Steps for Selecting an Assisted Living Facility

The following steps may help you find a suitable home. If you are assisting a loved one in looking for a facility, include him or her in as much of the selection process as possible. Consider that person’s interests, ideas and wishes as you look at the options.

Ask friends, relatives, clergy and physicians about their experiences in particular facilities.

Contact the Ombudsman for information on types of adult care homes, location and services available and for public records information.

Contact the County Department of Social Services: 

  • Financial aid. Applications for financial assistance can be made at the county Department of Social Services. A physician for all residents entering an adult care home or family care home must complete a condensed medical summary.
  • Talk with the Adult Home Specialist at the local Department of Social Services, which monitors the homes. Ask for an opportunity to review Monitoring Report Forms and/or Corrective Action Reports. These reports are public record.

Visit the home. In addition to arranging a meeting with the administrator and/or supervisor-in-charge, make unexpected visits on weekends (during visiting hours) and at meal times. Identify yourself to the staff and ask if you might walk through the facility to determine if you or your relative could live there comfortably.

  • Remember to respect the residents’ right to privacy as you visit. Use your eyes, ears, and nose to determine whether residents are receiving reasonable and proper care.
  • Ask about the administrator and/or supervisor’s involvement with the facility and its residents – the hours they are on site, the staff ratio, the stability of the staff and the manner in which problems are resolved.

Carefully examine the facility’s contract. Note what services are included and which services may require additional fees. If possible, have an attorney review the language of the contract to protect the interests of the resident.
Check for language that asks consumers to waive their rights such as mediation clauses.

Review the facilities written policies. Are you comfortable with the requirements and guidelines? Smoking, for example, may not be allowed indoors or be limited to certain rooms.

Ask about any special needs the resident might have. Determine provisions made for people allergic to tobacco smoke or require a special diet. Determine that there is adequately trained staff to meet the resident’s need.

Financial Considerations


All N.C. Residents entering an adult care home must have a basic health assessment within the first few days of admission. This N.C. regulatory assessment form is not used to set rates for reimbursement. However, some facilities set their “rate” of reimbursement on their own company assessment. There is NO STANDARDIZED formula for rate setting in North Carolina or for the forms used by facilities to determine private pay rates. Before signing a contract, consumers should clearly understand:

  • What aspects of resident care are being assessed and who is doing the assessment? What are their credentials?
    Does the consumer have an opportunity to participate or challenge the results?
  • Will the assessment create a change in how service is delivered?
  • What staff person(s) are responsible for the service?
  • What duration and frequency will the service be provided?
  • What staff person will be supervising the services?

Since there is no rate setting standard in North Carolina, the costs of adult care homes can vary from $1,800 – $5,500 a month. Many facilities charge a basic fee for a complete package of room, board, and services. Others have a base fee and then charge from a “menu” of cost associated with each specific service. There may be other fees associated with a stay at the assisted living:

  • Entry or application fee
  • Fees associated to admission to the secure unit designed specifically for persons with Alzheimer’s Disease or other types of dementia
  • Room holds when a resident is away for an extended period to the hospital or other health care setting.
  • Private room fees
  • Medication administration or packaging fee
  • Leave of absence fees for packaging medication
  • A pre-determined time to be a private pay resident
  • An additional payment to supplement the cost for private rooms or rooms in a special care unit when a person receives State County Special Assistance
  • Care fees associated with special needs such as isolation, difficult behavior, extra housekeeping if the resident is incontinent of has other health care needs
  • Activity fees
  • Special dietary needs may require extra fees for food or preparation

Remember, that ALL charges for services should be specifically outlined in the contract/resident agreement and agreed to by both the resident and the facility. Many companies will negotiate special rates, discounts and other benefits to moving into their community. Be sure that these are also detailed in the agreement including the special rate, the end date of the “special” and if other promises are made about deals for the future, that these are also well documented and agreed upon by both parties. This might include having a room when the person changes their pay status from private pay to SCSA. Some long-term care insurance policies will pay for assisted living care. Verify this coverage before the move-in date so there is no surprise at the first month billing. The lease agreement or admission contract is also called the RESIDENT AGREEMENT. This important document indicates costs and responsibilities of the resident and/or their representatives to ensure payments to the facility in exchange for services. These are not regulated or standardized either.

Consumers should:

Request a copy of the contract prior to admission to review the language and prepare questions.

Keep a copy of the signed contract on hand.

• Facilities are obligated to make sure that residents and their representatives understand their rights, the language of the contract, the programs available to cover services and the limits of these programs.

• has legal authority to handle the resident’s financial affairs.

• If a resident has been declared legally incompetent, a guardian or Power of Attorney may have to sign all of the necessary papers for admittance. BEWARE mediation clauses that may ask you to waive your right to contact an attorney!

What to Look for in an Assisted Living Setting


• Clean, hair tidy, shaved, odor-free
• Communicating with one another
• Involved in activities
• Satisfied with the care being provided


• Ample, nutritious, tasty
• Appropriate temperature
• Menus posted, choice of foods


  • Interacting with residents in cheerful manner
  • Promptly responding to resident’s needs
  • Adequate number to ensure proper care for all residents
  • Administrator’s availability with staff supervision and resident’s needs

Physical Plant:

• Clean environment, beds made, clean and adequate supply of linens
• Absence of insects
• No safety hazards
• Safe conditions, ample lighting, draperies clean and hanging properly


• Activities posted on calendar
• Varied and interesting activities
• Participation of residents in activities
• Single focus, designated Activity staff person

Medical Services: 

  • Type of staff on duty full time
  • On-going training hours provided by facility
  • On-site medical visits by doctor, and specialists (foot doctor, dentist, therapists)
  • Pharmacy service (Can your pharmacy provider accommodate the facility system?)
  •  Special Care for residents with dementia