Should you really be saying YES (?) to “FREE” advice?

We have a number of quite serious concerns about the use of “free” Elder Care referral services: they are not free; their referral fees can be quite substantial and may impact and compromise the quality of care and costs of services for seniors; they only recommend those who agree to pay them a referral fee and families that use them may well be in need of professional as opposed to advice conflicted by sales commissions.

Many companies, ourselves included do not use them because they breach our ethical guidelines regarding putting the best interests of our members and their families first.

“There is an American franchise chain that has come to Canada advertising themselves as a free service which will “find & compare senior housing options, see senior housing communities in our area all in one place; compare costs, amenities and services; get free, customized search results from our proprietary directory. ” 

The above is an excerpt from a recent blog by Audrey Miller,MSW, RSW, CCLCP: “Why Do I Need to Pay for Your Service When I Can Get It For Free?”.   We partner with Audrey’s company, Elder Caring Inc, for geriatric care management expertise. 

I have to admit that we have been approached by a number of “free referral” businesses to see if we would like to “partner up”.  We have explicitly said “NO!” for a number of reasons.

Number 1: this service is not free & the advice is not impartial.

These “free” referral companies collect what are fairly significant fees for referring to residential homes and other senior service providers, and they only refer to companies that agree to provide a referral fee.  Firms that do not partner and who may disagree with the practise on ethical and other grounds will not appear on their recommended lists.

Importantly these free services do not get paid unless families take up services from one of the names handed out. This takes away their focus from the needs of the family to the needs of their bottom line.

“My advice about Internet placement services is ‘buyer beware,’” says Eric Carlson, the director of the Long Term Care Project of the Senior Citizens Law Center and the author of a legal treatise on institutional care issues. “Even though it’s tempting to delegate a decision to such a service, you can’t assume there’s quality control behind their recommendations. You have to understand that the service will have a motive to refer based on its agreements with facilities.” From “The Questionable Lure Of Free Long-Term Care Placement Services”, David Spiegel.

Number 2: Families may end up paying more for residential and other care services  and/or the quality of these services may well fall because of the financial impact of referral fee payments.

Referral commissions get taken from payments made by families to residential care/retirement homes and other care providers including home care companies.  For those firms that cannot raise their prices, to adjust for payment of referral fees, there is a risk that the quality of service may suffer as costs are cut to accommodate referral fees.  In industries where referral fees are paid there is much academic research that shows consumers end up paying more!

At  Mosaic Home Care we allocate a significant part of our revenue to a) resourcing the oversight of our caregivers and our  families, b) to training and service innovation, and c) to the provision of other important services, such as our lifestyle services. If we had to pay referral fees we would likely have to cut funding to key service components.   

For firms that already pay royalty and marketing fees to their franchisor, the payment of referral fees has to be an unwelcome additional business cost.  For instance, many of the firms in the home care market place are franchisees. 

Allowing free referral services to operate without regulation poses a risk to the cost and quality of services in the industry as well as its ethics.  We need to remember that we are dealing with vulnerable individuals and families at a vulnerable time.  It is important that the industry is able to help these individuals make balanced objective decisions without the types of incentives, standards and lack of disclosure that conflict with this objective.      

Number 3: most importantly we have ethical concerns for those families that may need professional advice.

In many instances we are talking about families with older adults who may have complex care needs which would benefit from professional counselling.  We have ethical concerns over the representation of “free referral services” in terms of their ability to provide professional advice when in fact the advice is directed towards “heads on beds” as opposed to the best interests of the client. 

The following are quotes taken from a Washington State Legislature House Bill report into Elder Care Referral Services and is attributed to industry representatives opposing the introduction of legislation.  The comments support our concerns regarding the limitations of the advice provided by these referral services:

The requirement for the referral agency to perform an assessment and care plan is burdensome and impractical for the agencies to undertake…Referral agencies are not case managers and they look to families and physicians to be the decision makers in selecting housing and care services.”

Number 4: The $ cost of a referral fee is not an insignificant amount when compared to the costs of professional advice?  

We understand that choosing the right retirement home/residential care or home care provider can be a daunting task. We support those who are trying to help individuals find their way through the maze but we believe that there are better, cheaper and more ethical ways of doing this. 

Because these services are labelled as free many may be unaware of the actual payments they are making, or indeed whether the money paid is worth the service they receive.   From what we know referral fees, for retirement homes, are equivalent to 50% or more of the first monthly payment. Given that monthly fees for retirement residences are between $3,000 and $6,000 the referral fee may not be an insignificant amount.  Referral fees for homecare services are we believe around 6% of monthly fees.     

Number 5: There are many ways to find out about retirement homes and other care options in the community that are indeed free and without obligation.

Information is available from Community Care Access, family doctors, Senior Centres and many other areas. 

Mosaic Home Care has community resource centres around the GTA with information on numerous for profit and not for profit services: unlike a referral agency we do not collect any remuneration for providing you with this information or impose any obligation on you or the service provider should you make a decision.  Our community based information services are free! 

If you need guidance but not full on advice, a geriatric care management professional would be able to help you for what would most likely be a modest initial consultation fee.  Most geriatric care managers provide advice tailored to families looking to make the transition from home to retirement or long term care.  For example Audrey Miller of Elder Caring provides a $150 fee for a wide ranging initial 1 1/4 hour consultation.  

What is a geriatric care manager, or aging life care professional as they are now becoming known?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential.  The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

We have a number of serious concerns about the use of “free” Elder Care referral services.  They are not free, the referral fees can be quite substantial, they only recommend those who agree to pay them a referral fee and families that use them may well be in need of professional and not conflicted advice.  Many companies, ourselves included do not use them because they breach our ethical guidelines regarding putting the best interests of our members and their families first.

That said we do believe that there is a need to help educate families about care and the options available and that a service that researches those options for their benefit is of use.  That is why we dedicate a good portion of our revenue to providing community resources and educational events for families looking for information and guidance in making important decisions for their older family members.   

Come visit one of our two and soon to be more community resource centres around the GTA.

Jane Teasdale

Business Development and Community Relations, Mosaic Home Care & Community Resource Centres


And here are some more resources on geriatric care management services

Elder Caring Inc, our joint venture partner for geriatric care management services.

Iris Consulting for Seniors for Seniors– Managing Director Jill O’Donnell

Elder Care Canada – Managing Director Pat Irwin

Aging Life Care.org  

Geriatric Care Managers Filling the Gaps, Joining the Team Senior Care Canada

From the Caregiver’s Library

How can a Geriatric Care Manager help my parent as they enter a nursing home? Aging Options

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