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Who Regulates Assisted Living Facilities in Florida?

Florida was one of the first states in the United States to begin legislating assisted living facilities (ALFs). The Florida Agency for Health Care Administration, Bureau of Long Term Care Services is the entity responsible for ALF licensing.

The Florida Department of Health (DOH) is responsible for conducting physical plant inspections to ensure that environmental health and food service standards are being met within facilities.

To maintain their licensure, all facilities are required to meet certain regulatory standards, and to undergo periodic audits to ensure their continued legality.

Note that each state health department or social services office regulates assisted living communities, sometimes more broadly referred to as “residential care settings.” There are no federal government ratings for these communities.

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Assisted living communities are known to provide senior housing, supportive services, personalized assistance with activities of daily living (ADLs), and various levels of healthcare.

Also, most states also regulate residential care homes, also called personal care homes or board and care homes. These typically have a home – like setting and fewer residents than assisted living communities.

Even though there is a national nursing home website to view the audit and licensing history of Medicare – approved nursing homes, no such website exists for assisted living communities. Especially since states — not the federal government — regulate assisted living communities.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency that regulates and provides ratings for nursing homes and skilled nursing facilities — not assisted living communities.

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But since the CMS does offer guidance to state Medicaid services regarding rules for facilities that are Medicaid – certified, it includes about half of all assisted living facilities. Assisted living regulations vary by state, and here are few assisted living regulations in Florida

Assisted Living Regulations in Florida

1. Scope of Care

All assisted living facilities in the state of Florida are expected to obtain a Standard license to operate legally, which allows facilities to provide things like limited medication assistance, housing, promotion of social engagement, and basic assistance with activities of daily living, such as bathing, dressing, and eating.

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Coupled with the Standard license, other licensure, such as the Limited Nursing Services, Limited Mental Health, and Extended Congregate Care (ECC) licenses, may be obtained to allow facilities to provide greater assistance with activities of daily living and mental healthcare.

Note that the ECC license offers the greatest level of assistance for people with physical or mental disabilities and dementia – related illnesses. Properly licensed facilities may also admit home healthcare agencies to assist residents with greater care needs.

Have it in mind that obtaining extended licensure allows seniors to age in place rather than being relocated if their health or mental capacity should begin to deteriorate.

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2. Admission Requirements

Assisted living facilities in Florida can only accept new tenants if they are equipped to meet each resident’s needs. ALFs can more or less admit people who are able to participate in social and leisure activities, who can walk around with minimal assistance, and who can perform most activities of daily living, such as eating and bathing, with only minimal assistance.

However, these facilities cannot accept individuals who require the use of restraints or who represent a danger to themselves or others.

Also note that those who need 24 – hour nursing care, who are bedridden, or who require complete assistance with most of their activities of daily living also cannot be accommodated. Additionally, certain conditions or illnesses may disqualify an individual from residence.

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3. Facility Requirements

Assisted living facilities in Florida are expected to meet certain logistical requirements to ensure that residents live in a positive, accessible, and home-like atmosphere.

Note that the state allows facilities to provide either private apartments or single and multiple – occupancy bedrooms within shared spaces.

However, both types of lodging require lockable doors, full – use kitchens, a minimum of square footage, and accessibility features for people with reduced visual and functional capacity. Private assisted living apartments are expected to offer at least 80 square feet per resident.

Multiple – occupancy rooms can accommodate no more than two residents and should have a minimum of 60 square feet of usable space per person.

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If a room is multiple – occupancy, at least 35 feet of living and dining space is expected to be provided per resident. Bathrooms may be shared, but at least one lavatory and one bathing area must be provided per every six and eight residents, respectively.

4. Staffing Requirements

Note that every assisted living facilities in Florida is expected to employ direct care staff, and should have enough staff on the grounds to meet the needs of their populations. Florida employs staff – to – resident ratios to make sure that the service plans of residents can be accommodated.

Have it in mind that a minimum number of weekly employee hours must be maintained by the facility, and this number will be based on the number of people in residence.

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Also note that assisted living facilities that have Limited Nursing Care or Extended Congregate Care licensing are expected to have a nurse on staff that can provide medication administration and other services.

In facilities that have Extended Congregate Care licensure to house disabled or mentally handicapped individuals, either an administrator or supervisor will have to be assigned to the management of that facility’s Extended Congregate Care program.

Staff in ECC units will be specifically trained to care for residents with specific disabilities and residents with dementia or related mental health issues.

5. Food Service Standards

When food services are provided by the facility, Florida assisted living laws state that the facility should provide residents with regular meals that meet nutritional needs.

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Note that these needs are established by the Food and Nutrition board based on sex, age, and activity level of residents.

Special therapeutic diets required by a resident’s physician must also be met. These therapeutic diets must be prepared and served as ordered by the resident’s physician.

Also note that no more than 14 hours may pass between the evening meal containing protein and breakfast in facilities that serve three or more meals per day.

Meal intervals are expected to be distributed throughout the day. No less than two hours and no more than six hours should pass between these meals. ALFs must offer snacks at least once a day to patients who do not have kitchen access.

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6. Medicaid Policy

Note that Florida Medicaid doesn’t directly finance assisted living. Howbeit, there are many programs that do reimburse for personal care services received in an assisted living facility.

Nursing home – eligible residents may have their personal care services, such as assistance with activities of daily living, reimbursed under Florida’s Long – Term Care Waiver program.

Florida Medicaid also administers a large PACE program, and facilities licensed to accept Medicaid may accept especially frail seniors who are covered under PACE.

However, it’s imperative to note that Florida residents aren’t entitled to receive funding from these programs, and the number of participants is limited – so not everyone who qualifies will be able to take advantage of the funding provided.

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7. Medication Management Regulations

In as Florida, licensed nurses make up part of the staff in any assisted living facility that have extended licensure, including Limited Nursing Service and Extended Congregate Care licensed facilities.

These nurses can legally administer a consenting resident’s medication for them if the resident is unable to do so for themselves.

Unlicensed personnel, or Direct Care staff, may go so far as to help a resident self – administer their medicines. Assistance with the self – administration of medicines can include the staff member reminding an individual to take their medicines, helping to get packages open, or reading labels for residents.

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But note that direct care staff may only do this, if they have completed six hours of medication – specific training at the start of their employment, to be reinforced with an additional two hours of training per year. Furthermore, Direct Care staff may only assist with the self – administration of medicines that are regularly prescribed and routinely taken.

8. Staff Training Requirements

To become an assisted living facility employee in Florida, direct care staff take a two – hour training orientation that includes curriculum organized by the Department of Elder Affairs Administrators of ALFs are expected to have a high school diploma or GED and must pass a competency test within 90 days of employment.

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Note that the training required for administrators includes a minimum of 26 hours of training on topics related to the health and safety of residents.

Every two years, an administrator is expected to undergo an additional 12 hours of training on topics related to the management of a long – term care facility.

In addition, at facilities that have Extended Congregate Care (ECC) licensure to accommodate disabled or mentally compromised residents, additional training is required on top of that which staff and administrators in Standard facilities must undergo.

Direct care staff in ECC facilities will have to engage additional two hours of in – service training within six months of hire on topics related to the special needs of ECC residents.

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ECC administrators and supervisors require an additional six hours of training regarding ECC populations, to be completed within 90 days of hire, and every two years they must take six hours of continued training.

9. Reporting Abuse

Typically, the Agency for Healthcare Administration advises that before lodging a complaint of an assisted living facility, residents first take the matter to facility administrators.

If no resolution can be reached, then the Agency for Healthcare Administration can receive complaints of long – term care facilities which fail to meet state requirements or fulfil their contractual obligations to care recipients.

In Florida, the online complaint form can be found at, or at the Agency’s healthcare provider complaint portal at The AHA can also be reached by dialling (800) 955 – 8771.

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Also, for the reporting of suspected elder abuse, concerned parties will have to contact Adult Protective Services using the Florida Abuse Hotline, which is administered by the Department of Children and Families. Find them online at or call toll – free at (800) 962 – 2873. A reporting form can be downloaded by visiting


Choosing the right assisted living facility for yourself or a loved one is one of the most important decisions you will need to make as a senior, and so thorough research of potential facilities is critical.

While state regulations cover many of the same aspects of assisted living, the specifics of the requirements as shown above vary considerably from state to state.