Assisted Living Facilities

Consumer's Guide 

ENTERING INTO AN ASSISTED LIVING FACILITY 
How is assisted living in Virginia managed, and regulated? 
Unlike the laws regulating nursing center, there are no federal laws and statutes that regulate assisted living facilities. This means that for the consumer there are less protections regulating contractual constraints and the quality of care in assisted living facilities versus nursing centers. Virginia does have statutes and regulations that specify requirements on assisted living facilities but they are much less than the requirements on nursing centers. For example, nursing centers are not allowed to require a third party guarantor for payment as a condition of admission to the facility. That is not true of an assisted living facility. Another example is that nursing centers have less flexibility in discharging a patient from its facility than an assisted living facility has when it wants to discharge a resident. Thus the consumer has much less legal protection when entering an assisted living facility and this should be kept in mind when reviewing a contract. In fact, the contract itself must be carefully reviewed to determine what rights and protections the consumer has. 
Still, assisted living facilities in Virginia are licensed by Virginia's Department of Social Services and Virginia's Long Term Care Ombudsman Program is charged with investigating complaints and resolving disputes between residents and assisted living facilities. 
The Uniform Assessment Instrument (UAI) 
Virginia regulations require that no resident can be admitted or retained for whom the facility cannot provide appropriate care. To ensure this result every prospective resident to an assisted living facility must be assessed by the UAI within 90 days prior to admission. The UAI assesses an individual's social, physical health, mental health and functional abilities. Thus the UAI is used to determine whether a particular facility has the capacity to deal appropriately with the needs of the prospective resident. From the UAI a facility should proffer an appropriate service plan of care to the prospective resident. Make the admissions director or other appropriate employee review the UAI with you and explain how the facility can meet the resident's needs through its service plan. In addition, the UAI should be used as a means of determining costs. (See below the section on "The Pricing of Assisted Living Care") Since the resident's needs are determined by the UAI and the plan of care, the services should be priced out so that the resident, the family and the facility understand what are the needs of the resident and what is the cost in providing for those needs. 
The Pricing of Assisted Living Care 

State law requires assisted living facilities to fully disclose all of the costs of care. However, facilities are loath to explain all the costs and consumers usually don't inquire. General costs are usually quoted but not until the first bill comes does the consumer realize the total cost of care. 
Understand the basic daily rate. Usually this includes lodging and food costs but know what additional services are covered by this rate. They may vary from facility to facility. Some facilities include degrees of care based on daily rates. For example a facility may offer three levels of care: Level I (Standard Care) Level II (Intermediate Care) and Level III (Extensive Care) Which level of care a resident requires depends on the residents personal and health care needs (As determined by the UAI). In addition to these levels of care, a facility may have a schedule of ancillary charges based on usage. Ancillary charges may include personal laundry, television, and beauty shop costs. Another typical ancillary cost is medical supplies, which may be billed on an as needed basis. Find out what these medical supplies are, how much they cost and based on the plan of care how often will the resident need such supplies. 
Another typical form of pricing that facilities use is to have one basic daily rate and everything else priced a la carte. For example, the facility may have one basic daily rate for all residents and any additional service priced on an as needed basis. The daily rate may only include lodging, food and laundry but all additional personal care needs would be priced separate. Such additional personal care needs could include assistance with bathing, assistance with dressing, and administration of medications. Find out the extent to which the resident will require such additional personal care and make the facility total such charges so that a monthly cost can be estimated before the first bill arrives. 

Other Costs
Deposits. Some facilities assess a refundable security deposit, while others charge a non-refundable entrance or "community fee". Some deposits might not be refundable, even if you move elsewhere, and never take possession of the room! Have the assisted living administrator explain all deposits and advance payments to you. 
Refunds. Look to see if the assisted living contract includes the circumstance on how your rent and other payments can be refunded. This can involve considerable savings when the resident leaves, or changes accommodations, etc. 
Late Fees: Most facilities charge a late fee if payment for the charges are received late. Fees may vary from a set fee plus an additional charge for each day beyond the present term for unpaid rent. Some facilities charge an annual percentage rate (often 18%) assessed daily on unpaid rent. 
Increase of Fees: What if the facility wishes to increase its basic daily rate or other fees after you sign the contract? Generally Virginia regulations do not prohibit facilities from raising their fees. They do require that facilities give proper notice when they wish to raise fees. Most contracts give a 30 notice of when fees may be raised. This fact can obviously be a strain on an individual who has just enough income and resources to afford the cost of care. Ask the facility how often in the past they've raised their fees and when do they expect to increase their fees again. 



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