Assisted Living Move-In Fees and Community Fees: The Charges Before the First Month

A family finds a good assisted living home. The monthly rate fits the budget. Then the contract lands, and a new charge sits on page one. It is a one-time fee, due at signing or at move-in. It can be called a move-in fee, a community fee, or an entry fee. This guide explains what that fee is, why homes charge it, where it must be disclosed, and what to ask before you sign. Our assisted living section holds more guides on costs and contracts.

The monthly rate is not the whole first bill

Most families budget by the month. That is a sound start, but the first bill holds more than one month of costs.

The national median cost of an assisted living community is $6,200 per month, from the CareScout cost survey. Read that as a mid-point for the nation. Half of homes cost more, and half cost less. Your town, your home, and your care needs set your real rate. No home owes you the median rate.

On top of that monthly rate, the first bill in most cases holds three added items. The first is the one-time move-in or community fee, the topic of this guide. The second is the first month of level-of-care charges, if your loved one needs help with daily tasks from day one. The third can be small set-up charges, such as a key fee or a parking fee, if the home lists them.

A family that plans only for the monthly rate can be caught short in the first week. Ask for the full first bill in writing before you set a move date.

What a move-in fee is, and what it is not

A move-in fee is a one-time charge for the work of starting a stay. Homes use it to pay for the contract work, the first nurse review, the care plan set-up, and the prep and clean of the room. Some homes fold a room hold into it if the room sat empty while you made up your mind.

It is not a security deposit in the way a flat rental deposit works. In most states, assisted living is not rented under flat landlord law. The fee may not come back at the end of the stay at all. Do not assume a refund.

It is not advance care. It buys no hours of help, no drugs, and no meals past what the monthly rate covers. If a sales talk links the fee to care, ask the home to show that link in the contract text.

It is not the same in each home. One home may charge a high one-time fee and a lower monthly rate. The next home may charge no fee and a higher rate. Compare homes on the total cost of the first year, not on one line.

Names the fee goes by

Homes do not use one name for this charge. Watch for these names in contracts and fee lists.

The name does not change what it is: a one-time charge at the start. If you see two of these names in one contract, ask if they are two charges or one charge listed twice. Get the answer in writing.

• Move-in fee.
• Community fee.
• Entry fee or entrance fee.
• Administrative fee at admission.
• New resident fee.

Where the fee is disclosed

The fee should show up in at least one of three places. Check each one.

First, the residency contract. This is the binding text. The fee, its amount for that home, and its refund terms should be stated here or in a fee schedule tied to the contract.

Second, the fee schedule or rate sheet. Many homes give a sheet that lists the base rate, care levels, and one-time fees. Check that the sheet matches the contract. If they differ, the contract in most cases rules, so ask the home to fix the sheet or note the right figure in the contract.

Third, state disclosure forms. Some states make homes give new residents a standard disclosure that lists fees and services. Ask if your state has one, and ask the home for a copy if you did not get one.

If the fee is in none of these, do not sign yet. Ask for it in writing first. A verbal fee can grow. A written fee can be checked, compared, and held to.

Refund terms to ask about

Refund rules vary by home and by state. There is no single national rule. Ask these points one by one.

Write the answers into the contract or get them on home letterhead. A kind verbal promise is hard to enforce months later.

• If the resident dies or must leave for a hospital in the first month, is any part of the fee paid back?
• If the family ends the contract in the first 30 or 90 days, is any part paid back?
• Does the fee come back if the home cannot meet a need it said it could meet, and the resident must move out?
• How long does a refund take, and who gets it if the resident has died?

How the fee fits with level-of-care fees

The move-in fee is a start cost. Level-of-care fees are an ongoing cost. Our guide on assisted living level-of-care fees explains how homes charge more as help needs grow, with tiers for tasks such as bathing, dressing, and drug help.

The two fees meet in the first bill. A family can pay the one-time fee and the first month of a care tier in the same week. Ask the home to split the first bill into lines: base rate, care tier, one-time fees, and any small set-up fees. A split bill is easy to check. A lump sum is not.

Also ask how often care tiers are reviewed. A review can raise the monthly cost with no new one-time fee, or the home may charge a new review fee in some cases. Know the rule before the first review lands.

Who pays for what

• Original Medicare does not pay the move-in fee, the community fee, or the monthly cost of room and board in assisted living.
• Medicare Advantage HMO plans in most cases do not pay these housing fees. A plan pays for covered medical care, not for the home's rent or start fees.
• Part D pays toward covered drugs under its own rules. It pays no part of a move-in fee.
• Medicaid pays toward assisted living in some states through waiver programs, for people who qualify. Rules and fee cover vary by state. A state program may or may not cover a one-time fee.
• A Medigap policy pays toward costs for care Original Medicare covers. It does not pay a move-in fee, since Medicare does not cover that fee.
• Private pay covers the move-in fee in most cases: family funds, savings, a home sale, or long-term care insurance if the policy terms cover the home and the stay type.

Sample situation

Tom helps his mother, Grace, choose an assisted living home. The rate sheet shows a monthly cost close to the $6,200 national median. At signing, the contract lists a one-time community fee due that day. Tom had not seen that fee on the tour. He asks the home to split Grace's first bill into lines, and to state the refund terms for the fee in writing. The home adds a note: part of the fee is paid back if Grace must leave in the first 90 days for a health cause the home cannot meet. Tom also asks how care tiers are reviewed, and learns a review comes each three months. He can now plan the first year of costs with the fee, the rate, and the tier rule all in view. Grace moves in the next week, with no surprise charge left to find. Tom keeps the split bill and the refund note in her contract file. When his sister asks what the move cost, he can show her each line: the rate, the care tier, the one-time fee, and the terms if the stay ends early.

What to ask before you sign

The monthly rate draws the eye, and homes know it. The full cost of a move is the rate, the care tier, and the one-time fees at the start. Ask for each line in writing, read the refund terms, and compare homes on the first year as a whole. Then the first bill will hold no shock.

• What one-time fees do you charge at move-in, and what is each fee for this home?
• Show me the fee in the contract or fee schedule. Do the two texts match?
• What part, if any, is paid back if the stay ends in the first 30 or 90 days?
• Does the fee cover a room hold? If so, for how many days?
• Split the first bill into lines for me: rate, care tier, one-time fees, small fees.
• How are care tiers set and reviewed, and can a review add a fee?
• What fees can be added later that are not in this contract?