Our facility kept telling us they will give us the price after they are assessed. We keep asking for a price. They have been there almost a month and we got a huge bill. They are charging points because Dad had a fall last week. If he does not fall for 3 months they will not charge in the future. They are penalized for falls? My dad's behavior is very strong willed and he gives them a hard time when they are dealing with my mom. They are charging us 4 points for his behavior. This sounds ridiculous! Has anyone experienced this?
Base care levels are included in the "base" cost. Base care includes giving medication 4 times a day - with meals and at bedtime; for medication more often or on a different schedule, there's a extra charge. Base care includes 6 toileting assists a day and 1 incontinence event; more than that costs extra. Basically people that need more care need more staff and/or supplies. The extra charges are used to fund appropriate staffing levels. I have found the system to be mostly fair with some months having more extra charges than others.
Depending upon how your dad fell, they may have determined that he needs to have an assist when he's up and about. That's a lot more staff time. If that's not what they're providing, ask exactly why the fall resulted in an increase in care level.
Behavior can absolutely result in an increase in care level. If a resident won't take meds, requires extensive persuasion with personal hygiene and/or lots of intervention and assistance, that all takes time and that's what you're paying for.
It is not unusual to have an adjustment in points (up or down) in the period after move in depending upon how the resident adapts to community living. However, it seems odd to me to not give a month or so adjustment period before deciding to greatly increase the level of care assessment. It looks like your Dad's AL is 'proactive' in assessing points, so you have to be proactive in making them reassess as your Dad adjusts.
Some communities have experimented with an 'all-inclusive' care approach. Basically, the residents who need very little hands-on care subsidize the care for the more needy residents. Generally, everyone has periods of higher need or needs more care as they age, so it would seem fair. However, the range of need is so great, that the amount they'd have to charge to 'even it out' would be prohibitively high for the resident who needs very little hands on care.
Not knowing the details of the fall nor the behaviors, I can't really give an opinion, but I would say that the AL's quickness in applying extra points would cause me to be diligent in making sure his assessment is always accurate.
State regulations factor into how they charge, too.
At least in my state, Kansas, the looser regulation means that Assisted Living homes have flexibility in how much support they can offer. This can translate to the same charge for all residents... or a point system. Someone said in a previous reply - time is money. That's what it boils down to. If someone needs more help, then they need more staff available. Is it fair for a relatively independent person to pay the same rate as someone who needs cueing, reminders, or physical assistance with just about everything? It doesn't really seem fair.
Additionally, family members tend to see their loved one as how they used to be, or how they behave on their best day. A loved one may act very differently when family is not around. It's hard for a family to understand increased charges for care if they don't see the behavior on a daily basis. Yes, the administration (usually nurse or social worker) should definitely have a conversation with the family about their assessment and explain why charges are the way they are. You should be able to request a care plan review meeting to have that conversation. When requesting, realize that these staff members are very busy and it may take some time to get it on their calendars.
Here's the thing. In theory, according to basic principles of contract, not only would the facility have to inform you of the price but you would have to agree to it. But obviously in terms of care services there has to be some flexibility, and so what normally happens is:
care needs are assessed
the level of services required is estimated
there is some kind of price banding according to the support required
these are adjusted as time goes on and needs increase.
But in principle it seems bonkers that the facility has said something like "let's see how they get on" and then sent you this kind of itemised bill. So to repeat - who agreed to what (and signed for it) when your parents moved in?
If the facility refused to carry out a needs assessment before your parents were admitted, I think they were pulling a bit of a fast one - not to mention potentially exposing your parents to risk. If, on the other hand, all parties agreed to a probationary period to fine-tune their care plan, that's different. Would you like to say a little more about the background?
Might be be a good idea to review the rental/lease agreement before you call a meeting to better prepare yourself.
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