How senior living referral services actually work — and how to use one safely

What you’ll learn in this guide:

• Why referral services are free to families — and who is actually paying
• What happens to your contact information after you fill out the form
• What a Washington Post investigation and a Senate inquiry found about the industry’s largest player
• What referral services genuinely do well, and where the model’s incentives work against families
• The questions worth asking any referral service before sharing a phone number
• How to independently verify any community a service recommends — using free, government-funded resources

The front door most families walk through

When a family starts searching for assisted living or memory care — often suddenly, after a fall or a hospital discharge — the first results they encounter are usually referral services: A Place for Mom, Caring.com, and hundreds of smaller local placement agencies. The pitch is consistent across all of them: a knowledgeable advisor, personalized recommendations, and no cost to the family.

That “no cost” part is true. But it’s true for a specific reason, and understanding that reason changes how the whole service is best used. Referral services are free to families the same way a real estate buyer’s agent is free to the buyer: someone else in the transaction is paying, and that payment shapes what gets shown.

None of this makes referral services useless — some families genuinely benefit from them, especially under time pressure. But the industry’s largest player became the subject of a U.S. Senate inquiry in 2024 over exactly this business model, and most of the sites a family will encounter do not explain it clearly. This guide does.

How the money actually moves

The core mechanism is a move-in commission. Senior living communities sign referral agreements with these services, and when a referred family signs a lease and moves in, the community pays the service a fee — typically 50–100% of the first month’s rent, which at today’s assisted living rates commonly works out to several thousand dollars per placement. Some agreements run even longer than the search itself: a referral can remain “claimed” by the service for months or, in some contracts, up to two years after the initial inquiry, meaning the community owes the fee even if the family arrives much later by another route.

Three structural consequences follow directly from that arrangement:

1. The list a family sees is a list of communities that pay. Referral services present options from their network of participating communities — the ones with signed commission agreements. A community that declines to pay referral fees generally doesn’t appear in the recommendations, no matter how good it is or how well it fits. In a June 2024 letter to A Place for Mom, the Senate Special Committee on Aging’s then-chair put it directly: the company’s claims of being unbiased “are undermined by the company’s own materials,” which “show that the listings families are shown are limited to facilities from which it receives a commission, leaving out more than half of available assisted living options nationwide.”

2. The service is paid on move-in, not on outcome. The commission arrives when a lease is signed. Nothing in the payment structure depends on whether the community turns out to be well-staffed, safe, or right for the resident a year later. That doesn’t mean advisors don’t care — many do — but it means the financial incentive rewards a completed placement, and a faster one, at a participating community.

3. Higher rent can mean a higher fee. Where the commission is a percentage of the first month’s rent, a more expensive community produces a larger payment for the same amount of advisory work. Families comparing a recommendation against a lower-cost option they found on their own may want to keep that math in mind. The Senate letter also raised the flip side: families whose budgets point toward lower-cost or Medicaid-funded care are less profitable to refer, and the committee accused the industry’s largest player of effectively screening them out.

What happens when you enter a phone number

The intake form on a national referral site does more than schedule a callback. In common practice, a family’s contact information may be sent to 10–15 participating communities at once, each of which has its own sales staff and occupancy targets. Families routinely describe receiving calls from multiple communities within hours of submitting a form, and follow-up contact that continues for months.

For a family in crisis-planning mode, that can feel like help arriving fast. For a family early in their research, it can feel like having handed a megaphone their parent’s situation. Neither reaction is wrong — but the trade is worth knowing about before the form is submitted, because it can’t be un-submitted. A few state laws now require consent before contact information is shared (more on that below); in most states, no such requirement exists.

What investigators found

In May 2024, a Washington Post investigation examined A Place for Mom, the largest referral service in the country. The Post compared 863 communities that received the company’s “Best of Senior Living” awards in 2023 and 2024 against state inspection records in 28 states, and found that 324 of them — 37.5% — had been cited by state regulators for serious violations affecting resident care. The cited violations included falls, medication errors, unanswered call buttons, failures of basic hygiene care, understaffing, and instances of violence and abuse. The investigation also reported, based on accounts from former employees and industry staff, that facility reviews on the platform were skewed by selective solicitation — communities encouraging only satisfied families to post.

The following month, the Senate Special Committee on Aging opened an inquiry into the company, citing concerns that it misleads users about the role commissions play in its recommendations and disadvantages low-income families.

Two things are worth holding at once here. First, these findings concern one company — the industry’s largest — and as of this article’s last review, the committee had not published final findings. Second, the structural features the investigation highlighted (pay-per-placement commissions, participating-community-only listings, no independent quality assessment) are not unique to that company. They describe the standard business model of the category. A family using any referral service is navigating the same incentives, whether or not that service has been in the news.

What referral services do well

An honest accounting cuts both ways, and the model has real strengths:

• Speed and local knowledge. A good advisor knows which communities have availability right now, at what price point, with what care capabilities — information that is genuinely tedious for a family to assemble from scratch, especially from out of state or on a hospital-discharge deadline.
• Triage. Families often start a search not knowing whether they need assisted living, memory care, or in-home care. An experienced advisor can help sort that out quickly.
• Local placement agents can offer something the national platforms usually don’t. Independent local agencies — often a single advisor covering one metro area — frequently tour the communities they refer to personally and know their reputations firsthand. They’re typically paid through the same commission model, so the same questions below apply, but “I have walked these halls” is a meaningfully different claim than a call-center match from a national database.

The practical takeaway isn’t “never use one.” It’s that a referral service functions as one input — a fast way to generate a candidate list — not as the vetting itself. The vetting is the part the commission model doesn’t pay for, and it’s the part families can do independently, for free.

A patchwork of state rules — and mostly no rules

There is no federal regulation of senior living referral services. A handful of states have stepped in:

• Washington was first, with the Elder and Vulnerable Adult Referral Agency Act of 2011. Agencies operating there must give clients a written disclosure statement before making a referral (including how the agency is paid), check the state health department’s enforcement database for each provider within 30 days before referring to it, pass recurring background checks, and keep records for six years.
• Oregon followed in 2017, and Arizona, Colorado, and Maryland have passed disclosure laws of their own — Arizona’s, for example, requires disclosing the referral fee and any conflict of interest before a referral is made, with civil penalties enforceable by the state attorney general.
• Missouri considered a similar bill in 2025 that would require fee disclosure and written consent before a family’s contact information is shared.

In the majority of states, none of these protections exist — no required disclosure, no verification duty, no consent requirement before contact information is distributed. Which means that in most of the country, the questions below are ones families have to ask themselves, because no law requires the answers to be volunteered.

Questions worth asking before sharing any contact information

Asked directly, over the phone, before filling out any form:

1. “How are you paid, and by whom?” A trustworthy service answers this plainly. Hesitation or vagueness on this question is itself information.
2. “Do you only refer to communities that pay you?” This is the coverage question — it reveals whether the “personalized recommendations” are drawn from the whole local market or from the participating network.
3. “Will my contact information be shared, and with how many communities?” And: “Can you contact them on my behalf instead, so my number stays private until I choose to share it?” Some services will accommodate this; many won’t.
4. “Have you personally visited the communities you’re recommending?” Local agents often have; national call-center advisors generally have not.
5. “How long does your referral agreement ‘claim’ me?” If a family later finds a community on their own, a long claim window can still route a commission — and a community quietly absorbing that cost has one more reason to hold firm on rent.
6. “Will you show me the state inspection history for each community you recommend?” Washington law requires an enforcement-status check before referral; nothing prevents a family anywhere from asking for the same thing voluntarily — or from pulling it themselves, below.

How to verify any recommendation independently — for free

Whatever list a referral service produces, every community on it can be checked against sources that have no commission at stake:

• State licensing and inspection records. Every state licenses assisted living (under varying names) and publishes inspection or enforcement records, usually through the state health or human services department’s website. Searching “[state name] assisted living facility inspection lookup” typically finds the database. This is the single most useful check — it’s the record the Washington Post used.
• The Long-Term Care Ombudsman program. Every state runs one, fully government-funded, staffed by trained advocates whose only job is protecting residents of long-term care facilities. Local ombudsmen often know which facilities generate complaints. Find the local program through the Eldercare Locator or by calling 1-800-677-1116 — a free public service of the U.S. Administration for Community Living.
• The local Area Agency on Aging. These county or regional agencies (also findable through the Eldercare Locator) maintain lists of local options and services without a placement-commission model behind them.
• Medicare’s Care Compare (medicare.gov/care-compare) — for skilled nursing facilities specifically, with staffing levels and inspection ratings. Note it covers nursing homes, not assisted living, which has no federal equivalent.
• A tour with the right questions. Touring a 55+ community covers the general approach; for assisted living, adding “may I see your two most recent state inspection reports?” to the tour is reasonable and revealing — communities are accustomed to the question, and a defensive answer is worth noting.

For families whose search involves significant financial commitments or contract complexity — entrance fees, care riders, Medicaid planning — the same due-diligence logic in the Continuing Care Retirement Community (CCRC) entrance-fee guide applies, and an elder law attorney (findable through the National Academy of Elder Law Attorneys directory) or an Aging Life Care Association geriatric care manager can review specifics before anything is signed. A care manager, notably, is paid by the family rather than by a facility — the reversed incentive is the entire point of that profession.

The pattern across all of this is simple: the referral service’s list is a starting point someone else paid to assemble. The inspection record, the ombudsman’s experience, and the family’s own tour are the parts nobody paid for — which is exactly why they’re the parts worth trusting most.

The checklist below condenses this guide into one printable page — each item is explained in the sections above, and the “Print this checklist” button at the top of this article produces just the checklist, sized for a refrigerator door or a folder.