"Level of Care" & Other Unsolved Mysteries
I used to think there was pretty much one way to make an omelet. You crack eggs, mix them, pour them in the pan, throw in your fillings, and then fold it over, right? Maybe some of you are thinking “absolutely wrong, the filling should be mixed in with the egg.” Maybe some of you microwave your omelet (yes, that is a thing…), and maybe some of you buy frozen pre-made omelets (not sure that's a thing) and never worry about cooking them. I once heard that a big chain restaurant which I cannot remember now mixed pancake batter in with their eggs to make the omelets more fluffy. Anyway, the point is, there is more than one way to make an omelet, and if you order one at a restaurant, chances are you won’t know or care much about how they do it as long as it tastes good. All of this to say, when you start looking at senior living communities and their pricing structures, there is more than one way to figuratively make an omelet.
I wish there wasn’t. It would make my job a lot easier, and would certainly make it less confusing for the families I work with. In fact, all of these “ways to make an omelet” (and I swear I’ll get off of this analogy eventually) are part of the reason why I opened my business. Because it isn’t easy, it’s complicated, and navigating it can get tricky.
So here’s what I mean.
When you tour a senior living community and finally get the pricing (this is a whole other topic I’ll cover eventually- the whole ‘waiting until the end of the tour for pricing thing’ **insert eyeroll here**), what you might not realize is that there are other elements that go into the final price that may not be evident just by looking at the pricing sheet. But lucky you, you found this blog post, and me, your personal omelet deconstructing guide to those elements that make up what you’ll actually be paying for a senior living community.
Here we go…
Rent Rates/ Monthly Fees Keep in mind while I get into these explanations that there is also a large difference between the models of a CCRC/ Life Plan Community and a stand-alone senior living community that offers Independent Living, Personal Care/ Assisted Living, and/or Memory Care.
That being said, rent rates (for rental communities obviously) or monthly fees are usually the first number (or maybe the only number) you’ll be shown. This number should correspond to the size of the apartment or living space, the amenities and services provided, and sometimes the desirability of the location. For example, many communities offer “premium” apartments that have upgraded appliances or finishes, or are close to the elevators or other community spaces that make that particular unit highly desirable.
Level of Care This is super important to understand, predominantly if you or your loved one needs care (or will be needing care in the future, which is almost all of us). Most communities will charge separately in Personal Care/ Assisted Living, and some in Memory Care, for the level of care that is required. This level of care is more often than not determined by a Nurse performing an assessment and scoring that person on a scale that is decided on by the community or the parent organization. It is very important to understand that since every community scores level of care differently, you can not compare a level two at one community to a level two at another.
For one thing, some communities have three levels and some have five or six, but can provide the same extent of service. Additionally, some scoring systems are based on the amount of time a caregiver will need to spend with the person each day performing care, and others are based on the actual ADLs (Activities of Daily Living) that the person requires assistance with. What’s more, things like cueing, prompting, and reminders will sometimes be taken into consideration for the score, and other times they will be considered part of the “basic service level”.
The reason behind “level of care” charges is sounds. Ultimately, residents that require more assistance will mean that the community requires more staff. In order to staff appropriately, and budget salaries appropriately, the level of care scoring tool is a way to make sure families are being charged fairly while allowing the resident to receive all the services they require. And because of the nature of care, it is likely that a resident may enter a one level of care but eventually require a different level. Not only is it common that as residents age in place they might require more assistance, it is also common to see a resident require a higher level when they first transition into a community, and then once they get into a routine and adjust to the new environment, their level of care may decrease.
Medication Management If you’re not confused yet, good for you. If you are, stay with me and grab a paper bag if you need to take a few deep breaths. Because not only do most communities charge a separate charge for the level of care, many will also separate medication management into a separate charge.
The reason for this is similar to the reason for the levels of care. More medications or more “med passes”, meaning a medication that is delivered multiple times per day, requires more staffing hours from Medication Technicians.
Typically, when you see that medication management is it’s own charge, the levels will be based on the number of medications, or the number of medication passes, that the individual requires. If an individual is able to manage their own medications, in most cases (Assisted Living, Personal Care, Memory Care) they will need to pass a test given by a nurse or doctor where they identify each medication, what it’s purpose is, and the dosage and frequency at which they take it from memory. With medication errors being so prevalent, I am usually an advocate for allowing the nursing department to take over medication management. When you do this, not only can the nurses be in charge of the medication administration, but also the reorders and scripts from the doctor.
Community Fee/ Entrance Fee
Here is where the CCRC/ Life Plan Community model and the rental model really differ. When you are considering a CCRC/LPC, most will require a buy-in of anywhere from $10k-$500K. Depending on the community, a portion of this may be partially or fully refundable. If, on the flip side, you consider a rental community, you will probably be looking at a “Community Fee” of somewhere between $1,000 and $5,000. These numbers can certainly be higher or lower depending on your area and the community, but in general these are the ballparks we see in my area. This fee typically covers the administrative expenses of moving a new resident into a community.
Second Person Fee- For couples or folks moving in together, most communities will charge a second person tenant fee. This fee ranges quite a bit depending on the community, but the average is probably somewhere between $800/month- $2000/month.
Pet Fee- Some communities will allow pets. Most will have a weight restriction, and in general the resident must be able to care for the animal or bring in a service to do so. This fee can range from $100-$800. Some communities have a one time fee and others may charge each month.
Utilities- More and more commonly, communities are providing utilities in an “all inclusive” style. Still some will charge more for cable and internet, as well as landline service. Depending on whether the community has a bulk contract, this will range based on the service that you want.
Ancillary Charges- These are fees that come up that are outside of what is usually offered at the community. Think tickets when a resident group goes to the opera, beauty shop services, and guest meals.
There is no limit to the different structures you might find when looking at and comparing communities. As I said, and as I’m sure you hoped I wouldn’t say again, these communities are as complicated as omelets. Hopefully this is helpful to guide you through the break-down and cross-comparison.
As always, if you need additional support, resources, or someone to talk to, reach out. firstname.lastname@example.org&