By Jan Warner and Jan Collins
Knight Ridder Newspapers

Family members should be on the lookout to insure the resident is receiving proper care.

A year after Dad died, we saw that our mother became more and more unsteady on her feet and needed help remembering to take her medications. We finally talked her into entering a residential care facility where she has remained for the past two years except for visits with my family and my siblings. The monthly fees that were initially $1,500 per month including her meals have now risen to more than $3,500 per month. The director tells us that Mom needs more care and assistance. We have noticed that she has become more frail of late. Is it time to seek assisted living or a nursing home? Does Medicaid cover residential care as Mom's money is running out?

A. Residential care facilities, which are synonymous with assisted living facilities, are nothing more than special living environments for elderly persons who, although generally in good health, need assistance with certain activities or functions. Generally, assisted living facilities provide a room or apartment, meals, housekeeping, medication management, assistance with personal hygiene, transportation, and certain activities. These facilities can range in size from two unrelated persons to hundreds.

Assisted living should be considered as a step above independent living and a step below institutionalization in a nursing home, where a higher level of supervision and care is necessary.

Over the past several years, assisted living facilities have been overbuilt throughout much of the United States. Although regulated by each state, anyone can build a residential care facility, while a nursing facility can be built only after securing a certificate of need from the appropriate state agency. Although subject to state regulations, an assisted living facility is not a medical facility and does not offer continuous resident supervision or skilled nursing care. Generally, state regulations require that these facilities have a written plan of care for each resident.

Despite their stated purpose, because of economics, some assisted living facilities have increased their fees and services as they try to retain sicker residents, thereby, in effect, competing with the nursing homes.

To increase their fees for sicker residents, some use the "point" system - that is, a charge is made for every assistance given to a resident. Some charge $.75 per point while others charge as much as $2. Think about it, if your mother needs help remembering to take her medication four times a day, she may be charged an additional $8 per day - $240 per month - for that service alone.

While we believe that assisted living facilities certainly have their place, we have seen and heard about horror stories where sick residents are retained without being given the appropriate care. We believe that all residents of assisted living facilities should be closely monitored by the family to make sure the needed level of care is being provided. We believe that geriatric care managers should be engaged by family members to review the records on a regular basis. We believe that facilities that take on the care of sick people without the proper staffing or regulatory authority are dangerous to the resident.

Medicaid does not directly cover residential care unless there is an optional state supplement program in your state of residence. This program provides a supplement to lower-income individuals that will allow them to stay in those facilities that participate in the program. To find out more, contact your local state agency.

Taking the NextStep: With monthly charges approaching $120 per day, we think it's time that you have your mother independently assessed by a geriatric care manager to determine her actual care needs. While assisted living facilities provide assessments, sometimes these can be self-serving and not in the best interests of the resident.

Jan Collins is a writer and editor. Jan Warner is a matrimonial, tax and elder-law attorney. Both are based in Columbia, S.C. Please send your questions to P.O. Box 11704, Columbia, S.C. 29211, or e-mail to janwarner@nextsteps.net.