Start with what your parent needs and what you can afford, then build a short list and check each community's state license and inspection record before you tour. The tour and the contract tell you the rest: who will actually provide care, what happens when needs change, and how prices go up. Here is the process, one step at a time.
Step 1: Be clear about what your parent needs
The National Institute on Aging describes assisted living as being for people who need help with daily care, but not as much as a nursing home provides. Residents typically get meals, help with personal care such as bathing and dressing, housekeeping, help with medications and round-the-clock supervision. NIA notes that facilities range from as few as 25 residents to 100 or more.
Before you look at buildings, write down:
- Daily help needed now: bathing, dressing, toileting, moving around, medications, meals
- Memory: is there dementia, wandering or confusion at night? If so, you may need a memory care unit
- Medical needs: assisted living is mostly non-medical. Diabetes management, oxygen, wound care or frequent falls may be beyond what some communities can handle
- What's likely next year: a community that fits today but can't handle the next stage means another move
- What matters to your parent: location near family, a religious connection, food, activities, a garden
If you're not sure what level of care fits, ask your parent's doctor. A nursing home may be a better match for someone who needs regular skilled nursing.
Step 2: Set a realistic budget
Plan on paying privately unless your parent qualifies for help. CareScout's 2025 Cost of Care Survey put the national median at $6,200 a month ($74,400 a year), up 5 percent from the year before. Prices vary a lot by state and city, and by how much care a resident needs.
A few points on who pays:
- Medicare does not pay for assisted living.
- Medicaid may cover some services, but this varies by state and depends on eligibility. In California, for example, the Medi-Cal Assisted Living Waiver covers services for eligible people in 15 counties, has a waitlist, and does not cover room and board.
- Long-term care insurance may cover part of the cost, depending on the policy.
Ask every community for its full price list, not just the base rent, and ask whether higher care levels, medication management or memory care cost extra. Medicaid rules vary by state and change often. This isn't financial or legal advice, so check your state's rules or talk to an elder law attorney before counting on it.
Step 3: Build a shortlist
Look for three to five communities that fit your parent's needs, location and budget.
- Search by location in the senior living directory or browse by state.
- Ask friends, your parent's doctor, a hospital social worker or local support groups which places they know well.
- Call each one before visiting. Ask about current openings or waitlists, base price, care levels offered, and whether they can meet any specific needs, like memory care or a two-person assist.
Step 4: Check the state license and inspection record
There's no federal star rating for assisted living. Unlike nursing homes, which Medicare rates on Care Compare, assisted living communities are licensed and inspected by each state. A 2015 federal review of state rules found that residential care settings are licensed and regulated at the state level, and that every state has at least one category of them. The names vary: assisted living, residential care, personal care homes and others.
That means the inspection record lives with the state agency that licenses assisted living. What it publishes, and how easy it is to find, varies by state.
California as an example
In California, assisted living communities are licensed as Residential Care Facilities for the Elderly (RCFEs) by the Department of Social Services' Community Care Licensing Division. RCFEs provide non-medical care and supervision.
- State law requires an annual unannounced inspection of every RCFE (since January 1, 2019), and inspection reports and plans of correction are open to the public.
- The state's Facility Search website shows license status, the date licensed, visits, complaints and licensing reports.
- The facility's full public file, held at the local Regional Office, includes any citations, civil penalties and administrative actions. You can ask to review it.
- Facilities must post their license where the public can see it.
On Pairlo, every licensed assisted living community in California links to its state license and inspection record.
What to look for in any state
- Is the license current, and does it match the name and address you were given?
- Substantiated complaints: what were they about, and how recent?
- Citations involving care: medication errors, falls, missed care, staffing, abuse or neglect weigh more than a broken fixture.
- Repeat problems across several years.
- Penalties or license actions, such as probation.
Bring anything that worries you to the tour and ask what changed.
Step 5: Tour, then ask the hard questions
Visit every community on your shortlist, and bring our touring checklist so you compare each one on the same points. The National Institute on Aging suggests meeting the director and key staff, then making a second visit without calling ahead, on a different day or time, and stopping by at a meal.
While you're there:
- Watch how staff talk to residents. Is it warm and respectful, or rushed?
- Look at residents. Do they seem well cared for and appropriately dressed?
- Check that it's clean, comfortable and free of strong odors.
- Try the food if you can.
- Talk to residents and families, if they're willing, about what they like and what could be better.
- See whether there's a safe outdoor space, and how residents get to medical appointments.
Questions about staffing
- How many care staff are on duty per resident on day, evening and overnight shifts?
- Is there a nurse on site, and for how many hours? Who handles medications?
- What training do caregivers get, especially for dementia?
- How long have the director and care manager been here? How often do key staff turn over?
- Does a doctor visit regularly?
Questions about care levels
- How do you assess my parent's needs, and how often do you reassess?
- What does each care level include, and what does it cost?
- What needs can you not meet? At what point would my parent have to move out?
- If my parent has dementia, is there a secure memory care unit, and what is different about the care there?
- Can outside home health or hospice come in?
Questions about price increases
- How much have rates gone up each year for the past few years?
- How much notice do you give before an increase? (In California, state law requires at least 90 days' written notice for most rate increases, with the reason, and bans lump-sum assessments.)
- What happens to the price when care needs change?
- What happens if my parent runs out of money? Do you accept Medicaid?
Step 6: Read the admission agreement before signing
The admission agreement or residency contract is the document that controls what you're actually buying. Read it carefully, ask about anything unclear, and read it again before signing. Look for:
- All fees: move-in or community fees, monthly rent, care level charges, and a list of extra charges
- How rate increases work, including notice and how care-level changes are priced
- Move-out and discharge rules: the reasons the community can ask your parent to leave, the notice period, and how disputes are handled
- Refunds of deposits or move-in fees if your parent leaves or dies early
- Who is signing as what: be careful about signing as a "responsible party" or guarantor in a way that makes you personally liable
- What happens in a hospital stay: is the room held, and at what cost?
If the contract is long or unusual, an elder law attorney can review it.
Red flags
- No license, or a license you can't verify with the state. Some people provide care without one.
- Serious or repeated citations for care, medications, abuse or neglect, without a clear answer about what changed.
- Vague answers about staffing, care levels or what triggers a move-out.
- Pressure to sign quickly or pay a large non-refundable fee on the spot.
- A price list that only shows base rent, with care charges "to be determined."
- Residents left alone for long stretches, unanswered call buttons, or strong odors.
- Reluctance to let you visit unannounced or talk to residents.
Practical next steps
- Write down your parent's care needs and a monthly budget.
- Build a shortlist of three to five communities using the senior living search.
- Look up each one's license and inspection record with your state's licensing agency.
- Tour each one twice with the touring checklist, and ask the staffing, care and price questions above.
- Get the admission agreement in advance and read it before move-in day.
- Gather the paperwork you'll need, such as power of attorney and health care proxy. Our documents checklist helps.
- Save the number for your local long-term care ombudsman, who advocates for residents of assisted living and board and care homes. The Eldercare Locator (800-677-1116) can connect you.
If you live far away, an aging life care manager can tour communities for you, review options and help with the move. You can also see how a shared family page works if several relatives are involved.
