Assisted living is licensed and regulated by each state, so the way you check an assisted living facility depends on where it is. That surprises a lot of families who expect a national rating like the one Medicare publishes for nursing homes. The seven steps below show how to choose an assisted living facility in any state, from confirming the level of care and learning your state's rules to checking the license and inspection record, touring twice, and reading the contract before you sign.

In This Guide

Start Here: Why Choosing Assisted Living Works Differently

If you've helped someone choose a nursing home, you may have used Medicare Care Compare. Nursing homes that take Medicare or Medicaid are measured against one body of federal participation requirements, state survey agencies inspect them under federal guidance, and those survey results feed the federal nursing-home ratings.

Assisted living works another way. According to the U.S. Department of Health and Human Services, residential care settings such as assisted living are licensed and regulated at the state level, every state has at least one category of residential care, and although states cover the same general areas, their requirements vary considerably. That's why the name, the rules, and even what counts as "assisted living" change when you cross a state line.

So the method below leans on three things that exist everywhere: your state's licensing rules and records, your own eyes on two visits, and the contract you'll be asked to sign. Take the steps in order. The early ones narrow your list quickly, and the later ones protect you before any money changes hands.

Step 1: Confirm Assisted Living Is the Right Level of Care

Before comparing facilities, make sure you're comparing the right kind. The National Institute on Aging describes assisted living as a setting for people who need help with daily care, but not as much help as a nursing home provides. Residents usually live in their own apartments or rooms, share common areas, and have access to services such as up to three meals a day, help with personal care and medications, housekeeping and laundry, 24-hour supervision and on-site staff, and social activities. Facilities typically offer a few levels of care, and residents pay more if they need extra services or special care.

NIA draws the line this way: assisted living is for people who may need some help with daily tasks but don't need around-the-clock care, while nursing homes are for people who can't care for themselves anymore and may need ongoing medical care. If your parent has dementia, look at memory care too. The federal Administration for Community Living describes memory care as a specialized form of assisted living that generally offers supports beyond traditional assisted living, such as specialized staff training or secured exits, though not every facility has every feature.

If you're unsure which setting fits, our comparisons of assisted living vs. nursing homes and assisted living vs. memory care walk through the differences, and board and care homes are worth a look if a smaller, home-like setting appeals. A doctor or hospital discharge planner can also tell you what level of help your parent needs now and is likely to need later.

Step 2: Learn How Your State Licenses Assisted Living

Because each state writes its own rules, spend fifteen minutes learning yours before you tour. Find out what your state calls assisted living (the licensed category may carry a different name), what services a licensed facility can provide, and which state agency does the licensing. Our assisted living by state directory is a good starting point for your state's rules and costs.

Knowing the rules helps you ask better questions. If your state lets some facilities provide more care than others, you'll want to know which kind you're looking at, because that decides whether your parent can stay as their needs grow. It also tells you which agency to call for inspection records in Step 4.

Step 3: Build a Shortlist

Start broad. Ask friends, your parent's doctor, a hospital social worker, or a local Area Agency on Aging which places they'd suggest, and add the facilities within a distance family can realistically drive. Being close enough for regular, unplanned visits often matters as much as anything on a brochure.

Then call each place before you visit. Ask how many people live there, what it costs, and whether there's a room available now or a waiting list, and mention any special needs your parent has. Cross off anything that plainly can't meet those needs or is far outside the budget, and aim to leave yourself three to five facilities worth visiting in person.

Step 4: Check the License and the Track Record

Don't skip this step; it's the one that protects you most. The National Consumer Voice for Quality Long-Term Care, a national resident advocacy group, advises finding out whether the facility is licensed, because when a facility is licensed you have more protections and a place to turn if you want to file a complaint. It also advises reviewing the facility's survey (inspection) reports and comparing them with other facilities.

Because each state licenses and regulates assisted living, ask the facility for its license and most recent inspection report, and ask your state's licensing agency how to see a facility's inspection history and any complaint investigations. Read for patterns and seriousness rather than a raw count: one minor citation that was fixed tells a different story from the same problem cited again and again.

Next, call your state's Long-Term Care Ombudsman program. Ombudsman programs are federally mandated advocates for people living in nursing homes, residential care communities, and similar adult care facilities, and anyone can contact them for free. Consumer Voice says the programs also provide information about how to find a facility and what to do to get quality care; you can find your state's program through the Consumer Voice state directory, which the federal ACL points families to.

Step 5: Tour Twice, With the Right Questions

By now your list should be down to two or three places. The National Institute on Aging advises visiting several facilities in person before deciding, then making a second visit without calling ahead, on another day of the week or at another time of day, and stopping by at mealtime. Consumer Voice gives the same advice for assisted living specifically: go back unannounced several times, including mealtimes, evenings, and weekends. The first visit shows you the facility at its best. The second shows you a normal day.

Bring these questions. They come from NIA's and Consumer Voice's guidance, and the answers are worth writing down so you can compare.

Topic What to ask
Staffing What is the staff-to-resident ratio on each shift? How many care providers are there per resident?
Training What kind of training do the care staff have?
Turnover How often do key staff members turn over?
Nursing What services do nurses provide, and how many hours a day is a registered nurse or licensed practical nurse on site?
Changing needs Who decides when a resident needs more services, or when the facility can no longer meet their needs: the resident or the facility?

The nursing question matters more than families expect. Consumer Voice notes that many facilities do not offer a nurse around the clock, so if your parent needs regular nursing care, get a specific answer rather than a reassurance. The "changing needs" question matters just as much, because it tells you how long your parent is likely to be able to stay.

Beyond the questions, trust what you see and hear. Do residents seem engaged or idle? Do staff speak to residents warmly and by name? Is the place clean, and does the food look like something your parent would eat? If you can, talk with a resident or a visiting family member away from the staff.

Step 6: Read the Contract and the Price List Before You Sign

The contract is where the promises made on the tour either show up in writing or don't. The National Institute on Aging advises getting detailed information about costs and which services are included, then reading the contract carefully, making sure all the agreements are clear, asking about anything you don't understand, and reading it again before you sign.

Consumer Voice's checklist is more specific. Use it line by line:

Check Why it matters
What the base rate includes Anything not included in the rate is an extra charge, so you need the full list.
The cost of each additional service Residents pay more when they need extra services, so these prices shape the bill over time.
All required fees Consumer Voice notes that "community service" fees are often required.
When a resident may be asked to leave The contract should spell out the circumstances, so you know them before a crisis.
What happens if the money runs out Ask directly, and get the answer in writing.
Whether the facility takes Medicaid If it says your parent can stay and use Medicaid for the whole stay, get that in writing.

Pay particular attention to the move-out terms. Because assisted living is regulated state by state, the rules on when a facility can ask a resident to leave, and how much notice it must give, are set largely by your state and by the contract itself (settings paid through Medicaid also answer to a federal settings standard), so read that section closely and ask the licensing agency or ombudsman about anything unclear. If a clause worries you, it's reasonable to ask an elder law attorney to review the agreement before you sign.

Step 7: Plan How You'll Pay

Money shapes the whole decision, so settle it early. The national median cost of assisted living was $6,200 a month, or $74,400 a year, in the CareScout 2025 Cost of Care Survey. Costs vary widely by state and by the level of care, so check our cost of senior care by state guide for your area.

Medicare Part A and Part B don't pay the room-and-board or custodial-care costs of assisted living, though a Medicare-covered medical service stays covered when the person receiving it lives in assisted living. Medicaid is a state-by-state question. The U.S. Government Accountability Office found that 44 states' Medicaid programs covered assisted living services as of March 2025, and 29 of those did so through Medicaid home and community-based services waivers, which let states limit the number of participants. GAO also found that most assisted living residents pay with their own money, and NIA notes that Medicaid may cover some aspects of assisted living depending on the state and whether the person is eligible.

This is its own topic, so rather than repeat it here, see our guides on how to pay for assisted living, Medicare and assisted living, VA Aid and Attendance and using it for assisted living, and Medicaid HCBS waivers by state. If Medicaid may be part of the plan now or later, ask each facility whether it accepts Medicaid before you get attached to it.

If Something Goes Wrong After Move-In

Even a careful choice can hit problems, and you don't have to sort them out alone. Start with the facility's administrator. If that doesn't resolve it, the Long-Term Care Ombudsman program investigates and works to resolve complaints made by or on behalf of residents, its services are free and confidential, and it acts on what the resident wants. You can also contact your state's licensing agency, which is the body that licenses and regulates the facility.

If you suspect abuse, neglect, or financial exploitation, don't wait. Our guide on how to recognize and report elder abuse explains who to call and when.

The Bottom Line: How to Choose an Assisted Living Facility

Choosing assisted living well comes down to checking what a sales tour can't show you. Learn your state's rules, look up the license and the inspection record, call your state's ombudsman program, visit when you're not expected, and read the contract as carefully as you'd read a mortgage. It's a few hours of work spread over a decision that shapes your parent's daily life, and the method is the same in every state even though the rules aren't.

Frequently Asked Questions

What should I look for in an assisted living facility?

Look past the lobby to three things. First, the record: a current state license and inspection reports without repeated serious problems. Second, the people: enough staff on every shift, nurse coverage that matches your parent's needs, and staff who've been there a while. Third, the fit: whether the facility can keep meeting your parent's needs as they change, and whether family can visit easily.

How do I check an assisted living facility's inspection reports?

Each state licenses and regulates assisted living, so ask your state's assisted living licensing agency how to see a facility's inspection (survey) reports. Consumer Voice advises reviewing a facility's survey (inspection) reports and comparing them with other facilities' reports, so request them for every place on your shortlist, not just your favorite. Step 4 above covers what to read for.

Can an assisted living facility ask a resident to leave?

Yes, in some circumstances, and those circumstances should be written into the contract. Consumer Voice advises reviewing the contract for exactly when a resident may be asked to leave and asking who decides when the facility can no longer meet a resident's needs. The rules behind those clauses vary by state, so ask your ombudsman or licensing agency if a clause is unclear.

Does Medicare or Medicaid pay for assisted living?

Medicare doesn't pay assisted living's room-and-board or personal-care costs. GAO found Medicaid programs in 44 states covered assisted living services as of March 2025, and waiver programs can cap enrollment, so whether it helps depends on your state and on eligibility. Most residents pay privately.

Learn More

Care TypesHow to Choose a Nursing Home: A Step-by-Step GuideHow to choose a nursing home step by step: use Medicare Care Compare correctly, read all four star ratings, check the Special Focus list, and tour. Care TypesAssisted Living by StateWhat assisted living costs, how licensing and Medicaid coverage differ from state to state, plus a guide to all 50 states so you can jump straight to yours. Care TypesAssisted Living vs. Memory Care by StateMemory care is assisted living built for dementia, and it costs more. Compare the two on care, cost, and coverage, then open a full guide for your state. Care TypesThe Long-Term Care OmbudsmanEvery state has a free, confidential long-term care ombudsman for nursing home and assisted living residents. What they do, whose side they're on, how to call. FinancialHow to Pay for Assisted LivingHow to pay for assisted living in 2026: what it costs and how private pay, Medicaid waivers, VA Aid and Attendance, and long-term care insurance each fit. Care TypesTypes of Senior CareFrom a few hours of help at home to 24-hour nursing care: the types of senior care, what each costs in 2026, whether Medicare or Medicaid pays, and how to pick.

Find personalized help comparing assisted living options at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.