In Florida, assisted living facilities provide a comfortable, homelike living setting for seniors and disabled individuals who require supervision and assistance to live independently. Room and board, as well as nursing and/or personal care services, such as assistance with activities of daily living (ADLs) like bathing, dressing, and mobility (getting up from a chair/bed, walking, etc.) are provided. Social activities, supervision, transportation assistance (either arranging or offering rides), and help with scheduling appointments are also provided. Please note: Some services may be provided at an additional cost above and beyond the regular monthly fee.
Assisted living residences that are designed and staffed specifically for persons with Alzheimer’s and other dementias are formally referred to Special Care Units (SCU). However, SCUs is more of a legal term, and in more common language, these residences are called Memory Care Homes. These types of homes in Florida differ from traditional assisted living in several ways. These include increased security and supervision, additional staff training, recreational activities specific for persons with dementia, and of course, cost. A point of distinction should be made that Memory care homes are not nursing homes. Generally these residences are less expensive and offer a better quality of life to their residents.
Both Memory care homes and assisted living residences can be non-profit or for-profit. They can be standalone buildings, wings/sections of buildings, private homes, homes for the aged, boarding homes, etc. These facilities can be licensed to accommodate just a single resident or up to several hundred residents. However, residents cannot be related to the administrator or owner of the ALF.
Due to the added level of security and supervision of special care units in Florida, memory care generally costs several hundred dollars more per month than does traditional assisted living. Statewide in Florida, as of 2019, the average cost of memory care is $4,130 / month, but based on the geographic location in which one resides, the average cost may be lower or higher. Both Miami ($3,953 / month) and Orlando ($3,864 / month) have average monthly costs less than the state average. On the other hand, both Tampa-St, Petersburg ($5,936 / month) and Jacksonville ($5,221 / month) have average monthly costs higher than the statewide average. In 2019, one of the most expensive regions in Florida is the Naples area, with an average monthly cost of $6,428. Even so, there are still reasonable options in that area that cost 40% less than the stated average. Another example of how the cost of memory care can vary significantly within the same region is Crestview, which is part of the Panhandle. There, the average monthly cost for memory care is $4,950 / month, but can be found as inexpensively as $2,590 / month and as high as $7,404 / month.
In Florida, special care units for persons with dementia must be physically constructed for the safety and wellbeing of those with such neurological disorders. While it isn’t specifically stated exactly what this entails, one example is that memory care facilities might have an enclosed outdoor area to prevent wandering. In addition, activities specifically geared towards persons with dementia are required, as well as the availability of staff around the clock.
Prior to employment, all staff must undergo a background investigation, including a fingerprint check by the FBI and the Florida Department of Law Enforcement. Training of staff varies depending on one’s position and what services are provided. That said, all employees who have not completed core training must attend an orientation prior to interacting with residents. This training must be a minimum of 2 hours and cover topics that pertain to the needs and safety of the residents.
All ALFs must have an administrator that oversees it. In order to fill this role, one must have taken a 26-hour training course that covers a variety of subjects, including training on dementia. Upon completion of the course, the individual must pass a test.
Employees working with persons with Alzheimer’s disease and related disorders (abbreviated as ADRD in Florida) in special care units must have appropriate training to work with this population. Staff who have interaction daily with individuals with ADRD, but aren’t responsible for directly caring for them, must undergo 4 hours of dementia specific training in the first 3 months of being employed at the facility. Staff who directly cares for persons with dementia must undergo 4 more hours of training within 9 months of employment required.
For assisted living residences that house a minimum of 17 residents, it is required that at least one staff who is trained in CPR be on duty at all times. If the ALF offers administration of medications to its residents, a member of the staff must be licensed to give it according to the physician’s order or the instructions on the medication’s label. ALF employees that aren’t licensed to give medications are still able to provide hands on assistance for self-administration of medications. However, some training is required in order to do so. This entails an initial 6 hours of training on medication assistance and an additional 2 hours of training each year.
Florida uses a minimum staff to resident ratio staffing approach, which means the required number of staff hours is based on the number of residents in the facility. For instance, a facility with up to 5 residents must have a minimum of 168 staff hours per week, a facility with 26 to 35 residents must have at least 294 staff hours per week, and a facility with 56 to 65 residents must have a minimum of 416 staff hours per week.
In Florida, in order to be admitted to an assisted living residence, including special care units, there are several requirements that one must meet. These include the following:
In addition to the above, residents must undergo an initial physical exam within a defined period of time, to be completed by a doctor or nurse practitioner. This timeframe is between 60 days prior to admission to 30 days after admittance. After the initial exam, a physical must be performed every 3 years to ensure residents continue to meet the requirements of assisted living facility residency in Florida. While this may seem obvious, residents of special care units must have Alzheimer’s disease or some form of dementia.
In most cases, a family will spend several weeks deciding which assisted living residence is best for their loved one. They then will spend several more weeks relocating their loved one and getting him/her settled in. Please note: Many assisted living residences have waiting lists, and therefore, admission is not always immediate.
While the cost of memory care can be quite expensive, financial assistance is available for low-income persons who need it.
Medicaid is a jointly funded federal and state program, and in Florida, the program that provides long-term care and supports is the Statewide Medicaid Managed Care Long-Term Care Program. Abbreviated as SMMC LTC, this program began in 2013, and prior to this, home and community based services (HCBS) were provided via HCBS Medicaid waivers. In addition to covering the cost of nursing home care, the SMMC LTC program will cover the cost of supportive services in a variety of settings, such as one’s home, adult day care, adult foster care, and assisted living. To be clear, this program will not cover the cost of room and board in assisted living facilities (or special care units for persons with dementia), but will offer assistance for care services. More on Medicaid.
OSS provides cash assistance to be applied towards the cost of room and board at an assisted living residence, adult foster care home, or a mental health treatment facility in Florida. At the time of this writing, the maximum cash assistance available for a single applicant is $78.40 / month.
While not limited to Florida, the VA offers an Aid & Attendance (A&A) pension (monthly cash assistance) for veteran’s and surviving spouses who receive either the basic VA pension or the basic survivor’s VA pension. Applicants must be at least 65 years of age or disabled and require assistance with completing activities of daily living. Examples include assistance with mobility, transferring, eating, and bathing. The cash assistance received from these pensions can be used as the recipient wishes, which means it can go towards the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing one’s countable income when determining one’s pension benefit amount. In 2019, veterans can receive as much as $26,765 / year, and surviving spouses can receive as much as $14,529 / year that can be put toward the cost of memory care. Learn more here.
There are also state Veterans homes, which are residential care facilities that provide long-term care for Veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans homes are typically reserved for veterans whose need for care stems at least 70% from their military service.
Worth noting, Florida also has a program called the Alzheimer’s Disease Initiative. While this program does not help pay for residential memory care, financial assistance may be provided to help care for a loved one with dementia. For example, respite care, both at home and in adult day care, is available to give caregivers a break from their caregiving duties.