5 Things Experts Want You to Know About Choosing the Right Long-Term Care Facility

2. Read official reports and online reviews

Use the results of government inspections and reviewers’ feedback to help get a more comprehensive picture of the facility.

Government inspection reports

Experts we spoke with recommend viewing the facility’s official state inspection history. In addition to any past regulatory violations, look for complaint patterns and how quickly staff addressed issues. If you need help interpreting the reports, you can contact your state’s long-term care ombudsperson for guidance. 

The U.S. Centers for Medicare & Medicaid Services also offers an online Care Compare tool. This resource compares nursing homes using a five-star rating system that includes health and safety inspections, staffing levels and quality-of-care measures.

Resident and family reviews

While reading online reviews, watch for recurring complaints, which could represent a red flag. 

If the situation allows, Collett recommends speaking with current residents and their families — not just those on the facility’s reference list. Firsthand accounts can offer a deeper look into the facility’s environment and day-to-day operations.

3. Understand cost and coverage options

Cost transparency is key. Ask questions so there are fewer surprises down the road — is there a base cost, regular rate increases or extra costs for certain services? For more insight, check out our guide on the hidden fees to watch for in assisted living facilities. 

Cost 

This varies drastically depending on location, facility type and the level of care required. Older adults who need more hands-on or specialized medical assistance will typically see higher costs. Facility offerings, such as certain amenities, programming, transportation or personal care services, may also affect price. 

Families can typically expect to pay between $5,000 and $10,000 per month, says Michael Brevda, an elder abuse attorney in Boca Raton, Florida. In the 2025 CareScout Cost of Care Survey, the median monthly cost for an assisted living community was roughly $6,200.

Coverage options

You may be able to help pay for long-term care with government assistance or a private insurance policy.

• Medicare: This federal program typically does not cover long-term care. Medicare primarily covers costs related to illnesses or injuries, and may cover hospital stays or qualifying short-term skilled nursing care. 
• Medicaid: This joint federal and state assistance program may cover the costs of long-term care facilities for eligible people. Unlike Medicare, Medicaid may cover individuals who meet specific income and asset criteria and require a certain level of care. Rules vary by state, so check your local Medicaid guidelines. 
• Long-term care insurance: This helps pay the costs of care for ADLs, such as bathing, dressing and eating. For more information, see AARP’s overview of long-term care insurance.

4. Note staffing numbers and approaches to care

Brevda says complaints about long-term care facilities often stem from inadequate staffing. “Many issues can be traced to facilities that simply do not have enough qualified staff to provide residents with the level of care and attention they need,” he explains. Assisted living care coverage varies by state. Not all states require Licensed Practical Nurses (LPNs) or Registered Nurses (RNs) to be staffed at all times.

Experts we spoke with emphasize the importance of asking specific questions about staffing, such as:

• What is the staff-to-resident ratio during the day, at night and on weekends?
• What qualifications are required for care staff?
• Do you have nurses on staff?
• What types of nurses are staffed and how many are on each shift? 
• How do you evaluate staff care performance?
• What ongoing education or training do you provide for staff?

Staffing requirements

It may be a good idea to request staffing data, especially if the facility gives vague answers about its worker-to-resident ratio, says Leslie Alin Tewes, a certified aging life care specialist in Ridgefield, Connecticut. 

What’s an ideal staffing level? 

Federal law requires nursing home facilities to provide “enough staff to safely care for residents” — but there is no current overarching staff-to-resident standard. There are no federal guidelines for assisted living facilities; they vary by state.

“A staffing ratio of one nursing assistant to eight residents on the day shift, seven days a week, is a fair, reasonable benchmark,” says Tewes. However, the ratio of nursing assistants to residents should increase if residents require more care. Facilities must post their staffing daily in a prominent place where residents and visitors can see it, she adds.

Specialized care 

If you’re considering a facility that offers specialized services like memory care, you may want to inquire about these extra needs. Suggested questions include:

• Who oversees the caregiving staff?
• What nursing support is available?
• How are individual care plans developed and updated?
• How does the team determine when someone’s care needs have changed?
• How does staffing differ in memory care?
• What type of training do the staff who care for memory care residents receive?
• What special measures do you employ to keep memory care residents from wandering?

Staff and resident relationships

It’s important for staff to interact with residents daily, beyond fulfilling basic duties. Consider asking staff what life looks like for residents after their basic needs are met, says Collett, the licensed residential care administrator in Idaho. “That answer tells you whether you’re choosing a place that’s managing decline, or one that’s actually helping your loved one live,” he adds. 

Ask how many staff members are permanent versus agency or contract. Staff who know residents well are more likely to notice subtle changes in their condition. “You want to see actual compassion and genuine relationships between residents and the people caring for them,” says Gloystein-Klatt.

Tewes suggests observing: Are residents clean and appropriately dressed? Are people sitting unattended in hallways? Do staff seem rushed? “Watch how they speak to residents. See whether the staffing you were told about is reflected in the care you actually observe,” she says.

5. Evaluate social and recreational opportunities 

Experts we consulted unanimously stressed the importance of ensuring the facility offers sufficient social and recreational programming. 

“I wouldn’t treat activities as ‘extra’ when comparing communities,” says Gloystein-Klatt. “Senior living should be about more than keeping someone safe. People still need connections, friendships, purpose, joy and opportunities to continue doing the things that matter to them.” 

Quality long-term care facilities should offer a robust calendar of activities and events that accommodate diverse interests and a range of cognitive and physical abilities. 

Research suggests that older adults who are more socially active may have better cognitive function than isolated adults. “[Social connections] aren’t a nice-to-have — they’re clinical,” Collett says, noting five important questions for evaluating a facility and its residents:

• Are they being mentally stimulated?
• Are they connected to others?
• Do they have a sense of purpose? 
• Do they feel seen rather than simply managed?
• Are they supported and encouraged to move their bodies?

“I call it SPICE — people have needs that are spiritual, physical, intellectual, cultural (or social) and emotional. If the facility isn’t set up to address them all, keep looking,” Collett adds. 

Personal hobbies and interests

Prioritize access to activities that help your loved one maintain their pastimes, whether it’s crafting, board games, book clubs, gardening or yoga. 

“Does this move support the life they love? That is what aging well means,” adds Sithong.

FAQs

What is the best way to transition to a long-term care facility?

It’s usually best to start the conversation before there’s a crisis. It can be much harder to understand your options when you’re also dealing with an emergency. “Ask your loved one what aspects of their life or health are becoming difficult, and what would make life easier or more enjoyable for them,” says Ashley Gloystein-Klatt, senior vice president of marketing and communications at Agemark Senior Living in Omaha, Nebraska. “Gloystein-Klatt also suggests starting with a short-term stay to give someone an opportunity to experience community life before making a longer-term commitment.

When moving into a facility, experts recommend bringing personal items that make the new space feel familiar, such as bedding, photos, artwork or a favorite chair. “Mentally, expect a grieving process, for them and for you,” says Eric Collett, a licensed residential care administrator in Boise, Idaho. 

What is the average monthly cost of a long-term care facility?

Long-term care costs can average around $5,000 to over $10,000 per month, says Michael Brevda, an elder abuse attorney in Boca Raton, Florida. The median monthly cost for an assisted living community is roughly $6,200, while the median monthly cost for a semi-private room in a nursing home is $9,581. That figure jumps to $10,798 for a private room.

What are the most common complaints about long-term care facilities?

The most common complaints Brevda receives in his elder-law practice involve inadequate staffing, poor communication with families, delayed responses to residents’ needs, medication errors and preventable issues such as pressure sores, infections and dehydration.

Questions or feedback? Email us at AARPSmartPicks@aarp.org.