How much assistance do you need? It's generally assistance with tasks of daily living. There are also independent living apartment buildings, some with dining rooms and bus transport for appointments, but no personal care.

It is my husband that needs assistance which I have been giving. We really do not want to move. My question was not about the assistance but about the verbiage that they are using. I have never seen assisted living places here using the term "Entrance Fee" and "rental fees" Most are called Buy in Fees and monthly fees.

This is a wild and tumultuous free
market. Many factors come into the building/offering of CCRCs. You MUST do a
lot of research because if you make a mistake with your $$$$, nobody is going
to come to your rescue and get it back. There are no real guarantees in the
eldercare facility.

First: Is the facility non-profit or for-profit?
Non-profits rate better for care and lower staff turnover. But be aware that at
any time, a non-profit can be bought by a for-profit corporation - in fact,
many already have and this trend is increasing.

This is not, repeat, not, to say
that for-profits are always bad. Many are quite nice. Where we found the
biggest difference was not at the Asst Living level, but at the Memory
Care/skilled nursing (e.g., 24/7 care commonly called "nursing home"
level care). At that level, the cost between non- and for-profits was
noticeable. We're talking a
$2-3K/monthly difference.

Also, when staff turnover is high, care
suffers at all levels. We've visited
places where the daytime staff that one saw in the public areas were all smiles
and welcoming, but at night the staff was indifferent and brusque - not just to
visitors, but to residents!

Cost is not as important as the type of
social environment. "Like to like" should be the motto of these
facilities. We investigated eight nearby full-service facilities for my MIL,
and every one of them had a different social atmosphere. We did very
intensive research and multiple visits, to ensure the one we picked
would be the best for her while being a place she would enjoy the most. As most
know from my other posts, we were successful. But it took months
to achieve it.

You can check a facility's inspection record through the appropriate state
regulators. Ours are on-line and although it took a lot of time, it MUST be
done. When I finished I had confidence the facility we chose was ranked
third in the state and had only extremely minor issues, which were promptly
corrected.

So what is the cost? There are two big
issues: one is the upfront buy-in cost; the other is the cost of 24/7 care. Due
to state licensing requirements, most senior facilities find it easier to apply
for an AL
license for all their living units, rather than designating some as 'independent'
and some as 'assisted'. For Asst. Living, we found little difference
between the various facilities we saw. In our high labor cost state,
"rent" ranged from $2800-$4000/mo., for smaller units that were
either studios, junior studios, or 1 bdrm. Some had 1/2 baths, some had full
baths. Not all had kitchens (we didn't
want one; MIL had dementia so not safe for her to cook).

Within Asst Living there were three levels
of care, as determined by MIL's
facility. The family can negotiate but it's
the facility that decides what to charge extra for. Every facility is different
but most have a similar type process. It can be expensive: MIL needed nothing
more than daily medication help and weekly bathing assistance. That cost
$900/mo. and was rated Level 1, the cheapest extra assistance pkg.

Buy-ins vary enormously. With a larger
buy-in you are paying for your monthly costs to never increase even if you need
24/7 care eventually. With a smaller buy-in if you need to move, your costs
will be charged market rate. This may sound great but every facility we met
with told us they raise rates 3-5% annually, every July, without fail.

So if you go in at age 60, and need 24/7
care at age 85, what the facility is charging today will be more than double
when you finally do go in. Will you have enough $$$$?

And please, do not fall in with the common
idea of "Well, at 85 I won't
care, and I'll probably be dead
anyway." My MIL was 84 when she went in. Imagine her shock to discover
that among her three other tablemates at meals, she was considered "the
baby"! People are living longer, and you might well be one of them.

We're
very happy we found a place that worked out so well for her, but it took effort
on our part.

I urge you not to short doing your
research. Find a place that suits you, even if it is a little further from
family. This is one of the most expensive decisions you will ever make, and you
should never have to regret it.

Thank you for your input. Every thing other than future costs is exactly as I have found it. Supposedly the place my niece found started as a Methodist care home but is no longer affiliated. It is definitely a for profit as any care is provided by outside staffing, seven levels of care.

Personally if my mind and body is gone I would rather just pay for a regular nursing home but this is for my husband.

Your comment about downsizing is one of my concerns as supposedly we could downsize but no mention of reduction of what they called intake fees. You are correct about when one moves to nursing situation vs staying in unit with increased level care costs.

Yes, you pay privately for caregiver to do things and help you out and some even have to have hired help to clean up when things are spilt and the cleaner there only does once a week in some places. Meals are costly too for each meal. And you have to give up lots like many pieces of furniture don't fit in as some are such tiny places to live in. Find out about transportation and if you still drive, then where to park, if not how to get around. Some you have to buy breakfast items and maybe snacks too and so how do get to grocery store, how about medications and appointments and those things, have to ask about it all and the costs for everything that must be paid out and figure it out to home care what is best and less or best for both your needs?

I understand your concern, this kind of pricing can feel confusing. What you’re describing is quite common: a base cost for housing, then additional fees depending on the level of care needed.

It’s important to ask for a clear breakdown and what’s included vs. extra, so there are no surprises later. Taking time to compare a few places can really help you feel more confident.