Questions to ask when touring assisted living or a nursing home

A tour is a sales presentation. The chandelier in the lobby tells you nothing about the night-shift staffing. Here is what actually predicts quality — and the questions that get past the script.

Before you go: check the record

Look up the facility’s inspection history first. Walk in already knowing its recent deficiencies, whether it’s been fined, and its staffing numbers — then watch how they answer questions about it. A facility that owns its record honestly is telling you something good.

Staffing — the number that matters most

• What is the caregiver-to-resident ratio on the day shift, and on the night shift? (Night is where thin staffing hides.)
• Is there a licensed nurse on-site around the clock, or on call?
• What is your staff turnover rate? (High turnover is one of the strongest quality warning signs.)
• How long have the caregivers on this floor worked here?

Care and safety

• How do you assess care needs, and how often is the care plan updated?
• What happens when a resident’s needs increase — can they age in place, or will they have to move (and pay more)?
• How are medications managed and by whom?
• How quickly are call lights answered? Ask residents, not just staff.

Money — get it in writing

• What exactly does the base rate include, and what is billed as an add-on or “level of care” fee?
• How often, and by how much, have rates risen in the past few years?
• What is the move-out and refund policy? What triggers an involuntary discharge?
• Do you accept Medicaid, and what happens if a resident’s private funds run out?

Inclusion and affirming care

For LGBTQ+ elders and their families, whether a community is genuinely welcoming is a quality-of-care question, not an afterthought. A good facility will answer these without hesitation:

• Does staff receive LGBTQ+ cultural-competency or inclusivity training?
• How do you support residents in being open about their identity and relationships?
• Are same-sex partners recognized in visitation and care-planning decisions?
• Do you have a nondiscrimination policy that explicitly includes sexual orientation and gender identity?

For more, SAGE advocates for LGBTQ+ elders and offers resources for families, and the Human Rights Campaign’s Long-Term Care Equality Index (LEI) rates facilities on inclusive policies and practices.

If there's a psychiatric diagnosis alongside the dementia

Schizophrenia, bipolar disorder, or long-standing serious depression alongside dementia — or on its own — changes which doors open, and the tour is where you find out. These are the questions that decide the placement, and they are the ones a tour will glide past unless you ask them flat:

• Do you accept residents with a psychiatric diagnosis, and do you have any now? A vague answer here is an answer.
• Who is your psychiatric consultant, how often do they round, and are they on staff or contracted? “We can arrange it” means there isn’t one.
• What behavior gets someone sent out to an ER, and how often has that happened this year? A facility that 911s every difficult episode will 911 your parent.
• Have you ever discharged someone for behavior? Ask for the circumstances. Involuntary discharge after a behavioral incident is one of the most common ways these placements end — and residents have appeal rights when it happens.
• What dementia-specific and de-escalation training does direct-care staff get, and who is on the floor at 2am when it matters?
• How do you approach antipsychotic medication? Facilities report this to CMS and it’s on our facility pages — look it up before you ask, then compare their answer to their number.

Do this before you fall in love with a place. And if a Medicaid-certified nursing home is in the picture, read up on the PASRR Level II screening — a serious mental-illness diagnosis triggers a state evaluation that has to happen before admission, and it is the single most common reason a settled-looking placement stalls.

Will anyone there be able to talk to them?

If English isn’t your parent’s first language — or isn’t their language at all any more, which dementia often does, stripping away later languages and leaving the first one — this is not a soft question. Someone who can’t tell staff where it hurts is at higher risk of every bad outcome on this site.

Two things are true and worth separating. First, whether staff speak the language is not something we can look up for you. CMS doesn’t collect it, so no directory — ours or anyone’s — can filter on it honestly, and any site that claims to is guessing. You have to ask, on the tour: who here speaks it, on which shifts, and what happens on the shifts where nobody does?

Second, and less well known: free interpretation is a right, not a favor. A facility that takes Medicare or Medicaid receives federal money, which brings it under federal nondiscrimination rules on national origin — and nursing homes are specifically required to give residents information and notices in a form and a language the resident can understand (42 CFR § 483.10(g)(3)–(4), (g)(16)). In practice that means the facility arranges and pays for interpretation for care discussions and consent — it is not the family’s job to supply an interpreter, and it should never be billed to you. Nor should a grandchild be the interpreter for a medical conversation, however willing; that is how mistakes and impossible burdens get made.

So: ask what interpretation service they use and how staff reach it at 3am. Ask how care-plan meetings will be run so your mother is in the conversation rather than the subject of it. If you get resistance, your free Long-Term Care Ombudsman can arrange interpretation for their own work with you and can raise it with the facility — that is exactly what they are for, and the service is free and confidential.

Federal language-access requirements come from Title VI of the Civil Rights Act and Section 1557 of the ACA as well as the nursing-home regulation cited above. Section 1557’s implementing rules have been rewritten and litigated repeatedly, so the fine detail of what a given provider must post or offer has moved around; the nursing-home requirement at 42 CFR § 483.10 is the more stable anchor, and it is the one to quote at a facility. If you’re denied interpretation, HHS’s Office for Civil Rights is where a complaint goes.

Trust your senses

Visit more than once, including unannounced and at a meal or evening. Are residents engaged or parked in front of a TV? Is there an odor (a persistent one signals understaffing)? Do staff greet residents by name? Eat the food. Talk to families in the parking lot. Your eyes and nose often tell you more than the brochure.

This guide is general information, not medical, legal, or financial advice. Rules vary by state and change over time. For personalized, unbiased help, your Area Agency on Aging and your state’s Long-Term Care Ombudsman are free.