How to Evaluate a Memory Care Community: What I Learned Touring Six Facilities

We toured six memory care facilities before choosing one for my mother-in-law. By the third tour, I'd stopped listening to the sales pitch and started watching the hallways.

Here's what I mean. The tour is a production. Someone whose job is to make you feel good about a very hard decision walks you through the nicest parts of the building, introduces you to staff who are expecting you, and hands you a glossy folder with an activity calendar and a chart showing all their caregivers have completed dementia training. You leave with a feeling. The feeling is the product.

If you're trying to figure out how to choose a memory care facility — or looking for the right questions to ask before you commit — here's what I wish someone had told me before our first tour: a memory care community is an organization. The same things that make any organization work well or poorly — leadership, culture, attention to detail — determine whether your parent will be okay there. The brochure won't tell you that. But if you know what to look for, the building and the people in it will.

It starts at the top: Why memory care leadership matters

I come from the Marine Corps. We were routinely inspected on details that seem absurd to civilians — did my underwear have loose threads, were my medals spaced precisely on my dress uniform, were my trousers creased correctly, did my belt extend exactly two and a half inches beyond the buckle.

The inspections weren't really about underwear. They were about command climate. If the details were right, it meant the leadership was paying attention. If the details were wrong, it meant nobody was watching. And if nobody was watching the small things, nobody was watching the big things either.

Memory care works the same way.

When I walked through facilities and saw mobile aide stations placed in locations where the aides couldn't actually observe the residents — that's not an aide problem. When I saw caregivers wearing earphones or scrolling their phones during their shift — that's not a individual problem. That's a management problem. It tells you that leadership tolerates it. It tells you that nobody is paying attention to the details that determine whether your parent has a good day or a bad one.

The community that had the most serious issues during our search had an executive director who'd been there for years. Long tenure. You'd think that's a good sign. It wasn't. Under her watch, staff turnover was high, there were repeated issues with state regulators, and when serious safety concern was raised, the facility's response was to blame the family. She wasn't the solution. She was the pattern.

In an industry where frontline caregiver turnover runs 40 to 60 percent, any sort of consistency in a community comes from the continuity and quality of its leadership. The aides will rotate. The activities coordinator will leave. The nurse on the night shift will move on. What stays — or should stay — is the person setting the standard. If that person isn't setting a high one, it doesn't matter how nice the lobby is.

What to observe, not what to ask

I care less about a training compliance chart than I do about watching what trained caregivers actually look like in practice. Virginia requires 10 hours of cognitive impairment training for direct care staff. That's the legal minimum, and many facilities stop there. The question isn't whether they've met the requirement. The question is whether you can see the training in the way people move through the building.

Here's what to look for. You don't need to evaluate each of these individually — watch the staff for ten or fifteen minutes and form an overall impression. The question you're trying to answer is: do the people who work here treat residents as whole people who are still here, still feeling, and still capable of more than you might assume?

Do staff come to the resident, or bring the resident to them?

A person with dementia can be startled by someone appearing suddenly from behind or above. Trained staff approach from the front, get to eye level, and make themselves known before making physical contact. They offer a hand before reaching for someone. This isn't one specific technique — it's the universal principle of reducing threat and giving the person a moment to orient. When you see it, it looks natural and unhurried. When you don't, interactions feel abrupt.

Do staff speak to residents like adults?

Are they patient when a resident asks the same question for the fifth time? Do they redirect gently when someone is confused, or do they correct them? ("No, Betty, your husband passed away" is the wrong answer. Always.) Every major dementia care framework agrees on this: meet the person in their reality, respond to the feeling behind the words, and never argue about facts. A trained caregiver who hears "I want to go home" understands that the person is expressing loneliness or fear — and responds to that, not to the geography.

Do staff match the resident's pace, or the schedule's?

Dementia care done right is slow. The person needs time to process what's happening, to participate in their own care where they can. If staff are rushing residents through meals, dressing, or transitions to stay on the facility's timeline, that's efficiency, not care. Those are not the same thing.

Are residents doing things, or having things done to them?

This is the one most people miss, and it might be the most important. Good dementia care means letting residents do things for themselves when they're still able to — feeding themselves, walking independently, making choices. It's slower and messier than doing it for them. But every credible dementia care framework — from Montessori to the Eden Alternative to CMS's own person-centered care standards — agrees that preserving autonomy and function is a core principle. A facility where every resident is being wheeled everywhere, fed everything, and dressed without participation isn't providing better care. It's providing more efficient care.

Are residents engaged, or parked?

Look at what residents are actually doing. Are people involved in activities that seem meaningful — conversation, art, music, small tasks like folding or sorting? Or are they sitting in a semicircle in front of a television with nobody talking? The Eden Alternative calls boredom one of the three plagues of institutional care. Montessori programming focuses on activities that tap into what the brain can still do. The specific approach matters less than the result: are people here living, or waiting?

Do staff know residents as individuals?

Do aides call people by name — their preferred name, not "sweetie" or "honey"? Can a caregiver tell you something specific about a resident's preferences, background, or routine? Person-centered care, at its core, means treating every resident as an individual with a history, a personality, and preferences that didn't disappear with their diagnosis. When staff know their residents, care is tailored. When they don't, it's one-size-fits-all.

Before your first tour, spend twenty minutes calibrating your eye. Teepa Snow's free videos on her Positive Approach to Care YouTube channel are the most accessible starting point — not because her method is the only valid one, but because her demonstrations make the universal principles visible and concrete:

• **Dementia 101** — What's actually happening in the brain
• **Using Hand-under-Hand to Assist with Getting Dressed** — What respectful physical assistance looks like
• **Challenging Behaviors and Dementia** — How trained staff respond to agitation
• **Meaningful Activities and Dementia** — What real engagement looks like

You'll know what good looks like after watching these. And when you walk through a building and see staff who are unhurried, who know names, who get to eye level and wait for a response — you'll recognize the culture of a well-trained team, regardless of which specific methodology they follow.

The inspection record is a leadership report card

Every state inspects memory care and assisted living facilities. In Virginia, that's the Department of Social Services under 22VAC40-73. These inspection results are public — you can search them by facility name or locality.

The question isn't whether a facility has ever been cited. Every facility has been cited for something. The question is: what pattern do the citations show, and under whose leadership?

A facility that got cited once for a documentation issue three years ago and hasn't been cited since is probably fine. A facility with a pattern of staffing violations, safety incidents, or repeated findings on the same issues — that's a leadership problem. That means someone at the top is either not seeing it or not fixing it.

Virginia's staffing minimums for memory care special care units are already low:

• 20 or fewer residents: at least 2 direct care staff
• 23–32 residents: at least 3
• 33–40 residents: at least 4

Those are minimums. If a facility has been cited for not meeting minimums that are already this low, that tells you everything.

Most memory care communities are licensed as assisted living, not nursing facilities, so the Virginia DSS search is your primary resource here.

Where to get the real story

The people with the most honest perspective on a memory care community are the ones who work inside it regularly but have no financial incentive to get you to move in.

An ombudsman told me something early in our search that reframed how I thought about all of this: It's not about whether a community is going to have issues. They will. They all do. It's about how they respond when the issues arise.

That stuck with me. Because the regulatory environment in most states — Virginia included — is not holding these communities to a particularly high standard. The law is largely written in the facilities' favor. The minimums are low. Enforcement is slow. If you're waiting for the state to tell you a facility isn't good enough, you'll be waiting a long time.

Which means the best information comes from people who are in and out of these buildings every day — but here's the thing: most of them can't directly tell you "this place is good" or "that place is bad." Ombudsmen, hospice workers, social workers — they have professional boundaries. They're not supposed to recommend or disparage specific facilities. You have to be savvy about how you ask.

The Long-Term Care Ombudsman

The ombudsman is a state-appointed advocate for residents of long-term care facilities. They investigate complaints, mediate disputes, and know which communities have patterns of problems. In Virginia, the program operates through the Department for Aging and Rehabilitative Services. Call them before your first tour.

Don't ask: "Is Sunrise better than Brookdale?" They can't answer that. Instead, try:

• "We're looking at three communities in Charlottesville. Can you tell me whether any of them have had complaints filed in the past two years, and what the general nature of those complaints was?"
• "What kinds of issues do you see most often in memory care communities in our area?"
• "If I were touring a facility for the first time, what would you tell me to pay attention to?"

These questions keep them on the right side of their role while giving you exactly the information you need. The complaint history is public information — they can share it.

Hospice agencies

Hospice nurses and aides are in and out of these communities every day, serving their own patients. They see the facility at 7 AM and at 9 PM. They see it on weekends. They know which buildings are well-run and which ones aren't, and they have no financial stake in where your parent lives.

They also can't tell you to avoid a specific facility. But they can answer questions like:

• "My mother has dementia and we're looking at memory care. Based on what you've seen, what should I be looking for when I tour?"
• "Are there communities in the area where you feel like your hospice patients are particularly well cared for?"
• "What's the biggest difference you notice between well-run communities and ones that struggle?"

You're not asking them to name names. You're asking for their professional perspective on quality. Most hospice workers I've talked to will give you more useful information in ten minutes than the sales team will give you in an hour.

Local dementia support groups

If there's a dementia caregiver support group in your area — through the Alzheimer's Association, a local church, or a hospital system — go. The people in that room are living this. Some of them have parents or spouses in the exact facilities you're evaluating. They don't have professional boundaries. They will tell you things the brochure won't.

Local Facebook and Reddit groups

Dementia-focused groups in your region often have threads where caregivers share experiences with specific facilities. A caveat here: take any single review with a grain of salt. Reddit and Glassdoor tend to attract the best and worst experiences. What you're looking for is trends over time. If multiple people over multiple years are describing the same problems — high turnover, poor communication, medication issues — that's not one person having a bad day. That's the culture.

Glassdoor and Indeed reviews

This is one most families never think of: look up the facility as an employer. What do current and former staff say about working there? High employee ratings usually correlate with better care. If the reviews describe chaotic management, constant short-staffing, or leadership that doesn't listen — those are the people taking care of your parent.

A senior care consultant

This is the resource I wish more families knew about. A senior care consultant is an independent professional who helps families navigate aging and living situations — not just memory care placement, but the full picture of what your loved one needs and what the options actually are. Many of the people they work with choose to stay in their homes. They're not selling you a facility. They're helping you figure out what's right.

We worked with Jen Dowda at Dowda Senior Consultants during our search, and I'm glad we did. Our situation was rushed — my father-in-law had just broken his hip, my mother-in-law's dementia had progressed further than we realized, and we were making high-stakes decisions while running on no sleep. Having someone with us who knew what to look for, what to ask, and what we were likely to miss was invaluable. If you're in the Richmond, Virginia area, I'd recommend her team. We are not sponsored or paid by Dowda to say this — they just do good work.

One important caveat: ask any senior care consultant directly how they are compensated. Some are paid by families, others receive referral fees from communities. Referral-based compensation isn't automatically bad — a good consultant with boots on the ground can be excellent regardless. But beware the other end of the spectrum: large referral-fee operations that station people in emergency rooms or use aggressive tactics to capture your information. Ask plainly: "How are you compensated?" and watch whether their recommendations feel like guidance or a sales funnel.

The community we ultimately chose for my mother-in-law wasn't even on Dowda's list. They received no compensation from that placement. They helped us anyway, because that's what they do.

Questions to ask a memory care facility that actually matter

Observation tells you more than interrogation. But there are things you genuinely need to ask because you can't see them:

• Are the memory care aides dedicated to the memory care unit, or do they float between memory care and assisted living? This matters more than people realize. Dedicated aides build relationships with residents, learn their routines, and recognize changes in behavior. Float staff are covering a shift. A resident with dementia who sees a different face every day is starting over every day. Ask specifically about memory care staffing, not overall community staffing.
• What is the staff-to-resident ratio in the memory care unit during the day? At night? On weekends? Best practice daytime is 1:5 or 1:6. If they won't give you a number, that's your answer.
• What is the annual turnover rate for your memory care staff specifically? Not the overall community number — the memory care unit. Industry average for assisted living is 41 to 42 percent, but memory care turnover can be higher because the work is harder. If they can only give you an overall number, they're not tracking it at the unit level, and that tells you something about how they manage it.
• How long has your executive director been here? Your director of nursing? Leadership tenure and stability matter more than anything else in a building where frontline staff turn over constantly.
• Who owns this community? Is it privately owned, part of a regional chain, or owned by a private equity firm? Private equity ownership typically means optimizing for a return on a timeline, and that shows up in staffing levels and maintenance. The ownership structure won't tell you everything, but it tells you where the financial pressure is coming from.
• Do you have onsite primary care or medical services? Some communities bring primary care physicians or nurse practitioners directly to the facility. This is a significant quality-of-life advantage — your parent gets medical attention without the all-day ordeal of being transported to an outside appointment.
• What exactly is included in the base rate, and what is extra? Get it in writing — a line-item list, not a brochure. I wrote a detailed breakdown of what families actually pay for memory care that covers the 20 to 50 percent gap between the quoted rate and the actual monthly bill.
• How does your level-of-care assessment work? How often do you reassess? Every facility uses different criteria. There's no standard. The assessment determines your pricing tier, and dementia only goes one direction. Ask what the spread is between their lowest and highest tier — it can be $3,000 to $5,500 per month.
• Can I visit unannounced, at any time? The correct answer is yes. Period.
• What does a typical Saturday look like? Not Tuesday. Saturday. This tells you whether they staff for weekends or park residents in front of a TV.
• What happens when a resident becomes agitated? You want de-escalation and redirection, not medication as a first response. One in seven nursing home residents receives antipsychotic medication without an appropriate diagnosis. Ask about their philosophy and their current usage rate.
• When was the last time a resident eloped? In memory care, "elopement" means a resident got out of the secured area. If they say it's never happened, they're not being honest. What matters is how they responded and what they changed.
• What would require my person to leave this community? This might be the most important question on this list, and most families never ask it. You're not buying care for what your person needs today. You're buying it for the remainder of their life. But every community has limits, and those limits are not standardized. Make them spell out precisely what their highest level of care includes. Can they handle two-person assists? Hospice? Behavioral escalation? If your person's needs exceed their highest tier, can you bring in private-duty aides, or does your person have to leave? How much notice do they give? Get this in writing. An unexpected move for an 85-year-old living with dementia is devastating.

How to actually compare facilities

When you're evaluating multiple communities, here's the most important thing I can tell you: don't compare marketing materials to marketing materials. Every brochure looks good. Every website has smiling residents and warm lighting. That comparison tells you nothing.

Compare contracts to contracts. Compare what's included and what's extra, line by line, in the actual agreements you'll sign. Compare level-of-care tier pricing and reassessment schedules. Compare discharge policies. The contract is the relationship. The brochure is the first date.

Compare observations to observations. What did you see the staff doing at Community A vs. Community B? Were the aides approaching residents correctly? Were residents engaged or parked? Did staff know names? Use the same eyes in every building and compare what those eyes actually saw — not what the sales coordinator told you to feel.

Compare current management to current management. Don't compare what Community A was like three years ago to what Community B is like today. Leadership changes everything. If a community has new management, that's a gamble — you're betting they can fix inherited problems before your parent is affected. Go in with your eyes open.

The only honest comparison is apples to apples: what's in the contract, what you observed with your own eyes, and who's running the place right now.

Go back at night: The unannounced visit

This might be the most valuable piece of advice in this entire article: after your scheduled tour, go back unannounced. At night. On a weekend. When the sales team has gone home.

Your daytime tour is the facility's best foot forward. The sales coordinator is guiding your attention, the staff know a prospective family is walking through, and the building looks its best. What you want to know is whether the care holds up when the spotlight is off.

Go back after your tour. You'll need to sign in and be let through the secure door — this is a memory care unit, after all. Just tell them you toured earlier and you'd like to take another look at the common area, or that you had a few more questions for the evening staff. They'll let you in. They may have an aide escort you — that's fine. You're not going in covertly. You're going in without the sales presentation.

From the moment you walk in, pay attention. How does the building feel at this hour compared to your daytime tour? Are residents being attended to or are they alone in their rooms? Is someone at the nursing station or is it empty? Does the building feel calm or chaotic?

And talk to the people on the floor. The aides. The night nurse. The person actually doing the work at 8 PM on a Wednesday. Most of them care deeply about the residents and will share perspectives you won't get from the front office — about staffing, about daily routines, about what the community is really like. They don't have an agenda. They just don't often get asked.

You asked on the tour whether you can visit unannounced at any time. This is where you use that answer.

Memory care vs. assisted living

One more thing, because I've talked to families who didn't realize there was a difference.

Assisted living helps with daily activities — meals, medication management, housekeeping, some personal care. Memory care is a specialized, secured unit specifically designed for people with dementia, with higher staff ratios and dementia-specific programming. It typically costs 15 to 25 percent more.

Bridgid wrote a detailed comparison of independent living, assisted living, and memory care that breaks down all the differences. If your parent has dementia and needs more than what home care can provide, you're looking at memory care.

Should you bring your person on the tour?

Tour alone first. Every time.

You need to be able to watch the staff, read the building, ask uncomfortable questions, and sit in the parking lot afterward processing what you saw. You can't do any of that if you're also managing your mother's anxiety in an unfamiliar place or worrying that your father is going to try to walk out the front door.

The tour is an evaluation. It requires your full attention. Bringing your loved one turns it into a caregiving event — and the facility knows it. They'll focus on your person instead of answering your questions, and you'll leave with a feeling about how they treated Mom for forty-five minutes instead of data about how they treat everyone the other twenty-three hours.

Once you've narrowed it down to one or two, consider a short second visit with your person — but only if their cognitive stage makes it meaningful. If your mother is early-stage and can still process new environments, a brief mid-morning visit framed as lunch at a nice place can help her feel some ownership over the decision. That matters. Schedule it between 10 AM and 2 PM, before sundowning risk. Keep it under forty-five minutes. Watch for agitation, repetitive questions, or wanting to leave, and be ready to go the moment any of those appear.

If your person is moderate-to-late stage, the visit serves your needs, not theirs. They may not understand where they are or why. That doesn't mean you're making the wrong decision — it means the decision is yours to make. Honor what they told you when they could still tell you, and make the best call you can with what you know.

Don't frame it as "we're touring memory care facilities." Say "let's go check out this place — I heard they have a great lunch" or "a friend told me about this spot, want to see it with me?" This isn't dishonest. It's kind. You're meeting them where they are — which, if you've watched those Teepa Snow videos, is exactly what trained dementia care looks like.

Set your expectations before you set foot inside

Nobody in the sales office will say this to you: no memory care community is going to be a one-to-one replacement for the care you would provide at home. The aides are not going to know that Mom likes her toast cut diagonally, or that she gets anxious when it rains. They're caring for a dozen people at once. Some of them are extraordinary. None of them are you.

That's not a reason to avoid memory care. It's a reason to recalibrate what your role looks like after move-in.

Your role changes. You go from being the person who does everything to the person who makes sure everything gets done right. You become an advocate — less tactical, more strategic. You're watching the care plan, talking to the nurses, building relationships with the aides who work the shifts when your parent is most vulnerable. You're the one who notices when something changes and makes sure the right people know about it.

Your presence still matters. Maybe more than before, because now you're the continuity. The staff will rotate. You won't. Know the aides on the evening shift, the weekend crew, the activities coordinator. When you're a known presence, your parent gets better care. The families who show up get attention. The families who disappear get whatever the system produces on its own.

Here's a trick nobody tells you: keep a candy bowl in your parent's room. The aides will come to the candy. That's not bribery — it's relationship building. You want the people caring for your parent to know you, like you, and feel comfortable talking to you. Bring coffee for the night shift sometime. Drop off pizza on a weekend. These are people doing hard work for not enough money, and a small, unexpected gesture goes a long way. When the aide who works the 3-to-11 shift knows you by name and knows you appreciate what she does, your parent gets better care. That's just reality.

And while you're visiting, you can learn a lot about how the facility actually runs without asking directly. The staff will be honest with you — more honest than management — if you ask the right questions in the right way. You're not interrogating them. You're having a conversation. But the conversation is doing work.

Try these:

• "Do you ever get to work in assisted living, or are you always in memory care?" — If they float between units, the memory care staff isn't dedicated. They told you on the tour that the aides are memory care-specific. Now you know if that's true.
• "This is hard work at night. How do you get a break?" — If the answer is "I don't" or "we're not really staffed for breaks," you just learned more about the staffing situation than the director would ever tell you.
• "How long have you been here? Do you like working here?" — Watch the pause. Watch the face. A genuine "yeah, it's good here" looks different from a careful non-answer. And if they say "I just started last month," ask who was here before them.
• "What's the hardest part of working nights here?" — This is an open door. If they say "the residents can be challenging at night, but we manage," that's normal. If they say "there's only two of us for the whole unit," that's a staffing problem the brochure didn't mention.
• "I noticed [specific aide's name] was great with the residents during my tour. Is she here most days?" — If nobody can tell you who works regular shifts, or if the answer is "she left last month," you're getting real-time turnover data.

None of these questions will get anyone in trouble. They're just conversation. But they'll tell you whether what management described on your tour matches what the people on the floor are actually living.

Your job isn't over when you sign the paperwork. It's different. You're trusting other people with the person you love most — and the work you put in now, building relationships and staying present, is what makes that trust well-placed.

The building matters more than you think — but not the way they want you to think

I want to tell you about the place we chose for my mother-in-law, because it illustrates something important.

The community is designed in small pods of eight residents. Each pod has its own dining table, kitchen, and living room. It feels like a home, not an institution. That mattered for her — the layout fostered closeness between her and her neighbors quickly. She built relationships in that pod that she never had at her previous facility, which was laid out like a hotel corridor.

She can get out of her room, walk around her pod, and if the larger activity area feels overwhelming — which happens with dementia — she can find her way back to a space that feels familiar and safe. That's not a luxury. That's design doing what architecture is supposed to do: serving the people who live there.

Other communities we toured were rectangles — rooms on the outside walls, one big common area in the middle. Others had grand marble lobbies with tall ceilings that felt opulent but sterile. Impressive to walk through on a tour. I'm not sure they felt like home to anyone living there.

The point isn't that pods are the only good design. The point is that the physical environment shapes daily life in ways that matter enormously for someone with dementia — wayfinding, overstimulation, sense of belonging, ability to retreat. When you're touring, ask yourself: does this place feel like somewhere my parent could live, or somewhere my parent would be stored?

Get on the waitlist now

I'm glad we found a place that works for my mother-in-law — good staff, good management, a design that fits her. But I need to tell you how we got here, because it wasn't through planning. It was through crisis. And I don't want that for you.

My father-in-law promised my mother-in-law decades ago that he would never put her in a "home." He has Parkinson's disease. He knew she had dementia. But he couldn't face the reality that he couldn't take care of her anymore. They lived together in assisted living, and we visited nearly every day. It was exhausting. But it looked like it was working.

Then he fell and broke his hip.

That's when we became acutely aware of how far her dementia had actually progressed. He'd been covering for her — just like I wrote about in another article. When he went into rehab for three weeks, my wife and I and her siblings took turns staying with her mom. We found her wandering. Panic attacks. Things we had never seen because he had always been there to manage them quietly.

Suddenly memory care was an emergency. We had no time to research it because we were simultaneously dealing with a broken hip for an 82-year-old man with Parkinson's. The assisted living facility told us the only way she could stay is if she moved to their memory care unit. We had no leverage, no one to appeal to.

They had a room available in memory care. We took it because we had no other options. It ended up not working out. We moved her to a different community a couple months later — the one she's in now, the one with the pods, the one we actually chose instead of being forced into.

The point of all of this is simple: things are going to accelerate. Dementia does not plateau. If you're not sure whether it's time, start thinking about it now — don't wait for certainty. The person compensating for your loved one — whether that's a spouse, a sibling, or you — is going to hit a wall. When that happens, you need options. Not one option. Options.

So if you're even thinking about memory care — even if it feels too early, even if your parent would be furious at the suggestion, even if it seems like things are manageable right now — narrow it down to two or three communities and put your name on the waitlist for all of them.

Yes, you'll pay a deposit for each. A thousand dollars, maybe more. It's worth it. Because when the crisis comes — and I'm not saying if — the cost of those deposits is going to be nothing compared to the pain of having to take whatever's available because you didn't prepare.

Do it before you think you're ready. Do it before your loved one thinks they're ready. The waitlist is not a commitment. It's an option. And when the time comes, you will be grateful you have options.

Memory care tour checklist

If you take one thing from this article, take this list. Print it, bring it on every tour, and fill it out in the parking lot before you drive away.

Before the tour:

• [ ] Look up the facility's inspection record (Virginia: dss.virginia.gov/facility/search/alf.cgi)
• [ ] Call the Long-Term Care Ombudsman and ask about complaint history
• [ ] Watch 2–3 Teepa Snow videos so you know what good dementia care looks like
• [ ] Check Glassdoor and Indeed reviews for the facility as an employer

During the tour — observe:

• [ ] Do staff approach residents from the front, at eye level?
• [ ] Do staff use hand-under-hand or similar trained techniques?
• [ ] Are residents engaged in activities or parked in front of a TV?
• [ ] Are aides wearing earphones or scrolling phones?
• [ ] Can residents move independently where they're able to?
• [ ] Does the building feel like a home or an institution?

During the tour — ask:

• [ ] Are memory care aides dedicated to the unit, or do they float?
• [ ] What is the staff-to-resident ratio — day, night, weekends?
• [ ] What is the annual turnover rate for memory care staff specifically?
• [ ] How long has the executive director been here? Director of nursing?
• [ ] Who owns this community?
• [ ] What's included in the base rate vs. what's extra? (Get it in writing.)
• [ ] How does the level-of-care assessment work? What's the tier spread?
• [ ] Can I visit unannounced, at any time?
• [ ] What does a typical Saturday look like?
• [ ] What happens when a resident becomes agitated?
• [ ] When was the last time a resident eloped? What changed?

After the tour:

• [ ] Go back unannounced — at night, on a weekend
• [ ] Talk to aides and night staff (not the sales coordinator)
• [ ] Compare contracts line by line, not brochures
• [ ] Compare what you observed, not what you were told

The tour is designed for your heart

You're making this decision during one of the hardest periods of your life. You're probably sleep-deprived. You're probably arguing with a sibling about what Mom would want. And now someone in a blazer is walking you through a building that smells like lavender and everything in you wants to believe this is the right place because you need this decision to be over.

I get it. I've been there.

But the tour is just the beginning. What matters is the organization behind the lobby — who's running it, how they run it, and whether the care you saw during the tour is the care your person will get every day.

Call the ombudsman. Read the inspection reports. Talk to the hospice nurses. Check Glassdoor. Walk through the building and watch the aides, not the lobby. Notice whether the residents look engaged or parked. Notice whether the staff get to eye level and speak to your person like a person.

And after move-in, keep showing up. Keep the candy bowl full. Know the staff. Know the residents. You are the continuity in a system where everything else rotates — and your presence makes the care better.

There are good communities out there. The work you do now — the research, the tours, the unannounced visits, the hard questions — is how you find them.

Sources

Staffing and quality data:

• AHCANCAL — 2025–2026 Staffing Report — Industry turnover rates, staffing shortage data, and caregiver wage information.
• Alzheimer's Association — Dementia Care Training & Certification — essentiALZ and other professional credential standards.
• NCCDP — Certified Dementia Practitioner — National certification requirements for dementia care professionals.

Virginia regulations and oversight:

• Virginia Administrative Code 22VAC40-73 — Assisted living facility licensing standards, including special care unit (SCU) staffing minimums and training requirements.
• Virginia Department for Aging and Rehabilitative Services — Long-Term Care Ombudsman — Resident advocacy, complaint investigation, and facility oversight.

Safety, overmedication, and quality research:

• CMS — National Partnership to Improve Dementia Care — Antipsychotic reduction initiative and facility-level usage tracking.
• Human Rights Watch — "They Want Docile" (2018) — Investigation into antipsychotic overuse in U.S. long-term care facilities.

Facility inspection (Virginia):

• Virginia DSS Assisted Living Facility Search — Searchable database of inspection results for licensed assisted living and memory care facilities in Virginia.

Dementia care training and techniques:

• Teepa Snow's Positive Approach to Care — Hand-under-Hand technique, Positive Personal Connections, GEMS Brain Change Model, and free video resources for families and professionals.
• PMC/NIH — Montessori-Based Programmes Impact on Dementia — Peer-reviewed research on structured cognitive stimulation reducing agitation and psychotropic medication use.