our choice, although I thought my mother would be happier in a somewhat larger place with more variety of faces and activities.
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Regarding the monthly cap: it turned out to be incorrect. This seemed so strange to me, since the person who told me to ask about it had previously worked for the same company in sales. I asked if the ALF could give me any estimate at all of the average cost of add-ons for their current residents, and the sales person was unable or unwilling to tell me. I commented that I could envision the total cost for a long-term resident eventually amounting to double the basic fee (of about $4,000). The rep said, oh, no, she couldn't imagine it getting that high --- at most she would estimate $1,700 extra. That's quite a wallop to the wallet. On the other hand, perhaps I can see a justification --- these are ALFs that say they provide "continuing care," although the different levels of need are all served in a single facility. In facilities with separate facilities for different care levels I understand that the base fee goes up as they move from, say, independent living to assisted living, and then on to skilled nursing care, because the physical facilities and staffing are different. So I suppose this is simply a way that a smaller facility manages the increasing operating costs of different care levels. I can understand that; but at first I thought it was a way to pick your pocket. I think the sales folks could handle it better.
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Hi, Jamie, yes, the facilities have all told me that. Of course that eliminates the visits to her primary care provider. But what about specialist visits? Don't most elderly people have to see specialist providers regularly as well? Or is my mother an exception? She has regularly scheduled appointments every four months with her cardiologist (small aneurism), neurologist (recent TIA and peripheral neuropathy) and dermatologist (recurring small skin cancers), as well as appointments at least every six months with her dentist, opthalmologist and audiologist. That's 18 non-PCP visits a year, for a total of $1,188. Is my mother seeing too many providers too often? The doctors are the ones who tell her to come back in four months, not us.
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Realtime,
The 'transport-to-doctor' fees are often mitigated by the fact that there are docs that come to the assisted living facility.
Jamie
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Thank you all for sharing your information and experiences. I was told unofficially yesterday that there's a monthly cap on extras, so we'll see what we can negotiate. I was particularly shocked by the transport-to-doctor fee --- all but two of my mother's health care providers are actually in walking distance of the ALF, but the cost was the same as the other two, 20 miles a way. If I continue to live in the community, I can handle the meds management and some of the other add-ons myself.
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We placed my FIL into the Independent side of a very nice, but not luxuriant Assisted living place in May of this year, and we live in the outskirts of Seattle. I'm sure that the costs vary depending on where you live, but he did have the one time Administrative fee of $2,000, and his monthly rent was $2,750.

This included his 3 meals per day, snacks and fruit were always available, as we're all of the activities, shopping excursions each week, and driving them to Dr's appointments, weekly housekeeping and bedding laundry service.

Everything else was ala'carte, so tack on about 300 dollars each level, for med management, diabetes management or the daily management of ADL's, dressing assistance, toileting, showers and such, reminders, and others things I can't remember. It can definitely quickly add up! We were fortunate in that we lived close by, and my husband was able to keep a daily close eye on him still, and took care of all those things.

Unfortunately, my FIL only lived there 9 weeks, before he fell ill with Pneumonia and Sepsis, and ended up in Hospital for 8 days, where they found he also had advanced Lung Cancer and he was released back to our home on Hospice. He passed away last Wednesday, after 6 weeks, so his 9 weeks of Assisted living was a very expensive (almost $20,000 dollar) experiment, as he had previously lived with us for the prior 13 years!

It was a lot of moving him out, setting him up, purchasing furnishings, a bed, just the usual things someone needs when they first move in, and once in, my husband and I were preparing our home to be sold, painting, yardwork and freshening up the place, when he became ill, and came back to us, therefore his apartment needed to be emptied again, bringing all of it Back to our home, amidst our chaos, it was mess! We're still digging out, and that us dealing with his recent passing and all his burial arrangements. We're exhausted as you might imagine, but it was a very interesting learning experience all in all.

I'm glad to have been able to care for him on Hospice in our home, glad that he passed away here with us, where he wanted to be, and that his passing was calm and comfortable.

Now we are trying to find our new normal, life with our kids and Grandies, not having the constant worry over my FIL, who was a fall risk, so we were never able to leave him here alone in our home, prior to Assisted living.

If anything, I would recommend you place your parent into AL, while they are still agile enough to conform and adjust, meeting new people, and being comfortable with their surroundings. Our Dad was a loner by nature, so he barely ever left his apartment, unless to eat, and that was never our plan, but you can't change someones basic personality, may he rest in peace.
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Years ago when my client's family moved her to AL, the "base cost" was $5,000 per month. That was "rent and food" only. Med management, laundry, cleaning services, shuttle services, etc., basically doubled the cost. I remember thinking how lucky she was that she was incredibly wealthy and could afford this posh place.

You need to look around and be sure to ask a ton of questions. NH's want your business and they want you to pick them--so they often put best foot fwd and you find yourself paying out the nose for the add ons.
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It varies by facility, but, the two Assisted Living facilities that I am the most familiar with have most everything included: three meals per day and 2 snacks per day, cleaning of their room, laundry service for clothes and linens, medication administration, daily check of blood sugar and pressure, assist with showers, changing clothes, getting to dining room, reminders, transportation to and from doctor appointments, and activities and entertainment. Hair cuts costs extra and are billed to the patient. 

I'd check around. I think the part of the country you are located also plays a part in the costs and prices.
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I called it the "ala carte" menu.

My mom had transferred from IL to the AL wing - it was an incredibly large retirement community. The place on the whole was very nice - the dining room even doubled as a restaurant that was open to the public. Theatre, coffee shop, art studio w/ classes, beauty salon etc.

However, the rooms themselves were nice - but pretty basic. In AL my mom was in a one bedroom with a "kitchenette" - no stove - probably a very safe decision. Anyhow- about $4,000 a month for all meals, once a week housekeeper, one shower a week and 2-3x daily garbage pick-up. Everything else was "ala carte".

On the plus side, for the first month there was no extra charges. You began with what you thought was needed in the way of extras and it was assessed and tweaked along the way. The final agreement committed to at the end of the month.

I can't recall item by item for the additional fees except for the private car that took people wherever- that was $35 but the person driving didn't wait during the activity/appointment. Drop off/pick up. I can say the bill was roughly an additional $1,000 for an additional weekly shower and medication management. It would have been even higher except my mother had private pay daily caregivers. They did her laundry and changed the bed sheets daily.
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Realtime, guess it depends on the facility. I was given a brochure with what was the basic rent for Independent Living for my Dad, plus a list of "add ons" should he need any of the services. Dad got one meal with his rent, the other two were "add ons", that was the norm for those who had a full-size kitchen. Included in the rent was weekly linen service and weekly housekeeping. Laundry was an "add on".

In IL my Dad had an "add on" for pill management. One price for once a day, another price for twice a day. Since my Dad was forgetful about his medicine, it was worth every penny. Plus they took full control of all the meds, using a sub-contractor for the medicine, which saved me from driving all over the place picking up meds from the drug store. Finally, Dad never ran out of pills :)

When Dad moved to Assisted Living, there was the basic rent and Dad had to pay extra for a land-line connection, and for having a life-alert pendent. His rent included 3 meals a day, daily linen service, daily housekeeping, and laundry service.

The facility did charge their IL and AL residents for travel to and from the doctor's office, there was the driver, and an Aide for the resident.

Yes, my Dad had a "set up" fee before moving in of $2,500 or what I would consider an Admin fee to get all the paperwork in order, get the apartment ready, etc.

Now, when my Dad moved into IL it was the end of December when he toured the facility. This is always a very slow time of the year for rentals. There was one apartment that would be ready in a couple of weeks as it was being remodeled. Dad jumped on it, especially since he was getting a yearly discount plus one month's free.... let's say he was in the right place at the right time :)
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