Before You Tour a Facility: What Family Caregivers Need to Know

There may be a time when a loved one remaining at home is no longer appropriate. The in-home caregivers did a great job, but know their needs are such that a facility, such as assisted living, will be best.

Choosing a long-term care facility for a loved one involves more than searching the LTC News Caregiver Directory, touring facilities, and reviewing the Long-Term Care Insurance policy and finances. Families must evaluate staffing quality, Medicare and LTC Insurance limitations, caregiver responsibilities, long-term affordability, and operational stability before a crisis happens.

Understanding both the financial and quality-of-care sides of long-term care planning can help protect your loved one’s dignity, preserve family finances, and reduce family stress.

You may think the hardest part of dealing with an older loved one needing extended care will be the emotional side. In reality, many families discover the hardest part is making major decisions quickly while exhausted, overwhelmed, and afraid of making the wrong choice.

You tour a beautiful assisted living community. The lobby smells like fresh flowers. Residents are gathered around a piano. The salesperson reassures you that everything will be fine.

Your Guide to Assisted Living: Facility Services, Costs and Search Tools

Then you look at the monthly cost. Assisted living, like all long-term care, is expensive. If your loved one has Long-Term Care Insurance, consider it a blessing, as many people ignore the issue until it is too late. If there is no LTC policy in place, your loved one will pay for the facility out of their income and assets, unless they have little or nothing. In that case, they can use Medicaid, but that limits their options.

Find the current and projected cost of long-term care services where you live.

You may have to do some shopping depending on your budget. You may visit another facility that fits your budget, but the staff seems rushed, residents sit silently in wheelchairs, and unanswered call lights flash in the hallway.

That’s when many families realize long-term care planning is actually two separate problems happening at the same time:

• How will you pay for care over what could be many years?
• How do you know the place providing the care is actually well-run?

Planning should have started decades ago, and if your loved one has an LTC policy, the process of finding and paying for quality extended care is much easier. You and other family members can focus on being a family rather than crisis management. This is a good time to consider if you have your long-term care plan in place, as most people acquire a Long-Term Care Insurance policy between the ages of 47 and 67.

If there is no LTC policy, you focus on finding affordable options. Most families focus heavily on one side while underestimating the other. The result can be devastating: a financially sustainable plan tied to poor-quality care, or an excellent facility the family cannot realistically afford in the long term.

The families who navigate long-term care most successfully usually are not the wealthiest. They are the ones who begin planning before urgency removes their choices.

Caregiving Has Become Both Financial and Operational

Family caregiving in America continues to grow rapidly. According to AARP and the National Alliance for Caregiving’s Caregiving in the U.S. 2025 report, roughly 63 million Americans now provide unpaid care for an aging loved one, representing a 45 percent increase since 2015. The financial strain of family caregiving is substantial.

For many adult children and spouses, caregiving becomes a second full-time job layered on top of careers, parenting responsibilities, financial pressures, and their own health concerns. It is unsustainable.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, has repeatedly warned in caregiving research that unpaid family caregivers are increasingly the backbone of America’s long-term care system.

Family caregivers are the backbone of long-term care in this country. —Susan Reinhard, senior vice president, AARP Public Policy Institute.

Many caregivers suddenly find themselves acting as financial coordinators, healthcare advocates, insurance navigators, transportation managers, medication monitors, and crisis responders all at once. However, most family caregivers receive little guidance before being forced into these responsibilities.

The emotional strain can be enormous. Adult children often struggle with guilt, family disagreements, burnout, and the fear that one bad decision could affect a parent’s safety, finances, or quality of life.

According to the Family Caregiver Alliance, long-term caregiving carries significant financial consequences, and many caregivers continue providing intense care while suffering from poor health themselves. More than one-third of caregivers continue to provide intense care to others while suffering from poor health themselves.

Sibling conflicts can further intensify stress. One adult child may provide most of the hands-on care while others live farther away or disagree about finances, facility placement, or medical decisions. Many caregivers also balance full-time jobs while coordinating doctor appointments, medications, transportation, and financial planning late into the evening.

At the same time, the financial stakes are enormous.

According to the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE), approximately 56 percent of adults age 65 and older will eventually need long-term services and supports that meet the federal definition of long-term care.

The issue is significant and often ignored when someone is younger and healthier. Many people don't consider long-term care in their retirement planning.

Those future aging and chronic health needs can include help with:

• Bathing
• Dressing
• Mobility
• Supervision due to dementia
• Medication reminders
• Other daily living activities

Many families are financially unprepared for how expensive that care can become.

Medicare Does Not Cover Most Long-Term Care

One of the biggest mistakes families make is assuming Medicare will cover ongoing long-term care expenses. It will not. Medicare is health insurance. It is not designed to pay for extended custodial care, which includes help with daily living activities or ongoing supervision for chronic illness or dementia.

According to the Centers for Medicare & Medicaid Services (CMS), Medicare does not pay for long-term custodial care. It will pay for short-term skilled care. Medicare pays for short-term skilled nursing or rehabilitation coverage under very specific conditions, but those benefits are temporary and conditional.

Many families discover this only after a hospitalization or health crisis.

That misunderstanding can quickly create financial panic. Long-term care costs often exceed what Social Security retirement income alone can support. In many areas, monthly extended care costs now exceed the average retiree’s mortgage payment several times over.

Long-Term Care Costs Continue Rising

Long-term care costs vary dramatically depending on where you live and the level of care required. According to an LTC News survey of long-term care costs nationwide, the national average base cost of assisted living is over $5,000 per month, but many metropolitan markets exceed $8,000 or even $9,000 per month, plus surcharges that add to that cost based on the services required. Nursing home care can climb significantly higher.

Home care costs also continue to rise due to labor shortages, wage pressure, and increasing demand for caregivers. Research from PHI, a nonprofit organization focused on the direct-care workforce, has repeatedly warned that demand for caregivers continues to outpace supply in many regions of the country.

Our nation's long-term care system, and specifically our direct-care workforce , have long needed investment. That reality hasn't changed, and growing demand for care is only placing further pressure on the system. — Jodi M. Sturgeon, president and CEO, PHI.

That means families should never rely solely on national averages when building a care plan. Use the LTC News Cost of Care Calculator to find the average cost of extended care services where you live.

A realistic financial plan should evaluate:

• Local home care costs
• Assisted living expenses
• Memory care pricing
• Nursing home rates
• Inflation trends
• Future care escalation
• Duration of likely care needs

The difference between a lower-cost rural market and a major metropolitan area can amount to hundreds of thousands of dollars over a prolonged care event. Consider your loved one's LTC Insurance benefits (if any), social security income, pension income (if any), and earnings from investments to determine your budget to pay for long-term care.

How Long-Term Care Insurance Changes the Conversation

Long-Term Care Insurance can dramatically improve care flexibility and preserve financial stability for many middle-class and upper-middle-class families.

Unlike health insurance and Medicare, Long-Term Care Insurance is specifically designed to help pay for extended care needs, skilled, semi-skilled, and homemaker and companionship services.

Benefits are generally tax-free and may help cover:

• In-home care
• Assisted living
• Memory care
• Adult day care
• Nursing home care

Families with an LTC policy will have more choices because they are not forced into Medicaid providers, spend-down strategies, or rapid liquidation of retirement assets.

Coverage can also reduce pressure on your adult children who may otherwise become unpaid caregivers for years. Perhaps most importantly, Long-Term Care Insurance can help older adults remain at home longer, preserving independence and quality of life.

Most older adults prefer to remain in their homes as they age whenever possible, according to multiple AARP aging surveys examining aging-in-place preferences.

The challenge is timing. Waiting until health problems emerge can make coverage more difficult or expensive to obtain.

LTC News Long-Term Care Insurance Learning Center

Why Waiting Too Long Reduces Care Choices

Many families begin planning only after a fall, stroke, dementia diagnosis, or hospitalization. However, by then:

• Emotions are elevated
• Decisions become rushed
• Facility availability may be limited
• Finances are harder to reorganize
• Siblings may disagree
• Caregivers are already exhausted

Crisis planning rarely produces the best outcomes. The reality is that time creates options. Urgency removes them.

Research Facilities Before Touring Them

Before scheduling a tour, families should evaluate facilities using publicly available federal tools. You can start with the LTC News Caregiver Directory and search for caregivers and facilities by zip code. Comparing long-term care providers by location makes finding quality care options much easier.

Then you can search the Medicare Care Compare, which allows families to review:

• Inspection histories
• Staffing levels
• Complaint records
• Health deficiencies
• Federal enforcement actions
• Overall star ratings

The ratings are not perfect, but they can quickly identify facilities with serious operational concerns. This step alone can save families from wasting time touring communities with troubling histories.

Distance matters too.

A highly rated facility located 90 minutes away can be difficult for families to monitor consistently. Frequent family visits remain one of the strongest accountability pressures on long-term care providers.

What Families Should Watch During a Facility Tour

Marketing presentations rarely reflect the full reality of daily operations. What you observe directly matters more. If possible, tour during shift changes or meal periods when operational stress becomes more visible.

Pay attention to:

• Staff interactions with residents
• Resident appearance and grooming
• Unanswered call lights
• Resident engagement
• Noise levels
• Odors
• Dining room activity
• Staff responsiveness
• Cleanliness of common areas

The residents themselves often tell the story.

• Are residents socially engaged or isolated?
• Do they appear alert or heavily sedated?
• Are staff members making eye contact and speaking respectfully?
• Smell matters too.

Well-run facilities may have a faint clinical smell. Heavy air freshener can sometimes mask deeper sanitation or continence-management problems.

Ask to see the dining room during a real meal service, not just during a quiet tour window. Observe whether residents appear rushed, ignored or assisted respectfully.

Questions Families Should Ask During Every Facility Tour

Most families spend too much time discussing amenities and not enough time discussing staffing. The staffing structure determines care quality far more than the activity calendar or lobby décor.

Some of the best nursing homes I've worked with have high staff retention, and sometimes you'll even see generations of family members who've worked there. You want staff who feel they're doing something meaningful. — Nancy Avitabile, LMSW, owner of Urban Eldercare and aging life care manager, New York, quoted in U.S. News & World Report, "How to Choose a Good Nursing Home: Expert Tips for 2025," by Elaine K. Howley, updated November 26, 2025.

Important questions include:

• What is the certified nursing assistant-to-resident ratio during day, evening and overnight shifts?
• What percentage of staffing comes from agency workers?
• What is the annual turnover rate among direct-care staff?
• How long has the director of nursing or wellness director been in place?
• How are leadership vacancies handled?
• How quickly are call lights answered?
• What infection-control procedures are currently in place?
• How are medications managed and reviewed?
• How are family concerns escalated?
• What happens if a resident’s care needs increase?

If your loved one has Long-Term Care Insurance, ask them if they will help complete claim forms — File a Long-Term Care Insurance Claim.

Listen carefully to the answers. Clear operational answers matter. Deflection is a warning sign.

Why Staffing Stability Matters

Staffing is one of the strongest predictors of resident outcomes.

Turnover in health care staff may disrupt patient care and create operational and organizational challenges, and nursing home staff turnover rates are particularly high. — Karen Shen, PhD, Brian E. McGarry, MD, and Ashvin D. Gandhi, PhD, JAMA Internal Medicine. 2023.

A facility experiencing chronic turnover often struggles with:

• Communication
• Consistency of care
• Medication management
• Response times
• Resident familiarity
• Family trust

Leadership stability matters too. The wellness director or director of nursing often oversees:

• Chronic disease management
• Care planning
• Medication oversight
• Staff coordination
• Family communication
• Regulatory compliance

When those leadership positions remain vacant for prolonged periods, operational quality can deteriorate quickly. Well-run communities usually have contingency plans and interim leadership strategies to maintain stability during transitions.

The leadership-vacancy question is an important one, as facilities often take on the personality of their leadership. The honest answer involves interim staffing — most well-run facilities maintain relationships with executive search firms that handle what an interim wellness director does during gaps in permanent leadership, so resident care stays steady through transitions.

Facilities that can’t articulate how they bridge those gaps — that say something like “we just figure it out” or “we share the workload” — are flagging a real risk. The wellness or resident services director runs chronic disease management, medication reconciliation, family communication, and survey readiness for the whole community. A vacuum in that role for more than a few weeks shows up in resident outcomes within a quarter, even if the marketing materials never reflect it.

The nursing home administrator and director of nursing are the two key leadership positions in nursing homes and play an important role in delivering high-quality long-term care services, according to a 2025 peer-reviewed study published in the Journal of the American Medical Directors Association that examined the association between leadership turnover, star ratings, and consumer satisfaction.

Warning Signs a Facility May Be Struggling

Families should never ignore operational warning signs during a visit.

Potential red flags include:

• Persistent strong odors
• Unanswered call lights
• Disengaged residents
• Visible understaffing
• Rushed employees
• High agency staffing use
• Residents isolated in rooms
• Poor cleanliness
• Inconsistent communication
• Heavy staff turnover

Even attractive, well-marketed facilities can struggle with staffing and care quality behind the scenes.

Steps Families Should Take Before a Care Crisis Happens

The best long-term care decisions usually happen before a medical emergency forces immediate action.

A practical order of operations includes:

1. Gather financial records and insurance policies.
2. Review Medicare limitations carefully.
3. Assess realistic future care needs.
4. Compare local care costs using the LTC News Cost of Long-Term Care Services Calculator.
5. Review Long-Term Care Insurance coverage, if available.
6. Research facilities online before touring.
7. Tour multiple communities.
8. Ask staffing-focused questions.
9. Establish legal planning documents.
10. Create a realistic long-term funding strategy.

Families should also discuss caregiving expectations openly before a crisis develops. Many caregiving conflicts begin because assumptions were never clarified early.

Why Early Planning Gives Families More Control

Long-term care planning is not simply about finding a facility or organizing finances. It is about protecting dignity, preserving independence, reducing family stress, and maintaining quality of life during one of the most vulnerable periods of aging.

The consequences of aging require planning. The best planning starts well before you retire. However, if you have older family members, even if they cannot qualify for Long-Term Care Insurance or have limited financial resources, a family discussion about long-term care should take place before the crisis begins.