This fall, my father sat down for a semi-annual assessment with staff members at his assisted living facility in Tinton Falls, N.J. They decided his condition — at 72, he has advancing Parkinson’s disease — necessitated an upgrade to the next level of care.

The meeting yielded an upgraded bill, too: a nearly 18 percent bump, about $12,000 a year.

Most assisted living residents foot the bill on their own or with help from family. Cost increases typically come in two forms: annual upticks to cover rising expenses, and more significant hikes accompanying a move to the next tier of care, such as help with bathing or dressing.

The annual rises can be daunting enough. The MetLife Mature Market Institute recently reported that assisted-living costs climbed 5.2 percent from 2009 to 2010, to a national monthly average of $3,293, outpacing both inflation and the interest earned on savings and bonds — a problem for the elderly on fixed incomes.

But add a more expensive service package, and the bill can become prohibitive. And as the costs soar, relations between families and the facilities caring for elderly relatives can sour, said Miriam Oliensis-Torres, who runs a geriatric care management firm, Geriatric Support/Pathway Care, in Milwaukee.

Sometimes the reasons for the new status can be apparent, as when a resident becomes incontinent. But the decision can also seem arbitrary. If they disagree with it, residents and their families have to work at maintaining quality care while simultaneously challenging the policies of the institution providing that care. It’s a tricky balance.

The institutions often urge families to approach assisted living a bit more realistically. “It’s important for people to remember that their loved one is moving into assisted living because they need services,” said David Kyllo, executive director of the National Center for Assisted Living. “They’re not moving in because of a change in address. It’s needs-driven.”

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