Tuesday, July 16, 2024

Assisted-living centers have become an appealing retirement option for hundreds of thousands of boomers who can no longer live independently, promising a cheerful alternative to the institutional feel of a nursing home. But their cost, which is so crushingly high that most Americans can’t afford them, is what distinguishes them. These highly profitable facilities often charge $5,000 a month or more and then layer extra fees at every step. Residents’ bills and price lists from a dozen facilities offer a glimpse of the charges: $12 for a blood pressure check; $50 per injection (more for insulin); $93 a month to order medications from a pharmacy not used by the facility; $315 a month for daily help with an inhaler.

The facilities charge extra to help residents get to the shower, bathroom or dining room; to deliver meals to their rooms; to have staff check-ins for daily “reassurance” or simply to remind residents when it’s time to eat or take their medication. Some even charge for routine billing to a resident’s insurance for care. “They say, ‘Your mother forgot one time to take her medications and so now you’ve got to add this on and we’re billing you for it,’” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit. About 850,000 older Americans reside in assisted-living facilities, which have become one of the most lucrative branches of the long-term care industry catering to people 65 and older. Investors, regional companies and international real estate trusts have jumped in: Half of operators in the business of assisted living earn returns of 20 percent or more than it costs to run the sites, an industry survey shows. That is far higher than the money made in most other health sectors.

Rents are often rivaled or exceeded by charges for services, which are either packaged in a bundle or levied à la carte. Overall prices have been rising faster than inflation, and rent increases since the start of last year have been higher than at any previous time since at least 2007, according to the National Investment Center for Seniors Housing & Care, which provides data and other information to companies. There are now 31,000 assisted-living facilities nationwide — twice the number of skilled nursing homes. Four of every five facilities are run as for-profits. Members of racial or ethnic groups account for only a tenth of residents, even though they make up a quarter of the population of people 65 or older in the United States.

A public opinion survey conducted by KFF, the organization formerly known as the Kaiser Family Foundation, found that 83 percent of adults said it would be impossible or very difficult to pay $60,000 a year for an assisted-living facility. Almost half of those surveyed who either lived in a long-term care residence or had a loved one who did encountered unexpected add-on fees for things they assumed were included in the price.

Assisted living is part of a broader affordability crisis in long-term care for the swelling population of older Americans.…

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