Buying an assisted living community in Treasure Coast

• 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 Martin, St. Lucie and Indian River counties on the Atlantic coast and Okeechobee and Highlands counties inland: Stuart, Palm City, Port St. Lucie, Fort Pierce, Vero Beach, Sebastian, Okeechobee, Sebring and Avon Park. Port St. Lucie is the largest city and has grown quickly as a suburb within reach of Palm Beach County to the south.

The coast draws retirees and winter residents, and health care, construction, real estate, boating and sport fishing are big parts of the economy. The coast lies in the Indian River citrus district, named for the lagoon. Inland, Okeechobee and Highlands are cattle, dairy and citrus country around Lake Okeechobee and along the ridge near Sebring, with many retirees of their own. Home service companies, the building trades, marine businesses and medical practices find steady customers here.

The coast is seasonal, with winter residents filling restaurants, golf courses and service schedules, and summer is quieter. Hurricane Nicole came ashore near Vero Beach in November 2022, and the region has a long history of storms, so check insurance, flood zones and how a business came through recent ones.

Water quality in the St. Lucie River and the Indian River Lagoon is a recurring problem, and in a bad year it can hurt fishing, boating and tourism businesses. Inland, distances are longer and the labor pool thinner. A company in Sebring or Okeechobee may be one of very few of its kind nearby, which can mean loyal customers and little competition, but also few people to hire. Most new homes on the coast are going up in and around Port St. Lucie.