What Type is Right?

Many individuals do not need the expensive and intensive level of care provided by a nursing home, however, they cannot continue to live independently.

ALFs provide housing, personalized support services and health care designed to meet the needs of those who need help with Activities of Daily Living (ADL).

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

Various Care Levels

ALFs can offer different levels of assistance, from minimal to comprehensive. The following are the three types of state licenses for assisted living facilities in Florida.

  • Housing (private, semi-private, rooms, suites or apartments)
  • Meals, special diets and snacks
  • 24-hr staff available to supervise residents
  • Assistance or help with ADLs
  • Assist with medications by a nurse
  • Arrange for health care services
  • Health monitoring
  • Housekeeping
  • Help with laundry and maintenance
  • Social and leisure activities
  • Provide or arrange for transportation to health care services
  • Respite care

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 impairments
  • Provide or arrange for rehabilitative services
  • Provide escorts to medical appointments
  • Educational programs to promote health and prevent illness


Some ALFs are specifically designed for Alzheimer’s and other memory impairments. The level of assistance can be minimal to comprehensive. ALFs that specialize in this kind of care must have an ECC license. A specialized unit must have a physical environment that provides for the safety and welfare of residents, offers activities specifically designed for these residents, have 24-hour staffing availability and employ staff who have completed an eight-hour approved training course.

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
  • Admin. & 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. 

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.

ALF’s 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.t


Financial Concerns

Residency in an ALF can be paid by:

  • Private funds
  • Long Term Care Insurance policy
  • 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.

Click here for a “Questions to Ask” worksheet that will assist you in evaluating ALFs you are considering.