How Do You Choose an Assisted Living Facility?

The short answer: choose the level of care first, the operator second, and the building last. Most families do it in the opposite order. They tour the lobby, taste the food, and sign, and then learn six months later that the facility cannot keep a resident who needs a two-person transfer, does not accept Medicaid, or has no memory care unit to move into when the dementia progresses. Assisted living is licensed and regulated by each state, not by Medicare, so the rules about who can stay, who must leave, and who pays differ in New Jersey, New York, and Connecticut. The facility that fits is the one whose license, discharge criteria, payment policy, and inspection record match the person’s likely trajectory over the next three to five years, not just their needs today.

Posted on September 20, 2026 (updated on September 21, 2026)

Hotel-style lobby hallway with framed art and a brass floor lamp, with the headline "Look Beyond the Lobby"

This article walks through the decisions in order: whether assisted living is the right setting at all, what kinds of licensed assisted living exist in each state, when memory care or a nursing home on the same campus matters, whether Medicaid will ever pay, where to find inspection reports and complaints, and what to ask on the tour. The companion article on what to check before signing an admission agreement covers the paperwork itself.

Takeaways:

Assisted living is state-licensed, and each state defines differently what a facility may do and when it must discharge a resident; read the license category, not the brochure
Medicaid pays for assisted living services in limited ways in all three states, never for room and board, and only in facilities and beds that participate; ask about payment policy before the first tour
If dementia is part of the picture, choose a facility with a licensed or certified memory care program now, even if the resident does not need it yet
Inspection reports, complaint histories, and enforcement actions for assisted living are public in every state, but they are not on Medicare’s Care Compare, which covers nursing homes only

FREE WEBINAR

5 Things to Know About

Estate Planning

When You Turn Sixty-Five

Is Assisted Living the Right Level of Care?

Assisted living sits between living at home with help and a nursing home. It is housing plus meals, supervision, and hands-on help with bathing, dressing, medications, and mobility, with nursing oversight but not around-the-clock skilled nursing. The person who belongs there needs more help than a few hours of home care can provide, or is unsafe alone, but does not need a nurse at the bedside. Before committing to a move, families should rule out two things.

First, whether more support at home would work. Home care agencies, adult day programs, and the state home care programs described in our article on whether Medicare pays for housekeeping keep many people at home longer than families expect, and a person with a serious illness can add palliative care at home. Palliative care is often confused with hospice. The National Institute on Aging draws the line: “In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis,” while “hospice care is a specific type of palliative care that is provided in the final weeks or months of life.” For someone whose main problems are pain, symptoms, and coordination of care rather than help with daily tasks, a palliative care consult may change the question from “which facility” to “what support at home.”

Second, whether the person already needs a nursing home. Each state’s assisted living rules describe residents the facility may not keep, and a person who already meets those descriptions on move-in day will be discharged soon after. The New Jersey list, described below, is the most detailed and is a useful screen in any state.

Hospice, for what it is worth, is available in either setting. Medicare’s hospice page says a person “can usually get Medicare-approved hospice care in your home or other facility where you live, like an assisted living facility or a nursing home,” and eligibility under 42 C.F.R. 418.22 requires a physician’s certification that “the individual’s prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course.” Medicare pays the hospice services. It does not pay the rent. Medicare’s long-term care page states flatly that “Medicare doesn’t pay for long-term care,” including the non-medical services a person receives “in an assisted living facility.”

What Kinds of Assisted Living Exist in Each State?

The word “assisted living” is a marketing term until you know the license behind it. The three states organize it differently.

New Jersey

The New Jersey Department of Health licenses assisted living residences and comprehensive personal care homes under N.J.A.C. 8:36, and separately licenses assisted living programs that bring the same services into subsidized housing. The regulations are built around a defined concept of “aging in place,” which N.J.A.C. 8:36-1.3 calls “a process whereby individuals remain in their living environment despite the physical and/or mental decline and growing needs for supportive services.” A resident who wants to take a risk the facility considers unwise, such as walking without a walker, is entitled under N.J.A.C. 8:36-5.18 to have the facility “seek to negotiate a managed risk agreement” rather than simply refuse. New Jersey also requires, under N.J.A.C. 8:36-5.1(e), that the admission agreement “clearly specify if the facility or program will or will not retain residents” with each of the higher-care characteristics the rules list, “to what extent, and, if applicable, at what additional cost.” That clause is the single most useful sentence in a New Jersey agreement, and families should read it before anything else.

New York

New York’s structure has more layers. The Department of Health licenses adult care facilities, meaning adult homes and enriched housing programs, and certifies some of them as assisted living residences under Public Health Law Article 46-B. An assisted living residence is defined in Public Health Law 4651 as an entity that “provides or arranges for housing, on-site monitoring, and personal care services and/or home care services” for five or more unrelated adults. Two add-on certificates matter. An enhanced assisted living certificate, under section 4651(15), lets a residence admit and keep people who are “chronically chairfast and unable to transfer,” need physical assistance to walk or climb stairs, depend on medical equipment, or have “chronic unmanaged urinary or bowel incontinence.” Without it, a resident who declines to that point must move. A special needs assisted living certificate lets a residence serve people with dementia and other special needs under a plan approved by the Department; under section 4655(5), “no residence shall market themselves as providing specialized services unless and until the department has approved such applicant for a special needs assisted living certificate.” A New York family should ask to see the operating certificate and any enhanced or special needs certificate before touring.

Connecticut

Connecticut does not license the building at all. It licenses the care. Under General Statutes section 19a-490(l), an assisted living services agency is “an agency that provides chronic and stable individuals with services that include, but need not be limited to, nursing services and assistance with activities of daily living.” The agency delivers those services inside a managed residential community, which is the apartment building with meals, housekeeping, transportation, and a service coordinator. The community itself files a notarized disclosure with the Department of Public Health under Regulation 19-13-D105(c), including how it tells tenants that it “is not licensed by the department,” but it holds no license. The practical consequences are two. The resident is a tenant with the rights of a tenant, which section 19a-694 confirms, and the care agency may serve only people who are “chronic and stable,” so a resident whose condition becomes unstable can lose services while keeping the apartment. Connecticut also has a separate, older category, the residential care home, which is licensed by the Department of Public Health and can be paid for through the state supplement program under section 17b-83. It offers less privacy and less nursing than a managed residential community but is one of the few settings a Connecticut resident on public benefits can afford.

Should You Choose a Facility With Memory Care?

If the person has a diagnosis of Alzheimer’s disease or another progressive dementia, yes, even if they do not need a secured unit today. Dementia is the most common reason an assisted living resident is discharged, and the move from a general unit to a memory care unit inside the same building is far less disruptive than a move to a new facility. Each state regulates what a facility that advertises memory care must show you.

In New Jersey, a facility that “advertises or holds itself out as having an Alzheimer’s/dementia program” must, under N.J.A.C. 8:36-19.2, have written program policies “available to members of the public” and written “criteria for admission to the program and criteria for discharge.” Under N.J.A.C. 8:36-19.4(b), it must give a prospective resident’s family a “clear and concise written list” of dementia-specific activities and their frequency, along with its “safety policies and procedures and any security monitoring system.” Direct-care staff must receive annual dementia training under N.J.S.A. 26:2M-7.2. Ask for all of it in writing.

In New York, memory care means a special needs assisted living certificate, and the Department of Health must have approved the residence’s special needs plan before it may market itself that way. Ask for the certificate and the plan.

In Connecticut, section 19a-562(b) requires each “dementia special care unit or program” to give written disclosure, “signed by the patient or responsible party,” covering eight topics that include staffing ratios and training and “the cost of care and any additional fees.” Direct-care staff in a dementia unit must have at least eight hours of dementia-specific training within 120 days of hire and eight hours annually under section 19a-562a(b), and every assisted living services agency must train direct-care staff on dementia at hire and annually under section 19a-562b.

Two questions cut through the marketing in every state. What, specifically, happens when a resident in the general unit develops wandering or aggression: is there a memory care unit on site, is there a bed, and what does it cost? And what is the discharge criterion from the memory care unit itself, since even secured units have limits.

What Happens When Needs Increase?

This is the question the tour is designed to avoid, and it is the one that decides whether the move lasts. Every assisted living resident is on a trajectory, and every facility has a point at which it will say it can no longer meet the resident’s needs.

New Jersey spells out the point. Under N.J.A.C. 8:36-5.1(d), a resident “may be, but is not required to be moved” once a higher level of care is documented, which the rule defines to include a resident who needs 24-hour nursing supervision, is “bedridden for more than 14 consecutive days,” is totally dependent in four or more activities of daily living, has severe cognitive decline and cannot respond to cueing, has a stage 3 or 4 pressure sore, needs more than “assistance with transfer,” is “a danger to self or others,” or has a medically unstable condition. Whether the facility will keep such a resident is what the agreement must state under 8:36-5.1(e). When a facility does discharge, N.J.A.C. 8:36-5.14 requires written notice “at least 30 days in advance” stating “the reason for discharge and the resident’s right to appeal,” except where the discharge is for one of the 8:36-5.1(d) reasons or an emergency, and the notice must include the Long-Term Care Ombudsman’s contact information under N.J.A.C. 8:36-4.1(a)37.

New York ties retention to the certificate. A residence without an enhanced certificate cannot keep a resident who becomes chairfast or incontinent in the ways section 4651(15) describes, and section 4655 requires residences to tell prospective residents that “there may be a point reached where the needs of the resident cannot be safely or appropriately met at the residence.” When a New York residence terminates, 18 NYCRR 487.5(f), which the assisted living rules incorporate, requires “at least 30 days’ written notice, on a form prescribed by the department,” and the notice must tell the resident that if they object they “may remain in the facility while the operator commences a court proceeding, and unless the court finds in favor of the operator.” A New York resident therefore cannot be put out without a judge.

Connecticut’s assisted living services agency may discharge a client under Regulation 19-13-D105(d)(9) for a change in condition when the client is “no longer chronic and stable,” for financial reasons when “insurance benefits or financial resources have been exhausted,” and on other listed grounds. The regulation states no notice period for a client-level discharge, which is one reason the residency agreement’s own termination terms, required by section 19a-700(a)(8), matter more in Connecticut than elsewhere.

Against that backdrop, two structures promise continuity, and both need scrutiny.

Assisted living with a nursing home on the same campus. Many campuses have a licensed nursing home a building away. Ask whether the assisted living agreement promises priority admission to that nursing home, whether the promise depends on a Medicaid-certified bed being available, and what happens if the nursing home is full. If the promise is not in the written agreement, assume it does not exist.

A continuing care retirement community. A true continuing care contract, usually with an entrance fee, obligates the provider to move the resident from independent living to assisted living to nursing care as needed. These contracts are regulated separately in each state and carry specific consumer protections. New Jersey registers providers with the Department of Community Affairs under the Continuing Care Retirement Community Regulation and Financial Disclosure Act, N.J.S.A. 52:27D-330 and following, and gives the resident “the right to rescind a continuing care agreement without penalty or forfeiture” within 30 days after the initial deposit or signing under section 52:27D-344(b). Connecticut regulates continuing care providers through the Department of Social Services under General Statutes 17b-520 and following, requires a disclosure statement before any contract or payment under section 17b-522, and lets the resident rescind “within thirty days following the execution of the contract” under section 17b-523. New York regulates continuing care retirement communities under Public Health Law Article 46 through a council that includes the Attorney General, and under section 4609 a resident may cancel “for any reason” on 30 days’ written notice, with a refund of the entry fee less costs if notice is given “within the first ninety days of occupancy.” The financial health of the provider is the risk in these arrangements, and the disclosure statement each state requires is where to look for it.

Does Medicaid Pay for Assisted Living?

In all three states, sometimes, for the care but never for the rent, and only in participating facilities. Families who expect to run out of money should settle this before the first tour, because the facilities that take Medicaid are a minority and the ones that do often require years of private payment first.

New Jersey. The Managed Long Term Services and Supports program covers assisted living services for people who meet the nursing home level of care and the Medicaid financial rules described in our article on Medicaid planning in New Jersey. The state’s service dictionary is direct: “Individuals in an ALR/CPCH are responsible to pay their room and board costs.” For 2026, Medicaid Communication 26-01 sets the standard monthly room and board rate at 996.40 dollars and the resident’s monthly maintenance needs allowance at 147.65 dollars; the rest of the resident’s income goes to the facility. New Jersey also has a rule with no counterpart in the other two states. Under N.J.A.C. 8:36-5.1(h), an assisted living residence or comprehensive personal care home licensed on or after September 1, 2001 “shall attain a level of occupancy by Medicaid-eligible persons of at least 10 percent of its total bed complement within three years of licensure and shall maintain this level of Medicaid occupancy thereafter,” and under 8:36-5.1(k) a resident who was admitted privately and later became eligible counts toward the 10 percent. That is an occupancy target, not a promise that any particular resident will be kept once private funds run out, and facilities commonly impose private-pay periods of two or three years before considering a Medicaid conversion. Ask for the facility’s Medicaid policy in writing, ask how many current residents are on Medicaid, and read the agreement’s clause on what happens when the resident can no longer pay.

New York. Medicaid pays for assisted living only through the Assisted Living Program under Social Services Law 461-l, which operates inside licensed adult care facilities and is limited to people who, in the statute’s words, are “medically eligible for placement in a residential health care facility,” meaning a nursing home. The program has a limited number of beds, and since April 1, 2025, under section 461-l(3)(m), new beds are approved “on a case by case basis whenever the commissioner of health is satisfied that public need exists.” Assisted living residences outside the program are private pay, though every New York residency agreement must disclose “the availability of public funds” under Public Health Law 4658(3). A New Yorker who will need Medicaid should look for an Assisted Living Program bed specifically.

Connecticut. The Connecticut Home Care Program for Elders lists “assisted living services” among what it covers, but the Department of Social Services states that “the CT Home Care Program for Elders does not pay for room and board,” and the settings are narrow: state-funded congregate housing, federally subsidized housing, four affordable assisted living demonstration sites, and “a private assisted living pilot program with a limited number of slots” with a waiting list. The statutes behind the private pilot, General Statutes 17b-365 and 17b-366, cap combined enrollment at 125 people statewide. For most Connecticut families, Medicaid in a private managed residential community is not a realistic plan, and the alternatives are a residential care home, care at home under the Home Care Program, or a nursing home.

Long-term care insurance fills the gap for families who have it. Read the policy’s definition of an assisted living facility before choosing one, because policies often require a specific license or a minimum level of nursing presence, and a Connecticut managed residential community may not fit an older policy’s definition.

Where Do You Look for Complaints, Inspections, and Ratings?

There is no federal star rating for assisted living. Medicare’s Care Compare tool rates nursing homes on health inspections, staffing, and quality measures and flags Special Focus Facilities, but its list of provider types does not include assisted living, and neither the Centers for Medicare and Medicaid Services nor any national agency inspects it. The information exists, but it is in state hands.

New Jersey. The Department of Health’s long-term care facility search at healthapps.nj.gov lets you filter for assisted living residences, comprehensive personal care homes, and assisted living programs, and the same system posts survey reports, which are the inspectors’ statements of deficiencies and the facility’s plans of correction. New Jersey’s own nursing home report card has been discontinued; the Department’s page says it “has been replaced by the federal Centers for Medicare and Medicaid Services Five Star Rating system,” so do not look for a state rating. Complaints about nursing homes, assisted living facilities, and comprehensive personal care homes go to the Department’s 24-hour hotline at 1-800-792-9770, and the Long-Term Care Ombudsman investigates abuse and neglect at 1-877-582-6995.

New York. The Department of Health publishes profiles of every adult care facility, including assisted living residences and their enhanced and special needs certificates, at profiles.health.ny.gov/acf, with an inspections tab for each facility, and separate nursing home profiles with inspection and complaint information. Complaints about adult care facilities and assisted living go to the centralized intake line at 1-866-893-6772, nursing home complaints to 1-888-201-4563, and the Long Term Care Ombudsman Program is at 1-855-582-6769.

Connecticut. The Department of Public Health’s eLicense lookup verifies the license of an assisted living services agency, a nursing home, or a residential care home and is the state’s “primary source of verification,” and the Department’s guidance on choosing a nursing home directs consumers to it for “the latest survey findings.” Managed residential communities do not appear because they are not licensed. Complaints to the Department’s Facility Licensing and Investigations Section are filed through its online complaint form. The Long-Term Care Ombudsman is at 1-866-388-1888.

State records show what inspectors found. They do not show what the family across the hall knows, and the rest of the diligence is old-fashioned:

Ownership. Ask who owns the operator and the real estate, how long they have owned it, and whether the facility has changed hands or management companies in the last three years. Frequent turnover of ownership tracks with turnover of staff.
Staffing. Ask how many aides are on each shift, including overnight and weekends, how many residents each is responsible for, whether a nurse is in the building around the clock or on call, and how much of the staff is from agencies. Then verify by visiting at 7 p.m. on a Saturday.
Litigation and enforcement. Search the state court dockets and the Attorney General’s press releases for the operator’s name. Our articles on New Jersey enforcement cases and New York Attorney General settlements describe what those records look like when something is wrong.
Families. Ask the facility for the family council’s contact, or simply ask visitors in the parking lot how long their relative has lived there and what they would change.
Online reviews. Read them for patterns, not stars. Referral websites that list facilities are paid by the facilities they list, and their “ratings” are not inspections.

What Should You Ask on the Tour?

By the time you tour, you should already know the license, the payment policy, and the inspection record. The tour is for the questions only a person can answer:

What is the current monthly rate for this apartment, what does it include, and what does each higher care tier cost? Ask for the written assessment tool that assigns tiers. In New Jersey, N.J.A.C. 8:36-6.2(b) bars a facility from charging for a higher level of care “without documentation of reassessment by the registered nurse.”
How much have rates gone up in each of the last three years? Connecticut requires this history in the agreement itself for agreements signed on or after October 1, 2024, under section 19a-700(a)(4). Ask for it everywhere.
What notice do you give of a rate increase? New York requires “not less than 45 days” under 10 NYCRR 1001.8(b)(2)(xvi), and Connecticut requires 90 days under section 19a-694. Ask what the agreement says in New Jersey.
What are your discharge criteria, in writing, and how many residents did you discharge for care reasons last year? Where did they go?
If my mother is hospitalized, is her apartment held, at what cost, and what does she need to show to come back? Our article on eviction after a hospital stay explains why this matters.
Who manages medications, who administers them, and what happens when a resident refuses?
How quickly is a call button answered at night? Ask to see the log.
Which physicians, pharmacies, home health agencies, and hospice programs come into the building, and may we keep our own? New York’s Public Health Law 4658(3) requires the agreement to state that “residents shall have the right to choose their health care providers, notwithstanding any other agreement.”
Can a couple stay together if one needs more care than the other? Can a resident keep a pet, a car, a weekly aide of their own?
What is the policy on hospice, on do-not-resuscitate orders, and on dying in place? Some facilities quietly require a move at the end.

What Else Belongs on the List?

A few factors that families overlook until after the move:

Proximity to the people who will visit. The resident who is visited three times a week gets better care than the one who is visited monthly, in every facility. A slightly worse building ten minutes from a daughter beats a better one an hour away.
Hospital and physician relationships. Which hospital does the facility send residents to, and does the resident’s own physician have privileges there?
Language, culture, and faith. A resident with dementia often reverts to a first language. Ask which languages the aides speak on each shift.
The resident’s own documents. A durable power of attorney and a health care directive should be signed before the move, while the resident can still sign them, and the agent named in them should be the person dealing with the facility. Our articles on the types of power of attorney and who makes medical decisions without a proxy explain what each does.
The Medicaid timeline. If the resident will eventually need Medicaid, the five-year look-back is already running, and the choice of facility should be made together with a plan for how the transition will be paid. Our article on what a Medicaid application requires describes what the family will need to produce.
The paperwork. Ask for the full admission packet, including the residency agreement, the resident rights statement, the fee schedule, and any arbitration agreement, before you decide, and read it away from the building. The companion article on what to check in an admission agreement explains what to look for.

Plan Well. Live Better.

The right assisted living facility is the one that can still care for your parent three years from now, and can be paid for that long. At Milvidskiy Law Group, we help families evaluate facilities, plan how care will be paid for, review agreements before they are signed, and put in place the documents that let the family act when the time comes. Learn more about our elder law services.

This article is for general informational purposes only and does not constitute legal or medical advice. Reading it does not create an attorney-client relationship. Licensing rules, program eligibility, dollar figures, and telephone numbers change; the New Jersey, New York, Connecticut, and federal sources described were verified in September 2026 and the 2026 New Jersey room and board figures are from Medicaid Communication 26-01. Confirm each with the agency before relying on it.