Adult Family Care Home or Assisted Living — Which Fits Your Parent in Florida

In this article

1. First, rule out the idea that a smaller home means less regulation
2. The two settings side by side
3. Where a small home is the better choice
4. Where an assisted living community is the better choice
5. The limit both settings share
6. How Medicaid works in either setting
7. What to do this week
8. Visit both before you decide

If your parent needs daily help and you are choosing between an adult family care home and an assisted living community in Florida, the choice usually comes down to four questions: how many people she wants around her, who is awake and nearby at night, how her needs are likely to change, and how the stay will be paid for. Both settings are licensed by the Agency for Health Care Administration, both provide room, meals and help with daily care, and both have to send her elsewhere if she ever needs nursing supervision around the clock. What differs is the size, the staffing, and what happens as she declines.

First, rule out the idea that a smaller home means less regulation

Families often assume an adult family care home is an informal arrangement. It is not. Under section 429.65 of the Florida Statutes, it is a full time, family style living arrangement in a private home where the person who owns or rents the house provides room, board, and personal care around the clock for no more than five disabled adults or frail elders who are not relatives.

The provider must live in the home, and the state licenses it. Section 429.67 requires a level 2 background screening for the provider, the designated relief person, and every adult who lives in the household. Providers also have to complete state training on placement, abuse reporting, and monitoring residents' health.

The exception worth knowing: a household caring for no more than two adults who are not on state assistance does not need a license at all. If someone is offering to care for your parent in their home alongside other people, ask to see the license before anything else.

The two settings side by side

Where a small home is the better choice

A quiet house with five residents can suit a parent who is overwhelmed by noise and new faces, or who does best with one familiar person rather than a rotating team. If your mother hates crowds, that matters more than any amenity list.

There is also a practical reason. Section 429.67 requires every adult family care home to set aside at least one licensed space for a resident who receives Optional State Supplementation, the small monthly payment Florida makes toward room and board for people with very low income. If that program is part of her plan, a small home may have a space when nothing else nearby does. Our guide to Optional State Supplementation explains who qualifies.

We run two assisted living communities, Sugarmill Manor in Homosassa and The Gardens in Crystal River, not adult family care homes. Weigh what follows with that in mind.

Where an assisted living community is the better choice

The difference that matters most shows up at night and when needs change. In a small home, one provider lives with the residents and a relief person covers when the provider is away. In an assisted living community, caregivers work in shifts, so someone awake and on duty is the normal arrangement rather than the exception.

Dementia changes the math. A parent who wanders, who is up at 3am, or who becomes anxious when the one familiar caregiver leaves for an errand can outgrow a small home quickly. Florida's disclosure rule for dementia care, section 429.177, applies to assisted living facilities that advertise special care for Alzheimer's disease: they must put in writing what makes their care suited to it, and give you a copy when you ask. At both of our communities, assisted living and a secured memory care section are under one roof, so a resident whose memory declines can move down the hall instead of moving out.

The other difference is what happens if the provider of a small home falls ill, sells the house, or retires. The state requires notice and a plan to keep the disruption small, but your parent still has to move. A community with an administrator and a staff does not close because one person steps away.

The limit both settings share

Neither setting is a nursing home. Under section 429.73, an adult family care home may not keep a resident who needs 24 hour nursing supervision unless she is enrolled in hospice and both sides agree to her staying. Section 429.26 puts the same limit on assisted living, and adds residents who are bedridden.

If her doctor describes her needs as skilled and continuous, compare nursing homes instead. Our comparison of assisted living, nursing homes and home care walks through that line.

How Medicaid works in either setting

Florida Medicaid pays for long term care through the Statewide Medicaid Managed Care long term care program. Section 409.982 requires each plan's provider network to include both adult family care homes and assisted living facilities, so neither setting is ruled out.

Here is the catch, and it works against us as much as anyone. Being approved for Medicaid does not mean a particular home has to take it. Each home and each community chooses whether to accept Medicaid and which plans it works with, so your parent can be approved and still find that the place she likes does not take her plan. Ask that question on the first call, not after the tour.

What to do this week

Work through these in order. The first three settle what is possible before you spend a weekend touring.

Both kinds of homes must give you a written residency agreement before she moves in. Read the parts on rates, rate increases, and the reasons a resident can be asked to leave. Either way the law requires at least 30 days written notice before a rate goes up, under section 429.81 for small homes and section 429.24 for assisted living.

Visit both before you decide

Tour one small home and one community in the same week, ideally around a meal. In the small home, meet the relief person, not just the provider. In the community, ask how many caregivers are on duty overnight.

If you are looking around Homosassa and Crystal River, our side by side guide to Citrus County communities shows which offer memory care and which accept Medicaid, and our starting rates are published so you can compare before you call.

Frequently asked questions

What is an adult family care home in Florida?

It is a private home licensed by the Agency for Health Care Administration where the provider lives and gives room, meals, and help with daily care around the clock to no more than five adults who are not relatives. It is defined in section 429.65 of the Florida Statutes.

Is an adult family care home the same as assisted living?

No. Both are licensed by AHCA and both help with daily care, but an adult family care home is a private house with at most five residents and a live in provider, while an assisted living community is usually larger, with caregivers working in shifts and often a secured memory care section.

Does Florida Medicaid pay for an adult family care home?

It can. Florida law requires each Medicaid long term care plan to include adult family care homes and assisted living facilities in its network. Each home still chooses which plans it works with, so ask before you tour. The Elder Helpline at (800) 963-5337 starts the long term care screening.

Can an adult family care home take someone with dementia?

Some do, depending on the provider and what the house can safely handle. If your parent wanders or is awake at night, ask who is awake with residents overnight and what happens when the provider is away. A community with a secured memory care section is built for those needs.

How do I check whether an adult family care home is licensed?

Search the facility locator at FloridaHealthFinder.gov or call the AHCA consumer line at (888) 419-3456. A home caring for more than two unrelated adults, or anyone on Optional State Supplementation, needs a license.

Sources

• Florida Statutes section 429.65: adult family care home definitions
• Florida Statutes section 429.67: adult family care home licensure
• Florida Statutes section 429.73: adult family care home standards and continued residency
• Florida Statutes section 429.26: assisted living placement and continued residency
• Florida Statutes section 409.982: long term care plan provider networks
• Florida Agency for Health Care Administration: adult family care homes

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Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.