Society of Certified Senior Advisors: Senior Referral and Placement: Finding a Reputable Agent

New national standards are among the criteria that can help you choose an excellent senior placement service.

Often, the decision to move an older adult to a senior living community has to be made quickly. Mom has a fall and fractures her hip. Dad’s dementia progresses to a point where the family, or his wife, suddenly realizes he’s not safe at home anymore. The pressure to find a community with an opening that’s a good fit for the senior and within their budget can generate immense stress among all concerned. A good placement service agent is often the answer to calmly and capably help everyone sort out the options and make an informed choice. (See our August blog on downsizing for tips on what to do with excess household goods.)

The key is finding a placement service that has your best interest in mind. This requires knowledge of how referral and placement services operate, and how their owners and agents get paid. Although there’s no cut-and-dried agreement on the meaning of the terms “placement” and “referral,” one placement agent (who maintained confidentiality for their opinion) defines it this way:

What A Good Agent Can Do

You may want to choose a placement agency before someone in your family has an accident or incident that causes them to need to move immediately. After all, you’ll want to evaluate communities together and come to a common conclusion, if at all possible. Why should you use a qualified placement agency?

Qualified placement agents will:

Respect your privacy
Be upfront about their compensation
Ask questions to learn what is important to you
Understand your financial situation
Provide tailored recommendations to meet your specific needs
Educate you on all your options, so you can make a quality decision
Tour a variety of communities with you
Ask questions of tour guides to help you evaluate the community
Keep abreast of any violations at area communities and communicate them to you
Meet with you to talk about what you learned
Help clarify factors that may influence your decision
Offer gentle and respectful guidance
Provide a variety of local resources you may need on your journey, such as elder law attorneys, Medicaid planners, veterans’ benefits information, moving and downsizing resources, and much more.

“To me, a ‘referral’ is a name and contact information, which is predominately used by the large online agencies. The term ‘placement,’ to me, means a completely different model, which includes spending time personally with the potential resident and their families. I believe a majority of providers have far more issues with ‘referral’ agencies than local ‘placement’ agencies.”

In my personal, anonymous opinion, referral services are just that: a process of using a wide net to collect names and sell them to senior living communities. There is no loyalty to the end user—that is, aging adults and their families who are looking for care. Sure, referral services don’t cost anything, but many times the information is overwhelming and not even tailored to meet those specific needs, so the family feels like they are going in circles. Referral companies may have quotas to meet and are limited in the amount of time they can speak to their customers.

In contrast, placement services focus on taking the time to understand the goals and potential challenges that are unique to each family. These services identify all valid options that meet the specific needs of the family and hold their hand on the journey. For many people, searching for a senior living community is like navigating uncharted territory. It’s daunting and overwhelming, and many people who do this alone wish they would have had a trusted guide to help them.

Placement encompasses respecting an individual’s autonomy and privacy while equipping them with the information they need to make the best decision for their specific situation. It’s not about handing someone a list. Placement companies never sell names, and they often spend hours and even weeks with families, as opposed to the minutes that referral agencies give their clients. Many of the reputable placement companies were started by social workers and nurses, not venture capitalists.

Referral Services May Disappoint

Many families go online to find a senior living community. A pair of referral services, A Place for Mom and Caring.com dominate the market. They exist primarily as online directories to more than 20,000 partnered senior living communities. Both of these companies offer copious amounts of quality online content to attract potential customers. These services can and do connect people with good communities, but before choosing to work with them, be aware of how these companies make their placement decisions.

A Place for Mom advertises a “free” service, and while it is free to customers, the companies do get paid. When an older adult whom they referred enrolls in one of the communities in their network, the company usually earns the equivalent of a month’s rent, which can amount to many thousands of dollars. Agents often are remunerated with a cut of the proceeds and are thus incentivized to refer seniors to the priciest facility available.

While the company advertises that it will refer clients to appropriate facilities, it only considers those in its own network. Some may be excellent, and others not. Small, local operations may be missed entirely. And, when a customer types in their information, they may not read the fine print that says they can be contacted, again and again, by anyone the company shares it with.

The people hired as “placement specialists” are not required to have any special education or training, nor to adhere to any regulatory or professional ethics standards. Referral services can hire whomever they want, and they want someone who will convert calls into money.

Nevertheless, many senior living facilities sign up with these companies to get leads. “It’s a tool,” says Richard Hutchinson, CEO at Discovery Senior Living, which operates in 14 states. He once vowed never to use them, but now he thinks of their service like a credit card: expensive to use but a viable option when sales need a boost. “Every organization should think about using the service, but judiciously,” he says.

Finding A Reputable Agency

So, how can you choose an agent who prioritizes your interests? One option is to use a service listed with the National Placement & Referral Alliance (NPRA), an organization formed by the best actors in the industry to promote ethical services. The organization’s mission is “to cultivate the advancement of professionalism, fairness, and the development of the senior placement and referral industry through collective initiatives to better serve seniors and their families.” If you look at the code of ethics, NPRA members pledge to make sure the primary needs of their client should always be the primary consideration for recommendations, not financial incentives. They are bound to advise a client without pressure or coercion, to report abuse, and more.

The organization has a list of best practices that include having agents visit senior living providers in their area to research the facilities, keep track of any violations, and share those violations with clients. They will also try diligently to offer clients multiple options after touring facilities with them …not just read names of care facilities off a list. And NPRA members will disclose upfront how they are paid.

Another option is to find a care management agency, often with a brick-and-mortar storefront. These smaller agencies hire licensed professionals trained in geriatric concerns, who will meet with the family and prospective resident as one part of an hours-long evaluation. You can find a listing of these agencies on the website of the National Association of Professional Geriatric Care Managers, now part of the Aging Life Care Association.

The cost of this more traditional placement approach is about $300 to $800, according to Kaaren Boothroyd, the NAPGCM’s former executive director. It’s enough to deter many families. However, many consider it a small price to pay for individualized service from a knowledgeable advisor.

State Legislation Emerging

The reason that some big players are still in the business is, in part, due to a lack of legislation at the federal and state levels in the industry as a whole.

“We’re the only resource in the continuum of senior care that has no regulation,” said Liz Fischer, a CSA and president of the Oregon Senior Referral Agency Association. “There is currently no place to file a complaint about a referral agency and no penalties for causing harm to seniors. We don’t currently have background checks, so anybody could do this job and it could cause harm to seniors.”

Good players in the industry are pushing for laws to hold companies to high standards in an industry where the best have sometimes struggled to distinguish themselves from the rest of the field. Several states have led the way, including Oregon, Washington, and Arizona, with interest expressed by many more. While results have varied, these laws may eventually weed out the worst players.

Moving to a senior living community can be a stressful event, both emotionally and physically. A good placement agent can smooth the way, helping the family evaluate the options on a variety of criteria to form a cohesive decision. Hopefully, new laws will emerge to guide families to agencies that have their best interests at heart.