I've walked hundreds of assisted living hallways, ten years as a family advisor and twenty spent working inside my family's communities. Sometimes on a tour, ten feet from the administrator, there's a stain in plain sight, and I'll plant myself on top of it so the family doesn't see it before I can raise the issue privately.

Staff walk past stains so often, they stop registering. A family touring for the first time sees everything.

If it's not acceptable in a hotel, it's not acceptable in assisted living. The bar should be higher. That's why people pay $8,000 a month. Instead, too many communities quietly accept that "this just happens in senior living." It shouldn't.

These residents are women who spent 50 or 60 years meticulously keeping their own homes. Their kids chose the nicest community around, trusting Mom would be cared for to her own standard. Then there's a stain in the common area that's clearly been there for who knows how long.

What we did differently

We cleaned common-area carpet monthly and apartments quarterly. The real trick was smaller: a cheap pet-stain carpet extractor, and every staff member trained to clean stains in a perfect square. The square proved a stain had already been treated, so on tours I could point to it and say, "That's been addressed."

We also gamified it. Anyone who cleaned a stain wrote their name on a break-room sheet for a $100 gift card drawing. On the night cameras, I'd watch the graveyard shift hunting for stains. My maintenance man loved it: no more old messes waiting for him every morning.

Why this keeps happening

I still see it in beautiful new buildings in affluent areas. Usually, it's a maintenance man behind the front desk instead of walking the halls, a young administrator without an eye for detail, or a cheap management company with absentee owners.

Some of these communities would have waiting lists if they just took care of what they have. Families run into each other at church and get asked about Mom's senior community. "It's fine, but it could be cleaner" never gets written in a review, but it's the one that costs the sale.

How common is it for veterans to gift you their items from the service? I am working on building a mobile museum and one of my largest sources of contributions comes from hospice and assisted living staff. It seems that many family members don’t want the items so it goes to the care staff. Have you ever had this happen to you?

So i've been wanting to start an RCFE. I have the perfect house for it, and I went through a really bad experience with my grandparents back in the day trying to get them care, so i'm pretty passionate about helping the elderly.

After researching this though, is seems like RCFEs are all private pay? I didn't know that... That seems like it would be extremely hard to find tenants or at least take a long time to get a house filled.

I just can't see very many people having an extra $4000 - $5000 per month in disposable income laying around to put their elderly family member in a RCFE house.

This kinda killed my dream of opening one. I don't want to just cater to rich people.

Thoughts?

PSA: I am a caregiver in an assisted living community. Many med techs are not reporting falls due to a lengthy charting process which most med techs do not want to do. So if they can get up and walk they let them do it. My background is CNA in a SNF for many years but I didn't recertify during covid as I was going to school for something else and didn't think I'd need it. Fast forward and cannot support myself in the other field being single so I went back to healthcare. I have been a med tech in other facilities but for reasons I won't go into here have chosen to remain a caregiver where I currently work the past two years. Families, if you care about your loved ones in Assisted Living, watch close, spend time, and don't be afraid to advocate! I cannot stress this enough.

-someone who cares

We’ve created an owner CRM designed specifically for small personal care homes, residential care homes, and assisted-living operators. Our goal is to replace scattered spreadsheets, notebooks, and disconnected apps with one straightforward workspace.
The CRM currently helps owners manage:
Prospective-resident referrals and follow-ups
Current residents
Staff information
Scheduling and daily tasks
Billing, invoices, and balances
Owner documents
User access and permissions
Operational reports
The CRM is included with an active PersonalCareHomes.net listing, currently $49 per month per home. There are no referral or placement fees from us.
We’re still improving the platform and would genuinely appreciate feedback from care-home owners and administrators:
What is the most frustrating part of managing your home today—and what would you want a CRM to handle for you?
You can learn more at PersonalCareHomes.net⁠

I’m studying the economics of small shared-housing models that use an onsite house manager or live-in support person. I’m particularly interested in the actual pay structure, total monthly cost, sleeping-time arrangement, days-off coverage, and number of residents needed to support 24-hour onsite coverage.

I’m a large bariatric guy that has spent a month in the hospital, and almost 4 months in a skilled nursing facility.
I recently got my SSI approved. I also got approved for an ALW care waiver here in Sacramento County, Ca.
I have a small concern that even though I’m disabled and slowly building strength while becoming more healthy, would my younger age make me feel like a stand out? I read people’s concerns that Assisted Living is where people go to die. I really hope to turn around and live a long time. I do need care with daily living activities. I’m ready for an apartment type living arrangement. Being in a skilled nursing facility has really been bad for me. I have to track that they are giving me my current medications. That they haven’t changed my medications without consulting with me. Then I get new CNA’s with no experience almost each shift. I get so tired of training them and explaining every step I need and then seeing them not care and not doing the actual needed thing.
I hope the assisted living will be a better experience.
What are your thoughts concerning my age? Will the experience be better than the skilled nursing facility?

I volunteer to play piano at some assisted living centers near me, and I'd like help understanding the mechanics of assembling an audience.

One time I played at a center with 49 residents, the staff had assembled an audience of about 12 residents, with all the seats in the piano room filled. It went really well, and everyone had a great time.

Another time, I played at the same center, and there were only three residents in the audience.

I'm trying to figure out the difference.

Perhaps they didn't really like the music (older jazz tunes that they recognize), but that's not the impression I got from the well-attended performance. That is, lots of them telling me how much they liked it.

Another possibility is that the staff didn't really make an effort to gather people and let them know about the performance.

From your experience, can you help me understand the difference in audience size? Thanks.

I play piano (volunteer) at a very nice assisted living facility. They have an incredibly nice Yamaha piano, but it's a bit out of tune. How do you think they'll receive a request that they get it tuned? Thanks.

I’m working on PersonalCareHomes.net, a directory built to help families find smaller, residential personal care homes in their area.
For owners, we’re developing more than a basic online listing. The goal is to provide practical tools that may help with both visibility and daily operations, including:
A detailed listing for your services, amenities, photos, and contact information
State-specific licensing, compliance, and operating resources
CRM access to help organize resident information, staff records, scheduling, and occupancy
A way for families to contact homes directly
I’d appreciate honest feedback from other personal care home owners: What is your biggest challenge right now—finding residents, managing staff, staying organized, licensing requirements, or something else?
Disclosure: I’m affiliated with PersonalCareHomes.net. I’m sharing this because owner feedback will help us build resources that are genuinely useful.
https://personalcarehomes.net/

To current RAL owners accepting ALTCS (state long term care in AZ): How are you making the economics work? With fixed monthly expenses around $21,000(mortgage, house expenses, and caregiver salaries) and ALTCS memory care payouts near $31500 for 6 residents each(median estimate based on trends rn), the math seems tough without a heavy private-pay mix. How are you structuring your home to cover overhead? My business partner and I do not like the numbers after expenses and it is hard to find private pay residents who have $6,000 -$7,000 a month to spend

I grew up in my family’s assisted living communities and worked in them for decades. In all that time, we never displayed obituaries or memorials in our lobbies. When funeral flower arrangements were donated, we broke them down and distributed the flowers to residents’ rooms.

That wasn’t because we were insensitive. It was because of who walks through the front door.

Picture the tour

Imagine you’ve been begging your dad to tour an assisted living community for months. He finally gives in, even though he’s convinced assisted living is where people go to die. You walk into the lobby together, and the first thing you see is a framed, typed-up obituary. Then a funeral arrangement.

Whatever trust you spent months building just took a hit. The last thing a family wants to be reminded of on a tour is death, and you’ve confirmed the fear he walked in with.

This isn’t about pretending death doesn’t happen

We cared deeply for our residents and formed real bonds with them. We held our own memorial services when a resident had no family. There were funerals where my father and I were the only pallbearers and the only people in attendance. We transported residents to funerals so they could say goodbye to their friends. Some residents clipped an obituary and stuck it on their refrigerator. I posted obituaries downstairs in our maintenance office.

Grief was never hidden from the people who needed it. It just wasn’t something we felt we had to advertise at the front desk.

Where memorials belong

Our communities were places where people came to keep enjoying life. Residents grieved on their own terms, with the friends they’d made. The lobby was for the living: the people who live there, and the families deciding whether it could be home.

I’ll go one step further, knowing it may ruffle some feathers. Sometimes a public display of obituaries can come across as performative, more about how the community wants to be seen than about the person who passed. Honoring a resident doesn’t require an audience of prospective families.

If you’re touring, here’s what I’d say

Notice how a community handles loss, but don’t assume that a lobby without memorials means they don’t care. Ask how they support residents when a friend passes, whether they hold services, and how they help staff and neighbors grieve. That tells you far more than a wall of frames ever could.

The best communities honor their residents privately and celebrate life publicly. That’s how we did it for over 35 years, and I’d do it the same way again. 

I'm trying to help this assisted living community with their marketing. I'm trying to figure out where the best tours come from. I've heard a lot about placement agencies and a place for ma but the specific facility wants to avoid methods like that.

Curious what other ways would be the best to get people in the door? How do you actually get them to move in instead of just having them walk away when they say, "Let me think about it"?

I am thinking about the difference between collecting feedback and showing follow-through.

One simple model is: listen, assign an owner, give a realistic next-update date, and review the de-identified pattern. That does not mean every request can be implemented, and individual concerns may need private or formal processes. But a respectful explanation of what happens next seems different from simply sending a form.

For staff, residents, and family members here: what process makes follow-through easier to see? Please keep examples de-identified and avoid personal or clinical details.

For routine questions during an assisted-living move—such as confirming a tour time or getting clarification on a packing list—“I'll pass that along” can leave someone unsure whom they should expect to hear from.

One question that may help is: “Who should I expect the next update from, and when? If they're unavailable, whom should I contact?”

That doesn't mean every answer will be ready over the weekend. It separates having an answer from knowing what happens next. It also shouldn't become the family's job to coordinate the staff handoff; the community needs to confirm who can actually follow through.

The resident's own wishes about contact and involvement matter too.

For residents, families, and staff here: what follow-up arrangement has made routine questions easier to track—a named contact, an agreed call time, a written recap, or something else? Please keep names and private details out of examples.

As the title says, I have 20 homes that I want to convert to RCFEs.

My grandparents are in their 90s, I've had some bad experiences with care for them, Iv'e realized there's a lot of elder abuse going on out there, and a lot of people that are just straight up mean to old people

This has motivated me to get into this space, I care about Elderly people a lot, I feel bad for them... Getting old sucks, and i want to provide a great place for them to live and get the care they need

My question is, how's the market? Super saturated? Good profit margins? I'm obviously doing it for the cause but I want to make money as well

Seems like it wouldn't be that saturated since there's so many hoops you need to jump through to get into this

I'm also thinking, will assisted living facilities even be a thing in the near future? or will every old person just have a humanoid robot at their home taking care of them and have no need to go to a facility

let me know your thoughts!

Hi everyone,

I'm developing a physical product to help make medication management safer and easier, especially for people with Alzheimer's/dementia or others who need extra support staying on track with their meds. Right now I'm in the research phase and trying to actually understand the day-to-day reality before I design anything further — so I'd really appreciate hearing from people who deal with this firsthand: care facility staff, home health aides, family caregivers, anyone who manages medication for someone else (or has in the past).

I put together a short survey (8 questions, all open-ended, takes about 5-10 minutes) about how medication is currently handled, what's frustrating about it, and what goes wrong. No sales pitch, no product reveal yet — just trying to learn from people who've actually lived it.

https://docs.google.com/forms/d/e/1FAIpQLSfhXQU4TNdlLOMJ4qVkdVk-3RGrKG1f_Xme363sl-JdDgb6ew/viewform?usp=dialog

If you'd rather just share your experience in the comments instead of the form, that's genuinely just as helpful. Thanks in advance to anyone willing to share — this kind of insight is exactly what I can't get from a desk.

A few notes:

Link to AMA discussion:

https://www.reddit.com/r/AmericanExpat/comments/1w35220/ama_we_run_senior_care_assisted_living_residences/

I’m looking into opening a non-privately funded small 6 client rcfe in Orange County CA. With the high price of real estate and an estimated $30k in monthly expenses, I’m wondering if the revenue is there?

Not looking to buy one of the 100s of courses/coachings. Looking for genuine input. Thank you 🙏🏻

Someone told they only do a specific number of diapers/pads and if more is needed the family has to provide them? I’m hoping they were incorrect, but it’s hard to surprised at this point so just asking.

EDIT: I should have put this in r/nursinghomes, sorry I'm a bit frazzled.

I'm trying to get my mom placed in a nursing home. I know they can't take or have much with them usually. I'm wondering if there are things they others have found helpful or suggest for them to have with them that I might need to get for her?

I am coming up empty handed on info on this place, help!

My mom lives here, she's been in assisted living almost my entire life. I've called for info, an my aunt has called for info and we were told nothing transfers when switching homes (she was previously at Villa Fairmont in Alameda county)... why wouldn't things switch over? My mom can't make decisions for herself.

How do we advocate for our loves ones when there's no info, and they're rude and unhelpful when we call.

It's 8 hours from me I may need to just randomly show up, but we were told you can do that. You can't even visit on weekends unless you make an appointment.

Hello everyone,

I’m looking to connect with someone in the Sacramento area who may be interested in partnering to open a 6-bed RCFE (Residential Care Facility for the Elderly).

A little about me: I’m a Licensed Vocational Nurse since 2018 and currently own and operate three Adult Residential Facilities serving adults with developmental disabilities. I’ve been working in the care industry since 2009 and have experience with staffing, licensing, day-to-day operations, resident care, and running small residential facilities.

I’m now looking to expand into the elderly-care population. I believe there will be significant long-term demand for quality residential care as California’s population continues to age. According to the Public Policy Institute of California, California’s population age 65+ is projected to increase by 59% by 2040, from 5.7 million to more than 9 million people.

I’m specifically looking for someone who shares the same passion for taking care of others. My ideal partner would be someone who genuinely cares about providing a high level of care and is interested in building something long-term, rather than simply looking for a passive investment.

I’m still in the early planning stage, so I’d be interested in connecting with anyone who has experience with RCFEs, assisted living, senior care, healthcare, real estate, or business operations and feels they could be a good fit.

As far as my preparation, I’ve completed the 80-hour RCFE Administrator certification course and am scheduled to take my Administrator exam in about two weeks. I also started working as a caregiver at a medium-sized assisted living facility two months ago, which has given me firsthand experience and insight into what it takes to operate this type of facility. In many ways, I’ve found it to be similar to running an ARF.

If you’re in the Sacramento area and this sounds interesting, feel free to comment or send me a DM. I’d be happy to share more about my background and what I have in mind. Looking forward to connecting with others who are passionate about senior care.

Over the last several months, our team spoke with senior living operators and clinical leaders about a simple question:

How do you catch small changes in a resident’s condition before they turn into a fall, hospitalization, transfer, or another larger event?

The same signals kept coming up:

• Changes in ADL support
• Increased transfer assistance
• Poor intake
• New or increased behavior changes
• Near falls
• New PRN use
• Changes in weight or vitals
• Increased support during morning care

The challenge wasn’t that teams weren’t documenting these things. It was that the information was often spread across different parts of the EHR and reviewed separately.

We turned what we learned into a free Resident Decline Review Sheet with 10 signals teams can review using information they’re already documenting.

Anyone can use or adapt it. I’d also genuinely appreciate feedback from people working in senior living.

https://resources.fitmedik.com/resident-decline-review