Also called residential care homes, adult family homes, or adult foster care homes, depending on the state.
Choosing an adult care home is an important decision. Though smaller than an assisted living community, these residential settings offer a more personal environment, but they vary greatly in staffing, services, routines, and costs.
To streamline the search through hundreds of available options, 1st CHOICE uses your information and unique circumstances to create a focused list of homes for you to consider.
When evaluating these options, keep the following expert insights in mind:
Prioritize Communication on Tours
On your first visit, focus primarily on whether you can communicate well with the provider or resident manager. While almost all owners are involved in day-to-day operations, their hands-on care varies. Some handle direct care, while others focus on meal planning, shopping, and oversight, relying on lead caregivers instead.
Put Yourself in the Older Adult’s Shoes
Avoid making decisions based on your own preferences. While families often assume larger assisted living facilities are “better” due to big apartments and group events, the crowds and high staff turnover can be overwhelming. Frail seniors or those with memory loss benefit from smaller environments where a caregiver is always within eyesight or earshot.
Rethink Activities and Space
Adult children often look for group activities, but older adults tend to prefer individualized interactions. For someone with memory loss, the best activity is simply having someone to talk to and reminisce with. Additionally, be careful not to overemphasize room size or the need for a private bathroom. Bedrooms are primarily for sleeping; residents spend their days eating and socializing in communal areas.
Trust Your Own Observations
While 1st CHOICE guides your search and offers continued support after the move, recommending a specific home is outside our scope. The final provider you select must be based on what your eyes see, your ears hear, and your heart tells you.
Care, Staffing & Oversight
Operator Experience and Day-to-Day Involvement
The operator’s experience, background, and role in daily operations vary from home to home. A newer provider may still be a good fit; focus on the quality of care, oversight, and how the home meets the resident’s needs.
Ask:
- Who manages the home’s day-to-day operations?
- How involved is the owner?
- How are complaints or disagreements handled?
Staffing, Training & Backup Coverage
Consistent caregivers can help residents feel secure and understood. Some homes have an awake overnight caregiver; others may have a sleeping caregiver.
Ask:
- How many caregivers are typically on each shift?
- Are overnight staff awake or asleep?
- How are callouts covered?
- If an awake caregiver isn’t offered, what’s the process if one becomes needed, and who covers that cost?
Licensing, Inspections & Complaints
Confirm the home’s current license and ask to review a recent inspection report and any corrective actions. Keep in mind that infractions are common and are a record of past concerns that have been corrected.
Ask:
- Can I review the most recent inspection report?
Caregiver Roles, Health Support & Medication
Caregivers can provide certain services directly; other services require a nurse or other licensed professional to be involved. Understand how medications are stored, administered, documented, and monitored, and how health concerns are addressed.
Ask:
- How often does a nurse visit?
- How are medications and changes in condition documented, and who gets contacted?
When Care Needs Increase
Discuss the home’s ability to support changing mobility, dementia-related behaviors, incontinence, two-person transfers, or more complex care. Ask what circumstances might require a move.
Ask:
- What happens if needs exceed the home’s capabilities?
Emergency Plans & Family Communication
Preparation for emergencies and resident safety during power outages, severe weather, or other disruptions is the home’s responsibility.
Ask:
- How are families notified about falls, injuries, hospital transfers, or significant changes in health?
- What is the backup plan if a caregiver is unavailable?
Residents’ Rights, Privacy & Concerns
Residents should be treated with dignity and involved in decisions about their care and daily routines.
Ask:
- How are resident preferences accommodated?
- Does staff knock before entering bedrooms?
Daily Life & the Home Environment
Activities, Routines & Social Connection
Meaningful daily activities support cognitive health, emotional well-being, and a sense of purpose. Activities are particularly important for residents with memory loss, who benefit from structured, predictable engagement.
Ask:
- What does a typical day look like?
- Are residents expected to be out of bed or in their rooms at set times?
Personal Care & Toileting
Discuss how the home supports bathing, dressing, grooming, oral care, nail care, and toileting while respecting privacy and preferences.
Ask:
- How often is bathing offered, and can schedules be adjusted?
- How often are residents checked for toileting needs?
- How do staff respond when a resident needs help unexpectedly or resists care?
Meals & Special Diets
Home-cooked meals are one of the hallmarks of adult care home living, but quality and customization vary widely.
Ask:
- Who prepares meals?
- How are concerns about eating and drinking addressed?
- Can meals be adapted to personal and cultural preferences, dietary restrictions, swallowing difficulties, snacks, and hydration?
- How are changes in appetite noted and communicated?
Rooms, Bathrooms & Accessibility
Look at room size, privacy, furniture, storage, bathroom access, grab bars, shower entry, and space for walkers or wheelchairs. People who pay privately for services can typically opt for a private or semi-private room. Those receiving Medicaid support are asked by the state to share a room, but this also depends on the room types the operator has available and what works for them.
Ask:
- Are bathrooms private or shared?
Outdoor Space, Mobility & Safety
Check whether hallways, entrances, bathrooms, and outdoor areas are accessible. Ask how residents are supported with walking, stretching, or therapy recommendations. For residents at risk of wandering, discuss supervision, secure outdoor space, and how the home balances safety with independence.
Ask:
- How are wandering risks assessed and managed?
- What help is available for mobility or prescribed exercises?
Visitors, Outings & Appointments
Some homes are able to offer social outings and transportation to appointments.
Ask:
- What are the visiting rules, and is advance notice of a visit preferred?
- Who coordinates medical appointments?
- How can residents maintain relationships and participate in activities outside the home?
Costs, Agreements & Planning Ahead
Rates, Included Services & Additional Fees
Request a written breakdown of the base rate, care charges, and services that cost extra. Ask how rates may change as needs increase, what notice is given before increases, and whether there are charges for supplies, transportation, special care, or end-of-life support.
Ask:
- How are care levels assessed and priced?
- What could cause the monthly rate to increase?
- What happens to charges during a hospital stay or temporary absence?
Payment Options & Future Financial Needs
Ask which payment methods the home accepts, including private pay, long-term care insurance, or Medicaid, if applicable. If savings may run out, discuss this possibility early and ask whether the home may accept Medicaid in the future. Do not assume Medicaid will be an option; eligibility, availability, and policies vary. Be certain to obtain the details in writing. Verbal commitments are of no value to your family.
Ask:
- If applicable, would the home consider a change from private pay to Medicaid, and under what terms?
Deposits, Bed Holds & Move-In Timing
Before paying a deposit or bed-hold fee, get the terms in writing. Confirm whether the payment is refundable, whether it applies to the first month’s charges, what happens if move-in is delayed, and what happens if the resident’s needs or plans change. Avoid feeling rushed; make sure you understand the agreement before paying. Again, all agreements should be in writing.
Ask:
- What does the fee reserve?
- Is any portion refundable or credited toward rent?
- What if a hospital or rehabilitation discharge delays move-in?
Move-Out Policies & Contract Review
Review the agreement for notice requirements, refunds, rate changes, and circumstances in which the home may ask a resident to move.
Ask:
- What happens if the home can no longer meet care needs?
Consider having an attorney or trusted advisor review the agreement before signing.
Assessments & Admission Requirements
Some states and homes require an assessment before admission. Requirements differ by state, so confirm the process for the specific home.
Ask:
- Who completes the assessment?
- What does it cost, and who pays for the assessment?
A Final Word
It will help to remember that many operators aren’t marketers, so don’t expect a polished sales presentation. Most operators are first and foremost caregivers themselves, and they are giving careful consideration to who is a good fit for their home as well. They trust that you will provide them with information that is as detailed and accurate as you can make it.
1st CHOICE Advisory can help families understand options and narrow the search based on care needs, finances, location, and preferences. The final choice and agreement are between the family and the home’s operator. Review all terms carefully and confirm state-specific licensing and admission requirements before making a decision.