Buying an assisted living community in South 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?

South Florida covers Miami-Dade, Broward, Palm Beach and Monroe counties: Miami, Hialeah, Doral, Fort Lauderdale, Hollywood, Pompano Beach, West Palm Beach, Boca Raton, Jupiter, and the Florida Keys down to Key West. It's the state's largest metro area and its most international. PortMiami, Port Everglades and Miami International Airport tie the region to Latin America and the Caribbean, which supports a deep base of wholesalers, freight forwarders and logistics firms, many of them near the airport. Tourism and cruises, finance and wealth management, health care, real estate and construction carry much of the rest. Palm Beach County adds wealthy seasonal residents and, out west near Lake Okeechobee, sugarcane and vegetable farms. In the Keys, nearly everything turns on visitors, fishing and boating.

Companies that serve homes, condo buildings and other businesses do well here: the building trades, property services, insurance agencies, medical and dental practices, and professional firms.

Costs run high: commercial rent, wages and, above all, property and windstorm insurance. Price the insurance before you make an offer, not after. Miami-Dade and Broward make up the Florida Building Code's High-Velocity Hurricane Zone, with stricter rules for roofs, windows and structures. That raises building costs, and it also gives steady work to the contractors who know those rules well.

Much of the workforce and many customers speak Spanish as well as English, and a company that works well in both languages has an edge. The winter season matters more in Palm Beach County and the Keys than in Miami. In the Keys, the cost of housing makes hiring and keeping staff one of the hardest parts of running a company. Ask any seller there how they find workers and where those workers live.