Group Crafts Guide
To AssistedLiving Choices

July 9, 2007
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GRAND RAPIDS — Assisted-living centers have become more popular as the aging population seeks out a home-like atmosphere for elder care, said Frances Grant, deputy director of Citizens for Better Care.

But few are aware that terms such as "assisted living" and "independent living" are merely for marketing, and that most such facilities are unlicensed in Michigan, Grant said.

"In the last 10 years, many unlicensed homes have popped up. We used to say, 'In Grand Rapids, there's a church on every corner.' Now I think there's assisted living on very corner," Grant said.

Citizens for Better Care received a $51,000 grant through the KentCounty senior millage to hire someone to become an expert on assisted living and to compile a database of local assisted-living centers, their costs and services, Grant said.

"Many consumers, especially baby boomers, are helping their parents find facilities such as this. They don't know where to start, what questions to ask," Grant said.

"Since there is a lot of guilt with placing a parent and moving a parent out of their home, many times the adult children are drawn by the accoutrements of these places. They see a lovely environment and they forget they are consumers, and don't ask the right questions."

Yet the right questions are especially crucial because assisted living is not licensed or regulated by the state, she said. Assisted living is essentially a landlord-tenant relationship.

"People really need to read over that contract and see what they're paying for, what their services will be," Grant said. "For instance, the range of price on assisted-living facilities can go anywhere from $1,500 a month to $3,500, $4,000. It is possible people are just paying for the basic bed and board when they're being quoted $1,500. They might be surprised to find out they have to pay extra for meals, toilet paper, incontinence items, cleaning, whatever."

Some assisted-living centers offer a package of services at a certain price, with the price increasing with each step up into packages that have additional services.

Government benefits such as Medicare, Medicaid or Supplemental Security Income don't cover assisted living, so, in general, seniors must pay out of their own pockets. Most assisted-living centers operate outside the state's licensing structure, so there are no requirements on staff qualifications nor is there a formal complaint process.

For licensed nursing homes, homes for the aged and adult foster care homes, Citizens for Better Care can track those items, said Pat MacKinnon, program director and long-term-care ombudsman in the Grand Rapids area. A few facilities labeled as assisted living have licensing as homes for the aged or adult foster care homes. But for the majority of assisted-living centers, MacKinnon said she must rely on surveys filled out by the centers themselves.

"We try and gather information on the services that they provide; costs for those services; information on staffing, which is a big issue; any extra costs, whether there's a deposit or application fees; extras they might have, for example, can you have a pet; whether the facility itself is accessible with handicapped-accessible rooms. It's just some basic info, things people want to know," said MacKinnon, who developed the database under the senior millage grant.

"There is really no government oversight, so if I complain, no authority will come in and do an investigation," she said. "You are limited to what the contract agreement is. There's no obligation of the facility or community to do any kind of oversight or know what's up with a resident. There's no assessment process. If somebody needs a service, it's up to you to figure out what services you need and get that set up for yourself."

In addition to sharing information from its assisted-living database, Citizens for Better Care's Grand Rapids office offers consumers a checklist of issues to use when considering unlicensed assisted-living facilities.

Grant said Citizens for Better Care would like assisted-living centers to fall under the state licensing program for adult foster care.

"We feel very strongly. Citizens for Better Care has taken the stand that all assisted-living facilities should be licensed by the state," Grant said. "It's not a matter of recreating the wheel. Adult foster care could be used for the unlicensed homes."

If services provided by an assisted-living center fall under the state law that demands licensing for adult foster care and homes for the aged, the facility should be licensed, said Linda Lawther, president of the Michigan Center for Assisted Living, a trade group. But "assisted living" is a "loosely used term" that has no legal identity, so it would be difficult to know which facilities should be licensed, she said.

If provided services "fall under state law, they should be licensed. Otherwise, it's free enterprise," Lawther said.    

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