A tour of a board and care home is the single most important hour in the search process. The brochure tells you nothing. The website tells you very little. The state licensing record tells you the history but not the household. The hour you spend in the home, watching the residents and listening to the provider, is when you actually decide whether the home is right.
Most families do not know what to ask. They walk through the house, smile politely, accept a coffee, and leave with a vague positive impression that does not survive the next morning. This guide is the antidote: 15 specific questions that will tell you what you need to know, with the reasoning behind each one and what a good answer sounds like.
Print this list. Bring it with you. Take notes. The good providers will respect you for asking. The ones that bristle are telling you something you needed to know.
Before the questions: how to set up the visit
The first visit should be scheduled with the provider directly. Forty-five minutes to an hour is the right amount of time. Tour during the day, not in the evening. Walk through the whole house, not just the public rooms. Ask to be introduced to current residents. Ask to meet the caregivers on duty. Then, after you have done at least one scheduled tour, plan a second unannounced visit at a meal time before you sign anything. Mealtime is when a household reveals itself. Our step-by-step guide to finding a residential care home covers the broader process; this guide is the tour itself.
The 15 questions
1. How long has this home been operating, and how long has the current owner been here?
You are listening for stability. A home that has been licensed for ten years under the same owner has a track record. A home that just opened, or that has changed hands three times in two years, has more uncertainty. Newness is not disqualifying, but it raises the importance of your other due diligence. If the answer is “we just took over from the previous owner,” ask why and what is changing.
2. What is your current resident-to-caregiver ratio during the day, and what is it at night?
You want concrete numbers, not “we have plenty of staff.” A typical good answer for a six-bed home might be “two caregivers on day shift from 7 a.m. to 3 p.m., one caregiver on the swing shift from 3 to 11, and one caregiver overnight.” The ratio you can tolerate depends on the acuity of the residents, but more is generally better. Compare the answer to what you actually see when you walk through the house.
3. Is the overnight caregiver awake or sleeping?
This is the question almost no family asks and the question that matters most for many residents. Some homes have an awake overnight caregiver. Some have a caregiver who sleeps on the premises with a baby monitor and is required to wake within a certain response time. Some have an arrangement that combines both, depending on the night and the residents. None of these are inherently disqualifying, but you need to know which one you are buying. For a resident with a fall risk, a wandering risk, or timed nighttime medications, an awake overnight is usually the right answer.
4. How long have your current caregivers been with you?
High caregiver turnover is one of the strongest predictors of a struggling home. A good answer: “Maria has been with us for six years, Anna for three, and our weekend caregiver for two.” A worrying answer: “We just hired our day-shift caregiver last month.” Caregiver continuity is the backbone of relational care, and especially of dementia care, as the Alzheimer’s Association emphasizes in its dementia care recommendations.
5. What is your medication management policy, and can I see how you document it?
You are not asking to read confidential records. You are asking the provider to walk you through how they handle medications: who administers them, who documents them, what happens if a dose is missed or refused, how they coordinate with the pharmacy, and how they update the medication list when a doctor changes a prescription. A good provider will be glad to walk you through this. A defensive provider is telling you something.
6. What care levels are you licensed for, and what triggers a discharge?
This is the question that most often determines whether a placement lasts. Some homes can serve a resident from a low-acuity ambulatory level all the way through hospice. Some can only serve residents at specific levels and will discharge when needs increase. Get the answer in plain language and in writing. Ask specifically: what happens if my mother has a stroke? What happens if she develops late-stage dementia and starts wandering? What happens if she needs two-person transfers? The honest answer to “what triggers a discharge” should be the most important data point in your decision.
7. How do you handle medical events, especially at night?
You want the provider’s actual protocol, not a reassurance. A good answer might be: “If a resident has chest pain or trouble breathing, the caregiver calls 911 immediately and then calls me. If a resident falls without obvious injury, the caregiver checks for injury, helps them to bed if they are stable, calls me, and we contact the family in the morning. We have a written incident report for every event and a standing relationship with the local urgent care.”
8. Who is your medical director or consulting nurse, and how often do they visit?
Some small homes have a consulting registered nurse who visits weekly or monthly to review care plans, train staff, and provide medical oversight. Others rely entirely on the residents’ own physicians and outside home health services. Both can work, but the answer tells you about the home’s clinical depth. A home with a regular consulting nurse usually has a more structured approach to care planning.
9. Can I see a resident’s care plan (with personal information removed) so I understand how you document care?
You are not asking for confidential information. You are asking to see the format, the level of detail, and the kind of care planning the home does. A home with a thoughtful care plan template is a home that thinks carefully about residents. A home that says “we don’t really do those” or “it’s all in our heads” is telling you about the operational maturity of the place.
10. What is a typical day like here, and can I observe a meal?
You want the provider to walk you through the daily rhythm in their own words, and you want to actually see a meal if at all possible. Read our walk-through of a typical day to know what you are listening for. The meal is the single most revealing thing you can observe on a tour. Watch how the caregivers speak to residents, how the food is served, how long residents are allowed to take, how the conversation flows, and whether the residents look engaged or passive.
11. May I see your most recent state inspection report and any complaints from the past three years?
A reputable home will have these ready to share, because state law requires them to be available on request. Read the inspection report carefully. Look for repeat citations, serious violations, and the home’s response. Our guide to reading a care home inspection report walks through what to look for and how to interpret the language. You can also look up the home yourself in the California CCLD facility search or your state’s equivalent database before the tour.
12. What is the all-in monthly cost, and what is excluded?
Get a written breakdown. The base rate is one number; what is excluded matters as much. Common extras include incontinence supplies, two-person transfers, behavioral interventions, hospice coordination, medication management surcharges, and transportation to appointments. Some homes bundle these into the rate. Some charge separately. Some have a tiered “level of care” pricing structure. None of these are inherently bad, but you need to know what your real monthly cost will be at the resident’s current acuity and what it could become if their needs change. Our cost guide covers what is typical for each line item.
13. What is your move-in process, and what is your refund policy if it does not work out?
A good provider will describe a structured move-in: a meeting with the family, a preliminary care plan, a trial period, and clear expectations on both sides. Ask about the deposit, the first-month rent, and the refund policy if the placement does not work out in the first 30 days. Some homes will refund the unused portion. Some will not. Get the answer in writing.
14. How do you communicate with families?
Some homes call families weekly. Some send a monthly written update. Some use a private app or portal. Some communicate only when something is wrong. What is right depends on what the family wants, but the provider should have a clear practice and be able to describe it. If the answer is vague (“we’ll keep in touch”), that often means the practice is also vague.
15. May I have references from two or three current resident families?
This is the most important question and the one most families forget to ask. A good home should be willing to share references, with the families’ permission, who can speak honestly about their experience. Call those families. Ask them what they wish they had known before move-in, what the home has done well, and what has been hard. The references will tell you things you cannot learn any other way.
What to do after the tour
Within the first hour after each tour, sit down somewhere quiet and write your impressions while they are fresh. Note the smell of the house, the look of the residents, the demeanor of the caregivers, and any specific answers that surprised you. Score the home on the 15 questions above on a 1-to-5 scale. If you have toured multiple homes, compare the scores side by side.
Before you sign anything, schedule that unannounced visit at a meal time. Walk in the front door without warning. See what the household actually looks like when no one is expecting you. The home that looks the same on the surprise visit as it did on the scheduled tour is the home you can trust. The home that looks dramatically different is the home you should walk away from.
For more on what to watch out for during the visit, read our guide on red flags to look for when touring a care home. For more on how to verify the home’s track record, read our guide on inspection reports.
Browse the directory
Once you have a sense of what to ask, the search becomes much more focused. Browse the California RCFE directory, the Washington adult family homes, the terminology pages, or your own state directory to build a shortlist of four to six homes worth touring.
Sources and further reading: California Department of Social Services, Community Care Licensing Division; California CCLD Facility Search; Washington DSHS Provider Lookup; Alzheimer’s Association — Dementia Care Practice Recommendations; Centers for Medicare and Medicaid Services — Long-Term Care; Eldercare Locator.