Documents Needed for Assisted Living: A Paperwork Checklist

The documents needed for assisted living usually fall into three piles: a health assessment signed by your parent's doctor (often on a state form, sometimes with tuberculosis screening), a current medication list with signed orders, and copies of their ID, insurance cards, advance directive and power of attorney. Most communities also want some financial information. Then comes the residency agreement, which deserves a slower read than anything else in the packet. Rules come from the state, so the exact list changes depending on where your parent is moving.

The admission packet at a glance

Every community hands out its own checklist, and you should ask for it on the first tour. This table shows what tends to be on it and where each item comes from.

The health paperwork

The physician's report or health assessment

This is often the piece that holds up a move date, and the details vary a lot by state.

In California, a residential care facility for the elderly must have a medical assessment signed by a licensed medical professional and made within the last year before accepting the resident. It covers communicable tuberculosis, current medications, mobility and cognition. In Florida, the rule calls for a medical examination within 60 days before or 30 days after admission, recorded on the doctor's own form or on AHCA Form 1823.

Call the doctor's office as soon as you have a likely move date, and bring the community's form along. Appointments can be weeks out, and a form signed too early can expire before moving day.

TB screening

Whether your parent needs an actual tuberculosis test depends on the state and sometimes the community. California's rule asks for an exam covering communicable tuberculosis; Florida's asks whether there are signs or symptoms of it. Ask the community which screening it accepts and how recent it must be, then try to get it done at the same doctor visit.

Medication orders and the pharmacy

The community will want a medication list, and if staff will help with medications, it will usually want signed orders from the doctor. Florida's exam, for example, must list current medications and say whether the person needs help taking them. If your parent's list lives on the back of an envelope, start with our guide to building a medication list for an elderly parent, then hand a clean copy to both the doctor and the community.

Ask early how the community handles pharmacy. A federal compendium of state assisted living rules, published in 2015 and now dated, found that Georgia required the residency agreement to describe who on staff handles prescription refills, and Oregon required it to describe how medications are packaged and the resident's right to choose a pharmacy. If your parent has to switch pharmacies, prescriptions need transferring, so leave time for it.

Advance directive, POLST and code status

The community will ask for copies of your parent's advance directive and the name of their health care agent, and it will ask about code status: what should happen if their heart stops. Give copies. Keep the originals where the family can reach them.

If your parent has a POLST or an out-of-hospital DNR, that order travels with them. Florida's rule even lets the doctor attach the state DNR form to the health assessment. If the directive is old or from another state, our guide to advance directive forms by state covers whether it still works, and our POLST form explainer covers the medical order.

The legal and financial paperwork

Power of attorney and who can sign

Admissions offices want to know who can legally sign for your parent. If your parent can sign their own residency agreement, they should. If you'll sign as their agent, bring the financial power of attorney; if there's a guardianship, bring the court papers. If memory changes have you wondering whether your parent can still sign, our guide to organizing after early signs of memory loss covers getting key papers signed while they still can.

Not sure what exists? Our list of important documents for aging parents covers each one, including what to do if one can't be found.

HIPAA authorizations

The community's nurse will talk with your parent's doctors, and you'll want to talk with both. A health care proxy usually only kicks in when your parent can't decide for themselves, so a separate authorization fills the gap. Our guide to the HIPAA authorization for a parent explains how to set one up with each office.

Insurance cards and the financial application

Make front and back copies of every card: Medicare, a Medigap or Medicare Advantage card, Part D, and any long-term care insurance policy. Our guide to Medicare documents for a parent covers which card is which. If your parent has long-term care insurance, call the insurer before the move and ask what it needs from the community to start paying claims.

Many applications also ask about income and assets. Bring what's requested, and keep a copy of everything you hand over in case a Medicaid application asks for the same records later.

Reading the residency agreement

The residency agreement is the contract. It sets the price and the services, says what happens when needs change, and lays out how your parent can be asked to leave. When that 2015 federal compendium was written, nearly every state required one, 35 states required it to include admission and discharge policies, and Maryland required the agreement itself to recommend review by an attorney. Those counts are a decade old, so check your parent's state for current rules. A 2017 Consumer Reports article on these contracts also advises having an elder law attorney look it over. If a lawyer isn't in the cards, read it with a pen and the questions below.

Fees and how they go up

Look for the base monthly charge and what it includes, any one-time move-in fee and whether it's refundable, and the notice required before rates go up. That Consumer Reports piece notes that most contracts run a year, so fees are likely to go up at each renewal.

Massachusetts uses a state residency agreement cover sheet that the resident or their legal representative initials section by section. It's written for Massachusetts, but several of its warnings are good questions anywhere: monthly costs can rise when more services are added, a reassessment can change the service plan and the bill, and a resident who runs out of money may be required to move.

Level of care assessments

Many communities price care in tiers or points, based on an assessment of how much help your parent needs with bathing, dressing, medications and so on. Find out who does the assessment, how often, whether you're told before the level changes, and whether you can see the scoring. This is often where monthly costs drift upward without anyone deciding they should.

Discharge and eviction

Read this section twice. In federal fiscal year 2023 data from the Administration for Community Living, discharge or eviction was first on the list of the five most frequent complaints ombudsman programs handled in board and care, assisted living and other residential care communities.

Consumer Reports notes the notice period is typically 30 days and the wording is often vague, something like "we can no longer meet your needs." An advocate quoted there suggests asking to limit discharge to specific reasons, such as nonpayment or care needs the community isn't licensed to provide. Also ask what happens after a hospital stay. Massachusetts's cover sheet says a residence can't prevent a resident from returning after a hospital or rehab stay, though the resident may have to hire private help if their needs have grown. Other states handle this differently.

Arbitration clauses

An arbitration clause means disputes go to a private arbitrator instead of court. A federal rule, 42 CFR 483.70(m), bars nursing homes that take Medicare or Medicaid from requiring residents to sign a binding arbitration agreement as a condition of admission or continued care, and requires any such agreement to give residents 30 calendar days to back out. That rule is written for nursing homes and doesn't reach assisted living, so whether an assisted living community can require arbitration depends on state law and the contract.

The 2017 Consumer Reports article quotes a trial attorney who suggests crossing out a mandatory arbitration clause or writing "refused" next to it, and getting a complete copy of what was signed. If the community insists, your parent decides whether the place is worth agreeing to it.

Signing as agent, not as the responsible party

If you sign for your parent, watch the signature block. Consumer Reports quotes an elder law attorney advising families to make sure they're identified as an agent, not the "responsible party," and to write "attorney in fact" after the signature. Signing as a responsible party or guarantor can make you personally liable for the bill.

Questions to ask before signing

Bring this list to the meeting before the one where the contract gets signed.

• Is the community licensed by the state, and under which license type?
• What exactly does the base rate include, and what costs extra?
• Is any part of the move-in fee refundable? How much notice comes before a rate increase?
• How do care levels work, who does the assessment, and will we be told before the level changes?
• Under what specific circumstances can a resident be asked to leave, and how much notice is given?
• Can my parent come back after a hospital or rehab stay? Is the apartment held, and is there a charge for holding it?
• What happens if my parent runs out of money? Do you accept Medicaid waiver payment, now or later?
• Is arbitration required or optional? Am I signing as an agent or as a guarantor?
• Which pharmacy do residents use, and can my parent keep their own?
• Who helps with medications, and when is a nurse on site?
• How much notice do we have to give to move out, and what do we owe after that?
• Can we have a complete copy of everything signed, including attachments?

Check the license and the inspection reports

There's no single federal rulebook. The 2015 federal compendium notes that residential care settings "are licensed and regulated at the state level," and even the name varies: assisted living, residential care, personal care home.

Search your parent's state health or human services site for "assisted living licensing" and the community's name. Oregon, for example, runs a licensed long-term care settings search with inspection reports, substantiated violations and regulatory actions. In other states you may need to call or file a records request. Look for patterns, such as repeated medication errors, rather than one stray citation.

The ombudsman covers assisted living too

It's easy to assume the long-term care ombudsman is only for nursing homes. It isn't. The National Ombudsman Resource Center describes the program as advocating for residents of nursing homes, board and care homes and assisted living facilities, and the Administration for Community Living notes the program operates in every state under the Older Americans Act.

The ombudsman is free and works for the resident, not the community, on things like discharge notices, billing disputes and care complaints. To find your local office, the Eldercare Locator at 1-800-677-1116 can connect you.

Paying for it: Medicare, Medicaid and the waiver question

Medicare doesn't pay for assisted living rent, or for the help with daily care that most residents need. Medicare.gov's long-term care page says Medicare doesn't pay for long-term care (also called custodial care), names assisted living as one of the places people get that kind of non-medical care, and says most health insurance, including Medigap, doesn't pay for it either. Your parent's regular Medicare coverage for doctor visits, hospital care and prescriptions continues as usual.

Medicaid can help in some states, but with services, not rent. The 2015 federal compendium states that "federal law does not allow Medicaid to pay for room and board in residential care settings" (it notes narrow exceptions such as respite care), so the resident still pays for the apartment and meals. States cover the care side mostly through home and community based services waivers, with names, eligibility rules and participating communities that differ by state. Waivers also let states cap how many people they serve, which can mean waiting lists, as KFF explains. If Medicaid is in the picture now or might be later, ask the community directly whether it accepts waiver payment, and whether a resident who becomes eligible can stay.

Change of address, in an order that works

Once the move date is set, work through these in roughly this order.

1. Social Security, which also covers Medicare. Medicare.gov says to change your official Medicare address through Social Security, even if your parent doesn't get Social Security benefits. People already getting benefits can update it online in a my Social Security account; others need to call or make an appointment.
2. Medicare Advantage or Part D plan. If the move takes your parent outside the plan's service area, they can switch plans during a special enrollment period. The window starts when they move and runs two full months after, or starts the month before if they tell the plan ahead of time. Check that their doctors and the community's pharmacy are in network too.
3. USPS mail forwarding. A change of address request only changes the address with the Post Office. USPS also warns that government agencies and financial institutions don't allow sensitive mail, such as bank statements and insurance information, to be forwarded. You still have to tell each sender.
4. Pharmacy. Transfer prescriptions and cancel automatic refills headed to the old house.
5. Banks, pension, insurers, credit cards, doctors, the DMV, voter registration. Our guide to organizing an elderly parent's bills has a bill inventory that doubles as a who-to-notify list.

The house left behind

If the house won't be sold right away, an empty house brings its own paperwork.

Call the homeowners insurer first, because policies can limit coverage once a home sits empty. One example from New York: the state Department of Financial Services explains that New York's standard fire policy lets insurers exclude losses that happen after a building has been vacant or unoccupied for more than 60 consecutive days, and that a widely used homeowners form excludes vandalism after 30 days of vacancy. Your parent's policy and state may set different terms, so read the vacancy section of their policy, tell the insurer about the move, and ask what coverage an empty house needs.

Then work through the rest:

• Utilities: keep heat and water on enough to protect the pipes, and drop services nobody needs, like cable.
• Property tax: some homestead or senior exemptions depend on the owner living in the home. Ask the county assessor what changes after a move.
• Someone with a key: name one person to check the house regularly, and write down who has keys and alarm codes.
• Deed, mortgage and any home equity line: find the papers before anyone talks about selling. If there's a reverse mortgage, call the servicer before the move and ask what the loan says about living elsewhere.
• Medicaid planning: if your parent might need Medicaid later, talk to an elder law attorney before selling, renting or transferring the house. How a home is treated depends on state rules and timing.

Frequently asked questions

What documents do you need to move into assisted living?

Usually a doctor's health assessment, TB screening if required, a medication list and signed orders, copies of ID and insurance cards, the advance directive and any POLST, the power of attorney, and financial information. Ask the community for its own checklist, since requirements vary by state.

Does Medicare pay for assisted living?

No. Medicare doesn't pay for room and board or daily personal care in assisted living, though it still covers your parent's medical care while they live there. In some states, Medicaid waivers may help pay for services, but generally not for room and board.

Do you need a TB test for assisted living?

It depends on the state and the community. Ask which screening the community accepts and how recent it must be.

Can an assisted living community require an arbitration agreement?

The federal rule against required arbitration applies to nursing homes that take Medicare or Medicaid, not assisted living, where state law and the contract control. You can ask to strike the clause, and having a lawyer read the agreement first is a good idea.

Can assisted living evict a resident?

Yes, for reasons allowed by state law and the agreement, such as nonpayment or needs the community can't meet. Notice and appeal rights vary by state. If a notice arrives, call the ombudsman right away.

Once the move is done

None of this needs anything fancier than a copier, a stack of envelopes and a few weeks of phone calls. Afterward, keep a short record of where the originals went, who signed what, and whom to call when the community phones at 2 a.m. You can write that yourself from this checklist. If you'd rather answer questions than design pages, Emergency Binder Now asks about 25 minutes of them and prints a binder for your parent: a one-page Emergency Information Sheet for staff or paramedics, pages on which legal documents exist and where each one is now, and a list of loose ends. You can page through a sample binder on your own time.

This checklist is meant to help you get organized; it can't stand in for legal, medical or financial advice. Assisted living is regulated state by state, and the rules and examples above may not match your parent's state or community. Check current state rules, and if you can, have an elder law attorney read the residency agreement before anyone signs.