My Elder discusses the hidden agenda behind these so called “free” elder care referral agencies.

Two weeks ago, I called the largest nationwide Free Placement Company, to find out if they contract with a particular substandard facility in Bronx, NY. I was shocked to learn that they do.

You should be aware of another serious problem. Placement agencies who receive a fee from facilities will not be there to advocate for you if there is a problem. They will not bite the hand that feeds them. In some cases, the facility will build the fee that they pay free agencies into your costs for living there.

Free-Based Senior Placement Agencies fall into the catch-all category of long-term care referral services, are the cyberspace era’s quick fix solution for the growing number of Americans seeking non-nursing home institutional care for their aging parents, relatives, and significant others. Unfortunately, this purported expert assistance in navigating this bewildering world of assisted living is, at best, a hit-or-miss proposition.

Senior-placement companies, which rely on commission-only sales people, funnel the aged only to facilities that have agreed to pay thousands of dollars in finders’ fees. Also, most placement companies do not screen homes for past violations. As a result, many agencies have referred seniors to facilities with documented histories of substandard care, including fatal neglect.

Behind these free offers can lurk a hidden cost. Placement companies, which rely on commission-only sales people, funnel the aged only to facilities that have agreed to pay thousands of dollars in finders’ fees.

In 143 cases over the past three years, seniors were victimized after companies placed them in adult family homes, or other long-term- care facilities, that had a record of serious violations, a Times analysis of Department of Social and Health Services documents reveals. They did not identify placement companies by name.

Cases include residents with dementia locked in rooms to prevent wandering; mentally ill adults drugged to control behavior; and bed-bound seniors abandoned without assistance for up to 16 hours.

Because it is unlikely that the free placement agency’s employees will be a nurse or social worker — a professional who has ethical and regulatory strictures requiring the disclosure of third-party fees — they will be under no obligation to reveal this fee structure. Some placement services do in fact disclose in their Internet advertising how they earn their fees. However, a casual web search shows that many do not, preferring instead to use the word “free” as a lure.

There are senior placement agencies who have stellar records and serve as an important bridge between seniors who need care and the facilities with open beds. But the lure of making fast money has also attracted dozens of profiteers to this little-examined industry. They face no licensing, education or training requirements, and can quickly set up shop.

“It’s an unethical business model,” said C. Byron Cordes, president-elect of the National Association of Professional Geriatric Care Managers, who practices in San Antonio. “If there are five assisted living facilities in your town and A Place for Mom has contracts with three of them but the fourth is the best for your mother – you won’t hear about it.” “You think you’ve found an ally when you’ve really found a salesperson,” he added.

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The Federal Anti-Kickback Statute prohibits knowingly and willfully paying or receiving remuneration in exchange for patient referrals from which payment may be made by a federally funded healthcare program (e.g. Medicare, Medicaid, Tricare, etc.). The AKS has been amended several times, including an expansion of the term “remuneration” in 1977, and added a knowledge requirement in 1980, mandating that an AKS violation must be committed “knowingly and willfully.”

The free placement companies do not routinely check to see whether a nursing home has a history of violations. As a result, The largest free placement companies have on their referral list dozens of homes with histories of substandard care, including homes currently on probation for abuse or neglect violations.

One free placement company’s new C.E.O. admits that although the company expects its advisers to visit the properties they recommend, he acknowledged that it could take them years to accomplish that, particularly in metropolitan areas with scores of facilities. In many cases, therefore, advisers will be referring callers to assisted living or independent living facilities, nursing homes, specialized dementia residences, continuing care communities or home care agencies that they haven’t visited for years, or haven’t seen at all.

You could question whether advisers with no required background in geriatrics or senior care are suited to guiding families through such decisions, even when a company provides some training. You could question how good advisers can be when they work solely by phone and never meet the senior or the family.

You must also be careful of fee-based elder care agencies that don’t disclose that they also receive fees from facilities and home health care agencies.
Some states are passing laws that will force free senior placement agencies to disclose how they earn their fees. Such a law exists in Washington and is about to pass in California.

Tips when using a Free Free Placement Company.

1. Don’t use a free placement company for any service that requires skilled care whether in a facility or at home. Providing skilled care is highly specialized, and unless your Free Placement Agency’s agent possesses the qualifications and skill set to help you navigate the skilled care world, you or your family member might end up in danger. You wouldn’t ask a real estate agent to build a house for you.

Most fee-for-service advocacy agencies are very reasonably priced and very affordable. Most assisted living facilities require that you pay with private funds (as opposed to Medicare or Medicaid). If you can afford to pay privately for an assisted living facility, you can afford to pay a professional who can help you with a quality placement. If you can’t pay privately for care, the free placement company will not do the placement. By law a nursing home that receives federal funds may not give a finders fee to an agency for placement

2. Call them at their toll-free number. Don’t fill out the online form. If you do you will be inundated with calls and emails. I tested this by filling out the form 4 days ago. I have received 30 calls and 45 emails since.

3. When you get an agent on the phone, make sure they only work in your area and are familiar with the facilities. Ask the agent for her qualifications and references. If you are satisfied with what she has to say, tell her that you only wish to speak to her. Give her your email address only. No phone numbers.

4. If you are asked to sign an agreement, review it very carefully before signing.

5. Do NOT go to a facility without the agent. Make the agent take you to all facilities in your area. If they don’t go with you, you don’t need them.

6. Do NOT sign with any facility before you see at least three facilities.

7. Before signing a contract with a facility or home care agency, have it reviewed by an attorney or an elder advocate.

8. Ask your agent to outline for you what they will do for you, if you are not satisfied with the placement.

9. Under no circumstances should you ever place an elder in a facility whose record of care is poor. Check them out thoroughly. Ask them for references, and call them.

My Elder provides elder advocacy services to families. Talk to us about long-term planning, finding the right home for your loved ones, preventing crisis and abuse, and ensuring they receive the best care possible.