Prefer the printable version? Download the PDF checklist (1 page) - bring it with you.
How to Use This Checklist
Tour at least two or three assisted living homes before you decide - ideally one large community and one small home so you can feel the difference between the two models. Bring this checklist to every tour and ask every home the same 18 questions in the same order. Write each home's answer in a column next to the question, or print a fresh copy for each visit. Do not rely on memory. By the third tour, the homes blur together, and a confident answer from home #1 starts to sound identical to a vague one from home #3.
The goal is not to catch anyone in a gotcha. It is to give yourself apples-to-apples data (a structured-tour approach also recommended by the National Center for Assisted Living consumer resources) so the comparison does itself when you sit down at your kitchen table afterward. The most useful answers come back with numbers, names, and documents. When a home reaches mostly for adjectives - "excellent," "family-like," "caring" - that is a cue to ask for the specifics underneath them.
Staffing (Questions 1–3)
1. What is your staff-to-resident ratio during the day, and what does it drop to overnight?
What you want is a specific number for each shift - for example, "one caregiver for every four residents during the day, one caregiver for every six residents overnight, plus the on-call nurse." "We have enough staff" or "it depends on need" leaves the number out, which is the part that matters. Maryland regulations set minimums, not ceilings, so the actual ratio a home chooses to run tells you a lot about how it operates. Press for the overnight number specifically - thin overnight coverage is easy to gloss over. Also ask whether the ratio counts the administrator, the cook, and the housekeeper; if it does, the real direct-care ratio is worse than the headline number.
2. Who are the people on shift right now - and how long have they worked here?
Ask to be introduced to the caregivers who are actually there during your tour. A well-run home is glad to introduce its team. Ask each caregiver how long they have worked there. High staff turnover tracks closely with poorer resident outcomes, so tenure is one of the more telling things you can learn on a tour. If the longest-tenured caregiver on shift has been there six weeks, that points to a home churning through staff, whatever the director says about it. Tenure of two-plus years across multiple caregivers is a strong positive signal.
3. Is there awake, on-site staff 24 hours a day, or is overnight coverage on-call?
In Maryland, every licensed assisted living program is required to have awake staff on site around the clock. The question still matters because it tells you how the home talks about its own obligations. The answer you want names the awake overnight caregivers by role. A hedge - "we have someone available," "staff sleeps on-site but responds immediately," or "we use a call system" - is worth following up on until you hear clearly that an awake caregiver is on the floor through the night. If what you hear does not match that requirement, ask the home to clarify, and confirm it before your parent moves in.
Medical & Medications (Questions 4–6)
4. Who administers medications - a CMT, an RN, or unlicensed staff?
In Maryland, medication administration in assisted living is performed by a Certified Medication Technician (CMT), a delegating nurse (RN), or an LPN. Unlicensed caregivers may assist with self-administration - handing a resident their pre-poured dose - but they may not administer from a multi-dose bottle. Ask specifically which credentials the staff hold and whether the home employs its own delegating nurse or contracts one. The answer to listen for names the RN and how often she visits. If you hear "our caregivers handle meds" with no mention of credentials, ask a follow-up about who is certified and who supervises them.
5. How do you coordinate with my parent's primary care doctor, and do you have an on-call nurse?
The best homes act as a clinical bridge between the resident and the outside medical world. Ask how they communicate with your parent's primary care doctor when something changes - do they fax a clinical update, call the office, or wait for the next visit? Ask whether the home has an on-call RN available 24/7 for clinical questions, or whether caregivers must send residents to the emergency room for anything beyond a scraped knee. A home that treats the ER as its first-line escalation is a home that may hospitalize your parent more often than necessary.
6. Walk me through what happens if my parent falls, refuses a medication, or develops a UTI.
This is one of the most revealing questions you can ask. Pose it as a single open-ended prompt and let the director talk. A well-run home will walk you through three distinct protocols - fall assessment and notification, medication refusal documentation and physician contact, and UTI symptom recognition (including behavioral changes like new confusion) with a specimen collection pathway. If the answer stops at "we'd call you," there is more to ask about. How much detail comes back here says more about a home's clinical depth than a brochure can.
Daily Life (Questions 7–9)
7. What does a typical Tuesday look like here, from breakfast to bedtime?
Not a weekend, not a holiday, not an open-house day - a typical midweek Tuesday. A good answer walks you through the whole arc: wake-up help, breakfast served family-style or in a dining room, a morning activity, lunch, quiet hours, an afternoon activity, dinner, evening routine, medications, and bedtime. If the answer collapses into "residents do what they want," that usually means nothing is programmed and residents spend the day in front of a television.
8. How do you handle food preferences, cultural foods, and texture-modified diets?
Food is one of the last pleasures people keep, especially in later life. Ask whether meals are cooked on site or brought in, whether the home can accommodate cultural or religious dietary needs, and whether texture-modified diets (pureed, mechanical soft, thickened liquids) are handled in-house or require a special order. A home with a real working kitchen can usually tailor meals to individual residents. Where many meals are plated at once from a set menu, "we have options" is worth pressing into specifics - which diets, prepared how, and how a one-off request gets handled.
9. Can I visit any time, or are there set visiting hours?
Maryland law does not allow assisted living homes to restrict family visits outside of a public-health emergency. A home that enforces strict visiting hours in normal times is a home that would rather not have outside eyes during medication passes, meals, or evening shifts. The right answer is some version of "come any time, just ring the bell." If you hear anything more restrictive, ask why.
Safety & Emergencies (Questions 10–12)
10. What is your plan for fires, severe weather, and power outages?
Every licensed Maryland assisted living program is required to have a written disaster and emergency plan. Ask to see it, or at least to hear it narrated. A good answer covers evacuation procedures with specific assembly points, how residents with mobility limitations are moved, and how medications and medical records travel. Ask specifically about generator capacity - does the home have a standby generator that runs refrigerators (for insulin), oxygen concentrators, and at least one room of lighting? If not, what is the plan for a 24-hour outage in July?
11. How many falls has this home had in the last 12 months, and what did you change after each?
Every home has falls; the number itself is not the concern. What you are listening for is whether the home tracks falls and reviews each one for cause, then adjusts: a different footwear policy, a new transfer technique, a repositioned nightlight, a change in medication timing. A home that can say "we had four falls last year, three in bathrooms; we added grab bars and a non-slip mat pattern" is telling you it pays attention. "We don't really have falls here" usually means no one is counting.
12. May I see a copy of your most recent OHCQ inspection report?
Every licensed Maryland assisted living home is inspected by the Office of Health Care Quality. Reports, including any deficiency citations and corrective action plans, are public records. A confident home produces the most recent report on the spot or emails it to you the same day. If a home hedges - "I'll have to ask," "we don't usually share those," "the state is updating the format" - you can pull the same report yourself from the OHCQ locator, so it is worth getting either way. Read it before you sign anything.
Pricing & What's Included (Questions 13–15)
13. What is the all-in monthly price for my parent's care level - with nothing extra billed later?
This is where most families get surprised after move-in. Ask for an all-in number for your parent's specific care level - Level 1, 2, or 3 in Maryland - and ask explicitly what it includes. The answer you want sounds like "$X,000 per month, which covers room, meals, medication administration, laundry, housekeeping, and all personal care assistance, with nothing else billed separately." Be cautious when the price comes as a base rate plus "care points" or "service tiers" assessed after move-in; those add-ons can run $500 to $2,000 a month and are a frequent reason families feel blindsided by their first invoice.
14. Which services cost extra - incontinence supplies, two-person transfers, hospice coordination, transportation?
Ask this even if the home told you the price is all-inclusive. Common add-ons at larger communities include incontinence supplies (briefs and pads, often billed at retail markup), two-person transfer surcharges once a resident needs more hands, physician or podiatry visit fees for in-house providers, transportation to medical appointments, and hospice-coordination fees. A small home typically rolls most of these into the monthly rate. A large community typically does not. Get the itemized add-on list in writing and compare it against the base rate before you sign.
15. How often do rates go up, by how much historically, and how much notice do residents receive?
Annual rate increases are normal and legal. The questions are how often, by how much, and with how much notice. Ask for the last three years of increases as percentages. Single-digit annual increases are typical; double-digit increases signal either a genuinely strained operator or a market that takes advantage of the difficulty of moving an elderly resident. Maryland requires at least 45 days' written notice before a rate change - confirm the home meets that minimum, and ideally provides more.
Transitions & Move-Out (Questions 16–18)
16. At what point would my parent's needs exceed what your license allows, and what happens then?
Every Maryland assisted living home is licensed at Level 1, 2, or 3 and has discharge triggers - points at which the law requires a transfer to a higher level of care. Ask the director to spell them out for your parent's level. Common triggers include two-person transfers (past Level 3), continuous skilled nursing needs, or behaviors that pose a danger to others. A good home tells you the triggers up front and helps families plan the next move well before it becomes a crisis. An evasive home leaves you to discover the triggers the week of discharge.
17. How do you support a resident transitioning to hospice - do they stay here or move out?
Most Maryland assisted living homes can keep a resident on hospice, working alongside the hospice agency's nurses and aides. The question is how willingly and how well. Ask how many current or recent residents were on hospice, and whether the home has ever had a resident die in their own bed at the home. Families overwhelmingly want the end-of-life period to happen in place, not in an unfamiliar hospice facility. A home that routinely keeps hospice residents until the end is a home that treats aging as a continuum, not as a series of transfers.
18. What is your refund policy on the community fee and the final month if we need to leave?
Community fees - one-time move-in charges - can run $2,000 to $5,000 at many Maryland homes, and refund policies vary wildly. Ask for the refund schedule in writing and read the last-month billing policy carefully. Some homes prorate the final month; others charge a full month plus 30 days' notice. Neither is illegal, but the difference can be several thousand dollars at a moment when the family is already navigating grief or a crisis.
Frequently Asked Questions
How many assisted living homes should I tour before deciding?
Tour at least two or three - ideally one large community and one small home so you can feel the difference. Fewer than two makes comparison impossible; more than five blurs together. Bring the same checklist to each, ask the same questions, and note the answers in the margin. When you spread the pages out afterward, the right home usually identifies itself.
What are the most important questions to ask on a tour?
Staffing ratio day and overnight, who administers medications and what credentials they hold, the home's most recent OHCQ inspection report, the all-in monthly price with every add-on spelled out, and the discharge triggers that would force your parent to move. If a home answers those five specifically - with numbers, names, and documents - the rest usually follows.
Should I tour on a weekday or a weekend?
Tour on a weekday, ideally mid-morning or around lunch. That's when staffing is at its normal level and you can watch a real meal, a real medication pass, and a real transfer. Weekends often run on lower staffing and scripted activity, so they can flatter a home. Come back for a second, shorter visit at a different hour before you sign.
Can I drop in unannounced to see what a home is really like?
Most licensed Maryland assisted living homes welcome brief, unannounced drop-ins during daytime hours. Call from the driveway, explain you're a prospective family, and ask for a 10-minute look. If the home will only see you by scheduled appointment, that is worth noting alongside everything else you learn. Be considerate: avoid meal times and never enter resident rooms without permission.
What red flags should I watch for on a tour?
A staff member who can't answer basic questions without asking the director; a strong odor in common areas; residents lined up in front of a loud TV with no engagement; reluctance to show the most recent OHCQ inspection or discuss deficiency citations; vague pricing answers; or a care director who has been in the role less than six months. Pay attention to what you smell and to the answers that arrive slowly or not at all.