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  • Writer's pictureMichael Kornhauser

Not all Assisted Living Facilities are Created Equal: Understanding the Differences Among Florida ALF Licenses and Why it Matters for Your Case


An assisted living facility with the letters ALF in front of it.

When considering whether to bring a case against a Florida assisted living facility (“ALF”) for abuse and/or neglect, it is important to consider the facility’s licensure status. In this blog, we break down the different types of Florida ALF licenses and how those differences might impact your case.

The Different ALF Licenses

1. The Standard Assisted Living Facility License. All Florida assisted living facilities must have a standard assisted living facility license. This license serves as a foundational requirement, encompassing direct physical assistance with or supervision of activities of daily living (e.g., ambulation, bathing, dressing, eating, grooming, toileting, and other similar tasks), self-administration of medication, or other similar services as defined by the Agency for Healthcare Administration. A facility with a standard ALF license may employ a nurse to perform the following tasks:

 

  • administer medications to residents,

  • take residents’ vital signs,

  • change residents’ bandages for minor cuts and abrasions,

  • manage individual weekly pill organizers for residents who self-administer medication,

  • give prepackaged enemas ordered by a physician,

  • observe residents,

  • document observations on the appropriate resident’s record, and

  • report observations to the resident’s physician.

 

Certified nursing assistants (also known as CNAs) may also take residents’ vital signs as directed by a licensed nurse or physician. See Fla. Stat. 429.255(1)(a). The standard ALF license also requires all staff to exercise their professional responsibility to observe residents, to document observations on the appropriate resident’s record, and to report the observations to the resident’s physician. See Fla. Stat. 429.255(1)(b).

 

Three other licenses can be added to the standard license, allowing the assisted living facility to provide supplementary services consistent with the scope and standard of care of the additional licenses.

 

2.      Extended Congregate Care (ECC) license. An assisted living facility with an ECC license allows a resident to age in place by providing the basic services of an assisted living facility as well as:

 

  • Providing limited nursing services and assessments,

  • Providing total assistance with bathing, dressing, grooming and toileting,

  • Measuring and recording vital signs and weight,

  • Engaging in dietary management, which includes offering special diets and monitoring nutrition, food, and fluid intake,

  • Supervising residents with dementia and/or cognitive impairments

  • Providing and/or arranging for rehabilitative services,

  • Providing transportation and escort services to medical appointments, and

  • Offering educational programs to promote health and prevent illness.


If a facility maintains an ECC license and intends to use the same, the resident who will receive ECC services must first undergo a medical examination in accordance with Florida Statute 429.26(5). If the resident is deemed appropriate for placement, the facility must maintain a written progress report that describes the type, amount, duration, scope, and outcome of services that are rendered and the general status of the resident’s health. See Fla. Stat. 429.07(3)(b)3. ECC-licensed facilities must also:


  • Demonstrate the capability to meet unanticipated resident service needs,

  • Offer a physical environment that promotes a homelike setting, provides for resident privacy, promotes resident independence, and allows sufficient congregate space as defined by rule,

  • Have sufficient staff available, taking into account the physical plant and fire safety features of the building, to assist with the evacuation of residents in an emergency,

  • Adopt and follow policies and procedures that maximize resident independence, dignity, choice, and decision-making to permit residents to age in place, so that moves due to changes in functional status are minimized or avoided,

  • Allow residents or, if applicable, a resident’s representative, designee, surrogate, guardian, or attorney in fact to make a variety of personal choices, participate in developing service plans, and share responsibility in decision-making,

  • Implement the concept of managed risk,

  • Provide, directly or through contract, the services of a licensed nurse, and

  • Provide specialized training for facility staff.



3.      Limited Nursing Services (LNS) license. An assisted living facility with a Limited Nursing Services license can provide the basic services of an assisted living facility, along with nursing services provided by licensed nurses acting within the scope of their nursing practice. Those services might include the application and care of routine dressings and care of casts, braces, and splints. See Fla. Stat. 429.02(14). The resident would still be required to meet admission and continued residency criteria. In other words, if a resident’s condition(s) otherwise required 24-hour skilled nursing care and supervision, the assisted living facility would be required to discharge the resident to a higher level of care (e.g., a skilled nursing facility). Per Fla. Stat. 429.255(1)(b), that decision is the responsibility of either the administrator or the owner of the facility. In addition, a facility licensed to provide limited nursing services must maintain a written progress report on each resident who receives such nursing services from the facility. The report must describe the type, amount, duration, scope, and outcome of the services that are rendered and the general status of the resident’s health. See Fla. Stat. 429.07(3)(c)2.

 

4.      Limited Mental Health (LMH) license. This type of license must be obtained if an assisted living facility serves one or more mental health residents. Services must be provided for the special needs of these residents, along with the basic services of an assisted living facility. A facility with this license must consult with the resident and the resident’s mental health case manager to develop and carry out a community living support plan. To learn more about the limited mental health license, take a look a Florida Statute 429.075.

Why it Matters for Your Case

The type of license held by an assisted living facility has a direct impact on the standard of care owed to its residents. For example, was a facility exceeding the scope of its license by providing services it was not licensed and/or competent to provide? If an assisted living facility was licensed to provide additional services, did it do so consistent with the prevailing standards of care? These issues must be considered when litigating a case of abuse and/or neglect against a Florida ALF.

How Do You Check the Licensure Status of a Florida Assisted Living Facility?
  • Step 1: Visit https://quality.healthfinder.fl.gov/Facility-Provider/

  • Step 2: Select “Assisted Living Facility” from the “Find a Provider, Facility, or Health Plan” Dropdown Menu.

  • Step 3: Select “Locate/Search Facility” from the “Search Type” Dropdown Menu.

  • Step 4: Select the County of the Assisted Living Facility from the Dropdown Menu.

  • Step 5: Select the Assisted Living Facility from the list of facilities.

  • Step 6: On the right side of the page, under Facility Information, look for the category, “Bed Types” to see if any beds are designated as Extended Congregate Care (ECC) beds.

 

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  • Step 7: Scroll further down to the section titled, “Service/Characteristics”. Look for the category, “Specialty License” to see whether the ALF has any specialty licenses beyond the standard license.  

 

Assisted-Living-Facility-Facility-Information-Example-2

Assisted-Living-Facility-Facility-Information-Example-3

 

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Not all assisted living facilities are created equal and recognizing these nuances is essential when seeking justice for those affected by assisted living facility abuse and/or neglect.

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