Philomena Nave, 85, had been caring for her only sister, Mary, 87, for nearly five years when dementia got the better of them.
“She finally stopped talking, was incontinent and wandering at night. I just couldn’t do it myself anymore,” Nave recalled recently in the kitchen of her Jeffersonville home.
In November, she had Mary evaluated by Brandywine Senior Suites in nearby East Norriton, an assisted-living facility with a dementia/memory-care ward. Nave said she paid $1,000 in admission fees and was expecting to be charged $5,000 more for the full month of services.
But within a few weeks, Brandywine Senior Suites had admitted Mary to a local hospital after she fell out of bed and hit her head. She never returned to Brandywine, dying in early January.
Yet in the meantime, Nave received a bill for the full month of December from Brandywine, even though her sister was in the hospital. She also received a bill in January for $17,000, though her sister had not been staying there.
“Brandywine couldn’t take care of her. She was combative and hitting the nurses. They had me sign papers for her to be admitted to a behavior ward” of Suburban Community Hospital, Nave said. “But they never told me she wouldn’t come back. So why did they take her in the first place?”
Brandywine Senior Suites president Brenda Bacon said she is not allowed to comment on a particular patient’s situation, given HIPAA laws. She noted, however, that “our disclosure and transparency about our bills is at a high level. It can be confusing at times, but we’re happy to talk to families about it.”
Since the $17,000 bill went out, Brandywine has waived all the fees for Mary Nave. But it’s a cautionary tale about the practice known as “bed hold,” by which assisted-living facilities can charge residents for a full month even if they leave for short- or long-term stays at a hospital or other care facility.
“Normally, when a resident is being transferred to a hospital for medical reasons, the facility almost always asks the family, ‘Do you want to pay the bed hold rate?’ but they’re not all up front,” said Andrea Murphy, long-term care ombudsman supervisor for Montgomery County Aging and Adult Services in Norristown.
“Think of them as you would a hotel: If you leave all your stuff, you’re going to get billed for those days,” Murphy said. “In Pennsylvania, it’s really buyer beware.”
She recommends always having "an elder-law attorney review contracts before placing a family member in any care facility,” and often refers families to the Montgomery Bar Association.
Mark Davis, an elder-law attorney in Lafayette Hill, noted that regulations on assisted-living policies are vague in Pennsylvania.
“Interestingly, there is nothing mentioned about bed hold or any requirement that may be addressed in the resident agreement” for assisted living, Davis said.
He recommends contacting the facility’s ombudsman with any questions or problems. (The ombudsman’s phone number should be posted prominently).
“Unlike personal-care homes and even nursing homes, where the resident is paying for a ‘bed’ more so than a ‘living unit,’ assisted living is more like an apartment lease arrangement,” Davis said. “So the assumption is unless either the residence or the consumer initiates discharge while the person is in the hospital, it’s understood that you keep paying and they can’t rent your room to anyone else.”
If you as a third party sign an agreement to pay, you may be personally bound to cover the bills.
Assisted-living residences are required to certify, prior to admission, that a resident’s needs can be met by the service provider, he added.
It’s caveat emptor, though. Personal-care homes and assisted-living facilities are licensed by the Pennsylvania Department of Human Services, previously part of the Department of Welfare. Nursing homes are licensed by the Pennsylvania Department of Health.
In New Jersey, assisted-living facilities are licensed by the state’s Department of Health, as are nursing homes. However, boarding houses and residential health-care facilities (offering 12 minutes of registered nursing care per week) are licensed by the Department of Community Affairs. For complaints, the process is the same: Contact the ombudsman, who then passes them on to the Department of the Public Advocate and the state agencies.
Before admitting a family member in an elder-care facility, geriatric-care manager Melissa Coopersmith says, ask about:
- Fees. What are the annual charges to live there? Is there a community fee, covering activities for the month? What have annual increases been for the last three to five years? If your loved one goes to the hospital, or on vacation, what charges will result, since they will not be using the community services? If this is not the appropriate community for the patient’s condition, are there fees to leave?
- Dementia care. What type of staffing is in the dementia unit, and how does the dementia unit differ from the assisted-living area? What are the support services (assistance with eating, incontinence, wandering, dressing, transferring from bed to chair)? When or how are patients considered for the dementia unit if they are in assisted living? What are those costs?
- Departure decisions. When does the facility determine it can no longer care for patients? If they can no longer walk? Complete activities of daily living? If the community asks a patient to leave or feels it can no longer care for a patient, what are the fees involved and what is the process?