You have toured the home. You have asked the operator your questions. You have checked the inspection reports and looked at the licensing record. You still do not know what it is actually like to live there.
The people who know are the ones who already live in the home and the families who visit every week. Their experience, told in their own words, is the most honest evaluation you will find. No brochure, no website, and no polished tour can replicate what a current resident’s daughter will tell you over the phone when you ask her how the home handled her mother’s first bad night.
This guide is about how to have those conversations, how to ask for them, what questions matter most, and how to read between the lines when the answers come back.
Why references matter more than almost anything else
A care home tour is a controlled experience. The operator knows you are coming. The house has been tidied. The caregiver on duty is the strongest one. This is not deception; it is human nature. We all put our best face forward when guests arrive.
References break through that presentation. A family member who has had a loved one in the home for a year knows what the home looks like on a Tuesday afternoon when no one is touring. They know how the staff responds at 11 p.m. when their mother is agitated. They know whether the operator returns phone calls within an hour or three days. They know whether the food is as good in month eight as it was during the first week.
The National Consumer Voice for Quality Long-Term Care has long emphasized that family and resident perspectives are essential components of care quality evaluation. State ombudsman programs across the country, which advocate for residents in long-term care settings, consistently recommend that families speak with current residents and their families before making a placement decision.
If you are still in the early stages of your search, our guide to finding a care home walks through the full process from start to finish.
How to ask the operator for references
The request is simple and should feel natural. During or after your tour, say something like: “We are very interested in the home. Would it be possible to speak with one or two families who have a loved one living here? It would really help us with our decision.”
Most good operators expect this question. They will have families who have agreed to serve as references. Some operators keep a short list of families who are willing to take calls. Others will ask a specific family for permission and then share their contact information with you.
What it means if the home provides references readily
A home that immediately says “of course, let me give you two names” is a home that has confidence in the experience it provides. The operator has relationships with families that are strong enough that families are willing to advocate for the home. This is a good sign, though it does not replace your own careful questioning.
What it means if the home hesitates or refuses
Some operators cite privacy concerns, which is reasonable to a point. They should not share family contact information without permission. But they should be willing to ask families on your behalf. If the operator says “we cannot do that” or “none of our families want to talk to prospective families,” that is a warning. It may mean the home has had recent complaints, high turnover, or family dissatisfaction. It may simply mean the operator is not organized enough to maintain references. Either way, it shifts the burden to you to find references independently, and you should consider whether a home that cannot produce a single willing reference is a home you want to trust with your family member.
How many references to request
Two is a reasonable number. One reference gives you a single perspective. Two gives you the beginning of a pattern. If both families describe a similar experience, whether positive or concerning, you have more confidence in the picture. If you are seriously considering the home, ask whether you can also speak briefly with a resident in the common area during a return visit.
What to ask family references
The goal of a reference conversation is not to confirm that the home is perfect. No home is perfect. The goal is to understand how the home operates day to day, how it handles problems, and whether the family feels respected and informed. Here are the questions that reveal the most.
About communication
“How does the home communicate with you about your family member’s care?”
This is the single most predictive question. A home that communicates well, proactively calling families about changes, responding quickly to messages, sharing observations about how a resident is doing, is almost always a home that provides good care. Breakdown in communication is the first sign of organizational problems.
Listen for specifics. “They call me whenever anything changes” is better than “they are pretty good about staying in touch.” Ask follow-ups: “How quickly do they return your calls? Do they reach out to you, or do you always have to initiate?”
About staff consistency
“How consistent has the staffing been since your family member moved in?”
Caregiver continuity is the backbone of good care in a small home. If the same two or three caregivers have been with the home for years, that is a powerful positive signal. If the family tells you that caregivers change every few months, or that they keep seeing new faces, ask how the transitions have affected their loved one. High turnover affects residents directly, as each new caregiver must learn the resident’s preferences, routines, and care needs from scratch.
The PHI research organization, which tracks workforce data in long-term care, consistently documents the link between caregiver retention and quality of care. Homes that keep their staff tend to keep their residents well.
About food and daily life
“What is the food like? Does your family member enjoy meals?”
Food is one of the clearest indicators of a home’s quality and values. In a small home, meals are typically cooked on-site, and the quality reflects the operator’s priorities. A family that says “Mom loves the food, they make her favorite Filipino dishes because the caregiver knows she is from Manila” is describing a home that cares about the whole person. A family that says “the food is fine, I guess” may be describing a home that treats meals as an obligation rather than an opportunity. Our guide to what a day looks like in a care home describes the rhythm of meals and activities in detail.
About how concerns are handled
“Have you ever had a concern or complaint? What happened when you raised it?”
This question is gold. Every family will eventually have a concern, whether about a medication issue, a change in their loved one’s behavior, a staffing problem, or something else. The measure of a home is not whether problems arise but how the home responds. Listen for: Did the operator listen without becoming defensive? Did they take action? Did they follow up? Did the problem recur?
A family that says “we had an issue with Mom’s clothing getting mixed up with another resident’s, we mentioned it, and it was fixed the next day” is describing a responsive, accountable home. A family that says “we raised a concern about Dad’s skin care and nothing changed for weeks” is describing a home with a different standard.
About the move-in period
“How was the transition when your family member first moved in?”
The first 30 days in a care home are the most emotionally intense period for both the resident and the family. A reference who describes a smooth transition, where the home was patient, communicative, and supportive, is describing an operator with experience and empathy. A reference who describes a rocky transition with little communication gives you a different picture.
About what surprised them
“Is there anything about the home that surprised you, either positively or negatively?”
This open-ended question often produces the most revealing answers. People tend to share what is top of mind, and that is usually either the thing they are most grateful for or the thing that bothers them most. Both are useful.
How to talk to residents directly
Talking with residents is different from talking with families. Residents are living in the home. Some may have cognitive impairment. All deserve your respect and sensitivity. Here is how to approach it.
During a tour
If residents are in the common area during your tour, the operator should introduce you. A natural, brief greeting is appropriate: “Hi, I am Sarah. My mom is thinking about moving to a place like this. Do you like living here?” Keep it light and conversational. Do not press for details or ask probing questions. You are reading the atmosphere as much as listening to the words.
What to observe rather than ask
Sometimes the most informative thing is not what a resident says but how they say it and how they look when they say it. Are residents relaxed and comfortable in the common spaces? Do they seem happy to see the caregiver? Do they interact with each other? Is there warmth in the household, or does it feel sterile and quiet?
Watch how caregivers interact with residents during your visit. Do they use residents’ names? Do they make eye contact? Do they speak with warmth, or do they speak about residents as if they are not in the room? The National Institute on Aging recommends observing staff-resident interactions as one of the most reliable indicators of care quality.
Respecting cognitive limitations
If a resident has dementia or significant cognitive impairment, they may not be able to answer your questions in a way that gives you factual information. That is okay. You can still learn from the interaction. A resident with dementia who smiles, seems at ease, and reaches for the caregiver’s hand is telling you something important about the home without saying a word. A resident who flinches, seems agitated, or avoids eye contact with staff is also communicating.
What residents often share
When residents are cognitively able and willing to talk, they tend to share certain things freely. They will tell you about the food (residents always have opinions about the food). They will tell you about their favorite caregiver. They will tell you whether they feel at home or whether they miss their old house. They may tell you about other residents, about activities they enjoy or find boring, or about small annoyances. Take it all in, but weight it proportionally. One resident’s complaint about the television schedule is not a red flag. A resident’s comment that “they do not come when I call at night” is.
Reading online reviews
Online reviews of small care homes are relatively rare compared to reviews of large facilities, but when they exist, they can be informative if you read them carefully.
Where to find reviews
Google Business listings are the most common source. Some homes also have reviews on Yelp, Facebook, or specialized care directories. The Centers for Medicare and Medicaid Services operates Care Compare for nursing homes, but small residential care homes (board and care homes, adult family homes, personal care homes) are typically not included in that database because they are licensed at the state level rather than certified by CMS.
How to interpret what you read
A handful of reviews does not create a reliable pattern. If a home has three five-star reviews and one two-star review, you cannot draw strong conclusions. What you can do is look for themes. If three different reviewers mention that the food is excellent, that is likely true. If two reviewers mention poor communication, that is worth investigating.
Pay attention to the specificity of reviews. A review that says “this home saved our family, the staff treated Dad like their own grandfather, and when he fell last March they called us within 15 minutes and had him evaluated by the next morning” is more credible than a review that says “great place, highly recommend.”
How the home responds to reviews
Many operators respond to online reviews, especially negative ones. The tone and substance of those responses tell you about the operator’s character. An operator who responds to a negative review with defensiveness, denial, or personal attacks is showing you how they handle criticism. An operator who responds thoughtfully, acknowledges the concern, and explains what they did to address it is showing you something very different.
The limits of online reviews
Do not make online reviews the centerpiece of your evaluation. They are one data point. Some families leave reviews while emotions are high, either very positive or very negative. Some reviews are posted by former employees with grievances. A few may even be posted by competitors. Use reviews to generate questions for your tour and reference calls, not as a substitute for them. Our guide to comparing care homes offers a framework for weighing all the evidence together.
Finding independent references
What if the home only provides one reference, or you want a second perspective that the operator did not curate? There are several approaches.
Ask the state ombudsman
Every state has a long-term care ombudsman program funded under the Older Americans Act. Ombudsmen advocate for residents in long-term care settings, investigate complaints, and can provide general information about a home’s complaint history. They cannot share confidential information about specific residents, but they can tell you whether a home has had recent complaints and the general nature of those complaints. Contact your state or local ombudsman through the Eldercare Locator at 1-800-677-1116.
Ask the home’s neighbors
This approach feels unusual, but it can be surprisingly informative. Neighbors see the home from the outside. They see the ambulance visits, the staff coming and going, the residents sitting on the porch. If you are comfortable doing so, introduce yourself to a neighbor and ask whether they have any observations about the home. You may get nothing, but you may also get useful context.
Ask local geriatric care managers
A geriatric care manager (also called an aging life care professional) who works in the area will often have direct experience with local care homes. They visit homes regularly, know the operators, and have placed clients in homes throughout the community. Their professional perspective can supplement or replace family references. If you are working with a care manager, ask them directly what they know about the home you are considering.
Look for community connections
Some care homes are active in local faith communities, senior centers, or caregiver support groups. If you are part of a similar community, ask around. Families who have placed a loved one in a small care home often share their experience informally within these networks.
When you are evaluating from a distance
If you live far from the care home, having reference conversations becomes even more important because you cannot easily drop in for an evening visit or observe the home at different times of day. Our guide to evaluating a care home from out of state covers the full set of strategies for long-distance evaluation, but reference calls are the most powerful tool available to a family that cannot visit frequently.
When speaking with references as a long-distance family, ask specifically about communication. “How often does the home reach out to you?” “Do they send photos or updates?” “If you call with a question, how quickly do they respond?” “Do they use any technology to help you stay connected, like video calls?” The answers will tell you whether the home can support a relationship with a family that is not local.
Red flags in reference conversations
Not every reference conversation will be positive, and that is actually a good thing. A reference who has only praise and no nuance may not be giving you the full picture. Here are the signals that should raise concern.
The home cannot or will not provide any references. This is the most significant red flag. A home that has been operating for more than a year and cannot produce a single willing family reference has a problem.
References are vague and generic. If a reference cannot give you a single specific example of something the home did well or handled poorly, the conversation is not useful. Push gently for specifics. If none come, the reference may have been coached or may not be closely involved with their family member’s care.
References describe poor communication. If a family says they have trouble getting information about their loved one, that the home does not call when incidents happen, or that they feel out of the loop, take that seriously. Communication problems rarely improve after placement. For more on what should raise concern during your evaluation, see our guide to red flags when touring a care home.
References describe high staff turnover. “There has been a new caregiver every month” is a serious concern. It suggests systemic problems with the operator’s management, compensation, or culture.
References describe problems that were never resolved. A single unresolved issue is worth noting. Multiple unresolved issues over time suggest an operator who does not listen or does not act.
How to weigh everything together
By the time you have toured the home, reviewed inspection reports, spoken with one or two family references, observed residents and staff during your visit, and checked online reviews, you will have a rich body of evidence. No single source is definitive. The power is in the pattern.
If the tour felt warm and the references confirmed that warmth with specific examples, if the inspection report is clean and the online reviews are positive, if the residents seemed comfortable and the staff seemed genuine, you are probably looking at a good home.
If the tour felt polished but the reference conversation revealed communication gaps, if the inspection report has recent citations and the online reviews mention the same issues, you have a pattern of concern that is worth taking seriously.
Use a side-by-side comparison framework if you are evaluating more than one home. Our care home comparison guide can help you organize and weigh the evidence from tours, references, and records.
The bottom line
The families and residents who already live in a care home are your most honest source of information. They have no brochure to sell, no tour to polish, no incentive to mislead. Their experience is the lived reality of the home, and it is available to you if you ask.
Your next step: when you schedule your next care home tour, tell the operator at the end of the visit that you would like to speak with one or two current families. Write down the reference questions from this guide and make those calls before you make your decision. The conversation will take 15 minutes. The clarity it provides is worth far more.