Buying an assisted living community in Southwest 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 Lee, Collier, Charlotte, Sarasota and Manatee counties on the Gulf coast and Hendry, Glades and DeSoto inland: Fort Myers, Cape Coral, Naples, Bonita Springs, Punta Gorda, Port Charlotte, Sarasota, Venice, Bradenton, LaBelle, Clewiston, Moore Haven and Arcadia. The coastal economy runs on people who choose to live or spend the winter here: retirees, seasonal residents, and the construction, real estate, health care, financial and home services that follow them. Tourism, golf and boating add to it.

Inland, the economy is agricultural: sugarcane around Clewiston, citrus, cattle and vegetables, with Immokalee in Collier County a center for farm work. The building trades, pool, landscaping and pest control companies, property managers, medical and dental practices, and marine businesses tend to do well along the coast.

This is one of Florida's most seasonal markets. From roughly January through April, restaurants, shops and service companies run at full speed. Summers are slower, so look at monthly revenue, not only the yearly total. The coast has taken two major hurricanes in recent years: Ian came ashore at Cayo Costa in Lee County in September 2022, and Milton at Siesta Key in Sarasota County in October 2024. Rebuilding brought a wave of work for contractors that won't last forever, so ask how much recent revenue came from storm repairs. Insurance costs and flood zones weigh on every property.

Housing costs near the coast make hiring hard, especially around Naples. New communities east of Interstate 75 in Lee, Collier, Charlotte and Manatee keep service companies busy.