How to choose a care place

Choosing a care place for someone you love is a big decision. It often comes at a hard time, after a fall, a hospital stay, or months of tired nights. You may feel rushed.

This page gives you clear steps: how to check inspection reports, what to look for on a tour, which questions to ask, and which warning signs mean "keep looking."

First, match the place to the need

Places give different levels of care. Think about what the person needs now and may need in a year or two.

• Living at home with help: in-home care, adult day care, respite care, or PACE.
• Help with daily tasks in a group home setting: assisted living.
• A secure, dementia-focused unit: memory care, often inside an assisted living community.
• Daily nursing care: nursing homes.

Write down the person's main needs, such as help with bathing, toileting, walking, medicines, wandering, sleep, and behavior changes. Also note the budget and who will pay. See what dementia care costs and Medicaid and long-term care. If Medicaid may be needed later, the Alzheimer's Association suggests talking with an elder law attorney before the move.¹

The steps, in order

1. List needs, budget and must-haves. Include location. Being close enough for family to visit often matters a lot. CMS notes that regular family visits can improve both care and quality of life.²
2. Build a short list of three to five places. Ask the doctor, a hospital social worker, friends, and your local Area Agency on Aging. The Eldercare Locator can connect you at 1-800-677-1116.¹⁴
3. Check inspection reports and ratings for each place (see the next section).
4. Take a scheduled tour. Bring the checklist and questions below. Take notes and photos of the price sheet.
5. Go back without calling ahead, at a different time of day. Try to see a meal, an evening, or a weekend.¹
6. Talk with residents' families if you can. Ask what they like and what they would change.¹
7. Get the contract and fee list in writing and read them at home before signing.
8. Ask to join a waitlist early if you like a place.¹

Share the work: one person can check reports while another tours. See our care circle tool, sharing care with family and long-distance caregiving.

Check inspection reports and ratings

State inspectors visit care places and write down problems, called deficiencies, citations or violations. Reports show you things a tour cannot.

Nursing homes: Medicare's Care Compare

Medicare's Care Compare website (medicare.gov/care-compare) rates nursing homes from 1 to 5 stars. There is an overall rating, plus three parts: health inspections, staffing, and quality measures.²

Some things to know about the stars, as of October 2026:³

• They compare homes within the same state. In each state, only the top 1 in 10 homes get 5 stars for inspections. The bottom 1 in 5 get 1 star.
• The inspection rating looks at the two most recent full inspections, plus complaint inspections from the past three years.
• The staffing rating comes from payroll records the homes send in each quarter. Care Compare also shows staff turnover (how often staff leave) and weekend staffing.²
• An abuse icon means the home was cited for abuse recently. Homes with this icon cannot score above 2 stars for inspections.
• A yellow warning sign in place of stars means the home is in the Special Focus Facility program. These homes get no star ratings at all. Ask the home, and the ombudsman, why it is on the list.

Each citation has a letter from A to L for how serious and how widespread it is. Letters G, H and I mean a resident was actually harmed. Letters J, K and L mean residents were in immediate danger.³ Read the details, not only the stars. Look for patterns, like the same problem cited again and again.

CMS itself says no rating system can capture everything. The stars do not measure dementia care directly.² Use them to build your list, then visit.

In Virginia, the Department of Health (VDH) also posts nursing home inspection reports and approved plans of correction (the home's plan to fix each problem).⁵ Every nursing home must post its most recent inspection results where residents can easily see them. It must also let you review the past three years of reports if you ask.⁴

Assisted living, memory care and adult day centers in Virginia

Medicare's star ratings are for nursing homes.² In Virginia, VDSS licenses assisted living facilities and adult day centers. Its online search lets you view each place's inspections and violations.⁶

You can search by name, city or county, or ZIP code. You can also filter for places with a Special Care Unit (a secured memory care unit).⁷ Each licensed assisted living facility gets at least one unannounced inspection a year.⁸ Places on a short, six-month license get at least two.⁸ If a place has a short license, ask why.

If you live in another state, ask your state's licensing agency or the ombudsman where to find assisted living inspection reports.

Tour checklist

Bring this list on each visit. Spend time in the common areas, not only the model room.¹

Eat a meal there if you can.¹ Also notice how you feel in the building. Your gut feeling counts.

Questions to ask

You do not need to ask every question. Pick the ones that matter most for your person.

Staff and training

• How many staff work with residents on the day shift? On nights and weekends?¹
• What dementia training do staff get, and how many hours? Is it required by the state?¹
• How long have most aides worked here?¹ How often do you use temporary agency staff?
• Is a registered nurse on site at all times? How often does a doctor or nurse practitioner visit?¹

Dementia care and behavior

• What makes your memory care different from the rest of the building?¹
• How do staff respond when a resident is upset, refuses a bath, or tries to leave?¹
• Is the unit locked or secured? How do you keep people from leaving unnoticed? See wandering.
• Do people with serious mental illness share the unit with people who have dementia?¹
• How do you get to know each person's history, routines and likes?
• What share of residents take antipsychotic medicines, and how do you try non-drug approaches first? In nursing homes, federal rules require a diagnosed reason for these drugs, efforts to lower or stop them, and limits on "as needed" orders.⁹

Health and changing needs

• What happens if care needs grow? Can the person stay as dementia advances ("age in place")?¹
• What would cause you to ask a resident to leave? How much notice do you give?¹
• Who goes with a resident to the emergency room?¹
• Do you work with hospice? Can a person receive end-of-life care here?¹

Money and contracts

• What does the base monthly fee cover? What costs extra? How often do prices go up?
• Do you accept Medicaid? Medicare? What happens if savings run out?¹
• May we take the contract home to read before signing?
• In Virginia assisted living: may we have your disclosure statement? The law requires it before admission. It must list fees, services, staffing on each shift, and admission and discharge rules.¹⁰

Family involvement

• How are families included in care planning?¹
• How and how fast will you tell us about falls, illness or changes?¹
• Is there a family council? Can we visit at any hour?

Red flags

Before you sign the contract

Read every page. If the contract is long or confusing, an elder law attorney can review it.

Federal rules protect people entering nursing homes that take Medicare or Medicaid:

• Arbitration. Some contracts include a binding arbitration agreement. This means you give up the right to go to court over a dispute. A nursing home may not require you to sign one to get in or to stay. You can say no. If you sign, you have 30 days to change your mind.¹¹
• Third-party guarantees. A nursing home may not require a family member to promise to pay from their own money as a condition of admission.¹² A family member with legal access to the resident's money may be asked to sign to pay from the resident's funds. Read carefully what you are signing and in what role.
• Medicare and Medicaid rights. A nursing home may not make the resident give up the right to Medicare or Medicaid. It may not make you promise not to apply for them.¹²

Assisted living contracts follow state law, which differs by state. In Virginia, compare the contract with the disclosure statement.¹⁰ Ask what happens if the person's needs change or they need to move. Our assisted living page has more on Virginia's rules.

Free help along the way

The Long-Term Care Ombudsman is a free program in every state. Ombudsmen help residents of nursing homes, assisted living and similar homes with complaints and with their rights. They also give information.¹³ Ask the ombudsman what they know about places on your list. Find your local office through the Eldercare Locator at 1-800-677-1116.¹⁴

Other help:

• The Alzheimer's Association 24/7 Helpline at 800-272-3900 is free. Staff can talk through housing and care options and find local services, with interpreters for many languages.¹⁸
• To complain about a Virginia nursing home, contact the VDH Office of Licensure and Certification at 1-800-955-1819 or online.¹⁵
• To complain about a Virginia assisted living facility or adult day center, use the VDSS online complaint form. It is not a confidential channel, so for abuse or danger call APS or 911 instead.¹⁶

After the move: keep looking

The first weeks show you how the place really works. Visit at different times, get to know the aides by name, and go to care plan meetings. Raise concerns early with the nurse or director. If problems are not fixed, call the ombudsman.

See moving a parent into care for the move day and first weeks. Guilt and grief are common, even after a good choice. See caregiver stress and burnout.

If you are a caregiver and you feel hopeless or think about ending your life, call or text 988 any time. See our help page for more.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.