Multiple senior placement service agencies are billing the same adult family home provider for a resident admission.

With placement fees of 100% (or more) of the monthly care fee the resident pays, some providers find themselves being bullied – even threatened – into paying two placement fees ranging from $6,000 to $12,000 for the same client.

This practice elevates the meaning of Seattle Times reporter Michael Berens’ article “Seniors for Sale” to a whole new level.

Have You Paid Two Referral Fees for the Same Resident?

Recently, an adult family home provider shared he paid referral fees to two different agencies for the same client – one fee under threat of being sued. In total 220% of the resident’s monthly care fee totaling $14,600.

Sadly, this is not a new or isolated problem which is why I am making this concern public; to raise awareness of the issue so that other care providers can avoid finding themselves in the same predicament.

This provider had signed a contract with both agencies. He paid a placement fee to the agency that was actively working with the client and facilitated the placement. He then paid the second agency that claimed they were first to refer this client and threatened to sue him unless he paid their 120% placement fee.

If you feel these are unacceptable senior referral practices, you’re not alone. At a minimum, I hope the provider filed a complaint with the Attorney General’s office in Olympia.

Since I posted this piece I received 3 confidential emails from providers who said this also happened to them, asking to remain anonymous for fear of being black-listed by the agencies in question.

Here is the lesson

As a standard practice, you should always, always, document the date, time, and source of each and every referral phone call you receive and keep that  information indefinitely – that’s your only protection to establish WHEN and WHERE that referral came from, and WHO is legitimately entitled to a placement fee, if anyone.

The Senior Referral Act also requires every agency to document this and send you an intake form. So if you, as the care provider do not receive a referral intake form from an agency, you technically have no obligation to that agency.

The providers in question all said it was easier to pay both referral fee than to fight the injustice, but allowing any referral agency to bully and blackmail adult family home providers into “pay or be sued” (one agency, in particular, is well known to routinely threaten providers with lawsuits) without trying to resolve the issue in good faith sends a message to the referral industry that these predatory practices are acceptable and tolerated.

If you heard me talk at the Adult Family Home conference or have come to any of my marketing seminars, use the “Referral Intake” form I provided – there is a space to document the time, date, and source of each referral you receive.


  1. Learn how to protect yourself from multiple simultaneous referral fee claims against you
  2. Discover the 3 simple steps the BEST placement services follow, and
  3. Download the “Termination of Non-exclusive Senior Referral Assistance Relationship” form.

Joseph Spada
Joseph Spada

Adult Family Home Consultant, geriatric nurse, owner of Spada Care Homes, Ohana Hale Senior Living, and Savanna Healthcare; DSHS instructor of the AFH Administrator Training; speaker; author.

    2 replies to "Paying Two Referral Fees for the Same Resident – Part 1"

    • John Chiira Gichohi

      I am a new AFH Provider, licenced last week.
      Am ready to receive Private Pay. Which Referral agency would you recommend for me?

      • Joseph Spada

        The best referral agencies are small and local to your location. Find them on Google by searching “senior referral services” or “senior housing placement services.”
        Keep in mind that most will favor working with established providers (often 1 year), so make a lot of calls and learn about what they might specifically look for from the providers they work with. Build a website! Most consumers search Google for AFHs near them and if you’re not there they can’t know about your business – we can build one for you.

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