Choosing a Residential Care Facility

A move to an assisted living facility (ALF) or nursing home is a decision that involves both the caregiver and the care receiver if he or she is competent. The term “long term care” is often used to describe care in a residential facility, but the term can refer to on-going care needed by frail persons living at home. The continuum of facilities providing long term care is described below.

It helps to learn as much as possible about possible long term care choices and how to evaluate residential facilities. Assisted Living Facilities and nursing homes in Florida are licensed by the Agency for Health Care Administration (AHCA). Always ask to see the AHCA inspection report when visiting a facility. Their web site is There is also a web site that provides information on facilities in each county of Florida. Click on “Facility locator” at

There are several free booklets published which provide information on housing and care options. They are available free at various stores in Pasco, Pinellas and surrounding counties of Florida. There are also businesses that provide relocation assistance and help seniors find facilities that meet their criteria and care needs. There is often no cost to the senior for this service.

Types of Housing Providing Facility-Based Long Term Care

Continuing Care Retirement Communities

Continuing Care Retirement Communities (CCRCs), also called life-care facilities, provide residents with shelter and health care in return for an entrance fee and periodic monthly fees. Only properly licensed facilities may use the term “Continuing Care Retirement Community” or “life-care” in marketing efforts. CCRC’s may appeal to those who can afford them because of having several levels of care ranging from independent living to nursing home on the same grounds. Residents who need nursing care just move to another part of the facility. There are several different payment plans. Some retirement communities that are not CCRC’s offer several levels of care. Be sure to compare various communities before making a choice.

Adult Family Care Homes

Adult Family Care Homes (AFCH’s) are family-type living arrangements in private homes. These are an option for housing and supportive services for no more than five disabled adults or frail elders. Persons choosing to live in an AFCH must not require 24-hour nursing supervision. These homes must be licensed by the Agency for Health Care Administration as Adult Family-Care Homes unless room, board, and personal care is provided for relatives or no more than two adults who do not receive a state supplement. For more information, see the resources for Assisted Living Facilities listed below.

Assisted Living Facilities

Assisted Living Facilities (ALF’s) provide housing, meals, personal care services and supportive services to older persons and disabled persons unable to live independently. They are called Board and Care Homes in some states. Residents in ALF’s cannot have conditions that require 24-hour nursing supervision unless receiving licensed hospice services. Some ALF’s have specialty licenses to provide limited nursing services or mental health services, and some specialize in providing services to persons with Alzheimer’s Disease. If you are looking for a facility to care for someone with Alzheimer’s, there is an article in the Alzheimer?s pages of this Directory that outline some special questions that should be asked.

Most residents pay with their own or family funds. Other funding sources are the Assisted Living Medicaid Waiver program, Nursing Home Diversion program for those who qualify for Medicaid nursing home care. Many insurance companies that sell long term care insurance offer assisted living coverage.

The Florida Affordable Assisted Living  “is intended to serve as a comprehensive clearinghouse of information for assisted living consumers, operators, and developers, managed by the Elder Housing Unit within the Department of Elder Affairs as a part of the Communities for a Lifetime.”

Nursing Homes

Nursing Homes provide more care than assisted living facilities. There are two levels of nursing homes, Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF).

Skilled Nursing provides nursing care on a 24-hour basis. Also included are therapy, diet supervision, activities, and medication management. An RN Supervisor is on-site and a physician is accessible. Medicare may pay for skilled nursing care in a facility if the patient meets the necessary criteria. For more information about Medicare, call 1-800-Medicare (1-800-633-4227) or visit the Medicare web site. Medicaid may pay for this type of care for persons who meet the income and asset eligibility.

Intermediate Care provides personal care and supervision of dressing, bathing, diet, and self-administered medications. This level of care may be covered by Medicaid for those who financially qualify, but Medicare only pays for skilled nursing and will not pay for what it calls “custodial care” or intermediate care.

Before deciding that nursing home care is the only option, contact the Helpline at the Area Agency on Aging at 1-800-963-5337. (Calling from outside the area: 727-217-8111) Or call the CARES Unit of the State of Florida Department of Elder Affairs (727-588-6882) to evaluate other options.

Choosing a nursing home can be complicated and emotional. Sometimes a choice is dictated by what homes have beds available that day. However, if time allows, it is good to learn what to look for in a nursing home and to compare various local nursing homes.

While looking for a home that will meet your care receiver’s needs and that gets a good review is important, other factors such as whether the home is close enough for family to visit frequently should also be considered. Nursing facilities and ALFs are licensed by the Agency of Health Care Administration (AHCA). AHCA recommends one or more visits to the facility as part of the decision making process. One of these should be scheduled with an opportunity to talk with staff and take a tour. Drop in another time without scheduling an appointment to make certain that the facility still seems attractive and treatment of residents seems the same. Be sure to look at floors above the first floor.

Things to observe when visiting a nursing home include:
* Do residents appear happy, comfortable, and at home?
* Is the facility clean, odor free, and well-staffed?
* Are residents being taken care of in a timely manner?
* Are the rooms decorated with personal furnishings and belongings?
* Do the residents have adequate privacy?

Among the questions you should ask when visiting are:
* What deficiencies, if any, were cited during the last inspection? (Ask to see the survey, which is AHCA’s inspection report.)
* How many residents does each nurse and nurse’s aid care for during each shift?
* What do they do about medical services and special therapies?
* What transportation arrangements for residents are available?
* What special training does the staff have?
* What are the policies regarding deposits, refunds, and bed holds?
* How much advance notice is provided before increasing charges?
* How are personal possessions safeguarded?
* What activities are available? (Ask to see calendar.)
* What are the designated visiting hours, and are exceptions allowed?
* Does the nursing home have a program to limit the use of physical restraints?

When considering legal and financial issues involved in long term care decisions, many people find it helpful to consult an elder law attorney, an expert in counseling, educating, and advocating for seniors regarding illness, incapacity, and death. Learning what financial decisions to make and avoid if Medicaid will be needed for nursing home care is just one of many reasons to visit an elder law attorney. See the Category Listing for legal services for elder law attorneys.

Veterans may want to include a U. S. Veterans Administration (VA) nursing home as one of the choices they consider. The Baldomero Lopez Veterans’ Nursing Home is located in Land O’ Lakes in Pasco County, Florida. This is a 120-bed facility with 60 beds dedicated to serving mobile Alzheimer’s patients. To be eligible, a veteran must have been a Florida resident for at least one year, honorably discharged, and need nursing care. Costs vary depending on income. To locate a VA nursing home anywhere in Florida, visit the Florida Department of Veterans Affairs web site. For more about several types of VA benefits often overlooked by older veterans, visit the National Veterans Administration (VA) web site.