How to Choose an Assisted Living Facility (Contract Guide)

Your mother walked out at two in the morning looking for a bakery that closed years ago. A police officer brought her home. It was the second time this month.

The next morning you search for “memory care near me.” Within the hour, a friendly voice calls to say the help is free and three places have openings if you can tour by Friday.

If your parent is missing, in immediate danger, seriously injured or having a medical emergency, call 911. For local help at home while you decide, call the Eldercare Locator at 1-800-677-1116.

Everything else can slow down by a day. This page covers how to choose an assisted living facility, memory care or a nursing home, what each one costs, and what the contract can and can’t make you agree to. If a hospital says she needs a nursing home, read what to do when the hospital sends a parent home too soon first, because the rules and the clock are different.

The short version

Look when the help at home no longer matches what she needs, not after the next crisis. A move made in an emergency gives your parent the least say.
Assisted living is regulated by states, not Medicare. Rules, names and inspection reports differ from state to state.
“Memory care” has no single national definition. Ask what it includes and get the answer in writing.
Medicare generally doesn’t pay for assisted living or long-term nursing home stays. Medicaid covers nursing homes for people who qualify, and some states also cover services in assisted living.
A free referral service is usually paid by the places it recommends. Ask how it’s paid and which places it doesn’t work with.
Tour more than once, and read the contract at home. A nursing home that takes Medicare or Medicaid can’t require you to guarantee payment.

On this page: Is it time? · Types of care · Cost and who pays · Referral services · How to tour · The contract

Is it time? The signs that home no longer fits

There is rarely one clear moment. More often the signs pile up until the help at home no longer matches the need.

Common signs include falls that keep happening, wandering or getting lost, and missed meals or medicines despite help. Another is a caregiver who is exhausted, or nights when no one can be there.

No single sign means she has to move. First look at what more help at home could do: what Medicare pays for at home, what in-home care costs, and living with family. If you’ve tried those and the gaps keep growing, a move may be the safer choice.

If your parent can still make decisions, whether and where to move is theirs to decide. Ask what matters most to them: a garden, a church, a dog, being near you. Those answers help you choose between places that can all meet her needs. If she says no, here is what to do when a parent refuses help.

Assisted living, memory care and nursing homes: what each offers

Names vary by state, but most places fall into a few types.

Type	What it generally offers	What it generally doesn’t
Assisted living	Meals, help with bathing and dressing, 24-hour supervision and staff on site, activities	The level of nursing care a nursing home provides
Memory care	Assisted living or nursing home care in a unit or program designed for people with dementia	One national standard; rules vary by state
Board and care home	Similar help in a small home, usually 20 or fewer residents	Nursing and medical care, usually
Nursing home	Nursing care, 24-hour supervision, meals, personal care and rehabilitation therapy	Usually a private apartment
Continuing care retirement community	Independent living, assisted living and nursing care on one campus	A low price; most charge a sizable entrance fee

Assisted living is regulated by states, not by Medicare. That is why the rules and inspection reports differ so much. Nursing homes that take Medicare or Medicaid must also meet federal standards. You can look up a nursing home’s inspection record on Medicare’s Care Compare.

Memory care can mean three different things. It may be a separate building, a secured section of a building, or just a program inside a larger one. As of 2015, some states required places that advertise dementia care to disclose what they actually provide. Rules vary by state, so ask each place exactly what its memory care includes, and ask for it in writing.

Ask what “24-hour supervision” means in practice. Staff on site around the clock doesn’t mean someone is watching your parent all the time. That matters most if she wanders.

What it costs, and who pays

National medians in 2025 were about $6,200 a month for assisted living. A nursing home averaged $315 a day for a shared room and $355 for a private one. Your area may run much higher or lower. For the full picture, see how families pay for care.

Medicare generally doesn’t pay for assisted living room and board or personal care. It also doesn’t pay for long-term nursing home stays. It covers short-term skilled nursing or rehab after a qualifying hospital stay, with daily cost sharing starting after day 20. Coverage stops after day 100 in a benefit period, or sooner if she no longer needs daily skilled care.

Medicaid covers nursing home care for people who qualify. A resident on Medicaid generally pays most of their monthly income toward the cost. They keep a small personal needs allowance, set by the state but at least $30 a month. Some income can be set aside for a spouse at home.

Some states also cover services in assisted living, and others don’t. Even where they do, federal Medicaid waiver funding generally can’t pay for room and board, so your parent may still owe the rent and meals. These programs can limit how many people they serve, so there may be a waiting list. Our guide to Medicaid and home care explains how eligibility works, and long-term care insurance and VA Aid and Attendance are two other ways families pay.

If she pays privately now and may need Medicaid later, ask every place before move-in whether it accepts Medicaid. Ask what happens when a resident’s money runs out. Get the answer in writing.

Hospice can be provided in a nursing home or assisted living. Medicare generally doesn’t pay room and board for a parent who lives there. See hospice care and how to choose a hospice.

Referral services: helpful, but not neutral

When you search online, you’ll often reach a referral or placement service. Some describe their help as free because the facilities they recommend pay them. Washington State, for example, requires these services to disclose how their fee is figured and any ownership interest in the places they recommend.

A referral service can save time. It may also show you only the places it works with. Before you share any details about your parent, ask:

How are you paid, and by whom?
Do you get paid more by some places than others?
Which places in my area do you not work with?
Will you share my information with facilities or other companies?

You don’t have to use a referral service at all. You can find places yourself through Care Compare for nursing homes, your state’s licensing agency for assisted living, the long-term care ombudsman and your Area Agency on Aging. The Eldercare Locator, 1-800-677-1116, can point you to your local offices.

How to tour an assisted living facility or nursing home

Visit more than one place, and go more than once. If you can, make a second visit unannounced, at a different time of day. Medicare suggests watching whether staff are slow to respond. A mealtime visit tells you a lot: how people are helped, whether the food looks good, and whether residents talk with each other.

Bring your parent if you can. Even with memory loss, she may react strongly to a place, and that reaction is worth noticing. If touring would overwhelm her, visit first yourself, then bring her to the one or two you like best. Some places offer short respite stays, from a few hours to several weeks, which can let her try a place before deciding. Our page on respite care covers what those stays cost and who pays.

Ask about staffing, and get specific. How many staff are on duty during the day, overnight and on weekends? What happens in a medical emergency? How often do staff leave and get replaced, and what training do they have, especially in dementia care? Talk with residents and their families if they’re willing. Ask the ombudsman whether the office knows of recurring concerns, and check inspection reports for nursing homes and state reports for assisted living.

For memory care, ask these as well:

How do you keep residents safe if they wander?
What do residents do all day? May I see this week’s activity schedule?
What do staff try first when someone is distressed or agitated, and when would medication be considered?
What dementia training do staff have, and how often is it renewed?
If her needs grow, can she stay, or will she have to move?

If the memory problems are new, or she has changed suddenly, find out why before you choose a place. A sudden drop is often not the dementia itself. Medicare’s GUIDE program also offers a care navigator and respite support at home.

Read the contract before you sign

Admission paperwork often arrives in a thick packet, on a busy day. Take it home, read it, and ask questions. If the amounts are large or the terms unclear, have an elder law attorney review it.

Nursing homes that take Medicare or Medicaid

Federal rules protect you here.

No guarantor. The home can’t require a third party, such as an adult child, to guarantee payment as a condition of admission. It can ask a representative with legal access to your parent’s money to sign to pay from her funds, but that person isn’t personally liable.
No waiver of rights. It can’t make your parent promise not to apply for Medicare or Medicaid.
No required gifts. If she is on Medicaid or eligible for it, the home can’t require a donation to be admitted or to stay.
Arbitration is optional. Signing can’t be a condition of admission or of continued care. The home must tell your parent she can refuse, and she can cancel within 30 calendar days of signing.
Discharge is limited. A home can transfer or discharge a resident only for specific reasons: needs it can’t meet, improved health, danger to others’ safety or health, unpaid bills after reasonable notice, or the home closing. It usually must give 30 days’ written notice, with appeal rights and the ombudsman’s contact information. While an appeal is pending, it generally can’t discharge her unless that would endanger health or safety.

Her rights as a resident include choosing her own doctor, taking part in planning her care, and refusing treatment. She also keeps her privacy and can raise complaints without retaliation. She can have visitors at times she chooses, and family must be let in promptly as long as she agrees.

Assisted living and memory care

The contract is governed by state law, and protections vary by state. Look closely at:

the base monthly rate, and what it includes
which charges are rent and meals, and which are for care
how extra care is priced, often in “levels of care,” and who decides the level
how much notice you’ll get before rates rise, and how often they’ve risen
move-in fees or deposits, and whether they’re refundable
the reasons the place can ask your parent to leave, and the notice it must give
what happens if her money runs out, and whether the place accepts Medicaid

Continuing care retirement communities

Timing matters. A continuing care retirement community is usually something to consider before a parent needs substantial daily care, because many expect residents to enter while they can live independently. Admission requirements vary. The entrance fee is often large and may or may not be refundable.

If she later applies for Medicaid, the fee can count as a resource when all three of these are true: it can be used to pay for her care, part of it would be refunded if she died or left, and it doesn’t give her an ownership interest. A resident’s financial security is also tied to the community’s long-term health, so review the contract and the community’s finances closely.

Who signs

If your parent can still make the decision, she signs. If she can’t, the person with legal authority signs for her. See what a power of attorney is and what it covers.

What to say

To your parent: “I’ve been worried about the nights, Mom. I’d like us to look at a couple of places together, just to see. You’d have the final say.”

To a referral service: “Before I give you my mother’s information, how are you paid, and which places near me don’t you work with?”

To a facility, about money: “If my mother’s savings run out, can she stay here on Medicaid? Can I see that in writing?”

On a tour: “Can I come back on Saturday at dinnertime, without an appointment?”

Common mistakes

Waiting for a crisis. A move made in an emergency gives your parent the least choice.
Touring only the places a referral service suggests. Find others yourself, too.
Assuming “memory care” means the same thing everywhere. Ask what it includes, and get it in writing.
Signing as a guarantor. A nursing home that takes Medicare or Medicaid can’t require it. Sign only as her representative, if you have that authority.
Skipping the contract. Read the fees, rate increases and discharge terms before move-in day.
Not asking about Medicaid. Find out now whether she could stay if her money runs out.

Free printable: Tour and Contract Questions

The questions to bring on every visit, in one place: staffing, memory care, what the money covers, and the contract terms to check before you sign. It has room to write answers for each place you tour, so you can compare them side by side afterward.

It comes from Chapter 14 of my book, When Mom or Dad Can No Longer Manage Alone, which covers choosing a place, from the first tour to the signed contract.

Download the tour questions (PDF) →

Free. No email required. How to use it · All 18 tools from the book

Once you’ve chosen a place

Choosing is the first half. The second is the move itself, and the first month after it, when most families find out what they didn’t plan for. Read moving a parent into assisted living or a nursing home next.

And if scams or money worries are part of why she can’t manage alone, see how to protect a parent’s money.

Free help that has nothing to sell you

Eldercare Locator, 1-800-677-1116: connects you with local aging services, including your Area Agency on Aging and the long-term care ombudsman.
Medicare’s Care Compare: inspection records and star ratings for nursing homes.
Your state’s licensing agency: inspection and complaint reports for assisted living.
State Health Insurance Assistance Program (SHIP): free, unbiased Medicare counseling.

Questions families ask

How do I know when it’s time for assisted living or memory care?

Look for a pattern: falls that keep happening, wandering or getting lost, missed meals or medicines despite help, an exhausted caregiver, or no one available at night. No single sign means a move is required. If more help at home hasn’t closed the gaps, a move may be safer, and choosing before a crisis gives your parent more say.

What is the difference between assisted living and memory care?

Assisted living offers meals, help with personal care such as bathing and dressing, supervision and activities. Memory care is assisted living or nursing home care in a unit or program designed for people with dementia. It has no single national definition, so ask each place exactly what its memory care includes, in writing.

Does Medicare pay for assisted living or a nursing home?

Medicare generally doesn’t pay for assisted living room and board or personal care, or for long-term nursing home stays. It covers short-term skilled nursing or rehab after a qualifying hospital stay, with daily cost sharing after day 20, and coverage stops after day 100 in a benefit period or sooner if daily skilled care is no longer needed.

How much does assisted living cost?

National medians in 2025 were about $6,200 a month for assisted living, and $315 a day for a shared nursing home room ($355 private). Costs in your area may be much higher or lower, so ask each place for its rate, what it includes and how extra care is priced.

Can a nursing home make me co-sign or guarantee payment?

A nursing home that takes Medicare or Medicaid can’t require a third party, such as an adult child, to guarantee payment as a condition of admission. It can ask a representative with legal access to your parent’s money to sign to pay from her funds, but that person isn’t personally liable.

Can a nursing home discharge my parent?

Only for specific reasons: needs it can’t meet, improved health, danger to others’ safety or health, unpaid bills after reasonable notice, or the home closing. It usually must give 30 days’ written notice with appeal rights and the ombudsman’s contact information, and generally can’t discharge her while an appeal is pending unless that would endanger health or safety.

Are referral services for senior living really free?

They are usually free to families because the facilities they recommend pay them. That means they may show you only the places they work with. Ask how the service is paid, whether some places pay more, and which places in your area it doesn’t work with, before sharing your parent’s details.

Changelog

5 November 2026 — Published. Added the free Tour and Contract Questions printable from When Mom or Dad Can No Longer Manage Alone. Verified against the federal nursing home rules, Medicare and Medicaid coverage pages, and federal and state assisted living policy reviews listed below.

Assisted living and memory care rules vary by state; nursing home rules are federal and state. This page is re-verified every six months and whenever the federal rules change.

Sources

National Institute on Aging — Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care; Services for Older Adults Living at Home; How To Choose a Nursing Home or Other Long-Term Care Facility; What Is Respite Care?
Centers for Medicare & Medicaid Services — Your Guide to Choosing a Nursing Home (Sept. 2025)
Medicare.gov — Long-term care; Skilled nursing facility (SNF) care; Hospice care coverage; 2026 deductible, coinsurance and premium amounts
HHS Office of the Assistant Secretary for Planning and Evaluation — Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition
U.S. Government Accountability Office — Elder Abuse: Federal Requirements for Oversight in Nursing Homes and Assisted Living Facilities Differ (GAO-19-599); Continuing Care Retirement Communities Can Provide Benefits, but Not Without Some Risk (GAO-10-904T)
Administration for Community Living — Continuing Care Retirement Communities; Medicaid Long-term Care Services; Eldercare Locator, Assisted Living fact sheet; Long-Term Care Ombudsman Program
42 CFR 483.15(a) and (c) (admissions; transfer and discharge); 483.10 (resident rights); 483.70(m) (arbitration); 435.725 and 435.832 (post-eligibility income); 441.310(a)(2) (room and board)
Social Security Act §1917(g), 42 U.S.C. 1396p(g) (entrance fees of continuing care residents)
Medicaid.gov — Home & Community-Based Services 1915(c)
Federal Trade Commission — complaint against a senior housing referral franchisor, File No. 112 3155 (2012); Revised Code of Washington 18.330.050 (referral service disclosure)
2025 national cost-of-care survey, median monthly assisted living and daily nursing home rates (press release, March 2026)

Last verified: 4 November 2026 against Medicare.gov, CMS, federal nursing home regulations and the sources above · Next review: May 2027

Written by Mark Duda. Years running business development for one of New Jersey’s largest home health and hospice organizations, including the nurse liaisons who arranged care at the bedside before patients went home. More about me → · How this page was checked →

This page is educational and is not medical, legal or financial advice. Mark Duda is not a physician, a nurse, or an attorney. Costs, Medicaid rules and assisted living regulations vary by state and by place. Confirm the terms with the facility, your state agency and, for large amounts, an elder law attorney. See our disclaimers.