Assisted Living Base Rate: What It Includes and Excludes

On my first assisted living tour I filled a page of a legal pad. Dining room hours, the garden, whether my father could bring his recliner. At the bottom, circled twice, one number — the monthly rate the marketing director had said out loud.

Not one line on that page asked which document defined the number.

That was the miss. The spoken rate on a tour is a summary; the binding version is a fee schedule stapled somewhere inside the residency agreement, next to a second list of everything the rate does not buy. In my father's packet the two lists were eleven pages apart. Everything that later surprised us on an invoice — the care level charge, the per-pass medication fee — was on the second list the whole time.

So this is the tour sheet I wish I had carried: what a base rate legally is, the charges that most often sit outside it, and twelve questions whose answers you should refuse to accept out loud.

A base rate is whatever the fee schedule says it is

Assisted living has no federal rate rules. It is a state licensing system, and most states regulate how the price must be disclosed, not what the price contains. The base rate is a defined term in exactly one place: your agreement.

California is explicit about where the definition has to live. The admission agreement must state the basic services to be made available, the additional items and services available beyond them, and the rate for basic services — with a comprehensive description of what a single fee covers and a separate fee schedule for what it does not (22 CCR 87507(g), read 2 September 2026). The same section closes the back door: "A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement" (87507(g)(3)(B)2).

Read that from the other direction and it becomes a touring instruction. In a state with a clause like this, every future charge already has a page. Your job on the tour is not to negotiate; it is to get the pages — the fee schedule and the additional-services list — and read them side by side. Where they sit inside a 40-page packet, and what order to read the rest in, is covered in reading a residency agreement in one sitting.

For scale while you read: CareScout's 2025 Cost of Care Survey put the national median assisted living rate at $6,200 a month (press release, 2 March 2026). Whatever your quoted rate is, the question is which fraction of a resident's actual monthly bill it will turn out to be.

One state wrote the fine print down as a form

Washington makes every assisted living facility complete a standardized disclosure form — DSHS Form 10-351, required by RCW 18.20.300, which orders the state to keep the form "standardized, reasonable in length, and easy to read." The current form (Rev. 06/2026, read 2 September 2026) is nine pages of checkboxes, and it is the most honest document in this industry, because it states out loud what is elsewhere left to be discovered:

• Facilities in Washington are not required to provide help with daily activities at all. If they choose to, the required minimum per task is to "occasionally remind," provide "stand-by assistance," and "steady you." Physical help with bathing, dressing you rather than cueing you, one-person and two-person transfer assistance — each is a separate yes/no box the facility may decline.
• On medication, every facility must offer assistance: reminders, opening the container, placing medications in your hand. Administration — staff giving the medication — appears under a different heading, requires licensed or nurse-delegated staff, and is optional.
• On toileting, the form says directly that facilities "are not required to provide incontinence products but may assist you in ordering."
• Transportation gets its own section, which opens: facilities "are not required to provide or help with transportation."

Washington's rules bind only Washington. But the form works almost anywhere as a checklist of where base rates quietly end, because the categories are the same ones every operator prices: the gap between reminding and doing, between one staff member and two, between food served in the dining room and food carried to a door. Even the payment section of the form points at the seam — it cites the state's resident-rights law requiring written notice of "charges for services, items, and activities not covered by the facility's basic per diem rate" (RCW 70.129.030(4)).

The five lines that most often sit outside the rate

Across contracts, five categories account for most of the distance between the tour quote and the first full invoice.

Medication administration. The single most common surprise, because the tour answer — "we handle medications" — is true under both definitions. Assistance is often in the base. Administration is usually a care-level item or a per-pass fee, and per-pass pricing compounds: three passes a day is ninety billable passes a month. In my father's schedule the move from reminders to administration was worth roughly a dozen points by itself — most of one care level.

Second-person and physical assists. Stand-by help walking to the dining room may be included; a staff member physically assisting is a level up; two staff for a transfer is another. The words to find in the fee schedule are "one-person," "two-person," and "mechanical lift."

Incontinence care and supplies. Usually two separate charges — the care is scored into a level, the products are billed at the facility's markup or must be brought in by family. Ask both halves separately, and ask whether family-supplied products are allowed.

Tray service. Three meals in the dining room are almost always basic. The same meal carried to an apartment is often a per-tray fee after some number of free days (post-illness grace periods of three to seven days are common contract language). For a resident who stops coming down to meals, this line item arrives at exactly the wrong time.

Transportation and escorts. A scheduled group bus may be free; a staff escort who stays through a medical appointment is usually hourly. If a parent has a standing dialysis or infusion schedule, price this line before choosing a building, not after.

None of this is hidden, exactly. It is disclosed the way page 34 of a 41-page packet is disclosed. The tour is the one moment the facility is motivated to put answers in writing quickly — which is what the question list is for.

Twelve questions, and the page each answer should come from

Take these on the tour. For each one, the real answer is a document, not a sentence — the goal is to leave with a copy of the blank agreement, the current fee schedule, and (in states that require one) the standard disclosure form.

1. Which document defines the base rate, and can I take a copy of the current fee schedule today?
2. Is personal care priced by levels, by points, or à la carte — and can I see the scoring sheet or level definitions?
3. Does the base rate include any care at all, or is every hands-on service a separate charge?
4. Medication assistance or administration — which word does the contract use, and what does each cost?
5. Is medication charged per level or per pass? What is one pass, and what would three a day cost in 2026 dollars?
6. What does a two-person transfer requirement add per month?
7. Is incontinence care in a level or billed separately? Are supplies included, marked up, or family-supplied?
8. What does tray service cost, and how many days after an illness before it starts billing?
9. What do a staff escort and facility transportation cost for a routine medical appointment?
10. What is not on this fee schedule that residents here most often end up paying for? (Watch what happens to this one. A good answer names cable, salon, guest meals, pendant monitoring. A shrug is also an answer.)
11. When rates or the fee schedule change, how many days of written notice does the contract promise — and is an increase from a care-level change inside or outside that notice period?
12. May I have the disclosure form your state requires? If the tour guide does not know whether the state requires one, that is worth knowing too.

Question 11 deserves its own afternoon; the annual increase letter and the care-level carve-out behave very differently, and many agreements are drafted so that only the first is bound by the notice period at all.

Three states, three disclosure duties — and the route to yours

How much of this you are entitled to receive unasked depends entirely on the state. Three examples of the spread, all read 2 September 2026:

• California builds disclosure into the admission agreement itself — basic services, additional services, and their rates are mandatory contract content, and unauthorized separate charges are barred (22 CCR 87507).
• Washington uses the standing public form above, and sets notice clocks for changes: at least 30 days' written notice before services are reduced for reasons outside the facility's control, 90 days when the facility voluntarily cuts services in a way that could force a move — while additions to services need only prompt written notice (RCW 18.20.300 and DSHS Form 10-351).
• Texas requires each prospective resident to receive "a consumer disclosure statement in a standard form adopted by the department" (Health and Safety Code 247.026(b)(4)(B), text current through 1 January 2026); the state publishes the form as HHSC Form 3647.

Your state's rule will be worded differently again, and the licensing agency has a different name almost everywhere. The NCAL Assisted Living State Regulatory Review maps each state to its agency and rule chapter. And your area's long-term care ombudsman — free in every state, found through the Eldercare Locator — can tell you before a single tour what facilities in your state must hand over, which turns the question list from a negotiation into a pickup.

The base rate you write down on the tour is the floor of the bill, not an estimate of it. Getting the fee schedule the same day tells you where the ceiling can come from — and once your parent moves in, the number that moves is the care level, which is a different document and a different afternoon.

Sources

• 22 CCR 87507 — California RCFE admission agreement content: basic services, additional services, rates and fee schedules; separate charges must be authorized by the agreement (subsection (g)). Read 2 September 2026.
• RCW 18.20.300 — Washington disclosure of assisted living services on a standardized state form; notice periods for changes in services. Read 2 September 2026.
• DSHS Form 10-351 (Rev. 06/2026) — Washington's standard Disclosure of Services form: required ADL minimums, medication assistance vs. administration, incontinence products, transportation. Read 2 September 2026.
• RCW 70.129.030 — Washington resident-rights law requiring written notice of charges, including those not covered by the basic per diem rate. Read 2 September 2026.
• Tex. Health & Safety Code 247.026(b)(4)(B) — Texas consumer disclosure statement in a standard form (HHSC Form 3647). Text current through 1 January 2026; read 2 September 2026.
• CareScout 2025 Cost of Care Survey results — national median assisted living rate of $6,200 a month in 2025. Press release dated 2 March 2026; read 2 September 2026.
• NCAL Assisted Living State Regulatory Review — per-state guide to licensing agencies and rule chapters. Read 2 September 2026.
• Eldercare Locator — route to the long-term care ombudsman for any U.S. area. Read 2 September 2026.

This page is general information, not legal, medical, or financial advice. See the terms.