Watch Out: The Hardest Decision You Have to Make May Involve Bait-and-Switch

Image by Kyle Glenn.

A college dean who was overwhelmed with decision-makings once confided to me that they were nothing compared to the heartbreaker he was having to face. It wasn’t faculty or budgetary retrenchment. It was finding an assisted-living facility for his healthy, feisty 70-year-old mother and then, having to break it to her.

If 818,800 now live in 30,600 assisted-living facilities in the U.S, the dean joined millions in past and present of family members searching for one with reasonable monthly charges and safety as primary factors. Other considerations are the proximate distance between facility and a family member’s home, community choice (rural or urban), ratio of caregivers to residents, care needs, activities, and food quality.

Years later, a close friend recently had to end years of procrastinated dread about researching a destination for an 86-year-old widowed father. His increasing number of falls, were followed by hospitalizations and rehabilitation stays. And Medicare covers only 100 days of a calendar year.

Though ferociously independent, even he had to admit assisted-living would be a relief from having to find and court middle-aged widows and divorcees as “companions,” but essentially to do his meals and housework. The turnover was exhaustive. And when she toted up his monthly expenses, a google search of the median monthly cost of assisted-living quarters ($5,511 ) nearly equaled it—and he would be free from seeking “birds’ nests on the ground,”as he put it.

She could have contacted one of the agencies that serve a dozen facilities for commissions, but she didn’t trust them or their testimonials. That meant another google research of 45 Portland (OR) places until she had a short list of five to visit.

One of her first investigative “sweeps”involved deleting those whose licenses had been lifted by the state’s housing agency for significant violations (unsafe, theft, abuse, medication mix-ups, etc.). But her biggest criticism was having to page through dozens promotional pictures of supposedly happy residents and flowery prose—and gushy testimonials— to get to the bottom line: cost. Some just recommended contacting them for “further information.”

“Price is the one thing most of us want to know up front,’ she said, “before we spend time on gush or snapshots of well-preserved couples dancing or playing bingo.”She finally found the prices only to discover additional cost of thousands of dollars per month tacked on for the “level of care”her father would need. He was evaluated as a “Level III”at $2,000 for assisted showers twice per week, accompanied daily walks, and medication help.

She (and the family) were shocked because it would clean out his bank account within 21 months. Forbes’2024 finding was instructive in reporting the“median length stay in assisted living is around 22 months.”That’s usually when the money runs out and then having to find some other accommodation for their father until his death.

Now, the Census Bureau estimates that by 2040 some 80,800,000 will be over 65. Millions more like my friend will want to know the bottom-line costs of assisted-living without having to spend days repeating her labors.

The solution to this common, heartbreaking—often dangerous— family dilemma is obvious. The base monthly price and these additional charges should be stipulated on a website’s first page—with an indicator of the subsequent page spelling out services at each level, I to X. The Consumer Protection Bureau has limited staff and budget to pursue this growing extortion, much less policing this crime. Only a Congressional law or a president’s executive order can require such a national mandate, vital because families often “shop”other states’s offerings.

Naturally, lobbyists would bombard both branches of government if a hint of such a requirement appeared to threaten profits of facility owners and dividends to their stockholders. But like Social Security and Medicare, this is one issue that will unite the votes of families affected by the bait-and-switch cleaning out bank accounts and assets. It could force them to provide the care and feeding of elderly members, as in the“good old days.”Too, those over 65 almost always vote.

In the meantime, family members need to watch out for the bait-and-switch before signing a contract with an assisted-living facility. It will avert doubling the pain of the hardest family decision they ever make.