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My 94 year mother is in an assisted living facility and I just got the bill for a shocking $700 per month increase starting May 1. This is a 19% increase. How can I argue with them? I know that they are doing more work taking temperatures and swabs of each resident daily I believe, delivering meals to each resident to prevent communal dining, but is this reasonable? Have their costs gone up 19%? Has anyone else had a similar experience? Maybe someone who works inside an assisted living facility?

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I just learned my Mom's Assisted Living raised her monthly rate from $3225 to $4615 and have already taken the April auto pay! I learned this from checking her bank balances. This is a 43 percent raise, on top of the 7 percent raise in October 2019. I called the facility and was advised a letter had gone out 1/31/20 about the rate change. I did not receive the letter or I would have had time to address it before rate change took place. I was told the "real" rate for her room is $6,000, that she was grandfathered in at $3,000 three years ago, and the intention was always to gradually raise her rate to the $6,000. This is absolute B.S. and hopefully passes muster as a crime of price gouging during a National Emergency. I am setting up a conference call ASAP with Assisted Living management. If they do not back down, I will pursue each and every suggestion listed in this forum, starting with a complaint to the State Attorney General and including Twitter messages to capture media attention. I found this forum while researching how to combat this outrageous action by her Assisted Living. I am now your No. 1 fan! Thank you for whatever additional advice anyone cares to offer and best of luck to the others facing similar situations.
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OP replied to a response on the 7th saying an error was made in the amount of $400, the $300 was increase in care.
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H+++ no.
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The memory care where my mother lives has her POA come in for a conference every few months. At that time, a detailed "care plan" is provided, which highlights any changes to the services and level of care that's needed. As time goes by, most seniors will need additional hands on services and the price will rise accordingly.

I'd ask for a copy of the care plan before and after the increase.

My mom's care costs about $ 8,000 a month, and another elder I know was paying $ 14,000 a month per his son, who handled the bills. Elder care is expensive.
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disgustedtoo May 2020
Ditto for my mother (~rate/m.) Rates do vary from one state/region to another. Some are much less, but there is a lower income in those regions. Some are more, esp in higher income areas. Cost of living drives the cost of facility care.

Although it is expensive and out of reach for many, it is less expensive than bringing in 24/7 assistance. If one can and wants to provide in-home care with or without outside help, it certainly can be much less expensive, but many of us are seniors and/or have our own disabilities, or just can't deal with the various conditions the person might have.

I try to factor it out for others. 8k/m works out to about $11/hour, for 24/7 care. Granted most don't need 24 hour "assistance", but it has to be there regardless. Some (admin staff) make more money, the ones who do the "real" work get a lot less money, then there's everything else between (maintenance, facility costs including utilities and insurance, kitchen staff, food, etc.)

What some forget to factor in, IF they can find a less expensive in-home care scenario is you need to factor in all the costs of the residence too - house/apartment/condo, food, utils, etc - if they live in your home, then the actual housing cost isn't factored in unless you spend $ on making space for them.

While there are dangers living in a facility (like now!), including falls, those dangers exist at home as well. Since one would have to use special ways to prevent wandering, there's that concern, as well as utensils, tools, appliances, cleaning products, stairs, etc.

It isn't ideal for those of us who have to use a facility or struggle to provide home care, living in general isn't always ideal either. It is what it is.

I do think a small increase given their tasks are now increased would be "reasonable". OP's original 700/m (changed to 300 later?) would be $23/day. Given that providing meals in a dining area is less work than providing meals room-by-room, and any testing done plus PPEs, this is not too bad.

In my mother's case, I am a bit miffed, because they don't warn me ahead of time regarding extra laundry or supplies. Two months ago it was FOURTEEN (14!) extra loads of laundry and a couple packs of wipes! Really? For a 96 yo who at this point doesn't walk or stand? Not like she's rolling in the mud. She's in briefs but not really incontinent yet, just in case of accidents/can't get help to bathroom in time. Okay, so first month was a surprise for all - turns out to be night-time bed wetting due to UTI. Second time bed wetting started, nurse had it checked, so not too bad. I got the statement for May, and sure enough EIGHT extra loads and several packs of wipes, despite having delivered 3 packs in a month. I questioned it and asked if this is not UTI, then what's the issue. If it is, why no notice and no Rx for me to pick up? It adds up and also messes up the budget I have for mom's money/bills.

Took several days to get a reply, but testing/Rx in order... So, given response previously from the biller, cut off is around mid-month, so I KNOW there will be MANY extra loads because it started before mid-month, was NOT addressed before the end of the month (4/30 to be exact, so there are about 15 days plus a few for treatment to work.) I expect that next statement is going to have multiple laundry loads and maybe more wipes added. THAT should have been addressed after one, maybe two, nighttime incidences of bed-wetting. The NURSE knows this and stated it to me before! THAT annoys me - I could understand a slight increase if their duties have to be increased, but THIS should have been managed/addressed.
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I had same issue here in California where the owners of the Senior Care Facility sent a letter on 2/25 to all residents stating that the rent would increase.  For my mother it was increase of 75% (4000.00 - 6900.00 effective 5/1).   Of course this cost increase was ridiculous and I notified my mother that I will need to find her a new place.  Then in March we went into Shelter In Place and have been that way still.   On April 7th, my mother notified me that the owners were still going to raise the rent, but instead of 6900.00 they negotiated to 6000.00 which still did not make any sense.   I automatically wrote the mayor and the rest of the board and notified them of the situation.   They sent the email over to the City Manager and Lawyer.  I was notified that same day with a copy of a Moratorium on Residential Rent Increases for that city.   The order notifies all owners that the tenant will pay the same amount rent that they paid on 3/1 and also the rent stays the same 60 days after the Shelter In Place has been lifted.  So I would check with your city to see if there is Rent Freeze Place in order not only for your state for your particular city. 

I hope this helps.

Mike
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polarbear Apr 2020
Mike - good for you for pushing back
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at first I would say no, this is not reasonable, and I still think that.

I do wonder if all the requirements are adding a lot of cost to their operation. But even then this is a risk they took on. I guess no one could have predicted this, but why should they pass the cost onto you.

What does the contract you signed have to say about this? Are cost hikes allowed without adequate advance notice?
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Sicillian,

My daughter will tell u that private pay and Medicaid recipients are treated no different. But My Mom paid privately for 2 months and shared a room. When she went on Medicaid, I was told they were transferring her to a 4 bed room. The excuse was, her room was being made into a single room. I didn't argue because she was failing and was only in her room to sleep.

I wonder if these people realize that Medicaid doesn't pay for that beautiful AL they could have had. That they will end up sharing a room with a stranger. Like u said, maybe $50 a month for their personal needs. Only 2k to their name. And what will those spoiled kids do, maybe visit every so often.
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In response to a good remark from drooney on April  7th about it not being easy to qualify for Medicaid because of the "5 year look back period"---.  I never will forget meeting a woman at a church who had a beautiful house in one of the most exclusive neighborhoods in our city as well as having a beach house in FL.  She said that she and her husband were giving away their assets to their adult children as fast as legally possible so that they would qualify for Medicaid.  I'm sure that her children had excellent educations and were able to make good livings and I'm also sure that her grandchildren were already spoiled millenials.  My husband and I have had LTC insurance for years at a great expense to us. But we don't think that the rest of the taxpayers in our state or anywhere in the nation should have to pay taxes to keep us in Medicaid beds in skilled living facilities.  I believe that Medicaid is for the "poorest of the poor". I'm sure that the woman and her husband were able to afford an expensive elder law attorney. I believe that the people who are giving away their money to their children may  be in for a shock if they need more than the $30.00(?) a month they're allowed to keep for personal expenses.  I was visiting a facility and told a lady that she would qualify as a member of "Rosie the Riveters", and would be acknowledged as one with a certificate for just $10.00.  She said that she didn't think her son would let her spend HER money that way!
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disgustedtoo May 2020
Hopefully Medicaid will get to extend their lookback period (I read somewhere that might be a possibility, either longer period or unlimited.)

I also hope that these people end up in some less-than-ideal facility for all their wheedling. We did do the trust, POA, will business with mom when dad was failing, but mainly facilitated it as she wanted to do it. I didn't fully understand it all, other than it does protect her as the surviving spouse. The place dad ended up in was not a place I would have chosen. Many times she said she could care for him better at home, but she never made a move to make that happen.

Fast forward to mom starting to show signs of dementia. We had to revisit a few things, set up a new trust, etc. In hindsight, some of these provisions are good, as they can protect the person from themselves. However when the attorney told me to contact him if/when she needs a nursing home, I balked. Apparently the "plan" is exactly what you mention - preserve the assets for the children/heirs. My feeling is if someone has the funds to pay, they should pay. Inheritance is never guaranteed. Could I use that money? Sure. But, my parents saved, and after dad passed many times mom indicated potential plan to move to AL when she needed it. Of course she did nothing about "clearing" out stuff and when dementia started, NO WAY would she consider moving anywhere because she was "fine, idenpendent and can cook/take care of herself." She wasn't and couldn't.

She is in private pay, a place we chose after viewing a few local to where 2 of us live. Her place is nice and they take relatively good care (my other comment covers recent lapse in checking for UTI, but otherwise, no complaints!) We sold her condo (was in life-estate, so most of the money went to us, but we put it all back in the trust for her care.) Should she need NH in the future (she's 96+ now), my plan is to cover the cost as long as we can before resorting to Medicaid.

THAT is how it should be. Greedy people like those you mentioned, hopefully they'll get what's coming to them (aka not such a nice place to live.) Also, to my understanding, most AL isn't covered by Medicaid. If it is, I wouldn't want to see the places that accept it. Mostly Medicaid would be for those who need skilled nursing care, aka NH. NH isn't for those with just dementia. The kids will likely end up either having to take them in or paying the cost of AL or MC, if the need arises! Karma...
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This seems unreasonable and appears like price gouging? You are right to question this increase. There are a few things you can do that may help. Contact your states attorney general and tell them the situation. They may open an investigation for price gouging or offer other advice. Call medicare and let them know as well. I am sure they would not be happy paying more and would push the issue on why such a large increase. Contact your states omsbudsman. They advocate for the elderly in facilities. Explain the situation to them...they do have some powers when it comes to facilities and regulations. You should be able to go online and find there contact information. You may also consult with your own elder law attorney. They could be very helpful. If you do not have one...find a attorney who practices elder law. I have one for my mother and she has helped me tremendously. You can also try talking to the facility administrator...it may not change the increase but may offer information or reasons why they are making the increase. Then you can give the information to the other resources I have mentioned. I personally think a 700.00 increase during a pandemic is beyond awful. They must have no compassion what so ever for there elderly patients. We are all struggling to get through this situation and the added expense & stress over how to cover the increase is totally unnecessary right now. Good luck & I hope at least some of this has been helpful.
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disgustedtoo May 2020
If you meant Medicaid, then yes, contact them. If you meant Medicare, please understand that Medicare does not cover any LTC facilities.
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Call up your senator - ask to speak to an aide and do not stop asking-- call everyday. Yes the facility will have to have more CNAs to keep the patients from infecting eachother… but there must be a middle of the road--- otherwise they will lose their business-- breach of contract-- also call 211 and find a good elder-lawyer. Good luck.
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i would have gasped like i had ashma at that one, their prices are high enough without adding insult to injury, how would they like it if their rent at home or mortgage increased by that amount.
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This sounds like price gouging to me. For the price of gas or food to jump 19% in a national emergency it would be seen as an act of price gouging. This sounds like the same thing.

The assisted living facility should be able to show the justification of the price hike. If they can not get in contact with your state's Attorney General's office. They will crack down on the price gouging. Also reach out to your state's department of aging or health and human services. They may also be able to help.
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After skimming through most of the comments, I agree with the hazard pay, Considering COVID 19 is high in Ohio, they may have to pay incentives to keep their help. I know in Kirkland WA the help was walking out right and left and the deaths of the residents were horrible. I will also say, $3700 a month is a DEAL. My mom paid that in a Veteran's home. All the other homes in our area charge $7000 a month for the basic care. If there is 2 person assit, and they need 02 the care has been running $500 more a month. I agree is seems like a big jump, but considering you moved her just before the end of the year, they may be factoring that into the increase as well. I would ask. Keep in mind, there are NH closing in our area, NE, because there are so many residents who are on Medicaid, and the vacilities struggle to made ends meet.
Good Luck, and stay healthy.
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It depends on what they are doing and if there is any sort of government relief available to them or to you.

I am an RN and there is extra work involved. Some employees have been demanding an increase in pay. There may be extra things they are doing for social distancing - like having 2 dinner shifts instead of one. They may have hired more cleaning staff and certainly they are using more supplies like gloves and masks. ( or they should be.)

They should be quarantining their patients and changing routines with staff and patients.
If what they are doing is legal and necessary then they should be willing to provide you with a list of their extra expenses related to the covid-19 crisis to justify the added expense.
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No. That is an illegal practice and known in the broad umbrella of "price gouging" - especially during this Novel Coronavirus. Contact your State's Attorney.
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No
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Ok, I have a number for you!
Beneficiary & Family Centers Care Quality Improvement Organization (BFCC)
888-755-5580

If they can't help call 1-800- Medicare and ask for Inspector General.

Please share!
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Contact your state's Attorney General. Price gouging during a national crisis is against the law. They will investigate quickly and order a cease and desist order. The business may be fined for taking advantage of this crisis, especially when it comes to targeting the elderly!
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Check with your local community care licensing division and let them know about this increase. They regulate licensing for senior care businesses, if there is anything fraudulent happening, they will be the ones to investigate and represent you on your behalf. From my own perspective, this is not reasonable to do this during this time, but then again, I am not up to date with regs surrounding this issue. As a paying customer, you have the legal right to ask for a breakdown of their justification for the price increase. If they are legitimate, they will have no problem providing you with this information. On the other hand, if their intent is to price gouge to take advantage of the situation...then you have a very challenging dilemma...reach out to licensing. Good luck with everything.
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Your contract with the facility, and state laws usually mandate rent increase allotments. Remember Assisted Living is similar to a landlord tenant agreement. Review your contract(s) to clarify annual rent increases.

If it's a medicare/Medicaid facility, even if/when your relative is NOT on Medicaid/Medicare everyone who lives within a CMS (Medicare/Medicaid) facility is, technically protected by Federal laws.

Costs haven't risen during Covid19 protocols. In truth, costs have shifted,
ie: patients and residents are restricted from outside activities, which deleted transportation costs, which opened $$$$ for extra hand sanitizers. The cost of delivering meals to dining rooms is not much different than delivering meals to rooms.

Follow the directives to contact other families about costs, rent-increases, and look at the Assisted Living contract. Then contact the administrator or billing about the price increase.

Sidebar; We have an ongoing in-house scam to bill residents, for a communications package no matter if the resident utilizes the phone, TV or internet, etc. It's an all or nothing "package." Mentioned to emphasize that facilities are always 100% revenue driven places. The technical logistics is where the deception sits, hidden.

Excuses:
1.Your mother's costs increased due to re-classification. Medicare/Medicaid implemented a new payment system in October, which removed therapies as the determinant of monthly charges. (Re-classification did not increase costs, instead it dropped revenue.)
2. We just entered into the 3rd quarter, quarters have zero relevance.
3.COVID19 increased costs. Nope the infamous virus shifted costs, as mentioned previously.

Your Ohio local ombudsman might be helpful, also ... Unfortunately facilities are notorious for barely legal behaviors... When they violate laws ...their unethical responses = "the resident must have misunderstood."
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worriedinCali Apr 2020
It’s assisted living. It’s not a Medicare/Medicaid facility.
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19% increase is awfully high. If there was no prior warning, I would be very suspect. In fact, due to the pandemic and the increased risk for the elderly, this could look like a morbid business decision to keep the profits at the same level. I would first make sure there wasn't some sort of accounting mistake. If they back up this severe hike, I would go directly to a consumer advocacy person (think television person) to out this piranha-like business practice.
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I'd say first thing is to call and talk with administrator. Let them know that this percentage seems way too high. Tell them, you would consider something in neighborhood of 4 or 5 %. See what they say. Rents are negotiable. People do not all pay the same amount for their spaces. Sometimes when an increase goes in - they use that time to make adjustments to normalize the amounts / equalize. But they can also shift it if they want to keep your business.
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If all the residents are getting the same rent increase percentage then there is nothing you can do. The ALF is a private enterprise and does not guarantee your mother a place to live. Alternatively, maybe this situation could help you spending down some of your mother’s assets to go on Medicaid for NH.
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FloridaDD Apr 2020
In the current environment, many states are stopping evictions.   The ALF is subject to the same rules as other places.  Each court in Ohio is handling things differently.   I would contact the local court, and ask them how they are handling ALFs.
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Is this just an increase for rent or her care too. Are they charging because they need to deliver meals to the rooms?

In my opinion, 19% increase is a lot. I looked it up for ur state and I see no law putting a cap on rent increases.
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Price gouging during a state or federal emergency is a crime. Do the following:
1) Gather records of previous bills.
2) Simply request an itemized bill for the month (s) with the increase, including how you were notified of the increase.
3) Contact your State Attorney General's Office and file a complaint for price gouging. Keep extra copies & originals of all documents. Send copies.
4) At any opportunity, find out if others received Notices of the increase & how much. Are they only charging Self-pay or those with Private Long Term Care the huge increase. Are they charging Medicare? Medicaid?
5) Inform your local State Representatives! Even a personal letter to your Governor.
-- If they are one of the few who dragged their feet on requiring rigorous protections be put in place -- then it will be harder, but you could save lives. Also then the actions they took were pragmatic & needed, but technically optional.
6) Befriend a local or major news reporter. Develope a relationship of trust. You need to file charges and allow an investigation before it comes out in the press. But if you don't hear back in a reasonable time...people are down staffed & working from home. Go public!

It sounds like the extra charge is for basic daily/monthly rate. While they may have extra costs, like PPEs, they should have been using more of them already each Flu 😷 Season. Did they charge extra if a patient was immune comprised... because they should have used extra protection to protect that patient & prevent cross contamination.

Information is gold here! Is the total bill went up for specialized individual care, like extra resperitory therapy, that is allowed. Charging extra cause meals have to be delivered to the room due to CDC or State Requirements...not allowed!

Extra cleaning costs, not allowed! Besides with dining room closed, they are not sanitizing those tables daily.

If they are being price gouged by providers of PPEs or other essential supplies. Then it is their responsibility to file charges with the State Attorney General..not charge patients.

An analogy:
If someone stole there computers, wheelchairs, transfer equipment, and expensive PT equipment, then poured paint of urine on walls & floors it would be costly immediate expense. A criminal offence. A necessity of operations to clean, sanitize & replace immediately.

It would be a crisis for them. It would not be cause for raising standard rate of care!
Also, if they are only charging Self-pay patients for expenses provided to all, talk to an ACLU or private Attorney for Elderly Services. Ask them about pros & cons of going public. Best to have info from other families in any case!

Glad you brought this to everyone's attention! I pray your LO will be safe.
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Savannagh Apr 2020
Excellent advice!
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How is this gouging?

The monthly rate is quite moderate, even after the increase.

But more to the point, the OP has agreed no contract with the ALF. His mother has been in the care of this facility for three months, but for no doubt good reasons of his own he has chosen not to settle on it as a permanent, long term or even medium term placement for his mother.

You can be in a position where price increases are controlled by state law (in some states) and the terms of your contract.

Or, you can have the freedom to move your relative without notice to the ALF and suffer no financial penalty.

But you can't reasonably expect both.

I don't think it is the central issue, here, but the financial costs of the coronavirus - more specifically, responses to it - are incalculable. If the ALF's costs rise by only 19%* by the end of this next financial year I suspect they will be incredibly relieved.

*[They won't. Not a chance.]
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thepianist Apr 2020
Sorry, but how is this NOT rent gauging? If it relates to a higher level of care needed, they should have called a care plan meeting with the family. I suspect it's related to extra costs related to Covid 19. Not sure it's legit to raise the fee like that, depends on a variety of factors. But if the home it taking in thousands of dollars a month more, it sounds to me like opportunistic profiteering. Shameful.
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I reread your post after I commented and I realize that she is not rehab. In this case, call the Ombudsman for your state.
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No facility caregiving stops, COVID-19 or not! Please do look at your mother's original contract you had signed for and carefully read the fine print. Why a 19% rate increase instead of a reasonable 5%, for example, in less than a one month notice? Ask for an updated written copy that states the breakdown of necessary services. If unable to obtain a written notice, please contact the facility's director. If suspicious of fraud also contact an elder law attorney.
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Contact your local Congressman/woman and find out directly who you are suppose to contact about this. No this is not acceptable and there are severe penalties for gouging. Even insurance companies are waving co-pays, etc. for COVID-19 patients. We have a Governor’s Council son Aging in my state. See if you have one in your state. I am in S.C. If your mother is on Medicare in rehab, call the Center For Medicare/Medicaid Services. They will check it out. Does your mother have Medicare Supplement? Just wondering because you should not be receiving a bill if it is rehab. If she were in a nursing home as a resident and you are on self-pay, they will try to jerk you around. Call that Ombudsman. Google Ombudsman and your state and you will get the phone number.
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worriedinCali Apr 2020
Elaine....her mother is not on Medicare in rehab. She’s in assisted living. She’s not in rehab. She lives in assisted living, it’s all spelled out in the post.
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Go to Accounting office or call them if they don’t allow visitors...& ask them why the increase...& then see Head Nurse in charge if her needs & care increased ...maybe time for an updated care plan meeting. If her needs increased, then perhaps she needs a nursing facility instead of Assisted living. Communication is important. But as far as currently, nobody can be evicted for lack of paying rent because of covid 19 law . & I don’t think they can increase rent now ...at least in NY that’s now law. If talking to them is a waste of time, go further by contHugs 🤗
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