A nationwide chain of assisted living facilities promised elderly residents that if money ran out, they could pay for services with Medicaid. A change in policy by the company, Assisted Living Concepts, means Medicaid is no longer accepted and those who cannot pay are being evicted.
Older people often say one of their biggest fears is to wind up in a nursing home. That is one reason the assisted living industry has boomed. It offers a comfortable alternative, where people get to live in their own private apartments and leave the cooking and cleaning to the staff. But assisted living is expensive. And when people run out of money, there are few government rules to protect them.
Evicted At Age 99
Cordelia Robertson turned 99 in May. Two days later, she got the eviction notice.
Her son, Gene Robertson, says even though his mother is confused and doesn't understand what's going on, she would be devastated if she had to leave the home outside Seattle she has lived in for nearly 10 years.
"I think it would kill her," he says. "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. She smiles and she's always happy. But she don't know what's going on."
What is going on is that Cordelia Robertson has run out of money. She went through her entire life savings. She spent it on the rent at the assisted living facility.
"My mother spent $350,000," Gene Robertson says. "It was her money. And she is now broke. I mean, she has zero money."
He says officials at the assisted living facility always promised him that if his mother ran out of money, she could use Medicaid, the government health insurance for the poor.
However, last year, when Cordelia Robertson finally did need Medicaid, Assisted Living Concepts changed its policy and said it would no longer accept Medicaid.
In May, the company, which has facilities in 20 states, sued Cordelia Robertson to get her to leave.
Across the country, in New Jersey, Marilou Rochford tried to hide the Assisted Living Concepts eviction notice from her mother. But one of the aides let it slip.
"She said to me, 'Marilou, did I do something wrong?'" says Rochford, recounting the conversation with her mother, 84-year-old Betty Merklinger.
"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," Rochford says. "People of that generation, they're very much about following the rules and they're also very much about keeping their promises."
Rochford says she picked the facility for her mother nearly five years ago because it was friendly and homelike. She says officials there also promised her that her mother would never have to leave.
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 is not enough.
A New Corporate Policy
New Jersey's Public Advocate, Ron Chen, has stepped in and is investigating the company.
Chen says Assisted Living Concepts, in its application for a license in New Jersey, promised that up to 30 percent of its residents would be on Medicaid.
He contrasts that with ALC officials' "new corporate policy, which is all over their Web site, which is that they want to get rid of Medicaid patients entirely and become purely private pay." Chen says, "It's just not consistent."
That original license application, and the promise to serve the poor, was made 12 years ago. At the time, New Jersey officials asked Assisted Living Concepts to set up business in the state.
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 be interviewed for this story but gave the following statement 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."
Investigating Involuntary Discharges
Chen says he has received about two dozen complaints about Assisted Living Concepts in New Jersey. In late July, he announced he is contacting 500 current and former residents to see if they, too, faced involuntary discharge.
In Washington state, legislators have tried to respond, too. A new law says people already on Medicaid cannot be kicked out of their homes. However, the law will not protect people who are not yet on Medicaid, like Gene Robertson's 99-year-old mother.
"All I want them to do is let my mother go in peace," Robertson says. "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."
Around the country, other assisted living companies say they are unhappy with the aggressive way Assisted Living Concepts has evicted poorer residents. The backlash has been bad publicity for all of them.
The industry, however, is serving fewer and fewer low-income residents. A recent federal report noted that while the number of assisted living facilities has grown over the past few years, the number of residents on Medicaid housed in those facilities has been falling. Today, about 10 percent of all assisted living residents use Medicaid.