Buying an assisted living community in Florida

An assisted living facility gives older adults a room or apartment, meals, housekeeping, activities and help with daily tasks like bathing, dressing and medications. Most residents pay monthly from savings, sometimes with long-term care insurance or veterans' benefits. Others are covered by Medicaid long-term care plans, which in Florida contract with facilities under the Statewide Medicaid Managed Care program. Revenue is a recurring monthly charge for rent and care, so results depend on occupancy and on care charges keeping pace as residents need more help.

Florida has many small assisted living homes, with a handful of residents in a converted house, and larger purpose-built communities with dozens of apartments and often a memory care wing. Either way, staff work around the clock: an administrator, caregivers on every shift, a nurse or someone trained to help with medications, cooks, housekeepers and maintenance.

A nursing home is a different business: licensed nurses on duty at all hours, residents with heavier medical needs, and most revenue from Medicaid and Medicare rather than private pay.

• Steady occupancy that comes from referrals by hospitals, physicians, placement agencies and residents' families, not from discounts.
• Care levels priced to match what each resident needs, with assessments updated as needs grow.
• An administrator and shift leads who have been there for years and know the residents and families.
• Low caregiver turnover and little reliance on temporary staffing agencies.
• Clean inspection reports from Florida's Agency for Health Care Administration (AHCA), with no serious violations. These are public, so you can read them before your first call.
• A building in good repair, with its generator and fuel plan already approved.
• Licenses that match the residents it actually serves, such as extended congregate care or limited nursing services.

AHCA licenses assisted living facilities (part I of chapter 429) and nursing homes (part II of chapter 400). Assisted living facilities can add extended congregate care, limited nursing services and limited mental health licenses. The first two require no serious sanctions in the past two years (section 429.07). A 2026 law creates a memory care services license (section 429.076). Once AHCA's rules take effect (they're due by June 1, 2027), facilities that serve or advertise memory care will need it, and existing facilities get six months. Assisted living administrators must pass core training within 90 days of starting (section 429.52). Nursing home administrators are licensed under chapter 468.

Licenses don't transfer. At least 60 days before closing, the seller must notify AHCA and your application must arrive. Buying 51 percent or more of the shares counts as a change of ownership (sections 408.803, 408.806 and 408.807). You must tell residents in writing within 7 days of receiving your license (section 429.12). New nursing homes and added beds need a certificate of need (section 408.036). Facilities must keep a generator or other power source on site, with fuel, that can keep residents' space at or below 81 degrees for at least 96 hours (rules 59A-36.025 and 59A-4.1265).

• Occupancy history. Month by month for at least two years, with move-ins, move-outs and the reasons residents left.
• Inspection record. Inspection surveys, complaint investigations, fines and any moratorium (freeze) on admissions, and whether anything is under appeal.
• Staffing. Wages compared with nearby communities, overtime, use of temporary staffing agencies, and whether every shift has enough staff for what residents actually need.
• Liability. Insurance cost and claims history, especially falls, wandering residents and abuse or neglect allegations.
• The building. Roof, air conditioning, sprinklers and fire alarm, the generator and its fuel, flood zone and windstorm insurance, and whether the real estate is included or leased.
• Nursing home risks. A nursing home's Medicare agreement passes to the new owner along with any open plan of correction (42 CFR 489.18). A buyer of the assets can also become liable for Medicaid overpayments that were identifiable 90 days before the sale, if the seller doesn't pay them (section 400.179). Get those figures from AHCA first.

• What has occupancy looked like over the last few years, and where do new residents come from?
• How do you set care levels and charges, and when did you last raise them?
• How long have your administrator and shift leads been here, and how do you cover nights and weekends?
• What did your last few AHCA inspections find, and what did you do about it?
• How did the building and residents get through the last hurricane or long power outage?
• How many residents pay privately, and which Medicaid plans do you work with?
• Do you care for residents with dementia today, and how are you preparing for the new memory care license?