Reference guide

What we look for in a senior care contract

A plain-English reference describing the contract provisions our informational reports cover. Organized by topic — financial terms, care provisions, discharge, and dispute resolution — so families can understand what's typically in these contracts before reviewing their own.

Senior care contracts are legal documents drafted by attorneys representing the facility. They are designed to define the relationship between resident and operator, and they vary substantially in how they handle each of the topics below. Many provisions are uncontroversial. Others are worth understanding before signing — both because they may differ between facilities and because you may have questions you'd like to ask the facility or an attorney.

This page describes what we look for and explains industry context. If you'd like a description of your specific contract — clause by clause, with citations and questions to consider — our $99 report does that.

Financial terms

Rate adjustment provisions

Most contracts include a clause governing how and when the monthly fee can be changed. We describe the language verbatim and note three things: the notice period the facility must give before a change takes effect, whether there's a contractual cap on the size of any change, and whether there's a limit on how often changes can be made.

What we typically see:

Industry context: Rate adjustment language varies. Some contracts include a percentage cap (commonly tied to a published inflation index or a fixed annual maximum). Others include no cap. Some specify a minimum interval between adjustments; others do not. The presence or absence of these terms is something to look for and to ask about.

Questions to consider: What has the facility's actual rate adjustment history looked like over the past three to five years? Are there any facility policies — even if not in the contract — about typical adjustment timing or size? For an attorney: how does your state's law treat rate adjustment provisions in residency agreements?

Community and move-in fees

Many contracts require a one-time upfront fee — sometimes called a community fee, move-in fee, or administrative fee — collected at signing or at move-in. Amounts vary widely. Whether the fee is refundable, and during what window, varies even more.

What we describe: The fee amount, the rescission or refund window (the period during which a cancellation results in a refund), and what circumstances after that window result in any partial refund.

Industry context: Rescission windows of 14 to 30 days are common, but specific terms vary. The fee itself can range from several hundred to several thousand dollars depending on facility, location, and care level.

Questions to consider: Is the rescission window specified in writing, and is it consistent with what the admissions coordinator described? For an attorney: are there any state-specific consumer protection laws that affect the enforceability of these provisions?

Hospitalization and bed-hold payment terms

Hospitalization is common among senior care residents. Contracts vary in what the resident is required to pay during a hospital stay. Some require full monthly fee payment. Others provide a reduced "bed-hold" rate — a fraction of the full fee — that applies during absences over a specified length.

What we describe: Whether the contract requires full payment during absences, whether a reduced bed-hold rate is offered, the trigger length (e.g., absences over 7 consecutive days), and any conditions for the room being held versus released.

Industry context: Bed-hold rates of 50–75% of the full monthly fee are common but not universal. The rate, the trigger, and the maximum duration are all provisions worth checking.

Questions to consider: If hospital stays during the past year would have triggered the bed-hold provisions, what would the financial impact have been? For an attorney: are bed-hold provisions regulated by your state?

Ancillary supplies and markups

Many contracts state that supplies provided by the facility — incontinence products, wound care materials, nutritional supplements, and similar — are billed separately from the base monthly fee, often at a markup over the facility's cost.

What we describe: Whether the contract specifies a markup percentage, what categories of supplies are included, whether the resident may purchase supplies through an outside source, and the billing frequency.

Industry context: Markup percentages, where specified in writing, range from approximately 10% to 25% or more. Contracts that don't specify a markup percentage retain broader facility discretion.

Questions to consider: What does an itemized monthly statement of ancillary charges look like for a typical resident with similar care needs? For an attorney: are there state regulations on ancillary fee disclosure?

Medication management fees

Most senior care contracts charge separately for medication management — the storage, administration, documentation, and coordination of resident medications. The fee structure varies.

What we describe: Whether the contract distinguishes between medication assistance (for residents who self-administer) and medication administration (where staff directly administer), the fee tier structure if any, and how the fee scales with the number or complexity of medications.

Industry context: Medication management is genuinely time-intensive for facility staff and carries liability, which is why facilities charge for it. Fees ranging from approximately $75 to $200 per month are common, with significant variation by facility.

Questions to consider: If your parent's medication regimen changes substantially, does the fee change? Is there a documented process for re-tiering?

Care provisions

Level of care assessments

Senior care facilities typically charge for care in tiers, with each tier corresponding to a different monthly fee. The contract specifies how care levels are determined, who conducts the assessments, and what process applies if the family disagrees with a finding.

What we describe: The assessment frequency, who conducts the assessment (facility staff vs. independent professional), whether the contract specifies an assessment tool, and what review or appeals process applies if the family disagrees.

Industry context: Care level assessments conducted by facility staff are common — facilities argue, with some merit, that their staff knows the resident best. The structural concern is that the facility's revenue increases at higher care tiers, which creates an alignment question that a well-written contract may address with a documented review process. Whether your contract does so is worth understanding.

Questions to consider: What assessment tool does the facility use? How frequently are assessments conducted, and what triggers an off-cycle assessment? For an attorney: what are your state's regulations on care level disputes?

Staffing representations

Some contracts include language about the staffing the facility will provide — sometimes specific (a stated ratio of staff to residents) and sometimes general (commitments to provide care "as needed" without specific ratios).

What we describe: Whether the contract specifies any minimum staffing ratios, whether ratios vary by shift, and any commitments about notification if staffing falls below described minimums.

Industry context: Specific ratio commitments are less common than general care commitments. State regulations set minimum staffing requirements that apply regardless of the contract, but those minimums vary by state and are sometimes lower than what families assume. The Medicare star rating system includes a staffing sub-rating that's worth reviewing alongside the contract.

Questions to consider: What are the facility's actual staffing ratios on day, evening, and overnight shifts? Are those ratios published or available on request? For an attorney: how does your state regulate staffing representations in residency agreements?

Discharge and rules

Discharge provisions

The contract specifies the grounds on which the facility may terminate the agreement and discharge the resident, the notice period required, and any review or appeals process. These provisions vary substantially.

What we describe: The grounds for involuntary discharge listed in the contract, the notice period required for each, whether independent clinical review is required for behavioral or health-based discharges, and what appeals or review process is documented.

Industry context: Notice periods commonly range from 5 to 30 days depending on grounds. Federal law sets specific protections for skilled nursing facility residents (governed by the Nursing Home Reform Act), and state law adds further protections that vary by state. Assisted living, which is regulated at the state level, has substantial state-by-state variation in discharge protections.

Questions to consider: What is the facility's actual practice for discharges in cases similar to yours? For an attorney: what are your state's specific discharge protections, and are any of the contract's grounds preempted by state law?

Personal property after discharge

Many contracts include a clause governing what happens to a resident's personal belongings after discharge, particularly if the resident or family does not retrieve them within a specified window.

What we describe: The retention window for belongings, the disposition method after the window expires (storage continuation, donation, disposal), any storage or packing fees during the window, and any process for family to extend the window.

Industry context: Retention windows of 20 to 30 days are common. Many contracts allow disposal after the window if belongings are not retrieved, which can be a real concern for families dealing with a sudden discharge or a death.

Questions to consider: What is the actual process the facility follows when retrieval is delayed? Is there flexibility for out-of-state family members?

Facility rules changes

Many contracts include a clause stating that the resident agrees to abide by the facility's current rules and any future rule changes. This commits the resident in advance to rules that haven't been written yet.

What we describe: Whether the contract specifies notice requirements for rule changes, whether material changes to services or daily life require any specific procedure, and whether the current resident handbook is referenced or attached.

Industry context: Pre-acceptance of future rules is common. Whether the contract requires advance written notice of changes, and how much, varies. Asking for a copy of the current resident handbook before signing is something families commonly do.

Questions to consider: Is a current copy of the resident handbook available on request? What rule changes have occurred over the past year?

Dispute resolution

Arbitration and dispute resolution provisions

Many senior care contracts include arbitration provisions that direct disputes to private arbitration rather than court. These provisions vary substantially in scope, in whether they're presented as mandatory or optional, and in what opt-out windows they may include.

What we describe: Whether the contract includes an arbitration clause, where it appears (sometimes a separate exhibit), the scope of disputes covered, whether jury trial waiver language is included, whether the clause is presented as a condition of admission or as optional, and any opt-out window or withdrawal period.

Industry context: The Centers for Medicare and Medicaid Services prohibits skilled nursing facilities from requiring arbitration as a condition of admission. The rules for assisted living vary by state. Some states have additional consumer protections governing how arbitration provisions must be presented or what disputes they may cover.

Questions to consider: If the clause is presented as optional, what is the documented procedure for declining or withdrawing? Where is the clause located in the contract package — main agreement, exhibit, or separate signature page? For an attorney: arbitration provisions are a frequent subject of state-specific consumer protection law, and the enforceability of any specific provision is a legal question we strongly recommend discussing with a qualified elder law attorney before signing.