Best Practices

“NPRA has established a set of best practices that NPRA members must abide by, and that we hope all placement and referral agents, whether they are NPRA members or not, will abide by, because we believe that these practices are in the best interests of seniors and their families. 

We have shared these best practices with referral sources and with community organizations because we think that placement agents who follow those best practices are ensuring that seniors and their families are properly cared for.  We encourage all referral sources and community organizations to look to placement agents who follow these best practices as their placement partners.  We do not require, nor do we support, that either referral sources or community organizations work exclusively with members of NPRA.  NPRA membership is just one way that placement and referral agents can signify that they adhere to NPRA best practices. “


An NPRA agent shall recognize that the needs of a client should always be the primary consideration for any referral executed.


An NPRA agent should disclose to their clients the nature or source of their compensation. The client suitability and not level of compensation should be a primary influence in selecting referrals offered to clients.


An NPRA agent, agrees to observe all state and federal Medicare and Medicaid policies at hospitals, skilled nursing facilities, home health and hospice companies regarding vendor visitation, gifting, and compensation for each referral. NPRA agent will neither compensate nor pay an employee of these organizations for a referral.

An NPRA agent should abide by all state and federal referral laws, including never charging a fee of any kind for residents placed who are already approved or received into any state Medicaid Program.


An NPRA agent, should recognize the value of a quality intake [a suitability interview] which provides necessary insight when selecting a care provider for a client, specifically to determine proper care levels based on their situation, level of activity and care needs.

An NPRA agent, acknowledges a personal tour is in the client or client’s representative best interest. They should personalize the process with each client/family they serve.


An NPRA agent has a responsibility to make referrals of the most suitable options based on information provided regarding care needs, socialization, budget and geographic preferences and will, whenever possible provide multiple choices and allow the family or client to make the final decision without pressure or coercion.

 An NPRA agent will respect the right of the property owner or representative to do their independent assessment of the prospective resident and decide whether or not to accept them. The agent will not pressure or inappropriately influence a property to accept any client. 


An NPRA agent acknowledges that it is in the best interest of a client to review any available state surveys or enforcement actions and share results with the resident or resident’s legal representative when applicable.

An NPRA agent should personally visit and research a senior living property before offering the property as a referral to the client.


An NPRA agent, should not engage in the practice commonly known as ‘churning’ to move or relocate a previously placed client for additional economic gain. Any issues following placement of a client or requests to relocate a client should be addressed directly with the NPRA Agent, client representative, and engaged facility. An NPRA Agent, should not initiate any relocation. Only a client representative, family member or the facility should initiate the relocation of a resident. Relocation can occur after all parties have been unable to resolve their issue, and relocation is the only option and in the best interest of the resident.


An NPRA agent, acknowledges the need to maintain professional and general liability insurance for their practice of business.


An NPRA agent should report any witnessed incidents of elder abuse or suspected abuse to appropriate authorities. In addition, an NPRA agent shall report all health or safety violations observed within a senior living provider’s property to licensing authorities


An NPRA agent should be knowledgeable regarding the senior living options they contractually represent. An NPRA agent should also be knowledgeable about senior industry resources in their local area and refer clients when their needs are beyond the acceptable scope of practice of the placement and referral agent.


Under their NPRA membership an agent [at minimum] will meet the standards of their local or state trade association, including any state laws which regulate an elder referral agent and their associates.

An NPRA agent must be considered a member in good standing with their state or local association to maintain NPRA membership.

The National Placement and Referral Alliance


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