How to choose an assisted living community: what to look for on the tour

Every community you visit will look good. Tours are run by people whose job is to fill apartments, at times of day chosen to flatter the building, along routes that pass the renovated wing.

None of that is dishonest. It just means the tour is not the evidence. Here is what is.

Before you go

Narrow by geography first. The single best predictor of whether your parent is visited often is how far away you are. Twenty minutes is visited weekly; ninety minutes is visited monthly, whatever anyone intends today.

Check the record. For a nursing home, the CMS inspection rating and its underlying components — how to read one. For assisted living, there is no federal rating, so check your state licensing agency for inspection reports and complaints, and call the long-term care ombudsman for the area, who is independent, free, and will tell you things nobody else will.

Know which level of care you need. The terms are not interchangeable, and touring the wrong level wastes weeks.

On the tour: what to notice

The residents, not the lobby. Are people out of their rooms? Dressed, groomed, doing something? A day room of people asleep in front of a television at eleven in the morning tells you more than any brochure.

Whether staff use names. Listen to how staff speak to residents in passing. Warmth is hard to fake for a whole corridor, and impossible to fake in the people who did not know you were coming.

Smell. A persistent urine smell means continence care is not keeping up. A heavy air-freshener smell often means the same thing.

The call lights. If one is on, time how long it takes. Ask what the average response time is and whether they measure it.

The food. Ask to eat lunch there — a community confident in its kitchen will offer before you ask. Look at what residents are actually eating and whether anyone who needs help is getting it.

The activities board. Cross-check it against what is happening. A full calendar and an empty room is a calendar.

The questions that get straight answers

Staffing. How many care staff are on the floor right now, for how many residents? What about overnight and at weekends? Overnight is when the ratio thins and when falls happen. A community that answers precisely is telling you they track it.

Turnover. What is your staff turnover, and how long has the executive director been here? High turnover is the most predictive bad sign in this whole industry. A director who has been there five years is a good sign; the third director in two years is not.

The ceiling. At what point could you no longer care for my mother here? Ask it plainly and get it concretely: two-person transfers, insulin injections, a feeding tube, wandering, hospice. A vague answer is an answer — it means a second move later, and the answer you get in writing is the one that counts.

Medication. Who administers medication, what are their qualifications, and how are errors recorded and reported to families?

Dementia. If relevant: what training do staff have, and what do you do when a resident becomes agitated or tries to leave? Listen for whether the answer is about understanding the behavior or about controlling it.

Money. The full cost conversation has its own guide — the question families most often forget is how much the base rate has risen in each of the last three years.

Healthcare. Which doctor visits? How are hospital transfers handled, and how quickly is family called?

Go back

Visit twice, and make the second one unannounced. Evening, a weekend, or a mealtime — the hours when staffing is thinnest and nobody is expecting you. The difference between the two visits is the most useful information you will gather.

Talk to a resident's family. Ask the community to connect you, and also try catching someone in the parking lot. Ask what they wish they had known.

Before you sign

Take the contract home. Do not sign it in the building.

• What exactly does the base rate include, and what is billed separately?
• How and when can the rate change, and with how much notice?
• Under what circumstances can they ask my parent to leave, and how much notice do we get?
• What is the notice period on our side, and what is owed if we leave — or if my parent dies?
• Is the community fee refundable?
• What happens if the money runs out — do they accept Medicaid, and for which apartments?
• Is there an arbitration clause? Many contracts have one, waiving the right to sue. In some states you can decline it and still move in. Ask.

If the contract is long or an entrance fee is substantial, have an elder law attorney read it. It is a small cost against a decision measured in years.

The last check

After all the questions, there is one worth sitting with: can I picture my mother here on an ordinary Tuesday? Not on the tour — on a wet Tuesday in February with nothing scheduled. The building that answers that is usually the right one.