Since they started to dot the U.S. landscape in the early 1980s, assisted-living facilities have become the best hope of America’s seniors for avoiding confinement in a nursing home. Instead of a hospital environment, assisted living promised private apartments and communal dining in hotel-like settings, and some help with daily needs such as dressing and bathing.

Now, however, that picture is changing. A decade past the industry’s building boom, and following several bankruptcies and mergers, settings for today’s facilities can vary dramatically. Among the dozen we visited as part of our three-month investigation into assisted living were high-rise apartment buildings, down-at-the-heels mansions, and single-family homes run by large public companies, states, families, small businesses and nonprofits.

Purpose, too, has shifted. Assisted-living operators – out of compassion or a need to fill beds – are accepting and keeping residents even if their condition has worsened. As a result, many of the nearly 1 million people now in assisted-living facilities are more likely to be frail and sick than independent. And that has created a troubling mismatch between the care a resident needs and the care a facility and its staff can give.

Finding a good, safe and – because most people in assisted living pay for it out of pocket or through long-term-care insurance – affordable facility has thus become problematic for seniors and their families. Abetting the problem: Most facilities are operated by small private companies that don’t provide the information needed to make such a decision.

The time to start your search for an assisted-living facility is when you notice a senior showing some signs of decline. Deciding early can be crucial because better residences often have long waiting lists. Here are some suggestions to help you find the right place:

¢ Create a list of possibilities. To identify facilities, contact the local Area Agency on Aging office. The national Eldercare Locator can lead you to yours (800) 677-1116, or www.eldercare.gov. Try for a list of seven to eight facilities of varying size.

¢ Call your state’s long-term care ombudsman. Ask whether there have been complaints about facilities on your list and how to obtain inspection reports, if there are any. Information on whom to contact is available at our Web site, www.ConsumerReports.org. Click on “Health and fitness,” then – under Free Highlights – select “Assisted living,” then “Assisted-living regulations.” Kathy Greenlee is Kansas’ state long-term care ombudsman. She may be reached at (785) 296-3017 or (877) 662-8362. For more information about her office, click on http://da.state.ks.us/care.

¢ Meet with a geriatric-care manager. These pros are social workers, nurses or gerontologists who – for a fee – can tell you about the facilities you’ve selected, and how well they match your relative’s needs. Names are available on the Web site of the National Association of Professional Geriatric Care Managers (www.caremanager.org).

¢ Tour the top four or five choices. Don’t be swayed by the “chandelier effect” – the appeal of expensive-looking furnishings. Check instead for senior-friendly furniture – grab bars in bathrooms and along hallways, and nonskid flooring in baths. And view occupied rooms: You’ll be able to tell how thoroughly the staff cleans.

¢ Request the documents you need to help you make a decision. Information on medication policies, costs, levels of care, discharge criteria, and staff training and numbers is vital to compare assisted-living alternatives. Ask, too, for a copy of the contract.

After you’ve made an initial visit, stop by the promising facilities two or three more times when the staff is not expecting you. Stay for a meal and an activity and taste the food. Consider having your relative stay overnight as a tryout.

Once you’ve found a facility and your relative moves in, visit often to make sure there are no problems. Your family member’s health may deteriorate, so you have to be honest with yourself and with him or her when it’s time to move to a nursing home. A geriatric-care manager can help with that decision.