How to Compare Assisted Living Contracts: A 10-Point Worksheet for Families

You have brochures from three communities on the kitchen table, and every one of them structures its pricing differently. How do you compare them fairly?

The answer is to break each contract into the same set of questions and record the answers in columns, one per community. This worksheet gives you ten categories to fill in. Print it, bring it on tours, and use it to ask the questions that matter before you sign anything.

Before You Start: A Note on Payment Sources

If your family expects to use Medicaid, a Medicaid waiver program, or VA Aid and Attendance benefits, ask each community up front whether it accepts those payment sources. Acceptance can change refund policies, rate structures, and even the unit you are offered. Add a checkbox to each column of your worksheet: "Accepts Medicaid waiver? Yes/No" and "Accepts VA Aid and Attendance? Yes/No." Communities that accept public payment sources may have a limited number of beds set aside for those residents, so timing matters. The U.S. Department of Veterans Affairs publishes eligibility details for Aid and Attendance.

Getting Communities to Share Pricing

Some families find that a community will not hand over a full fee schedule until after a tour or even after a deposit. This is worth pushing back on, politely. Here are a few approaches:

• Request a "good faith estimate" by email. Frame it simply: "We are comparing several communities and would appreciate a written estimate of monthly costs for someone at a moderate care level."
• Ask for a blank copy of the contract during your tour. You are not committing to anything by reading it. A reputable community will provide one.
• Cite your state's disclosure laws. Many states require assisted living communities to provide a written disclosure of fees before a contract is signed. Your state's long-term care ombudsman can tell you what the law requires. The Eldercare Locator can connect you with your local ombudsman.

If a community refuses to share basic pricing in writing, treat that as a data point about how it operates.

1. Base Rent and Included Services

Record the base monthly rent for each community. Assisted living costs vary widely by state and even by county. Rather than relying on a single national median, search for your state's current figures through a resource like the Genworth Cost of Care Survey or your state's department of health. Ask each community for its rates in writing.

For each community, list what the base rent covers:

• Number of meals per day
• Housekeeping frequency
• Utilities included (water, electricity, heating, cooling)
• Basic cable and internet
• Scheduled activities and common-area amenities

Clarify which utilities are billed separately. Some communities cap utility usage or charge seasonal adjustments. Ask for a sample monthly statement showing typical charges for a resident at a care level similar to your loved one's. This gives you a realistic benchmark, not just the advertised rate.

2. Care Add-Ons and Tiered Pricing

Most communities charge for personal care services on top of the base rent. The structure varies. Some use a tiered system (Level 1, Level 2, Level 3) with a flat monthly add-on for each tier. Others use a point system or a fee-for-service model that bills for each task individually.

For your worksheet, record:

• The care level matrix and the monthly cost of each level
• Individual add-on prices for medication management, bathing assistance, dressing, toileting, transfers, incontinence care, and escort to meals
• How often care levels are reassessed (quarterly, annually, or upon a change in condition)
• Whether your family can request an off-cycle reassessment
• Whether there is a maximum daily care hour limit, and what happens if your loved one's needs exceed it

Ask for an example of total monthly cost for a resident with moderate needs. This is the number that lets you compare communities honestly. For more on how pricing tiers work in memory care settings, see Understanding Memory Care Contracts: What Families Need to Know About Fees, Care Levels, and Discharge Policies.

3. Entrance Fees and Refund Policies

Some assisted living communities charge an entrance fee, sometimes called a "community fee," that can range from a few thousand dollars to six figures in continuing care retirement communities. The National Institute on Aging notes that many communities offer declining refund schedules: for example, 90% refundable if you leave within the first year, then decreasing each year.

Record these details for each community:

• Entrance fee amount
• Refund schedule in writing (percentage refunded after 1 month, 6 months, 1 year, 2 years)
• Whether refunds come from the resale of the unit or from the community's general fund
• Whether the entrance fee is transferable to another facility within the same company

Financial Stability of the Community

A refund promise is only as good as the organization behind it. Ask whether entrance fees are held in a separate trust or escrow account. Request information about the community's ownership structure (for-profit or nonprofit), any recent changes in ownership, and whether the parent company has faced bankruptcy. You can check your state health department's website for inspection reports, violations, and complaints. If the community is a nonprofit, its IRS Form 990 is publicly available and shows financial health.

4. Move-In Fees and One-Time Costs

Beyond entrance fees, communities often charge smaller one-time amounts. List every fee you find:

• Application fee
• Move-in or community fee (if separate from an entrance fee)
• Security deposit
• Pet deposit
• Elevator or moving-day deposit

Typical totals for these smaller fees range from roughly $500 to $2,000, but they add up. Ask which are refundable and under what conditions. Inquire about charges for unit customization during move-in, such as painting, carpet cleaning, or installing grab bars. Request a written estimate of all move-in costs so you can compare total first-year outlays across communities. For strategies on reducing these costs, see How to Negotiate Assisted Living Move-In Fees and Monthly Rent.

5. Rate Increase History and Caps

Your loved one may live in this community for years. Ask for the annual percentage increase in base rent and care fees over the past three to five years. AARP recommends asking about rate increase history as a key factor in choosing a community.

Record:

• Average annual increase over the past 3 to 5 years
• Whether the contract caps annual increases (for example, 5% maximum, or tied to the Consumer Price Index)
• Required notice period for increases (typically 30 to 60 days)
• Whether increases follow a fixed schedule (for example, every January 1)

Ask for a copy of the most recent rate increase letter. The actual number on that letter is more useful than any promise about the future.

6. Termination and Move-Out Clauses

Record the required notice period for a voluntary move-out (usually 30 days) and whether the community shortens that period for medical emergencies or death. Ask about penalties for early termination, such as forfeiture of part of the entrance fee refund or an extra month's rent.

Review the involuntary discharge policy carefully. The contract should specify the conditions under which the community can require a resident to leave: nonpayment, behavior that endangers others, or health decline requiring a higher level of care. It should also state the notice period before discharge and whether the community provides relocation assistance or helps find alternative placement.

Rescission Periods and Attorney Review

Many states require a cooling-off period after you sign an assisted living contract, typically 7 to 30 days, during which you can cancel without penalty. Ask the community for the rescission period in writing. If the contract does not mention one, check with your state's long-term care ombudsman.

Before signing any contract, consider having it reviewed by an elder-law attorney. An attorney can spot clauses that shift risk to the resident, such as broad arbitration requirements or vague discharge language. This review typically costs a few hundred dollars and can save thousands.

7. Level of Care Assessments and Reassessments

The initial assessment determines how much you pay for care, so the process matters. Ask:

• Who conducts the assessment (a registered nurse, a social worker, another professional)?
• What tool or criteria are used?
• How often are reassessments scheduled (quarterly, annually)?
• What triggers an off-cycle reassessment (a fall, significant weight loss, a family request)?
• Can the resident or family appeal a care level determination, and what does the appeals process look like?

Request a copy of the assessment tool or scoring criteria. Understanding how care needs translate into costs helps you anticipate changes and question charges that seem out of line.

8. Additional Fees and Hidden Costs

This is the section where small charges accumulate. The Administration for Community Living recommends asking for a complete fee schedule before signing. Record prices for:

• Guest meals
• Visitor parking
• Transportation to medical appointments
• Personal laundry service
• Beauty and barber services
• Pet fees (monthly rent, breed or size restrictions)
• Unit transfer fees (moving to a different apartment within the community)
• Storage fees for belongings
• Late payment fees and returned check fees
• Fees for requesting copies of records or contracts

Get the price list in writing. A community that publishes a clear fee schedule is easier to budget around than one that reveals charges after you move in.

How to Use This Worksheet

Create a simple spreadsheet or table with one column per community and one row per question above. Fill in every cell. Where a community cannot or will not answer, leave the cell blank and note the date you asked. Blank cells tell you something.

Bring the worksheet on tours. Hand it to the admissions coordinator and say, "These are the items I need to compare. Can you help me fill this in?" Most will. Some will need to check with their business office and follow up by email. That is fine.

Once all columns are filled, calculate a projected monthly cost for each community at your loved one's current care level, then estimate the cost if care needs increase by one level. Compare the total first-year cost (move-in fees plus 12 months of rent and care) and the projected third-year cost (accounting for rate increases). These two numbers, first-year and third-year, give you a realistic picture.

Laws governing assisted living contracts vary by state. What is required in one state may not apply in another. When in doubt, contact your state's long-term care ombudsman through the Eldercare Locator or consult an elder-law attorney in your area.

This article provides general information for families and is not legal or financial advice. Consult a qualified attorney or financial advisor for guidance specific to your situation.