By the time most Las Vegas families take their first assisted living tour, they have a parent in crisis, a phone full of facility brochures, and roughly 45 minutes to make a six-figure, multi-year decision they can't easily reverse. This checklist exists so you don't make the decision blind. It's the same 47-question framework our advisors use on every Clark County tour — adapted from the work we've done with over 200 Vegas families.
Print this. Take it with you. Don't trust your memory after the third tour, because by then every facility looks like every other facility. Ask the questions. Write down the answers. Walk away with a comparable apples-to-apples scorecard.
Before you walk in: the three questions to answer at the door
Before the receptionist hands you a brochure and a clipboard, you need three pieces of information, in writing:
1. What is the all-in monthly cost for the care level my parent will need? Not the base rent. The base rent plus care-level fees plus medication management plus any other monthly charges. Most Vegas facilities will quote "starting at $4,800" and the actual all-in number for a Level 3 resident with medication management is $7,200. You need the real number.
2. What is the community fee, and is it refundable? Almost every Vegas community charges a one-time fee on move-in — typically $2,500 to $5,000 for assisted living, sometimes $7,500+ for memory care. Some are partially refundable for the first 90 days, some not at all. Get this in writing.
3. Do you have an available unit today, and what's the waitlist if not? Vegas facility waitlists run 0 to 6 months in 2026 depending on care level and unit type. If you're looking at a 4-month waitlist, you need to factor in interim care.
If a facility won't answer these three questions in plain numbers before the tour, that's information. Some of them will resist because they want the emotional commitment first. Don't give it.
The tour itself: what to actually look for
A good Vegas tour takes 60 to 90 minutes if it's done properly. If a facility pushes you through in 30 minutes, that's information too. Here's the 47-question framework, organized by what you're evaluating.
Physical environment (8 questions)
The environment shapes whether your parent will actually thrive in this place, beyond the marketing photos.
1. Walk the longest hallway end-to-end. Does it smell like urine, or like cleaning products masking urine? The honest answer is sometimes urine — even good facilities have moments. What you're testing is whether the smell persists in occupied rooms or only in shared spaces, and whether it's masked or addressed.
2. Are residents visible in common areas, or are they all in their rooms? A facility where residents are predominantly in their rooms is either understaffed for programming, or programming the wrong things.
3. What's the noise level at 11am and at 2pm? Mid-morning quiet usually means residents are bored or sedated. Mid-afternoon noise during programming is a good sign. Ask to come back for a second visit at a different time of day.
4. Look at the floors near baseboards and under furniture. Look at the bathroom grout. Look at the food serving area at 11:50am, just before lunch. Cleanliness in low-visibility areas tells you more than cleanliness in the lobby.
5. Are the resident rooms personalized? Photos on walls, familiar furniture, recognizable objects — these suggest residents and families have been encouraged to make rooms feel like home. Sterile rooms suggest the opposite.
6. Is the outdoor space usable? Vegas heat is real, but every facility should have a shaded, accessible outdoor space residents can use 9 months of the year. Walk it. Check for shade, seating, and whether it's locked.
7. Is the memory care unit secured properly? For memory care specifically: are exits secured with keypad codes that staff actually use, or are they propped open? Are courtyards fenced and shaded?
8. What does the dining room look like during a meal? If you can, time your tour to overlap a meal service. Watch the food, the table presentation, and how staff interact with residents who need feeding help.
Staffing and care (12 questions)
This is the single most important category. Vegas facilities range from 1:6 daytime staffing ratios to 1:18 — that's the difference between a resident getting prompt help and waiting 25 minutes for a call light response.
9. What's the daytime resident-to-care-staff ratio? Nighttime ratio? Get specific numbers, not "we staff to need."
10. How many caregivers are on duty right now, and how many residents do you have today? Cross-check the answer above with reality at this moment.
11. What's the turnover rate for care staff in the past 12 months? Industry average is high (60-90 percent annually). A facility under 50 percent is doing something right; over 100 percent is a red flag.
12. Is there a registered nurse on-site 24/7, or only during business hours? Who's on call overnight? Many Vegas assisted living facilities have an RN only during day shift. Memory care often has higher coverage.
13. How long does it take to fill a call light, on average? A good facility tracks this. Industry standard target is under 5 minutes; many facilities run 10-15.
14. Who passes medications, and what credentials do they have? In Nevada, medication management can be performed by Certified Medication Assistants (CMAs) under RN supervision. Confirm the supervision is real.
15. What's your protocol when a resident's care needs escalate? When do you assess for a care-level increase, and how is the family notified?
16. Do you have a falls prevention program? What does it actually involve? Vegas assisted living falls are a major cause of hospitalization. A serious program has gait assessments, environmental modifications, and post-fall huddles.
17. How do you handle a resident with significant behavioral symptoms — wandering, exit-seeking, agitation, sundowning? The honest answer involves environmental modification, structured activity, family communication, and as a last resort, medication consultation. Be wary of facilities that lead with medication.
18. What's your hospitalization rate per 100 resident-months? Most facilities track this. Lower is better.
19. Can my parent's existing primary care doctor continue treating them here, or do they need to switch to your medical director?
20. Do you have a relationship with a specific home health agency for skilled services that aren't covered by assisted living scope?
Activities and quality of life (6 questions)
Programming is the second-biggest signal after staffing. Bored residents decline faster — cognitively and physically — than engaged residents.
21. Show me today's activity calendar. How many residents typically attend each event? A calendar full of "Bingo, Movie, Music" with low attendance is theater. A calendar with varied programming and 30-50 percent of mobile residents attending is doing the work.
22. Are there activities outside the building? When was the last outing, and what was it? Vegas facilities can struggle with outings due to heat and transport. The good ones still do them — to a museum, a restaurant, a grocery store, a park.
23. What's the religious and cultural diversity of your programming? Some Vegas facilities have strong Catholic, Jewish, or LDS programming based on resident populations; others are more secular. Make sure the cultural fit is real.
24. What does the activity director's day look like? Activity director should be a full-time, dedicated role, not a part-time afterthought.
25. What's your policy on resident pets? Visiting family pets? Therapy pets?
26. How do you handle a resident who refuses to participate? A good answer involves one-on-one engagement, environmental adjustment, family communication, and acceptance. Not coercion.
Dining (4 questions)
27. Can I see this week's menu? Last week's? Next week's? Vegas facilities run from heated-frozen institutional food to genuine made-in-house. The menu, repeated week-over-week, tells you which.
28. Is there a registered dietitian on staff, and how often does she review individual resident plans? Required for most levels of licensed care; verify the frequency.
29. Can residents request alternative meals if they don't like what's being served? What happens if my mother has texture or allergy restrictions?
30. What time is dinner served, and is there flexibility for residents who prefer earlier or later? Many Vegas facilities serve dinner at 4:30 or 5:00. If your parent has always eaten at 7:00, this is a real friction point.
Family communication (4 questions)
31. How will I be notified of a change in my parent's condition? Of a fall? Of a hospitalization?
32. What's the communication protocol when something happens at 2am?
33. Is there a family portal or app where I can see daily notes, medication administration, and activity participation?
34. How often does the facility hold family care conferences, and can I request one?
Financial and contract (8 questions)
35. Can I see the current residency agreement? Take it home and review it before signing? Any facility that refuses is a hard no.
36. What is the all-in monthly cost for the care level my parent will need on move-in? Confirm in writing.
37. How are care-level increases assessed, and what does each level add to the monthly cost?
38. What's your historical annual rent increase rate for the past 3 years?
39. What's the community fee, and what's refundable?
40. Do you accept HCBW Medicaid? If so, what's the private-pay-to-Medicaid conversion path? Can you put the conversion language in the residency agreement?
41. Do you accept long-term care insurance reimbursement? Will you bill directly, or do I need to bill?
42. What's the discharge policy? Under what circumstances can the facility ask my parent to leave? This is the one most families don't think about. Read the involuntary discharge section carefully.
Regulatory and reputation (5 questions)
43. May I see your current Nevada BHCQC license and most recent survey? Every licensed Nevada facility has a current license posted publicly and a recent state survey. Both should be available on request.
44. Have you had any state survey deficiencies in the past 24 months? What were they, and what was corrected?
45. May I have references — three families currently placing here, and three who placed and have since moved out? A facility that won't provide both is information.
46. Are there any pending complaints or lawsuits I should know about?
47. May I come back unannounced, at a different time of day, before I make a decision? The answer should be yes.
After the tour: how to compare
Don't compare facilities based on the tour you took at 10am on a Tuesday in May. Compare them on:
- The all-in monthly cost, including projected care-level increases
- The actual care staffing ratio, daytime and nighttime
- The discharge policy and Medicaid conversion language
- The current state survey and any deficiencies
- A second visit, at a different time, ideally unannounced
If you tour 4 facilities and one stands out across all five dimensions, that's your answer. If they're roughly tied, the deciding factor is usually distance — proximity to family who will actually visit weekly. Residents whose families visit more, do better.
What we do on Vegas tours
When our advisors tour with a family, we focus on the questions families don't think to ask: the discharge policy language, the private-pay-to-Medicaid conversion terms, the staffing turnover rate, the involuntary discharge history, the BHCQC survey citations from the past 3 years. We don't sell facilities. We're paid by partner facilities on placement, but our recommendation is the one we'd make for our own parent. We tour with you for free, and we'll go back unannounced after your decision if you want a second set of eyes.
Citations and source notes
This checklist draws on Nevada Bureau of Health Care Quality and Compliance (BHCQC) licensing standards under NRS 449 and NAC 449, the Centers for Medicare and Medicaid Services nursing facility inspection framework adapted for assisted living evaluation, the Argentum National Center for Assisted Living quality framework, and the National Center for Assisted Living's Quality Initiative metrics for 2026. Specific Vegas market observations come from over 200 Clark County tours conducted by Vegas Senior Advisor since 2019.