How to Choose Senior Care

Verify Licensing and Certification

All residential care facilities — assisted living, memory care and nursing homes — must be licensed by the state. Nursing homes that accept Medicare or Medicaid must also be federally certified.

• Ask for the facility's current state license and verify it is in good standing
• For nursing homes, check Medicare Care Compare (medicare.gov/care-compare) for certification status, inspection reports and quality ratings
• For assisted living and memory care, contact your state's licensing agency — inspection reports are public records
• Ask whether the facility has ever had its license suspended, revoked or placed on probation

Review Inspection Records

Inspection reports reveal what surveyors found during their most recent visits. Key things to look for:

• Deficiencies related to resident abuse, neglect or exploitation — these are the most serious
• Repeated deficiencies in the same area across multiple inspections — patterns matter more than isolated incidents
• Civil monetary penalties or enforcement actions
• Complaints filed by residents or families and how they were resolved

Ask the facility to explain any significant deficiencies you find. A good facility will be transparent and explain what corrective actions were taken.

Evaluate Staffing

Staffing is the single most important factor in care quality. Ask about:

• Staff-to-resident ratios on each shift — day, evening and overnight
• Whether a licensed nurse (RN or LPN) is on-site 24 hours a day
• Staff turnover rate — high turnover disrupts continuity of care and is associated with lower quality
• How the facility handles staffing shortages — do they use agency staff?
• Training requirements for all staff, including dementia-specific training if applicable
• How long the administrator and director of nursing have been in their current roles

Conducting a Meaningful Facility Tour

A tour is your opportunity to observe daily life — not just the showroom. Visit at different times of day, including a mealtime and an evening visit if possible.

• Observe how staff interact with residents — are they warm, patient and respectful?
• Are residents engaged in activities, or sitting alone in front of a television?
• Does the facility smell clean? Persistent odors can indicate inadequate care
• Are call lights answered promptly?
• Talk to residents and family members — ask about their experience
• Ask to see a sample menu and observe a meal
• Ask to see the most recent inspection report

For a comprehensive list of questions to ask during a tour, see our facility tour checklist.

Understanding the Contract

Before signing any agreement, review it carefully — ideally with an elder-law attorney. Key items:

• What services are included in the base rate and what triggers additional charges
• How care-level assessments are conducted and how often
• Discharge and transfer policies — under what conditions can the facility ask a resident to leave?
• Refund policy for deposits and prepaid fees
• Whether the facility accepts Medicaid, and what happens if a resident runs out of private funds
• Arbitration clauses — these waive the right to sue in court
• Personal financial responsibility clauses — do not sign as a personal guarantor unless you intend to be personally liable

Resident Rights

Residents of licensed care facilities have legal rights, including the right to:

• Be treated with dignity and respect
• Participate in their own care planning
• Refuse treatment
• Privacy in their room and communications
• File complaints without fear of retaliation
• Contact the Long-Term Care Ombudsman

The Long-Term Care Ombudsman program advocates for residents of nursing homes and assisted living facilities. Find your state ombudsman through the Eldercare Locator at eldercare.acl.gov or 1-800-677-1116.

Warning Signs to Watch For

• Staff who seem rushed, dismissive or disrespectful toward residents
• Residents who appear unkempt, unwashed or in soiled clothing
• Persistent unpleasant odors
• Call lights that go unanswered for extended periods
• Residents who seem fearful or withdrawn
• Staff who cannot answer basic questions about care procedures
• Reluctance to show you inspection reports or answer questions about staffing
• Pressure to sign a contract quickly without time to review
• Unexplained bruises, injuries or weight loss in a current resident