The stunning price of assisted living

Also: Why Boston-area hospitals need to do more to prepare for hurricanes [View in browser](    [❤️]( October 4, 2022 Hi CommonHealth reader, I just got back from a health journalism fellowship, organized by the Blue Cross Blue Shield of Massachusetts Foundation, where the speakers included some big names: CDC director Rochelle Walensky, Massachusetts Gov. Charlie Baker and National Institute on Drug Abuse director Nora Volkow, to name just a few. My head is buzzing with new information and numbers, but there's one data point that stuck out to me. And it didn’t come from one of the famed speakers. It came from a site visit to an assisted living facility in Newton. It’s the bill that elderly residents — and their families — must pay each and every month to live at this facility: $8,000-$10,000 on average. The average price in the state is a bit lower (surveys put it in the $5,500-$6,500 a month range). At some facilities, it's a good deal more. But it's always thousands of dollars, and very little is covered by insurance. Indeed, 98% of assisted living residents pay privately, Tom Grape told me as he guided me through a tour. He’s the founder of Benchmark Senior Living, which runs this facility. It's one of the largest senior housing companies in the country and also a for-profit company. “It’s not inexpensive, that’s for sure,” Grape admitted. He said most people sell their homes and use that money to pay for assisted living. Still, he defended the cost saying it's roughly half the cost of nursing homes on a monthly basis. (That said, in Massachusetts, [more than half]( of nursing home residents are covered by Medicaid, and in some limited instances[Medicare foots the bill]( So what’s covered in that hefty assisted living bill? There are the basics: a room, three meals a day and programming like watercolor painting and the garden club. Then there’s a category called "patient management." It's the things staff do to help residents with their health. For those with dementia, it might be checking on them during the night to make sure they haven't wandered. Or it might be reminding residents to take medications on time. But in Massachusetts, those "patient management" duties are relatively limited. “Massachusetts has a more restrictive model of assisted living than other states,” said Grape. “Our nurses cannot do injections, cannot do drops in the eyes or change bandages," he continued. "[It’s a] crazy situation. So the same RN who works here can then go have a night job at a hospital and do all those things." That means if an assisted living resident in Massachusetts has medical needs that don’t require hospitalization or a nursing home but do require hands-on care, their family either has to come do it themselves, or they have to hire a visiting nurse, hospice provider or home health agency to provide that care. And, needless to say, that’s a big bill on top of the thousands of dollars these residents are already paying monthly. The visit left me with more questions than it answered: What happens if someone runs out of money and can’t keep paying the bill? How does the situation in Massachusetts compare to that in other states? How can this be made more affordable? And what about the huge swath of people who can’t even contemplate paying these high prices? I put that last question to Grape. “They end up having to make do,” he said. “Sometimes it can work out okay. And sometimes it’s a real imposition, a real burden and not a great situation.” If you have a loved one who has had a positive or negative experience in assisted living, I would love to hear about it. Or if you have insight into the system or questions, I’m all ears. Hit reply to this message to send me your thoughts. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [$80,000 and 5 ER visits: An ectopic pregnancy takes a toll]( A New York woman seeking to end a dangerous ectopic pregnancy in a fallopian tube finds the procedure more complicated and expensive than expected — even in a state with liberal abortion laws. [Read more.]( [$80,000 and 5 ER visits: An ectopic pregnancy takes a toll]( A New York woman seeking to end a dangerous ectopic pregnancy in a fallopian tube finds the procedure more complicated and expensive than expected — even in a state with liberal abortion laws. 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