The document discusses concerns around the high costs of assisted living facilities and how they can negatively impact the health and wealth of elderly residents. It provides recommendations for how family members can protect their loved ones, including thoroughly reviewing admission contracts and assessments, ensuring service plans accurately reflect needs, being aware of medication and ancillary service costs, understanding complaint reporting processes, and maintaining regular contact and oversight of care.

1. Has Assisted Living become “Assisted Losing”?
How the costs of Assisted Living Facilities can rob you of both health and wealth.
Are we prepared for the extended life we are living; physically, emotionally and financially? Do we have
the trusted network of family and resources willing to take on the challenges of aging? After travelling
hundreds of miles to see about my parents, I thought I was ready to do whatever was needed; but, as
they say, I had another “think” coming.
At the time Mom, aged 82 and Dad 85, could no longer fully care for themselves and their home. Dad, a
retired CPA with a recent diagnosis of Alzheimer’s disease, was trying to cash those non-negotiable
sweepstakes checks, (said they were payments for services rendered). And Mom still tried hosting her
Bridge Club, (catered lunch with white wine) and bowling in her church league, oxygen in tow. The
upkeep of the home was overwhelming and it was more than a notion to keep up with a wandering Dad
who always seemed to be on his way home, anybody’s home.
Assisted Living Facilities provide a range of comprehensive services that solved a lot of the care
concerns we had, but they come at a cost that would make you wince. Thankfully, Dad had a decent
retirement income, a few investments and annuities, so it appeared to be a financially viable option.
So, my brothers moved them into one of the better known facilities. And when I came to visit them five
months later, I found their new home to be attractive, staffed with friendly professionals, decent meals
and social activities. My parents seemed comfortable. Now some might say that this service in itself is
priceless. But keep in mind Assisted Living is a business with contracts structured to enhance the
profits of that business. This fact became ever so clear when the bills kept growing bigger with charges
for services that were more than merely questionable; this required a real investigation.
Protection from abuse, neglect and exploitation (ANEs) is the big challenge that our elderly and
disabled face daily. In Texas there are governing standards and codes that regulate all Residential
Care, including Assisted Living Facilities. The regulations appear under Health and Safety Code
Chapter 247 and Texas Administrative Code (TAC) Title 40, Part 1, Ch. 92 addressing facility licensing
and service delivery. Oversight is by the Department of Aging and Disability Services (DADS) with an
Ombudsman’s office serving Long Term Care facilities. There is a Bill of Residents Rights, but
enforcement depends on identification of a defined violation that is subject to interpretation; then an
investigation may begin. When it comes to our elder’s health and wealth, do we really have the time or
mental and emotional stamina that whole process would entail? After experiencing dramatically
increased monthly charges, multiple visits to the ER, debating with staff on which parent had Diabetes;
I would like to offer some recommendations that will help avoid some of the confusion and potential
danger experienced when leaving loved ones in Assisted Living facilities.
.
Admission and Contract
When looking for the best facility, you be the investigator. Interview the administrative staff and be
aware of the state regulations that govern these facilities. And ask for a copy of the resident
agreement and making specific note of how regulations and resident rights are addressed. Maintain
focused clarity; the emotional stress of this process can make you particularly vulnerable to fast talking,
service promoting, reassuring marketing professionals. Knowing how each facility contractually
addresses your rights is empowering protection of health and wealth.

2. Assessment
Title 40 TAC 92.41 (c), states: Resident assessment. Within 14 days of admission, a resident
comprehensive assessment and an individual service plan for providing care, which is based on
the comprehensive assessment, must be completed. The comprehensive assessment must be
completed by the appropriate staff and documented on a form developed by the facility.
Assessments are the key determining factor for the service plan, daily care and subsequent charges.
Therefore, they should be thorough, accurate and agreed upon by residents and/or their sponsors and
minimally cover the areas designated by TAC 92.41(c) (1). Many facilities have a base rate for basic
services and some include additional charges for an Alzheimer’s disease diagnosis. However, an initial
assessment could determine a requirement of only services covered under the base rate alone (like my
Dad, though diagnosed with Alzheimer’, could still Windsor-knot his tie but required direction to the
dining hall) Therefore, no contract should be signed committing to any additional charges before
this assessment is completed, discussed and agreed upon by the resident and/or their legal
sponsor and administrators.
Service Plan Accuracy
TAC 92.41 (c) (2) states: The service plan must be approved and signed by the resident or a
person responsible for the resident's health care decisions. The facility must provide care
according to the service plan. The service plan must be updated annually and upon a significant
change in condition, based upon an assessment of the resident.
The service plan describes the kind of care and frequency of delivery and is based on the assessment
findings. When assessments have errors, resulting service plans can be inappropriate, to say the least.
Seemingly minor issues, such as incorrect height and weight, or critical omissions of major health
problems (like not including Mom’s Diabetes diagnosis) can result in real catastrophes. Consider this: if
your loved one requires emergency attention and is unable to respond, these assessments and service
plans could be used to determine care and medication. Assessments filled with errors could dictate
service that could potentially be life threatening. Thoroughly examine the service plans, ensure they
reflect assessment accuracy. And review daily care records for service delivery accuracy and billing
compliance. Your loved ones health and wealth are at stake...
Medications
Assisted Living Facilities usually have contracts with a pharmacy of their choice. The resident has the
right to choose their own pharmacy, however this practice can be discouraged by various clauses in the
contract. For example: charging a fee in addition to the medication-dispensing fee for drugs obtained
from an “outside” pharmacy. Or, the facility will not dispense the medications from an outside pharmacy
at all, unless packaged according to specification of the facility and their pharmacy.
My parents’ Assisted Living Facility’s pharmacy did not volunteer the availability of generic equivalents.
And when a specific drug was assigned a different cost tier or dropped altogether by their insurance,
the prescription was filled and billed at the full price without prior notification of the change; another
avoidable cost increase.
Ancillary Services
TAC 92.41(e) (2) states: There must be a written admission agreement between the facility and
the resident. The agreement must specify such details as services to be provided and the
charges for the services. If the facility provides services and supplies that could be a Medicare
benefit, the facility must provide the resident a statement that such services and supplies could
be a Medicare benefit.
Whenever there are charges for additional services that increase the resident’s bottom line, there
should be a clear understanding if those services can be obtained through Medicare or other resources.

3. This includes durable medical equipment, therapies, and some social services. Know the policy
provisions of Medicare and the Medigap or supplemental plan the resident has. They may be paying for
these services through their premium already.
Filing a Complaint
Health and Safety Code Sec. 247.026 (a) and (b) (2) states: STANDARDS. (a) The board by rule
shall prescribe minimum standards to protect the health and safety of an assisted living facility
resident. The standards must: ensure quality care and protection of the residents' health and
safety without excessive cost.
Furthermore: 40 TAC Chapter 92.2 (19) definition of Exploitation: the term has the meaning in
Texas Health and Safety Code §260A.001 (4), which is the illegal or improper act or process of a
caregiver, family member, or other individual who has an ongoing relationship with the resident
using the resources of a resident for monetary or personal benefit, profit, or gain without the
informed consent of the resident.
This year, 2014, changes have been made to enhance the access and convenience for reporting
complaints. Under 40 TAC §92.102, the reporting requirements for abuse, neglect or exploitation have
been updated. One change requires a facility to obtain signed statements from employees, as a
condition of employment, acknowledging that they may be held criminally liable for failure to report
suspected abuse, neglect or exploitation. And there will be an Ombudsman for Assisted Living
Facilities. This is helpful, but we need to be proactive in our care and protection of loved ones.
After the aforementioned chain of events of overcharging, assessment errors, etc., I moved back home
to take care of my parents until they passed away three years later, one month apart But this may not
be an option for everyone. So protect them by doing the following: obtain a trusted Power of Attorney
for health and financial concerns. Be vigilant in the review of care records and signs of abuse, neglect
and exploitation. And, above all, maintain personal contact with your loved ones so that anything out of
the ordinary can be discussed and addressed. And after 18 months of mediated negotiations, I was
able to get credits and refunds of more than $24,000, an outcome that took time and painstaking
investigations that many cannot afford. Just remember, Assisted Living facilities will continue to do
business in the interest of business, unless you make due diligence your business.
I hope this helps.
At your service,
Paula Hawkins, your Senior Consumer Advocate.
512-619-7033