Assisted Living Overview

WHAT IS ASSISTED LIVING?

Many individuals do not need the expensive and intensive level of care provided by a nursing home. Assisted living bridges the gap between independent living and nursing home care. Assisted living residences can offer different levels of assistance, from minimal to comprehensive.

The goal of assisted living is to provide older adults a safe environment in which to live as independently as possible, while assisting them with daily living and care, and preserving their
dignity and wellbeing.

SERVICES

The state of Florida requires all assisted living residences to have at least a Standard License to operate. They must provide at least:

  • Housing (private, semi-private, rooms, suites, or apartments)
  • Meals, special diets, and snacks
  • 24-hr staff available to supervise residents
  • Assistance or help with Activities of Daily
  • Living (ADL) See list below
  • Nurse administered medications or assistance with medication management
  • Arrangement for health care services
  • Health monitoring
  • Housekeeping
  • Laundry and maintenance
  • Social and leisure activities
  • Provide or arrange for transportation to health care services

ACTIVITIES OF DAILY LIVING

ADLs are those skills required to manage one’s basic physical needs. Activities of Daily Living (ADLs) Include:

  • Bathing
  • Dressing
  • Grooming
  • Eating
  • Ambulation
  • Transferring
  • Toileting
  • Hygiene
  • Walking & other similar tasks
  • Supervision & help with medications

LIFESTYLE

Assisted living residences differ as much as the people who reside in them. You have heard the expression that people come in all shapes and sizes. Assisted Living Residences are no different and may be:

  • Apartment-like one-story residences
  • High-rises in downtown areas
  • Smaller home-like settings
  • Sprawling campus like communities

Assisted living residences can vary not only in physical size and style, but in the number of residents they house, from one to hundreds. When choosing assisted living, this consideration is very important. Will you or your loved one feel overwhelmed in a larger community, or will a smaller residence feel too small and isolated?

Aside from receiving the basic services described above, what does daily life in an assisted living residence look like? Of course, this depends on the residence, the services, and amenities provided and the associated residence costs.

Modern assisted living residences try to incorporate the total wellbeing of the residents, encouraging as much independence as possible. Cultivating relationships among residents
reduces the negative effects isolation can have on residents’ both physical and mental health.

Many assisted living residence’s common areas are open, bright, comfortable spaces where residents can gather and share life experiences. Residences may have smaller more intimate areas for reading, and group socialization. Some residences even have an onsite beauty salon and barbershop. Restaurant-style dining is common with menu choices and table service.

Look for residences that have robust social and activity programs. Activities may include:

  • Day trips/outings
  • Arts & crafts
  • Bingo
  • Board games
  • Dancing
  • Gardening
  • Holiday & social parties
  • Live entertainment
  • Fitness & movement classes
  • and much more

Assisted living is intended to provide housing and care, but social interaction, the freedom of choice, and the ability to make decisions offer quality of life for you or your loved one. Look for
residences that place an emphasis on the total wellbeing of residents.

Resident’s Care Managed


An ALF is required to have enough qualified staff to provide resident supervision and to provide or arrange for scheduled and unscheduled resident services. An ALF is not required to have a nurse on staff, though the ALF may employ or contract with a nurse to take vital signs (blood pressure, pulse, respiration, and temperature), manage pill organizers and give medications, give prepackaged enemas from a doctor’s order, and keep progress notes.

The ALF staff will manage the resident’s care, including ongoing assessments of the resident’s
needs and health monitoring. Additionally, the ALF staff will coordinate and assist the resident
to gain access to needed medical services, as well as mental health, social, educational, and other services.

A resident cannot be bedridden, cannot require 24-hour nursing supervision, and cannot have stage 3 or 4 pressure sores. The resident can contract with a third party, such as a home health agency or a nurse registry, to provide nursing and other medical services.

Licensing & Employee Screening


The administrator of an ALF must be screened through FDLE and the FBI. Employees providing personal care are screened through FDLE.

ALFs are licensed and inspected every two years by the State of Florida’s Agency for Health Care Administration (AHCA). The license should be conspicuously posted. ALFs that do not comply with regulations will be given a deficiency report that gives the total number of deficiencies cited. Current ACHA reports for all ALFs in Florida can be found at FloridaHealthFinder.gov.

Financial Concerns


Residency in an ALF can be funded by:

  • Private funds
  • Long Term Care Insurance
  • Optional State Supplementation (if the resident is eligible), in addition to the person’s existing monthly income
  • Medicaid Assistive Care Services (if both the resident and the ALF are eligible)
  • Assisted Living for the Elderly Medicaid Waiver program (if eligible)
  • Nursing Home Diversion Waiver
  • Veteran’s Benefits

Contract Basics


A resident will be covered by a contract between the ALF and the resident. The contract should include:

  • the services and accommodations to be provided by the ALF
  • the rates or charges
  • provision for at least 30 days written notice of a rate increase
  • the rights, duties, and obligations of the residents
  • a refund policy
  • the policy for a resident’s unit if said resident’s health requires temporary admission to a nursing home or hospital
  • the purpose of any advance payment and a refund policy for such payment

Extended Congregate Care (ECC) License


Extended Congregate Care (ECC) is a specialty license for assisted living facilities (ALFs). All ECC facilities are ALFs and all ECC beds are licensed ALF beds. However, not all ALFs are licensed to provide ECC services. The concept of ECC services in ALFs evolved from Florida legislators recognizing the need to allow residents the option to “age in place” as they become more impaired. Thus, ALF residents could remain in the ALF longer, and nursing home stays could be reduced or eliminated.

ECC Services include:

  • Limited nursing services and assessments
  • Total help with ADLs
  • Measurement and recording of vital signs and weight
  • Dietary management, including special diets, monitoring nutrition, food & fluid intake
  • Supervise residents with dementia and cognitive impairment
  • Provide or arrange for rehabilitative services
  • Provide escorts to medical appointments
  • Educational programs to promote health and prevent illness

Specialty Licenses Limited Nursing Services (LNS) License


ALFs with a LNS license are authorized to provide a number of nursing services in addition to the basic services of a standard license.
Services include:

  • Nursing assessments
  • Care & application of routine dressings
  • Care of casts, braces, and splints
  • Administration & regulation of portable oxygen
  • Catheter, colostomy, and ileostomy care and maintenance
  • Application of cold or heat treatments, passive range of motion exercises, ear and eye irrigations, and other services

Limited Mental Health (LMH) License


Limited mental health facilities are licensed to provide for the health, safety, and welfare of mentally ill residents.

Assisted Living “Questions to Ask”

We have developed Yes/No “Questions to Ask” Worksheet where you can compare three different assisted living residences evaluating a variety of services, amenities and accommodations.

Need Help Finding the “Right” Assisted Living Residence for Your Loved One’s Needs?

Service Providers:

Need Help Downsizing & Transitioning to Assisted Living or Retirement Living?

Services Providers:

More Information

Sage Aging Podcast


Transitioning from Home to Assisted Living (episode 51)
How to Choose the Right Senior Living Community (episode 23)