The Assisted Living Says Mom Needs More Care Than It Can Give — Your Options in Florida

In this article

1. Find out exactly what changed
2. The line no assisted living can cross
3. How Florida's license ladder works
4. Standard
5. Limited nursing services
6. Extended congregate care
7. Nursing home
8. Where we sit on that ladder
9. Use the 45 days well
10. What to do this week, in order
11. If the answer is a nursing home

When an assisted living community tells you your mom needs more care than it can give, there are usually four ways forward in Florida: a fresh assessment that shows she can stay, hospice care brought into the building she already lives in, a move to a community whose license allows more, or a move to a nursing home. Which of those is open depends on two things. The first is what the current building is licensed to do. The second is whether her needs have crossed the one line that no assisted living community in Florida may cross.

You also have more time than it feels like. Unless a doctor certifies an emergency, Florida requires at least 45 days of written notice before a community ends a residency.

Find out exactly what changed

"She needs more care" is a conclusion, not a reason. Under section 429.26 of the Florida Statutes, the decision about whether a resident can stay belongs to the owner or administrator, and it has to rest on an evaluation of her needs, a medical examination, and what the building is able to provide. So the first question to ask is which need, specifically, the community cannot meet. Write down the answer.

Then call her doctor. A physician, physician assistant, or nurse practitioner completes the health assessment Florida uses for assisted living, and a new one often clears up a misunderstanding: a hip that was healing, a medication that caused confusion, an infection that has since passed. The statute is plain that the doctor's form informs the administrator's decision rather than overruling it, but it is the best evidence you have, and an administrator who sees a changed picture can change their mind.

The line no assisted living can cross

Families often hear "she needs a higher level of care" and assume a different assisted living community will fix it. Sometimes it will. But Florida sets a ceiling that applies to every license type, and if your mom is past it, no assisted living community can keep her.

That ceiling, from section 429.26, is a resident who needs 24 hour nursing supervision, or who is bedridden, meaning she cannot move or reposition herself in bed, cannot transfer to a chair, or cannot sit safely in a chair without help. A resident may stay through a bedridden stretch of up to 7 consecutive days, or up to 14 days in a community licensed for extended congregate care.

There is one exception. A resident receiving hospice can stay when the community and the resident agree, a licensed hospice provides the added care, a physician agrees her needs can be met there, and a written plan of care covers both her scheduled and her unscheduled needs. If your mom is near the end of life, ask about hospice before you ask about a move.

How Florida's license ladder works

Every assisted living community in Florida holds a standard license, and some carry one or two added designations. Section 429.07 sets out what each one allows.

Standard

Personal care: help with bathing, dressing, eating, walking, and medication. A standard community can keep a resident whose needs stay within that range.

Limited nursing services

Nursing tasks beyond what a standard license allows, performed by a licensed nurse, with a written progress report kept on each resident receiving them. The resident still has to meet the general assisted living criteria. If she stops meeting them, the law calls for relocation unless the building also holds the next designation.

Extended congregate care

The highest assisted living designation. The statute says its purpose is to let residents stay in a familiar setting as they become more impaired, and it allows nursing and supportive services well beyond the other two. Even here, the 24 hour nursing supervision limit still applies.

Nursing home

Past the line above, the answer is a skilled nursing facility. That is a different license, a different kind of building, and usually a different way of paying. Our comparison of assisted living, nursing homes, and home care walks through how they differ.

You can look up any community's license type on FloridaHealthFinder, the state's public facility search. Do that before you tour. A community without the right designation cannot legally take on the need that started all this, however good the tour feels.

Where we sit on that ladder

Here is the part that does not work in our favor. Sugarmill Manor and The Gardens both hold a limited nursing services license. Neither holds extended congregate care. That means if your mom's current community is telling you she needs what only an extended congregate care license allows, we would hit the same ceiling, and we will tell you so on the first call rather than after a tour.

What we can tell you is where she falls. If the change is about dementia, someone trying to leave or needing a person nearby through the day, both communities run a secured memory care neighborhood, and our guide on when assisted living is not enough covers those signs. If the change is a nursing need, we can tell you which of the three licenses it calls for.

Use the 45 days well

A community cannot decide on Monday that your mom leaves on Friday. Section 429.28 requires at least 45 days of written notice, with narrow exceptions such as a physician certified emergency move to a more skilled setting. Our guide to Florida assisted living resident rights covers what that notice has to contain and the exceptions in detail.

What to do this week, in order

If you would rather write than call, our contact form reaches the same people, and you can describe what the current community told you in your own words.

If the answer is a nursing home

Sometimes the honest answer is that she has moved past what assisted living can offer, and that is not a failure on your part or hers. It usually means the care she needs has become nursing care. Ask her doctor for an order, ask the nursing homes you call about openings and how they are paid, and lean on the hospital social worker if she is admitted along the way. If she is in the hospital when this comes up, our hospital discharge checklist covers what to ask before she leaves.

And if the answer turns out to be that she can stay, or move somewhere with the right license and stay for years, the 45 days you spent asking questions will have been worth it.

Frequently asked questions

Can an assisted living facility in Florida make my mom leave because she needs more care?

Yes, if her needs go beyond what the building is licensed to provide, but it must give at least 45 days of written notice unless a physician certifies an emergency move to a more skilled setting. Ask for the reason in writing and call the Long Term Care Ombudsman at (888) 831-0404.

What care is too much for assisted living in Florida?

Florida law bars every assisted living community from keeping a resident who needs 24 hour nursing supervision or who stays bedridden longer than 7 consecutive days, or 14 days in an extended congregate care community. Hospice is the one exception.

What is the difference between limited nursing services and extended congregate care?

Both are added designations on a Florida assisted living license. Limited nursing services allows some nursing tasks beyond a standard license. Extended congregate care allows more, so residents can stay as they become more impaired, but it still cannot serve someone who needs 24 hour nursing supervision.

Can my mom stay in assisted living on hospice?

Often, yes. Florida lets a community keep a hospice resident when the community and resident agree, a licensed hospice provides the added care, a physician agrees her needs can be met there, and a written plan of care is in place.

How do I check what license an assisted living community holds?

Search the community on FloridaHealthFinder, the state's public facility lookup run by the Agency for Health Care Administration. The license type shows whether the building can provide limited nursing services or extended congregate care.

Sources

• Florida Statutes section 429.26, appropriateness of placements and continued residency
• Florida Statutes section 429.07, license required and license types
• Florida Statutes section 429.28, resident bill of rights
• Florida Department of Elder Affairs: Long Term Care Ombudsman Program
• FloridaHealthFinder: assisted living facility search

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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.