MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
ROBERT SIEGEL, host:
And I'm Robert Siegel. Older people say that one of their biggest fears is winding up in a nursing home. That's one reason that the assisted-living industry has boomed.
It offers a comfortable alternative. People get to live on their own in a private apartment and leave the cooking and the cleaning to the staff. But assisted living is expensive, and when people run out of money, there are few government rules to protect them. NPR's Joseph Shapiro reports.
JOSEPH SHAPIRO: Cordelia Robertson turned 99 in May. Two days later, she got the eviction notice.
Mr. GENE ROBERTSON: I tried to plead the case.
SHAPIRO: Gene Robertson is the woman's son. He says even though his mother is confused and doesn't understand what's going on, she'd be devastated if she had to leave the place outside Seattle, Washington that's been her home for nearly 10 years.
Mr. ROBERTSON: I think it would kill her. This lady is probably 80 pounds. You could pick her up with one hand. You could put your fingers around her wrist. She is just a little, little, little, teeny, frail, frail person with a laugh, and she smiles and she's always happy. But she doesn't know what's going on.
SHAPIRO: What's going on is that Cordelia Robertson has run out of money. She went through her entire life savings because she spent it on the rent at that assisted living facility.
Mr. ROBERTSON: My mother spent $350,000. It was her money, and she is now broke. I mean, she has zero money.
SHAPIRO: Gene Robertson says officials at the assisted-living facility had always promised if his mother ran out of money, they'd take her as one of their lower-paying Medicaid residents. Medicaid is the government health insurance for the poor. But last year, when Cordelia Robertson finally did need Medicaid, the company, Assisted Living Concepts, changed its policy and said it would no longer accept Medicaid.
The company has facilities in 20 states. In May, it sued Cordelia Robertson to get her to leave. Gene Robertson never thought his mother would outlive her savings, but he didn't think she'd live to the age of 99 either.
Mr. ROBERTSON: She did everything right. She lived too long. I mean, if you want to look at it economically, she lived too long.
SHAPIRO: Across the country, in New Jersey, Marilou Rochford tried to hide the eviction notice from her mother, but one of the aides let it slip and told her mother.
Ms. MARILOU ROCHFORD (Daughter): And he said to me, Marilou, did I do something wrong?
SHAPIRO: Her mother, Betty Merklinger, is 84.
Ms. ROCHFORD: I said, oh mom, you did nothing wrong, and she said, are you sure? And I just thought it was so sad that someone of that age would look at me and be so upset and think the only reason that they would be telling me to leave would be because I broke the rules or I did something wrong, and you know, people of that generation, they're very much about following the rules, and they're also very much about keeping their promises.
SHAPIRO: Rochford says she picked the facility for her mother nearly five years ago because it was friendly and homelike and because officials there promised her mother would never have to leave.
But now, even though Rochford's mother has been approved by Medicaid and the family is willing to pay several hundred dollars a month extra to keep the one-bedroom apartment, Assisted Living Concepts says that's not enough.
New Jersey's Public Advocate, Ron Chen, who runs a state legal advocacy agency, has stepped in and is investigating the company.
Mr. RON CHEN (Legal Advocate): Okay, so I'm reading now from their application a certificate of need. Direct quote: Residents will not be asked to move from the residence because of spend-down situations.
SHAPIRO: Chen reads from the company's application for a license in New Jersey. The company promised that up to 30 percent of its residents would be on Medicaid.
Mr. CHEN: And contrast that with ALC's new corporate policy, which is that they want to get rid of Medicaid patients entirely and become purely private-pay. It's just not consistent.
SHAPIRO: That original application and promise to serve the poor was made 12 years ago. At the time, New Jersey officials begged Assisted Living Concepts to set up business in the state because while other companies built residences of marble and crystal to attract the wealthy, Assisted Living Concepts was doing something very different. It built comfortable but frills-free facilities aimed at middle and low-income elderly.
The company has long since changed hands. Officials now at Assisted Living Concepts declined to speak on tape for this story but said in an e-mail: To provide the best care for residents and to remain a solvent business, there are limits on the number of Medicaid residents any assisted-living facility can serve.
I asked Ron Chen about the company's complaint that what New Jersey pays for Medicaid residents has not kept up with inflation.
Mr. CHEN: I would be the first to welcome some increased Medicaid rates, but until that happens it's the residents that I've got to be most concerned about.
SHAPIRO: Chen says he has received about two dozen complaints about Assisted Living Concepts. In late July, he announced he is contacting 500 current or former residents to see if they too faced involuntary discharge.
In Washington state, legislators have tried to respond too. A recent law says people already on Medicaid can't be kicked out, but that won't protect people who aren't on Medicaid yet, like Gene Robertson's 99-year-old mother.
Mr. ROBERTSON: All I want them to do is let my mother go in peace. I don't want to create any stress for her. I don't want to create any problems for her. I just want her to pass on in a gentle manner.
SHAPIRO: Around the country, others in the assisted-living industry say they're unhappy with the aggressive way Assisted Living Concepts has evicted poorer residents. It's bad publicity for all of them, but the industry in general is serving fewer low-income residents.
A recent federal report noted that while the number of assisted-living facilities has grown over the last few years, the number of residents on Medicaid has been falling to about 10 percent of all residents in assisted living. residents use Medicaid.
Joseph Shapiro, NPR News.
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