Buying an assisted living community in Orlando and Central Florida

• 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.

• 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?

This region covers Orange, Seminole, Osceola, Lake, Sumter and Marion counties: Orlando, Winter Park, Kissimmee, St. Cloud, Sanford, Clermont, Leesburg, Ocala and the large retirement communities of Sumter and Lake counties. Tourism is what the area is best known for, built on the theme parks, the hotels, the vacation rental homes around Kissimmee and the Orange County Convention Center. It's far from the only business. The University of Central Florida and the military simulation and training offices near it support a technology base, and health care is a major employer.

Marion County is horse country, with thoroughbred farms around Ocala, and it has added warehouses and distribution centers along Interstate 75. Retirees in Sumter and Lake create steady demand for medical practices, home care, home maintenance and auto services. The building trades, restaurants, and companies that serve hotels and rental homes do well across the region.

Central Florida is inland, so storm surge isn't the worry it is on the coasts. Hurricanes still bring wind damage and flooding, though: Hurricane Ian flooded neighborhoods in Orange, Seminole and Osceola counties in 2022. Ask whether the business or its customers were affected.

Tourism keeps demand steadier through the year than in markets that depend on winter residents, with busy stretches around school holidays. Hotels, parks and restaurants compete hard for workers, which pushes up wages for any company that hires hourly staff. New homes have spread fast in Osceola, south Lake and southeast Orange counties and around Ocala, so check whether a company's customers are in growing areas or older ones. Traffic on Interstate 4 limits how much ground a service company can cover in a day.