Opening an ALF

The Agency for Health Care Administration regulates assisted living facilities on the basis of Florida Statutes and the Florida Administrative Code. The requirement to open an assisted living facility can be found on thier application, which provides a check list of the needed items and inspections for licensure. This application and the accompanying check list can be found by  CLICKING HERE.

ALFs in Florida range in size from one resident to several hundred and can include individual apartments or rooms that a resident shares with another person. Basic ALF services include:

•             Housing, nutritional meals, and special diets;
•             Assistance with the activities of daily living (bathing, dressing, eating, walking);
•             Administering medications (by a nurse employed at the facility or arranged by contract);
•             Assisting residents to take their own medications;
•             Supervising residents;
•             Arranging for health care services;
•             Providing or arranging for transportation to health care services;
•             Health monitoring;
•             Respite care (temporary supervision providing relief to the primary caregiver); and
•             Social and leisure activities.

Some ALFs arrange or directly provide these services to their residents. Others require the resident to arrange their own services as agreed upon in the contract between the resident and the facility. An ALF may employ or contract with a nurse to take vital signs (blood pressure, pulse, respiration, and temperature), manage pill organizers, give medications and keep nursing progress notes. A resident can also contract with a licensed home health care provider for nursing and other health care services, as long as the resident does not become more ill than is allowed in an assisted living facility. If an ALF in Florida would like to provide any services beyond those allowed in the standard license, a specialty license must be acquired. These licenses allow the ALF to accept residents who need more advanced nursing or mental health care. The specialty licenses are listed below.

Limited Nursing ServicesA limited nursing services (LNS) specialty license enables an ALF to provide, directly or through contract, a select number of nursing services in addition to the personal services authorized by the standard license. A nurse is allowed to practice within their scope of licensure with limited prohibitions. The nursing services authorized to be provided under this license may only be provided as authorized by a licensed practitioner’s order. A nursing assessment that describes the type, amount, duration, scope, and outcomes of services, and the general status of the resident’s health, is required to be conducted at least monthly on each resident who receives a limited nursing service. An LNS licensee is subject to monitoring inspections by the AHCA or its agents at least once a year.

Limited Mental Health: An ALF that serves one or more mentally ill or disabled residents must obtain a limited mental health (LMH) specialty license. For the purposes of assisted living licensure, a mental health resident is defined as an individual who receives social security disability income (SSDI) due to a mental disorder or supplemental security income (SSI) due to a mental disorder, and receives optional state supplementation (OSS). This definition is limited as there may be other assisted living facility residents with severe and persistent mental illness who have a case manger but do not meet this specific definition.

The LMH license requires basic staff training in mental health issues and requires the ALF to ensure that the resident has a community living support plan, provides assistance to the resident in carrying out the plan, and maintains a cooperative agreement for handling emergency resident matters. There may be residents with severe and persistent mental illness who have a Department of Community Affairs (DCF) case manager but do not otherwise meet the definition of a mentally ill ALF resident.

Pursuant to s. 394.4574, F.S., the Department of Children and Families must assure that:

•      A mental health resident has been assessed by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse to be appropriate to reside in an assisted living facility;
•      A cooperative agreement to provide case management, as required in s. 429.075 F.S, is developed between the mental health care services provider and the administrator of the ALF-LMH;
•      A case manager is assigned for each mental health resident;
•      The community living support plan, as defined in s. 429.02 F.S. has been prepared by the mental health resident and a case manager in consultation with the administrator of the facility; and
•      The ALF is provided with documentation that the individual meets the definition of a mental health resident. 

Each DCF Circuit Administrator develops, with community input, annual plans that demonstrate how the district will ensure the provision of state-funded mental health and substance abuse treatment services to residents of ALF-LMH facilities.

Extended Congregate Care: 
An assisted living facility with an extended congregate care license provides the basic services of an assisted living facility as well as:
• Limited nursing services and assessments,
• Total help with bathing, dressing, grooming and toileting,
• Measurement and recording of vital signs and weight,
• Dietary management, including special diets, monitoring nutrition and food and fluid intake,
• Supervision of residents with dementia and cognitive impairments,
• Rehabilitative services,
• Escort services to medical appointments,
• Educational programs to promote health and prevent illness.

Aside from certain task, an ECC licensed facility can provide almost any service.