As the medical care system in the United States becomes increasingly complex and financialized, for-profit entities have become common and entrenched for the ostensible purpose of controlling costs and improving patient services. For instance, Medicaid administration has been contracted out by many states to managed care organizations (MCOs), which are in fact private, for-profit, corporations.

Pharmacy benefit management companies (PBMs) are now positioned between insurers and pharmacies to direct insured patients to approved pharmacies that must adhere to the PBM’s formulary and prices. Medicare is undergoing consistent and continuing privatization through manipulation of the 65+ population by Medicare Advantage.

In fact, this form of system elaboration increases costs and further complicates the medical system thereby increasing the opaque and anti-democratic nature of privatized, government-funded health care. Along with deregulation, financially opaque and complicated arrangements are distancing the structure and function of the health care system from the comprehension and control of “we the people.”

The purpose of this post is, through an example, to illustrate how for-profit entities find opportunity in the needs of a rapidly increasing elderly population. Among other for-profit corporations that have been integrated into the assisted living and nursing home system, referral services now exist to guide prospective tenants and patients to assisted living and skilled nursing facilities.

A Place for Mom, is the biggest and best-known of these services. No doubt, many readers of this post have noticed Joan Lunden’s soothing assurances about how this service intends to be a guide to the best place for mom. The truth is that mom will be referred to whichever facility is willing to pay for the referral.

A Place for Mom advertises itself as a “free service,” but the ads don’t tell the whole story. Indeed, television ads featuring Ms. Lunden would lead viewers to believe that the company is not even a company but rather just a free service that does nice things for moms (and dads or anyone else supposedly).

Because A Place for Mom is a for-profit company, its revenue must come from somewhere. In fact, nursing homes and assisted living operations using the service pay a fee for referrals equivalent to one month of their monthly charge. This information is not present on the company’s website homepage. However, it raises profound ethical issues that must be explored in some depth.

Empirical evidence suggests that a Place for Mom revenue is driven more by the facilities willing to pay than by an objective evaluation of the quality of care in those facilities. For instance, exactly which skilled nursing facilities with which the company has a referral agreement in the Kansas City area is difficult to discern from its website (https://www.aplaceformom.com/nursing-homes/kansas/kansas-city).

However, I did find Indian Creek Health Center of Overland Park listed as a Place for Mom’s referral. The CMS website on which the five-star rating for each facility can be found indicates a 1 – the lowest rating – for Indian Creek. As another example, Overland Park Center for Rehab and Nursing listed on the A Place for Mom website as a “partner” (facilities willing to pay for referrals are dubbed as partners by the company), is currently rated as a 5 on Nursing Home Compare. Unfortunately, no similar government rating system exists for assisted living facilities.

A Place for Mom does not want to give you a list of their partners so you can check them out. The company’s employees will tell you nothing until they have your name, email, and an agreement ensuring that any referral will have been clearly arranged by them and will be remunerated.

Does A Place for Mom run a high-pressure “boiler room” operation? I suspect this to be the case because I contacted the company despite warnings on Yelp not to do that. A large proportion of people who have attempted to use the service have concluded that it is predatory and once contacted will become a major pest through incessant calls and emails.

The two examples of CMS 5-Star ratings for partners would suggest that the quality of care provided by facilities isn’t the primary factor in the A Place for Mom recommendation. However, a robust, scientific evaluation of this service isn’t possible due to the skillful way salespersons have you committed to their service before providing any referrals.

Furthermore, calling the 800 number or providing an email or phone number for the purpose of gathering information is problematic. The instant you enter your phone number as requested by the website your phone will ring. You will then be connected with someone who probably knows next to nothing about nursing homes or assisted living facilities. In my case, for instance, the salesperson was brand new. I could sense that her job was to capture me as a customer. It was clear that if I didn’t tell them exactly for whom I wanted to find a facility I wasn’t going to receive any information.

These services exemplify the dangerous nature of deregulated government-funded systems. Neoliberals, conservative Democrats and Republicans, and libertarians promote the mistaken notion that government is inept, whereas private businesses can provide services much more efficiently. Contrary to the belief in the advantages of the free market over the government in health care, these privatized services tend to be opaque and predatory and manipulate unsuspecting citizens into care that is far more costly than if it were provided by the government.

It is important to consider the ethical concerns raised by operations like A Place for Mom:

• Individuals are lured into these services under the misrepresentation that quality of care is the primary consideration in guiding customers to assisted living and nursing home facilities.

• Funds that should be dedicated to patient care are diverted to a for-profit entity.

• Evaluation of the service by social scientists is not possible due to a veil of secrecy.

MESSAGE TO ADVOCATES:

(1) Demand that CMS and state legislatures begin to regulate referral services;

(2) Increase and improve regulation and financial transparency of assisted living facilities;

(3) Pressure CMS to provide a rating system for assisted living operations; and

(4) Stop believing that the nursing home system business process as it exists can be improved – it must be transformed rather than reformed.