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Checklist: Choosing an
Assisted Living Facility

By: CaregiverZone

Seniors and people with disabilities who don't require skilled medical care but do need help with activities of daily living, such as bathing, dressing or remembering to eat, can benefit from assisted living facilities.

The facility selected will have a profound impact on your loved one's dignity, quality of life and sense of well-being. We'll walk you through the process and help with your homework so you can make the best possible choice.

Assisted living facilities vary widely in size, from several residents to hundreds. They typically offer private rooms or small apartments, common areas for socializing and recreation, planned activities, 24-hour staffing and controlled access. The activities and common areas provide social contact that can help seniors and people with disabilities avoid isolation and depression

Most facilities offer personalized support services such as meals served in a common dining area or taken to a resident's room, shuttles for errands and appointments, housekeeping, help with medication management and emergency call monitoring. The residences also offer some supervision.

Step One: Draw your boundaries

Once you decide the city or region where your loved one's assisted living facility should be, compile a list of assisted living facilities in the area that meet your criteria. Next, evaluate your financial resources and future needs. Learn about public and private insurance programs and financing alternatives, such as Medicare, Medicaid and long-term care insurance.

Step Two: Learn the ropes

Whether you're making a decision during a crisis or planning ahead, involve your loved one as much as possible. When you compare assisted living facilities, some factors matter more than others. No perfect assisted living facility exists

Finding an assisted living facility that meets your needs is Goal No. 1. But don't underestimate Goal No. 2: getting the assisted living facility to accept your loved one. Assisted living facilities often have a shortage of beds and are permitted a degree of latitude in selecting prospective residents. While you tour the facilities and interview the staff, be thorough, clear and professional. Show them that you're part of the solution and will work closely with them to achieve the best care possible for the new member of the community.

Be ready to:

  • Explain the level of care needed. An assisted living facility should provide enough care to meet present and future needs while encouraging and allowing residents to remain as independent as possible.

  • Visit several facilities; services and fees will vary greatly. Our checklist will help you compare facilities and organize your impressions of different homes.

Step Three: Go

Make an appointment for the official tour. Ask to see more than the public areas. Visit several residents' rooms. Return during off times, such as evenings and weekends, and stroll through the facility on your own. This will allow you to experience it without an official interpretation.

Take a blank checklist to each visit.

Take a deep breath and clear your mind. You're ready.

Assisted living facility checklist

Name of assisted living facility:
Phone number:
Date(s) of visit:
Contact information:
General rating on a scale of 1 (poor) to 5 (excellent): 1-2-3-4-5

Does the facility accept residents who:
  • Have Alzheimer's/dementia?

  • Wander?

  • Use a wheelchair?

  • Use a walker?

  • Smoke?

  • Have pets?

Bedroom/living space
  • Is it big enough?

  • Is there a nurse's call button near each bed?

  • Is it well-lighted?

  • Does it have a window?

  • Is it clean and pleasant?

  • Is there a private bathroom?

  • Is there a call button in the bathroom?

  • Are there grab bars?

  • Is it wheelchair-accessible?

  • Can residents bring furniture and personal belongings?

  • Are the living quarters private?

        If shared:
  • How many roommates would there be?

  • How would the roommate/s get along with your loved one?

  • What's the policy if roommates have problems with each other?

  • What's the policy on choosing or switching roommates?

  • Can you and the senior meet the roommate/s in advance?

  • Is there a privacy curtain for each bed?

  • Are separate rooms available for private visits?

  • Is the facility in a safe area?

  • Is it convenient to:

    • Shopping

    • Medical facilities

    • Family and friends

    • Places of worship

    • Recreational facilities

  • Is the building well-kept? Is the exterior well-maintained?

  • Is there a nice outdoor area? Are residents encouraged to use it? Is it accessible to wheelchairs, with plenty of benches and shade?

Tip: Don't judge a facility based solely on its looks. However, a poorly kept nursing home may indicate inadequate care of residents.

Building safety
  • Would the senior be able to get out in an emergency?

  • Are the emergency exits clearly marked and accessible?

  • Do halls and bathrooms have grab bars?

  • Are there wheelchair ramps?

  • Are hallways wide enough to accommodate wheelchairs?

  • Is the building generally clear of clutter?

  • Are evacuation instructions posted that residents can read?

  • Does the nursing home hold fire drills?

  • Are exit doors unlocked from the inside? Locked doors prevent wanderers from leaving the building, but they also create a potential hazard.

  • Do exit doors have alarms in case a wanderer tries to leave?

  • Are stairway doors kept closed to prevent potential spread of fire?

Ask for paperwork showing that the home has been inspected and meets federal and state codes for fires and disasters.

  • If there is a smell of urine, is it mild? A mild urine odor is normal for a medical facility, but be leery if the smell is strong. Be equally concerned if a powerful room deodorizer is being used to mask an unpleasant odor. That could mean the facility is trying to obscure an unclean area rather than clean it.

  • Is the temperature comfortable?

  • Is the noise level acceptable?

  • Do you see personal, home-like touches?

  • Is it well-lighted? Does it have good natural light?

  • What is the staff-to-resident ratio? In general, 1-to-8 is appropriate for daytime and 1-to-15 for night. Nursing homes caring for dementia patients need a higher ratio.

  • Is the staff visible?

  • How long are staff shifts?

  • What is the procedure for background checks? Who does it, how and when?

  • How is staff members' morale? Observe their demeanor and their interactions with each other and the residents.

  • Do staff members know residents' names? Do staff and residents greet each other in passing?

  • How does the staff respond to your questions? Trouble signs: Are they rushed, uncomfortable, angry?

  • If either the resident or staff members are not native English speakers, can they communicate effectively with one another?

  • What is the procedure for notifying families of any changes in routine or medical condition?

Ask to meet these staff members if they are not part of your official tour:

1. Manager of facility and/or on-site administrator

  • How long have they been with the facility?

  • How can they be reached?

2. Activity director

  • Full-time or part-time?

  • Are they creative and innovative?

  • Do they offer programs that would appeal to your senior?

3. Social workers

  • What are their hours?

  • What services do they offer residents and families?

4. Aides

  • How many on duty during the day? Att night? At least one RN should be on duty at all times.

5. Social workers

  • · How many on duty during the day? At night?

6. Volunteers

  • How often do they come?

  • Are they from the community? If so, this might indicate that the facility welcomes observers and values outside interaction with its residents.

  • Are they screened?


Arrange to eat at the facility.

  • Is the food attractive and nutritious?

  • Is the dining area pleasant?

  • Are special dietary needs accommodated?

  • Are food choices available?

  • Is the meal schedule flexible?

  • Is the food culturally familiar?

  • Does the staff help residents to the dining room if needed?

  • Does the staff help residents with meals if needed?

  • Can trays be taken to the room?


Most states survey and license assisted living facilities. Ask for a copy of the latest reports. If the facility doesn't have a copy, the state's health department should. If you have questions, ask a staff member to go over it with you.

  • Does the facility post a valid license?

  • Does the facility have a written description of an assisted living facility resident's rights and responsibilities?

Resident services

Are the following services available? If so, note whether they are included in the basic fee or cost extra:

  • Assistance with bathing

  • Assistance with dressing

  • Assistance with medication

  • Arranging or providing transportation

  • Arranging medical appointments

  • Beauty parlor or barber

  • Linens· Laundry

  • Shopping/errands/trips

Other residents

If your loved one is lucid, try hard to find a facility with similar residents. Living with residents suffering from dementia will not offer a good quality of life to a resident who is frail but mentally alert. It is also disturbing to a confused resident to be placed with primarily lucid residents.

  • Do other residents appear happy, relaxed?

  • Are they well groomed? Are their clothes clean? Are they dressed appropriately for the temperature?

  • Are they interacting with each other or just sitting around not doing much? Do they isolate themselves in their rooms?

  • Talk to residents about the facility:

    • What do they like best?

    • What do they like least?

    • What is daily life like at the facility?

  • Are most residents at the same level of mental function as your loved one? If not, are residents kept mainly with others at similar levels of mental function and cognitive awareness?

Daily life in the facility
  • Look at activity schedules. Are they varied? Are your loved one's interests reflected? Are activities planned with residents' involvement in mind?

  • Are residents involved in the community outside the facility? If so, how?

  • Are field trips available?

  • Are there recreational facilities such as game rooms on site?

  • Does the home offer opportunities to exercise?

  • Are residents encouraged to be as independent as possible? Ask residents and staff, and make your own observations.

  • Is the schedule for meal times, activities and other events flexible?

  • Is there a resident and family council? How often does it meet? Has the council taken any action?

  • Does the facility use physical or chemical restraints?

    • How many residents are in restraints?

    • When are restraints used?

    • What is the policy on restraint use?

    • Is the family involved in that decision?

The contract

All admissions should involve a contract including details about:

  • Basic and extra costs

  • Payment schedule

  • Refund policy

  • Eviction procedures

  • Bedholding policy in case of hospitalization or other reasons

  • Rights and responsibilities of resident and facility

Tip: Beware of any clauses that exempt the institution from liability for injury or lost possessions. You may want an attorney to review the contract.

Care plan

Not all states require assisted living facilities to write a care plan for each resident. If your state does not require it, you would be wise to request a care plan for your loved one. This assures that the staff has evaluated the resident's condition and developed written guidelines that promote communication and consistency.

Care plans begin with a comprehensive assessment of the patient, including level of function and social, emotional, mental and medical condition. The plan should focus on maximizing independence and functioning at the highest level possible. The assisted living facility should revise the plan every three months or whenever the resident's condition changes.

Ask to see sample care plans. Since plans are confidential, the facility might respond that they can't show you any. Explain that you'd like to see ones with all names and identifying information removed.

  • Do the plans focus on maintaining independence?

  • Are the plans individualized or generic?

  • Do the plans involve the resident and family?

  • Do they cover every aspect of the resident's life - physical, psychological, social?

  • How often does the staff consult the plans?

  • Have the plans caused the staff to take any action?

  • Who writes and implements the care plans?

  • Are the plans updated every three months or after every condition change?

  • What kind of payment and insurance does the nursing home accept?

  • Medicare

  • Private health insurance

  • Long-term care insurance

  • Medicaid

  • Ask about the basic fee, and clarify exactly what it does and does not cover. For each home, basic vs. extra costs vary. Costly extras can include laundry, room delivery of meals and incontinence supplies. Obtain a written list of what is included in the basic fee and what costs extra.

Second opinions

      Try these sources:

  • Hospital discharge planners

  • Nonprofit organizations specializing in your circumstances

  • Friends who have faced similar situations

  • Private geriatric care managers

  • Volunteers from the community

Final notes


What I liked most about this nursing home:

What I liked least about this nursing home:

Overall impressions: