Questions to Ask the Executive Director Before Signing in Memory Care

Quick answer: The 14 questions below are the ones we wish every family asked the executive director before signing a memory care contract. They cover four areas where assumptions hurt families later: staffing and care quality (the operational reality), financial terms (the cost reality), discharge criteria (the contract reality), and family communication (the relationship reality). The right answers do not guarantee a great experience, but the wrong answers reliably predict regret. Communities producing the best outcomes give specific, transparent, written answers to all 14. Communities producing the worst outcomes deflect, generalize, or pressure you to sign before answering.

Why this conversation matters

The executive director meeting is often the last formal conversation before signing a memory care contract. By that point, families are emotionally invested, the tour is over, and the operational pitch has been delivered. Many families do not realize this is also their last meaningful opportunity to surface the questions that will shape the next 1-3 years of care.

After placing hundreds of families into SoCal memory care communities, we have seen the same pattern repeat. The questions that should have been asked at this meeting are the ones families wish they had asked when something goes wrong six months later. The categories below cover the issues that surface most often.

A note on framing: these questions should be asked directly, in person, with someone taking notes. A confident, well-run community welcomes them. A community that becomes defensive at these questions is telling you something useful about how operational issues will be handled after you sign.

Staffing and care quality

1. What is your caregiver-to-resident ratio on each shift?

California sets minimum staffing standards, but communities vary widely in how much they exceed minimums. Specific numbers matter:

• Day shift (typically 6 AM to 2 PM): What is the ratio?
• Evening shift (2 PM to 10 PM): What is the ratio?
• Night shift (10 PM to 6 AM): What is the ratio?

A confident, well-staffed community gives exact numbers. A weak community pivots to “individualized care” or “we adjust based on need.” The pivot is the answer.

What strong looks like: 1:5 or 1:6 during the day, 1:7 or 1:8 in the evening, 1:10 or 1:12 at night for memory care.

2. What is your caregiver turnover rate over the past 12 months?

Memory care depends on continuity. Caregivers who know residents make better care decisions, catch changes earlier, and produce better outcomes. Industry-wide turnover in memory care runs above 60% annually at lower-quality communities. The best communities run below 35%.

Ask directly: “What percentage of caregivers who were here a year ago are still here today?”

What strong looks like: Below 40% annual turnover and a willingness to share the number.

3. Who is the primary medication administrator on each shift, and what is their training?

In California, medication administration in memory care is typically performed by certified caregivers or licensed personnel. Medication errors are among the most common quality issues in memory care, and they often correlate with staffing and training shortcuts.

Ask: “Who administers medications on each shift? What is their training? How are medication errors tracked and addressed?”

What strong looks like: Specific roles by name and shift, defined training, an honest acknowledgment that errors occur and a structured process for reporting and addressing them.

4. How are care plans created, and how often are they updated?

Care plans should be created by a registered nurse or comparable clinical role, based on an in-person assessment, and updated at minimum quarterly with more frequent review when conditions change. Families should be invited to participate.

Ask: “Who creates the care plan? Who updates it? How are families involved? When was my mother’s draft care plan created?”

What strong looks like: RN-led care plans, quarterly reviews minimum, family invited to each review.

Financial terms

5. What is the base monthly rate, and what is included?

Base rates vary widely in what they include. Some include all care services, some structure care as a separate fee. Ask for a written breakdown of what is included in the base rate.

What to confirm: Room and board, meals, housekeeping, utilities, basic activities, and what level of personal care is included before tier increases apply.

6. What triggers a move from Care Level 1 to Care Level 2 or 3, and what is the cost difference?

This is the question that most surprises families after move-in. A community quoted at $9,500 monthly base may bill $11,500 or $13,500 after the first care level reassessment. The triggers for moving care levels should be defined in writing.

Ask: “Show me the written care level definitions and the cost for each level. How often are care levels reassessed? Who decides when to change them? Can I appeal a change?”

What strong looks like: Written care level definitions, defined assessment intervals, a process for family input on changes.

7. What is your annual rate increase pattern over the past 5 years?

Memory care rates typically increase 4-8% annually. Some communities have been more aggressive in recent years. Ask for actual increase percentages by year for the past 5 years.

Ask: “What were your annual rate increases each of the past 5 years?”

What strong looks like: Specific numbers, with an honest acknowledgment of current inflation pressures and the community’s approach to passing costs through.

8. What is your security deposit, community fee, or move-in fee, and is any portion refundable?

Most memory care communities charge a one-time community fee or move-in fee of $2,500 to $10,000 in addition to first month’s rent. Some are refundable in specific circumstances, most are not.

Ask: “What are all of the one-time fees? Are any refundable if the move does not work out within 30 days?”

What strong looks like: Transparent fee disclosure, a stated refund policy for short-stay departures.

Discharge criteria

9. Under what conditions can you discharge my mother?

This is the question that families never ask and later wish they had. Memory care communities have the right to discharge residents under specific conditions, and the criteria should be in writing in the contract. Common discharge triggers include:

• Behavioral expressions the community cannot safely manage (aggression, severe agitation, elopement)
• Medical conditions requiring care beyond the community’s licensure
• Non-payment
• The community’s determination that needs exceed their capability

Ask: “Show me the written discharge criteria. What is the notification process? How much notice do families get? What is the appeal process?”

What strong looks like: Written, specific criteria, 30-day minimum notice for non-emergency discharge, a clear appeal process.

10. What is your protocol for behavioral expressions like aggression or wandering?

Behavioral expressions are common in moderate to advanced dementia. The community’s response shapes the resident’s experience and the likelihood of discharge. Strong communities use non-pharmacological interventions first (environmental adjustments, redirection, activity engagement) before escalating to medication. Weak communities lead with sedation.

Ask: “When my mother becomes agitated, what is your first response? Second response? When would you call us? When would you call for a medication adjustment?”

What strong looks like: Non-pharmacological-first protocols, clear family communication chain, structured de-escalation training for staff.

11. What happens if my mother needs more care than this community can provide?

At some point in advanced dementia, the care needs of a resident may exceed what assisted living memory care can provide and require skilled nursing. The community should have a clear process for assessing this transition and supporting the family in finding the next level of care.

Ask: “If my mother declines to the point where this community cannot meet her needs, what is your process? How much advance notice will I have? Do you help with placement at a higher level of care?”

What strong looks like: A structured assessment process, family involvement in the decision, help finding the next setting.

Family communication

12. How will I be communicated with about changes in my mother’s condition?

Family communication patterns in memory care communities vary widely. Some communities have a structured protocol with named primary contacts and defined communication intervals. Some communities communicate only when crises occur. The pattern shapes the family experience significantly.

Ask: “Who is my primary contact at the community? How often will I get an update on my mother’s condition in routine times? What triggers a call to me?”

What strong looks like: Named primary contact, monthly or more frequent routine updates, defined call-the-family triggers (falls, new symptoms, behavioral changes, medication changes).

13. Can I see your last state inspection report and any recent complaints?

California publishes community care licensing inspection reports, and a confident community will share them readily. The report shows citations issued at the most recent inspection and how they were addressed. Complaint history is also relevant.

Ask: “Show me your most recent state inspection report. Walk me through any citations and how they were resolved. Have you had any complaints filed in the past 12 months?”

What strong looks like: Transparent disclosure, walk-through of any citations with corrective action, willingness to discuss complaints openly.

14. What is your typical resident length of stay, and what causes residents to leave?

This question tells you a great deal about the operational reality of the community. Length of stay varies based on the resident population’s acuity at admission. Reasons for departure (move to skilled nursing, death in place, family-initiated move, community-initiated discharge) show the community’s profile.

Ask: “What is the average length of stay here? What are the most common reasons residents leave?”

What strong looks like: Specific numbers, honest reflection on the resident population, low rates of family-initiated or community-initiated discharges (which suggest mismatch issues).

Scoring the conversation

After the meeting, walk through your notes and score the community across the four areas:

Three weak areas out of four is usually enough to keep looking. Strong communities give specific, written, transparent answers across all four. The communities that produce the best outcomes are the ones easiest to evaluate honestly because they are operating from a position of confidence in their actual care quality.

What to do if the conversation goes poorly

If the executive director becomes defensive, deflects, or pressures you to sign before answering, that is information. Some appropriate responses:

• “I want to be sure I understand the details before deciding. I’ll review the information you’ve provided and follow up.” Then take 48 hours, ideally with the meeting notes shared with a placement specialist or trusted family member.
• “Can you send me the written documentation for what we discussed? I want to make sure I have it correctly.” Communities that cannot produce written documentation for things they verbally committed to are giving you useful information.
• “I appreciate the time. I have more questions I need to think through before signing. When can we schedule a follow-up?” Same-day or same-week pressure to sign is one of the most reliable red flags in senior living.

The most regrettable placements we see almost always involve families who felt pressured at the contract conversation and signed against their better judgment. Slowing down rarely costs you the placement (a community that loses your interest because you wanted more time is a community to be wary of). Speeding up frequently produces regret.

Frequently asked questions

Should I bring someone with me to the executive director meeting?

Yes, if at all possible. A second set of ears catches things you miss when you are emotionally invested. A sibling, a trusted friend, a placement specialist, or a geriatric care manager are all good options. The community should welcome additional family or advisors at the meeting.

Can I take the contract home to review before signing?

Yes, always. A reputable community will provide the contract before the executive director meeting (ideally) or at minimum allow 48-72 hours to review before signing. Communities that pressure same-day signing are demonstrating something important about how they will treat you later.

Should I have an attorney review the contract?

For a contract that may run $100,000-200,000 over a year or more, attorney review is reasonable. An elder law attorney typically charges $300-500 to review a memory care contract and identify problematic clauses. Common issues that benefit from attorney review include discharge criteria, fee escalation language, liability waivers, and dispute resolution clauses.

What if the executive director doesn’t know the answers to these questions?

This is itself an answer. The executive director should know the operational details of the community they run. If they cannot answer questions about staffing ratios, turnover, or care plan processes, either the community lacks the discipline to have answers, or the executive director is too new or disconnected to know them. Either is a quality signal.

What if I’m asked to put down a deposit before getting full answers?

Decline politely and ask for the documentation in writing first. “I want to review the care level definitions, discharge criteria, and rate history before making any financial commitment. Can you send those documents and we can schedule a follow-up call?” A community that cannot accommodate this is a community to be cautious about.

What to do next

If you are evaluating memory care communities in San Diego, Orange County, or Los Angeles, the most useful next step is often a no-cost placement consultation. We help families build shortlists of communities that match specific care needs, accompany families to tours when helpful, and work through the executive director questions together. There is no obligation. We only recommend operators we would place our own parents into.