May 16, 2025
Roughly 70% of seniors will need some type of long-term care during their final years, according to Genworth. Yet, most people don’t know much about the industry unless they have a loved one in a care facility or are actively looking for one.
From staff turnover to surprise fees, here are the secrets you need to know before you commit someone you love to one of the 30,600 assisted-living communities across the country.
1. It’s all about the staff
With nearly 478,500 workers powering the long-term care and assisted living industry, it’s ultimately the staff, rather than the building or branding, that can determine whether your loved one feels at home.
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When you tour a facility, keep an eye on how the staff interact with residents and see if the employees look tired or worn out. Check with management about staffing levels during the day and night to see if the facility has a registered nurse available around the clock.
A study published in the International Journal of Nursing Studies found that higher staffing levels led to better outcomes for residents, so check the facility’s staff-to-resident ratio before you sign up.
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2. High staff turnover could be a red flag
While staffing levels are important, a facility’s retention rate is also something to look into. If a facility sees high turnover of employees and management, that could be a signal that something is wrong.
Besides, you wouldn’t want your loved one to build a good relationship with someone at the facility only for that staffer to leave a few months later.
3. Ownership matters, especially private equity
Private equity firms have been snapping up nursing homes as of late, and the trend has alarmed some industry advocates. After all, an investment manager might have more experience cutting costs and initiating layoffs than managing health care outcomes for elderly patients.
In 2024, the Center for Medical Advocacy studied the impact of the private equity takeover of 29 facilities in Iowa and found that the transition led to “considerably lower health inspection and overall ratings, lower nurse staffing ratings, more abuse citations, higher federal civil money penalties, and more denials of payment for new admissions.”
Before you select a facility, check to see if it’s owned by a private equity firm or a team of health care professionals.
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4. It's a heavily regulated industry
The long-term care industry has always been tightly regulated and the Biden administration tightened it further by implementing a minimum staffing requirement for LTC facilities participating in Medicare and Medicaid, according to law firm Wilson Elser.
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This means you can expect most facilities to meet a minimum standard of care.
5. Extra fees can quickly add up
Some facilities can add extra fees to the services they provide, which means you could face bills for health screenings or extra therapy sessions at any time, according to Care.com.
These hidden additional charges can quickly add up, so make sure you get all the details and a full pricing list from the facility before you sign a contract.
6. Facilities may discharge “difficult” residents
The American Council on Aging has called involuntary discharges from nursing homes across the country a “legitimate problem.”
Roughly 14,000 complaints about improper discharges are filed with local Long-Term Care Ombudsman Programs every year, which makes it one of the top five types of complaints filed in the industry.
There are federal guidelines that set limits on the factors that can lead to a resident being discharged, but it’s a good idea to review the contract and understand all the terms and conditions before you sign up.
7. Family involvement matters
Even if you pick the best nursing home and conduct thorough research before signing up, one of the only ways to make sure your loved ones are safe and comfortable is by visiting them or calling to check in as often as you can.
With this in mind, try to pick a facility that is close to where you and your family live so that frequent visits are not an inconvenience.
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Vishesh Raisinghani is a financial journalist covering personal finance, investing and the global economy. He's also the founder of Sharpe Ascension Inc., a content marketing agency focused on investment firms. His work has appeared in Moneywise, Yahoo Finance!, Motley Fool, Seeking Alpha, Mergers & Acquisitions Magazine and Piggybank.
