Assisted Living Checklist

50 questions to ask — and observations to make — when touring any assisted living or memory care community. Check items as you go, note the red flags, and print the full list before your tour.

Not sure what care level fits?

Items marked Red flagare the most critical — poor answers to these should pause your decision.

Reviewed by the AllyKin Editorial Team·CMS data via Medicare.gov Care Compare·Last updated: January 2025·Methodology: How we research and rank →

0 of 52 items checked

Safety & Emergency Systems

The foundation of any quality community — life-safety features that cannot be compromised.

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Emergency pull cords or wearable call buttons in every room and bathroom
Test one during the tour — press it and time how long before staff responds. Under 2 minutes is good; under 5 minutes is acceptable.
Red flagSecured exits and monitoring for memory care or wandering residents
Ask specifically how the community prevents elopement. Keypad-only exits and alarmed doors are standard; wander guards on residents are a plus.
Red flagSprinkler system throughout all buildings (CMS 2016 mandate for AL receiving Medicaid)
Backup generator that powers critical systems including lights, HVAC, and nurse call
Ask when it was last tested and what it covers.
Handrails in all hallways and grab bars in all bathrooms
Non-slip flooring in bathrooms and common areas
Safe outdoor space (courtyard, garden) that is secured for residents who wander

Staffing & Care

Staffing is the single strongest predictor of care quality. These questions reveal the reality behind the brochure.

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Red flagStaff-to-resident ratio during the day shift (ask for specifics, not 'we're always fully staffed')
Good AL: 1 aide per 6–8 residents during the day. Memory care: 1:4–6. Ask what the ratio is on weekends and nights.
RN or LPN on-site (not just on-call) during business hours
Many AL communities have an on-call RN but no licensed nurse on the premises during the day. This limits care for complex medical needs.
Red flagBackground checks on all staff (ask for the policy in writing)
Average staff tenure — specifically for direct care workers (CNAs, aides)
High turnover is a red flag. Average tenure under 1 year means instability in daily care relationships.
Dementia-specific training for staff who work with memory care residents
Consistent assignments — residents see the same aides daily, not rotating staff
What happens if my loved one's care needs increase — do they have to move?

Meals & Nutrition

0/6

At least two meal choices at every meal (including breakfast)
Ask to see the menu for the past 2 weeks.
Registered dietitian reviews menus regularly
Special diets accommodated: diabetic, low-sodium, pureed, kosher/halal
Ask which of these they accommodate and at what extra cost, if any.
Dining room hours — is food available outside scheduled meal times?
The best communities have open-hours dining or at minimum a 24/7 snack station.
Family members allowed to join meals (and at what cost)
Visual check: are residents in the dining room during a meal time eating and engaged?

Activities & Social Life

0/7

Posted weekly activities calendar with at least 3 options per day
Ask for last month's calendar, not just what they plan to do.
Activities available 7 days per week, including evenings
Outings off campus — shopping, restaurants, cultural events
One-on-one activities for residents who don't participate in groups
Religious or spiritual services available on-site
Physical fitness programs: walking club, chair yoga, balance classes
Ask residents: what's your favorite activity here? (their answer tells you more than any brochure)

Medical & Care Services

0/6

Physician visits on-site or telemedicine capability
Ask how often a physician or NP visits and whether the resident's current doctor can continue to see them there.
Pharmacy delivery and medication management system
Who administers medications? Is it a CNA, LPN, or RN? Some states require specific licenses for medication administration.
Physical, occupational, and speech therapy available on-site
Incontinence care available without extra charge
Some communities charge extra for incontinence supplies or assistance. Confirm this in writing.
Hospice or palliative care can be received in-place (resident doesn't have to move)
How are hospital readmissions and post-hospital transitions handled?

Cost & Contracts

The contract is where promises become enforceable. Read it — or have an elder law attorney review it.

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Red flagAll-inclusive price quote — ask what is NOT included
Many communities quote a base rate then charge separately for incontinence care, extra laundry, medication management, and more. Get an itemized list.
Red flagRate increase history: how often and by how much has rent increased in the past 3 years?
3–5% annually is typical. Communities that have raised rates 8–15%/year are a financial risk.
Red flagMove-out policy: under what conditions can you ask a resident to leave?
Legitimate reasons: resident is a safety risk to others, or needs a higher level of care. Illegitimate: behavioral issues that are dementia symptoms.
Refund policy for deposits and advance rent if you move out
Does the community accept Medicaid? If so, can the resident stay on Medicaid after spending down?
Arbitration clause in the contract — are you waiving your right to sue?

Physical Environment

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Red flagFirst impression smell: fresh air, not urine or heavy air freshener masking odors
Persistent urine smell is a hygiene failure. Heavy floral spray often masks it.
Apartment size fits your loved one's furniture and preferred belongings
Natural light in rooms and common areas
Common areas feel lived-in and active, not empty
Laundry facilities convenient and in good working order
Parking and transportation for family visits and medical appointments
Pet-friendly policy if applicable

Reputation & Oversight

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Red flagCMS Five-Star rating of 3 or higher for quality measures and staffing
Check medicare.gov/care-compare. A 1- or 2-star rating on Health Inspections warrants significant scrutiny.
Red flagNo Immediate Jeopardy (J-L) citations in the last 3 inspections
State licensing current and no active corrective action plans
Online reviews on Google, Yelp, and Caring.com — pattern analysis (not just star average)
Recent ownership changes — new owner may mean instability in staff and culture
Talk to family members of current residents in the parking lot or lobby (unscripted)

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Sources: CMS Conditions of Participation · AARP Public Policy Institute · National Consumer Voice for Quality Long-Term Care · AllyKin editorial review. This checklist is for informational purposes; consult an elder law attorney for contract review.