Increasingly, the regional management team at Distinguished Assisted Living Inc. is hearing variations of the same story from the six communities in its region: Some residents and families are having a difficult time paying for board and services. In more than one case, established residents with increasing ADL needs are running out of assets, while family supporters have lost jobs or otherwise are unable to help financially as much as they would like. In other cases, residents are falling behind on their pharmacy bills, family members are more likely to balk at paying higher fees as their loved ones’ needs increase, or residents are skimping on needed services because of concerns about shrinking assets. Meanwhile, the flow of new residents has been affected by the downturn in the residential housing market. Houses just are not selling well, which affects potential residents’ ability to pay or prompts them to stay put longer.
Up to now, each resident’s situation has been handled on a case-by-case basis, and concessions made where possible. But with no end yet in sight for the current economic recession, what initiatives or policies should Distinguished Assisted Living consider to manage residents who are having trouble meeting their financial obligations? Two senior living executives weigh in.
Loretta Kaes
Vice President, Health Services
Chelsea Senior Living
Fanwood, NJ
[email protected]
The recession has changed the financial status of assisted living residents and families, along with everyone else, so it is necessary to be flexible and think outside the box.
First, it’s important to adjust expectations about residents in the current economic climate. For instance, it may no longer be realistic to base the acceptance of new customers on the condition that they have enough assets to support their stay as private-pay residents for three or four years. At Chelsea, that requirement currently is one or two years.
Secondly, the provider needs to minimize unwelcome surprises by requesting six months’ notice before a resident’s financial resources are depleted. Clear communication allows enough time for the provider to steer residents and families to other payment options that are available. Most states have a plan in place to help such seniors with medical expenses. Large pharmaceutical companies have started to offer free or reduced-price medications for qualified seniors. Other options include veterans’ benefits, social security, and Medicaid waivers.
Finally, the provider must become educated and open-minded about alternative payment options such as Medicaid. In New Jersey, providers are required to set aside 10 percent of their units for Medicaid residents. The success of Chelsea is testament that providers can serve private-pay and government-assisted residents, alike, and do so viably.
Brenda Kennedy
Vice President of Clinical Services
Bell Senior Living
Greensboro, NC
[email protected]
Both during the admission process and on an ongoing basis, it’s important to capture as much information as possible about a resident so as to anticipate the trajectory of the care she will require. At the same time, it’s critical to understand her financial health as much as possible. Frequent, ongoing, and frank communication about the level of care and services that a resident likely will need can only help her (and her family) to plan ahead.
Of course, some residents do end up running out of assets, and a family’s financial status can change. Many times, families are reluctant to discuss the change in circumstances or otherwise delay telling the community until it is too late to intervene. To prevent that from happening, Distinguished Assisted Living should concentrate on building strong relationships with their residents and families. Families are more likely to turn to the community for help in advance if they understand that the community staff genuinely appreciates their loved one—not just her checkbook—and would hate to see her leave her home.
Given enough notice, Distinguished Assisted Living should sit down with affected residents and families to explore the options. These could include moving to a less-expensive room, living with a roommate, or identifying new payment streams such as veterans’ benefits. That said, the provider should draw the line on making financial concessions for her care. Care needs drive staffing levels, among other things, and for the sake of all residents, her care must not be compromised. It would be more advisable to enlist the involvement of third-party care providers whose services could be covered by Medicare or some other provider, when possible.
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