How to Choose an Assisted Living Community

How to Choose Assisted Living, Step by Step

Choosing assisted living for a parent is a big decision, and it often has to happen fast. The steps below follow the National Institute on Aging’s (NIA) advice for choosing a long-term care facility, adapted for assisted living. They work whether you have months to plan or a week before a hospital discharge.

1. Write down what help your parent needs now and may need in two or three years.
2. Set a monthly budget from income, savings, insurance and benefits.
3. Build a short list from your state’s licensing search.
4. Call each community with the same questions.
5. Visit your top choices at least twice, once without calling ahead.
6. Read the contract and fee schedule, then decide.

If you’re not sure assisted living is the right level, compare it first with other settings in assisted living vs nursing home and senior housing options, or answer a few questions in the care options guide.

Start With Your Parent’s Needs and Wishes

NIA’s first step is to ask what services are needed now and what might be needed later. If you’re unsure, ask your parent’s doctor which services would help most. Common needs include:

• help with bathing, dressing or using the bathroom;
• managing medicines;
• meals and housekeeping;
• supervision at night;
• memory loss or wandering, which may call for memory care.

Then ask what matters to your parent. NIA lists meals, social and recreational activities, a religious connection and staying close to family and friends. A community near the adult child who visits most often can matter more than any amenity.

Plan for change. NIA says assisted living typically offers a few levels of care, and residents pay more for extra services. Ask each community how far its license lets it go before a resident would need to move.

Check the State License and Inspection Record

Assisted living is licensed by each state, so the state is your source for a community’s record. Every state uses its own license names, and some license several levels. Look up any community you’re considering on the state search and confirm the license is current and matches the care your parent needs. Many states post inspection reports and complaint findings there too.

Examples of official state searches:

• California: the Department of Social Services care facility search for Residential Care Facilities (RCFEs).
• Texas: the HHSC long-term care provider search for Type A and Type B assisted living facilities.
• Florida: the AHCA facility search, which also shows specialty licenses such as Extended Congregate Care and Limited Nursing Services.
• New York: the Department of Health adult care facility profiles.
• Illinois: the Department of Public Health facility lookup.

Your state page names the licensing agency, lists its license types and links to its search. For example, see Texas, Florida or Pennsylvania, where personal care homes and assisted living residences are separate licenses.

When You Have to Decide Quickly After a Hospital Stay

Many families start looking the week a parent is discharged. If that’s you, ask the hospital’s discharge planner or social worker two questions first: does your parent need skilled nursing or rehab before going anywhere else, and which local communities have openings?

If your parent needs rehab, a short stay in a skilled nursing facility may come first. Medicare covers that care only after a medically necessary inpatient hospital stay of at least 3 days in a row, and time under observation doesn’t count, so ask whether your parent was formally admitted. A rehab stay can give you a few weeks to visit assisted living communities properly. The Medicare nursing home guide explains the rules, and the nursing home finder shows ratings for rehab options nearby.

Even on a short timeline, don’t skip the license check or the contract review. A temporary or respite stay can let your parent try a community before committing.

Questions to Ask on the First Call

NIA suggests calling each place on your list before you visit. Ask the same questions everywhere so you can compare:

• How many residents live here, and is there an opening or a waiting list?
• What does the base rate include, and what costs extra?
• Which license do you hold, and what care does it allow?
• Do you accept Medicaid waiver payments or long-term care insurance?
• Can you meet my parent’s specific needs, such as diabetes care, a walker or memory loss?

What to Look for When You Visit

NIA recommends visiting several facilities in person and meeting the director, nursing director or other key staff. Then go back a second time without calling ahead, on a different day or at a different time, and stop by at mealtime.

What to check	What to look for
Residents	Dressed and well cared for, taking part in activities
Staff	Warm, respectful interaction with residents; calls answered promptly
Building	Clean, fresh-smelling, comfortable and well maintained; accessible for walkers and wheelchairs
Dining	An attractive, clean dining room and food that looks appetizing; ask to sample a meal
Outdoors	A safe place for residents to go outside
License	Current state license posted, matching the care your parent needs

Questions About Staff, Care and Daily Life

These questions come from NIA’s list, with a few added for assisted living:

• How many caregivers are on duty per resident during the day and at night? What training do they have?
• How long have the director and department heads worked here? How often do key staff turn over?
• Does a doctor or nurse check on residents regularly? How often?
• Who manages medicines, and what training do they have?
• What activities are planned on weekdays and weekends? May you attend one?
• How do residents get to medical appointments?
• What happens in an emergency, or during an infectious disease outbreak?

Write the answers down at each visit. Side by side, the differences in staffing and turnover usually stand out more than the décor.

Read the Contract and Fee Schedule Before Signing

NIA advises getting detailed information about costs and which services are included, finding out whether Medicare, Medicaid or long-term care insurance will pay, and reading the contract carefully before signing. Read it again before you sign, and ask about anything unclear.

Look for these in writing:

• the base monthly rate and exactly what it covers;
• how care levels are assessed, who decides, and what each level costs;
• how much notice is given before a rate increase;
• which health changes would require your parent to move out, and how much notice the community must give;
• refund rules for deposits and unused days after a move or death.

Federal discharge protections cover nursing homes, but in assisted living the contract and state law set these terms. If anything in the contract worries you, an elder law attorney or your state’s legal aid for older adults can review it.

Who Pays for Assisted Living

NIA says most people pay the full cost of assisted living themselves. Prices vary widely by state and community, so compare written fees from each place on your list.

• Medicare doesn’t pay for assisted living or other long-term custodial care. See does Medicare cover nursing homes.
• Medicaid may help through a home and community-based services waiver in states that cover assisted living. The waiver pays for care services, not room and board, and states can cap enrollment. Check your state in the Medicaid waiver guide and the Medicaid long-term care checker.
• Long-term care insurance pays for personal and custodial care in the settings a policy names, and NIA says some policies partly cover assisted living. See the long-term care insurance guide.
• VA doesn’t pay rent in assisted living but may pay for added services such as nursing visits or aide help. Aid and Attendance adds a monthly payment to a VA pension for veterans and survivors who need help with daily activities. See VA long-term care.

Warning Signs and Where to Get Help

Walk away, or ask hard questions, if a community won’t show you its license or inspection results, can’t say how many staff work at night, pressures you to sign the same day, or won’t give you a copy of the contract to take home.

After a move, check in often and get to know the staff. If problems come up, start with the director. If that doesn’t fix it, the Long-Term Care Ombudsman investigates and resolves complaints for assisted living residents; see residents’ rights and the ombudsman. If you suspect abuse or neglect, report it to Adult Protective Services or the state licensing agency, and call 911 if someone is in immediate danger. The abuse warning signs guide explains what to watch for.

NIA also suggests ways to ease the move itself: get to know staff before move-in, listen to your parent’s concerns without arguing about why they need to be there, and get support for yourself from a social worker or counselor. For free help finding local services, call the Eldercare Locator at 1-800-677-1116.

Frequently Asked Questions

How Many Assisted Living Communities Should You Visit?

NIA suggests visiting several facilities in person before deciding, meeting the director and key staff, and making a second visit without calling ahead on a different day or at a different time. Three is a practical number for comparing staff, food and fees side by side.

Can an Assisted Living Community Make My Parent Move Out?

Yes, under the terms of the contract and state law. Assisted living licenses limit how much care a community can give, so a resident whose needs grow past that limit may have to move. Before signing, ask which health changes would require a move and how much notice the community gives. If you disagree with a move-out notice, call the Long-Term Care Ombudsman.

What Is the Difference Between Assisted Living and a Board and Care Home?

Mostly size. NIA says board and care homes, also called residential care facilities or group homes, usually have 20 or fewer residents, with personal care, meals and staff around the clock. Assisted living communities range from about 25 residents to 100 or more. Both are licensed by the state.

Does Assisted Living Accept Medicaid?

Some do, in states whose Medicaid waiver covers assisted living services. The waiver pays for care, not room and board, and the state may cap how many people it serves. Ask each community whether it accepts the waiver and how many waiver residents it takes. Read the Medicaid waiver guide.

What if My Parent Has Dementia?

Ask whether the community has a memory care unit and whether it holds the license or certification your state requires for dementia care. NIA's tour questions include whether the facility has a special unit for people with Alzheimer's or another dementia and what services it provides. See the memory care guide.

More on Choosing a Facility

• Choosing a Nursing HomeRatings, inspections, staffing and the questions to ask on a visit
• Star Ratings ExplainedWhat each Care Compare star rating measures and its limits
• Inspection ReportsDeficiencies, scope and severity, fines and where to find reports
• Staffing and TurnoverNurse staffing hours, turnover and the federal staffing data
• Antipsychotic UseThe FDA warning for dementia, CMS's measure and what to ask
• Abuse Warning SignsWarning signs, CMS's abuse icon and who to call

This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.

Sources

1. NIA: How To Choose a Nursing Home or Other Long-Term Care Facility
2. NIA: Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care
3. Medicare.gov: Long-term care coverage
4. Medicaid.gov: Home and community-based services 1915(c)
5. eCFR: 42 CFR 441.310, limits on HCBS waiver payments
6. VA: Assisted Living
7. ACL: Long-Term Care Ombudsman Program
8. U.S. Department of Justice: Find support for elder abuse