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Assisted living options in Florida - Aging Wisely

Most individuals hope that they will be able to stay in their own homes as they age, but it is important for everyone involved to understand the care options, and when it may become necessary to consider an alternate living arrangement. There are an increasing number of options and resources to assist someone in maintaining independence in their own home. Most importantly, as chronic illness impacts your loved one’s life, it is important to get a good assessment of the options and the home environment. It is important to understand the costs of care at home and to review how the financial resources and public programs may impact one’s ability to remain at home.

When families are beginning to think their loved one may need to consider a move to a facility, they often don’t know where to begin. The aging resources have changed rapidly over the past decade, and there are more options than ever. The first level of retirement living is independent living, which occurs in many different types of settings. This may provide individuals the opportunity to downsize, remove the responsibility of caring for a home, and offer some amenities. Some places offer meals, activities or outings, and transportation. These are not supervised settings however, and not intended for someone needing assistance.

In the state of Florida, an Assisted Living Facility is defined as “residential care facilities that provide housing, meals, personal care and supportive services to older persons and disabled adults who are unable to live independently.” ALFs are intended to be a less costly alternative to more restrictive, institutional settings (nursing homes) for individuals who do not require 24-hour nursing supervision. Increasingly, ALFs are providing higher levels of care and allowing residents to age in place with more needs. In Florida, there is a basic assisted living license and 3 special licenses, LNS (Limited Nursing Services), LMH (Limited Mental Health) and ECC (Extended Congregate Care) under which facilities can provide additional specialty services. There are also special exceptions, such as a client under Hospice services can remain in an ALF while bed bound. However, each facility also makes its own determination as to what it chooses to handle and the level of care and services it will provide. For example, while an ALF may be permitted to handle an incontinent resident and provide a B & B (Bowel and Bladder, oversight and assistance) program, the facility may chose not to provide this type of service, thus meaning residents would need an alternative facility when they require this level of care.


Many people are surprised to learn that Assisted Living Facilities are not required to have an R.N. in the building. Small ALFs (less than 17 residents) are not required to have staff awake at all hours either. Many ALFs go beyond the minimal requirements, but due to this there is great variation in the level of service and staffing provided by each facility. Aging Wisely reviews all facilities when recommending placement and can provide you with this detailed information. We also visit facilities on a regular basis and keep updated on which places offer which types and levels of service.

In Florida, we also have Adult Family Care Homes, which “provide a full-time, family-type living arrangement in a private home for up to five (5) aged or disabled people, who are not related to the owner. To qualify for an AFCH license, the AFCH provider must reside in the same house as the residents.” This is an alternate arrangement for some care and support, but may be limited in the scope of what services are provided and generally does not provide the types of structured activities that most ALFs do.

A nursing facility provides 24 hour skilled nursing services and can handle more complex needs. Most nursing facilities are also the place where individuals receive therapy services, and may come for inpatient rehabilitation after a hospitalization. Therefore, most local facilities house a mixture of long term residents and short term rehabilitation patients.

It is very valuable to get an assessment when looking at these options, to ensure you have a good handle on the “level of care” needed and which places can best provide for your loved one’s needs. An independent care management assessment looks carefully at all aspects of the situation, from client’s medical needs to disease outcomes to family preference, lifestyle choices, location and finances. It offers an unbiased opinion and outlook on facilities and what is best for the client. Care managers also help counsel families through what to expect and how best to make the transition.

We have provided a sample story below that provides important lessons in this process. Also, keep an eye out for future articles about the costs and payment options for various care facilities.

Story: A client’s family member contacted Aging Wisely with concerns as their father was having some trouble at home. His wife was attempting to care for him but becoming overwhelmed. She had a home health agency helping most days, but he had started getting up at night and she was concerned for her safety, and her health and need for rest. She decided to look at assisted living facilities but did not choose to get any professional help at the time. She toured several places and asked friends and her doctor for recommendations. She found a place that she liked best and arranged for admission. She brought the client to be assessed and answered questions about his needs and behavior. Note: It is often tempting as a family member to minimize problems and these brief assessments done in this manner often lead to an inaccurate picture of the situation. Her husband was placed in the Assisted Living. Within two weeks, he had two falls and was found trying to leave the facility. He was hospitalized for some underlying medical conditions and now the facility refuses to take him back as they acknowledge they cannot meet his needs. Now the family is faced with another possible move and beginning the process again—and they are now rushed as he will have limited time in the hospital.

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