Utilization is at a record low, according to Mark Parkinson, executive director of the American Health Care Association and the National Center for Assisted Living, the largest trade group in the industry that represents around 4,000 centers. "Revenue is at record lows and spending is at record highs," said Parkinson, adding that unlike other health care sectors, the industry didn't get government support until September.
Most assisted living residents pay out of pocket, as federal programs like Medicare typically don't cover the stays. The assisted living facilities are not encumbered by federal supervision or existing insurance contracts and have a wide scope to bill residents for a variety of fees. Some have increased rents while others have billed residents to cover rising cleaning costs and masks.
"There is a real desire not to have to pass any of these costs on," said Parkinson.
In interviews in more than a dozen states, ombudsmen working on behalf of residents in long-term care facilities said that such fees are only a fraction of what is on bills and monthly rental statements. Because nursing homes and assisted living facilities limit visitors, their practices are less scrutinized. And some residents can assume that the costs will be borne by them.
Mr. Hambley, whose mother faced a $ 900 fee at her assisted living facility in Portage, Michigan, had one particular reason for skepticism: He works in the industry and runs an on-going care facility in another state.
Some of the additional costs, including a $ 11 daily lunch fee, stood out, particularly because his mother had complained about the quality of the lunches since the pandemic started. "It seemed like an opportunity to take advantage of an already vulnerable population," Hambley said. “You have no visits, no engagement. And on top of that, they're scared. "
After Mr. Hambley complained to state regulators, the facility lifted the fee. He asked not to name the place because his mother still lives there and he didn't want to compromise the quality of her care.
The charge could hit more doctor's offices soon. Last month, the American Medical Associated campaigned for Medicare to pay for a new billing code to cover the increased cost of protection.