Questions to Ask an Assisted Living Facility: 15 Things the Sales Director Hopes You Won't Ask

Every assisted living facility tour follows the same script. The sales director walks you through the lobby (always spotless at 10 AM), shows you the dining room (set for lunch with cloth napkins), introduces you to a resident who's thriving (handpicked), and ends with a cost sheet that lists the "base rate" (which is never the actual cost).

The tour is designed to answer your emotional questions — "Will Mom be happy here?" — while avoiding your practical ones. The questions below are the ones the sales director hopes you don't ask, because the answers reveal the operational reality behind the brochure.

These aren't hypothetical. They come from state inspection reports, caregiver forum discussions, and contract fine print that families discover too late. Print this list before your next tour.

Staffing questions

1. What is the staff-to-resident ratio on the night shift?

This is the single most important question, and most families never ask it. Tours happen during the day when the facility is fully staffed. But falls, medical emergencies, and confusion episodes happen at 2 AM, when staffing drops to its minimum.

Ask for the exact number: "Between 11 PM and 6 AM, how many care aides are on duty, and how many residents are they responsible for?" A ratio of 1 aide to 15 residents is common. A ratio of 1 to 30 is dangerous. Some facilities won't give you a straight answer — that itself is an answer.

2. Is there a Registered Nurse on-site 24/7, or is the RN "on-call"?

"On-call" means the nurse is at home. If your parent has a medical emergency at 3 AM, the on-call nurse gives instructions by phone, and an unlicensed aide implements them. In some states, assisted living facilities are not required to have an RN on-site at all — a Licensed Practical Nurse (LPN) or even a Medication Aide may be the highest-credentialed person in the building overnight.

Ask: "If my parent has a seizure at 2 AM, who responds first, and what is their clinical credential?"

3. What is your staff turnover rate?

High turnover means your parent will be cared for by a rotating cast of aides who don't know their preferences, their medical history, or the early warning signs that something is wrong. Ask for the percentage: "What percentage of your care staff has been here for more than one year?" If the answer is below 50%, dig into why.

Turnover in assisted living averages 50–75% annually across the US industry. A facility with significantly lower turnover is doing something right — better pay, better management, better culture. A facility that deflects this question is hiding a problem.

Safety questions

4. Can I see your most recent state inspection report?

In the US, assisted living inspections are conducted by state health departments (not CMS, which only inspects nursing homes). The results are public records, but they're often buried on state websites and formatted as dense PDFs. The facility has a copy. Ask to see it.

Look for: citations related to medication errors, falls without follow-up, staffing deficiencies, infection control violations, and residents who eloped (left the building unsupervised). One citation isn't necessarily disqualifying — the pattern and severity matter.

In the UK, ask for the most recent CQC inspection report and look beyond the overall rating. A facility rated "Good" overall can have "Requires Improvement" in specific areas like safety or leadership. In Australia, check the Aged Care Quality and Safety Commission's published reports.

5. If my parent falls and is uninjured, what is your fall protocol?

Many facilities are required to call emergency services for every fall, even if the resident is uninjured and simply needs help standing up. This policy exists for liability reasons, not clinical ones. The result: your parent takes an unnecessary ambulance ride ($800–$1,200), spends hours in an ER, and returns traumatized.

Ask: "Do your staff perform a fall assessment on-site, or do you call 911 for every fall regardless of injury?" Some higher-quality facilities have trained staff who can assess and assist without an ambulance — saving your parent the trauma and you the bill.

6. What is your elopement prevention protocol?

"Elopement" means a resident leaves the building unsupervised — a critical risk for residents with dementia. Ask what physical measures are in place (locked exits with alarms, GPS wander-guard bracelets, secured outdoor areas) and what the response procedure is when an elopement is detected. How quickly? Who is notified? When are police called?

Financial questions

7. What fees are not included in the base rate?

The base rate is a starting point, not a final price. Ask specifically about:

• Medication management fees: Some facilities charge $250–$500/month to administer oral medications. Others charge per administration — $10–$15 per event. If your parent takes medications four times a day, that's $1,200–$1,800/month on top of base rent.
• Care-level surcharges: Many facilities use a "points system" where each ADL need (help dressing, help bathing, incontinence care) adds points that push the resident into a higher — and more expensive — care tier. Ask how the levels are assessed, how often they're reassessed, and what the price difference is between levels.
• Community fee: A non-refundable move-in deposit, often $2,000–$5,000. Ask if this is negotiable. It almost always is — especially if the facility has open units.
• Incontinence care: Is this included, or charged separately? Some facilities require residents to purchase supplies exclusively through the facility at a markup.
• Tray service: If your parent is too ill to come to the dining room, is in-room meal delivery free or $10–$20 per meal?

8. What happens to the rate when my parent's care needs increase?

This is the "care creep" question. Some families report their parent's base rate increasing 30–40% within the first year as the facility "reassesses" their care level. Ask: "How frequently do you reassess care levels? What triggers a reassessment? Can I appeal the reassessment? What is the maximum monthly cost at your highest care level?"

Get the worst-case number in writing before you sign.

9. Is the community fee refundable if we leave within 30/60/90 days?

Some facilities refund part or all of the community fee if the stay doesn't work out within a trial period. Others keep every dollar. Ask before you hand over a check.

Contract and discharge questions

10. Under what circumstances can you involuntarily discharge my parent?

This is the question that keeps caregivers awake at night — and the one facilities most want to avoid answering directly. Common involuntary discharge triggers include:

• "Behavioral issues" (which can include dementia-related behaviors like wandering, sundowning, or verbal agitation)
• Care needs exceeding what the facility can provide (needing two-person transfers, IV medication, skilled nursing)
• Non-payment
• "Safety threat to other residents" (broadly defined)

Ask for the specific contract language. A clause that allows discharge for "behaviors that disrupt the community" could mean anything. If your parent has dementia, this clause is a ticking time bomb.

11. What is the notice period for involuntary discharge — and is it the same for voluntary?

Some contracts require the family to give 30 days' notice to leave, but allow the facility to evict the resident with only 3–5 days' notice for "safety reasons." This asymmetry is common and rarely flagged during the sales tour.

Ask: "If you decide my parent needs to leave, how much notice do we get? Is there an appeal process? Will you help with transition to another facility?"

12. Does the contract include a mandatory arbitration clause?

Many US assisted living contracts include forced arbitration provisions — meaning if the facility is negligent and your parent is harmed, you cannot sue in court. Instead, you go through private arbitration, which statistically favors the facility. Ask to see the arbitration clause. Ask if it can be struck from the contract. Some states have laws restricting mandatory arbitration in long-term care contracts — check your state's attorney general website.

Quality of life questions

13. Can my parent keep their existing doctors, or must they use your contracted providers?

Some facilities strongly encourage (or require) residents to use physicians and specialists who have agreements with the facility. This can mean your parent loses their trusted doctor of 20 years. Ask: "Does the facility support telehealth appointments with outside physicians? Is there high-speed internet in the bedroom for video calls?"

14. What does a typical Tuesday look like for a resident who doesn't participate in group activities?

This question reveals the facility's approach to residents who are introverted, mobility-limited, or simply uninterested in bingo. The sales tour always showcases the activity room. But what happens to the resident who stays in their room? Is there individualized engagement? Do staff check in regularly? Or are they essentially left alone until the next meal?

15. Can I visit unannounced at any time, including evenings and weekends?

Any facility that restricts unannounced family visits is raising a red flag. You should be able to visit your parent at 9 PM on a Sunday without scheduling it in advance. Ask about overnight guest policies too — some families want to stay the first few nights to help their parent adjust.

The checklist you bring to the tour

These 15 questions are a starting point. A complete facility evaluation also covers medication error reporting, Wi-Fi security (critical for preventing financial exploitation), mail handling policies, and the specific costs of every add-on service.

Our Assisted Living Guide includes a printable facility comparison scorecard with 50+ questions organized by tour phase — what to ask the sales director, what to observe during the walk-through, what to verify in the contract, and what to check after the visit. The scorecard lets you rate each facility on the same scale so you can compare three or four options side by side when you get home.

Print it before the tour. Fill it in during the tour. Bring it to the family meeting after the tour. It's harder to dismiss a scored evaluation than a vague impression.

This article is for educational purposes only. Inspection report availability and resident rights vary by state/province/country. In the US, contact your state's Long-Term Care Ombudsman program for facility complaint histories. In the UK, search CQC reports at cqc.org.uk. In Australia, check the Aged Care Quality and Safety Commission at agedcarequality.gov.au. Consult an Elder Law Attorney before signing any facility contract.