How to Select an ALF or Nursing Home

If you are considering a move to an assisted living facility (ALF) or nursing home, it helps to know as much as possible about your long term care choices and how to evaluate residential facilities.

The term “long term care” is often used to describe care in a residential facility, but the term can refer to on-going care needed by frail persons living at home. “Long term care” is one of many confusing terms you may encounter. Under the Additional Resources section at the end of this article, there is a link to a Glossary of Long Term Care Terms.

For a list of risk factors that suggest that it is time to consider a move to a long term care facility and for information about alternatives such as continuing care retirement communities, see The Four Stages of Caregiving, Stage Three, section 3. Consider another level of care.

If you or a person for whom you provide unpaid care at home do not have enough risk factors to require residential care, you may want to look at support services in the home and community. Here are links to several sections of our web site that offer information on community services and how to pay for them:

For those who are ready to start making choices about assisted living facilities or nursing homes, these options are discussed below:

Assisted Living Facilities (ALF’s)

Assisted Living Facilities (ALF’s) provide housing, meals, personal care services and supportive services to older persons and disabled persons 18 or older unable to live independently. They are called Board and Care Homes in some states. Residents in ALF’s cannot have conditions which require 24-hour nursing supervision unless receiving licensed hospice services.

Some ALF’s have specialty licenses to provide limited nursing services or mental health services, and some specialize in providing services to persons with Alzheimer’s Disease. If you are looking for a facility to care for someone with Alzheimer’s, there are special questions that you need to ask. See Residential Care Facilities in the Alzheimer’s and Related Disorders section of our web site and order Residential Care, the free Alzheimer’s Association publication listed under Additional Resources below.

According to the Year 2,000 National Center for Assisted Living (NCAL) Survey, the typical assisted living resident is a woman between 75 and 85 years of age who is mobile but needs help with about two activities of daily living (ADL’s): bathing, dressing, transferring, toileting, and eating.

The average monthly charge for ALF care is $1,873, with prices ranging from below $1,000 to more than $3,000 per month. More than 2/3 of ALF residents pay with their own or family funds. Other funding sources are Medicaid Waiver, managed care, and some Long Term Care (LTC) insurance policies. In Florida, ALF (Medicaid) Waiver funding, which is not as strict as regular Medicaid regarding income levels for eligibility, can cover costs in an assisted living facility for those who qualify.

Here are two national web sites to visit when seeking more information about assisted living facilities and how to choose one:

  • National Center for Assisted Living (NCAL), www.ncal.org. For more NCAL Assisted Living Facility Survey results, select About Assisted Living followed by Resident Profile and Facility Profile. This site also includes A Consumer Guide to Assisted Living and Residential Care Facilities.
  • Assisted Living Federation of America (ALFA), www.alfa.org. Select Consumer followed by Checklist for a checklist for consumers and prospective residents to use when comparing facilities.

ALF’s in Florida are licensed and inspected by the State of Florida Agency for Health Care Administration (AHCA). For a listing of Assisted Living Facilities in any Florida county, go to the AHCA web site, http://www.floridahealthfinder.gov. In the “Locate” column, select “Facilities or Providers”.

Additional information about assisted living facilities and ALF Medicaid Waiver is available through the Florida Department of Elder Affairs (DOEA) here. It “is intended to serve as a comprehensive clearinghouse of information for assisted living consumers, operators, and developers and it is managed by the Elder Housing Unit within the Department of Elder Affairs as a part of the Communities for a Lifetime initiative.” It provides information for consumers and professionals.  It offers a checklist to use to evaluate an Assisted Living Facility and that pdf file is available here: ALF-eval.pdf.

For more information about how to apply for the Assisted Living Waiver or for information about other resources in Florida’s Pinellas or Pasco Counties, call the Senior Helpline at 1-800-96ELDER (1-800-963-5337). Out of area callers, dial 727-217-8111. Nationally, call the Eldercare Locator toll-free at 1-800-677-1116.

If you are a caregiver, especially a long distance caregiver for someone who needs help in making the transition from home to residential facility, or you need extra assistance yourself, you may want to hire a care manager or placement service. Find information about various “Assisted Living Facilities/Placement” companies in the information resources listed above. For more about care managers, see The Four Stages of Caregiving, Stage One, section 4. Use a care manager. For names of care managers in any part of the United States and an explanation of what care managers do, visit the National Association of Geriatric Care Managers Association web site, www.caremanager.org.

Nursing Homes

Nursing Homes provide more care than assisted living facilities. There are two levels of nursing homes, Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF).

Skilled Nursing Facilities provide nursing care on a 24-hour basis. Also included are therapy, diet supervision, activities, and medication management. An RN Supervisor is on-site and a physician is accessible. Medicare and Medicaid pay for this type of care for eligible persons. For more information about Medicare, call Medicare’s toll-free number, 1-800-Medicare (1-800-633-4227) or visit the Medicare web site, www.medicare.gov.

Intermediate Care Facilities provide personal care and supervision of activities such as dressing, bathing, diet, and self-administered medications. These facilities are covered by Medicaid but not by Medicare. Please be aware that if a person is on Medicaid, it is illegal for the facility to request more money from the family.

The Florida Agency for Health Care Administration (AHCA) publishes regional Nursing Home Guides and provides the same information on its web site. Call AHCA toll-free at 1-888-419-3456 and ask for the Nursing Home Guide for Central Florida, which includes Pasco and Pinellas Counties. Guides are available for all areas of Florida.

If you prefer, use the Nursing Home Guide on the AHCA web site, www.fdhc.state.fl.us. Click on How To Select A Nursing Home for AHCA’s suggestions of what to observe and what questions to ask when visiting nursing homes. For comparisons of homes in a geographic area, click on Nursing Home Search By Region. Pinellas and Pasco Counties are in Region 5. AHCA rates nursing homes in Florida and provides details about each for comparison.

For a list of homes with particularly bad AHCA surveys (inspection reports), see Nursing Home Watch (find this link on AHCA’s home page). Complaints about facilities may be filed online or by calling the toll-free number.

Information about how nursing homes compare anywhere in the country is posted on Medicare’s web site, www.medicare.gov. Click on Nursing Home Compare and follow the instructions. The printed version is available by calling Medicare’s toll-free information line, 1-800-MEDICARE (1-800-633-4227). Ask for the nursing home comparison data for your state and county.

The AARP organization has information to help consumers with long term care decisions. According to AARP, location is an important factor to consider when choosing a nursing home because nursing home residents who have regular visitors get better care. For brochures on choosing a nursing home and protecting a resident’s rights, call AARP’s toll-free line, 1-800-424-3410.

The AARP web site, www.aarp.org, has several articles with tips, facts, links to other helpful sites, and free publications to order when making choices about nursing home care. On the AARP home page, select Life Answers, followed by Caregiving, to find the following articles:

  • Choosing a Good Nursing Home. Be sure to notice the list of “signs of GOOD care” and “signs of BAD care.”
  • Medicaid and Paying for Nursing Home Care.
  • Nursing Home Admissions Contract.

Persons applying for Medicaid coverage of nursing home care in Florida must be assessed by the Florida Department of Elder Affairs (DOEA) CARES (Comprehensive Assessment Review and Evaluation Services) office. For more information, visit the DOEA web site, www.state.fl.us/doea, and select Caring for an Elder followed by CARES. The local offices serving every area of the state are listed.

For Florida’s Pinellas and Pasco counties, call the CARES office in Largo, Florida, at 727-588-6882. Sometimes assessment by the CARES office can make a person a high priority for government-funded community services rather than residential care. Note: the DOEA CARES unit is not to be confused with CARES, Inc. (Community Aging and Retirement Services), a “lead agency” for case managed programs and provider of many services for older persons in Pasco County.

When considering legal and financial issues involved in long-term care decisions, many people find it helpful to consult an elder law attorney, an expert in counseling, educating, and advocating for seniors regarding illness, incapacity, and death. Learning what financial decisions to make and avoid if Medicaid will be needed for nursing home care is just one of many reasons to visit an elder law attorney. For more about what elder law attorneys do and how to find one, use these resources:

  • The National Academy of Elder Law Attorneys (NAELA) web site, www.naela.org, provides a listing of attorneys by area and has tips for choosing a good elder law attorney.
  • A number of elder law attorneys in Florida’s Pasco and Pinellas Counties are listed with the Senior Helpline of the Area Agency on Aging of Pasco-Pinellas, Inc. Run a search on Search for Community Resources, look up “Legal Counseling/Representation” in the printed Senior Resource Directory, or call the Senior Helpline at 727-217-8111 in Pinellas or toll-free 1-800-861-8111 in Pasco.
  • Call the Florida Bar Association toll-free at 1-800-343-8060 for a listing of elder law attorneys for any county in Florida.

Veterans may want to include a U.S. Veterans Administration (VA) nursing home as one of the choices they consider. The Baldomero Lopez Veterans’ Nursing Home is located in Land o’ Lakes in Pasco County, Florida. This is a 120 bed facility with 60 beds dedicated to serving mobile Alzheimer’s patients. To be eligible, a veteran must have been a Florida resident for at least one year, honorably discharged, and need nursing care. Costs vary depending on income.

To locate a VA nursing home anywhere in Florida, visit the Florida Department of Veterans Affairs web site, www.Floridavets.org. For more about several types of VA benefits often overlooked by veterans, see Benefits for Older Veterans and Their Families.

Additional Resources

  • Florida’s Long Term Care Ombudsman Program (LTCOP) offers a toll-free number, 1-888-831-0404, and a web site, www.state.fl.us/ombudsman. This Department of Elder Affairs-sponsored citizen’s group strives to improve conditions for residents of long term care residential facilities. On the web site home page, click on Residents’ Rights for a choice of Nursing Home, Assisted Living, or Discharged Nursing Home Residents’ Rights. Complaints against facilities may be filed online or by calling the toll-free number.
  • If a complaint against a nursing home or assisted living facility involves abuse or neglect of a resident, any person can report this by calling the Florida Abuse Hotline on the toll-free number, 1-800-96-ABUSE (1-800-962-2873). The TDD (Telephone device for the Deaf) Abuse Hotline number is 1-800-955-8770. The Abuse Hotline is available 24 hours a day seven days a week for confidential reporting of abuse and neglect of any type. For more about abuse, see Elder Abuse and How to Report It, Prevent It.
  • Glossary of long term care terms can be found on the LongTermCareLiving web site, www.longtermcareliving.com. Financial options and how to have a family conversation about long term care are discussed on this web site, also. Sponsors are The American Health Care Association and the National Center for Assisted Living.
  • The Family Guide to Long-term Care is a series of six videos available from Lifeview Resources. Call toll-free 1-800-395-5433 or visit the website, www.lifeviewresources.com. Two of these are called Making the Right Choice and Staying Involved. View video clips online before purchasing. If you are a caregiver, you can buy these at a discount by using your free membership number from the Caregivers Marketplace web site, www.caregiversmarketplace.com. For more information, look up these web sites on our alphabetical list of Caregiver Web Sites.
  • How to Care for Aging Parents, by Virginia Morris, is a comprehensive guide to caregiving. This book has chapters called “Home Away From Home,” “A Good Nursing Home,” and “Paying The Way”. For publishing information and reviews of other caregiving books that may be helpful, see our list of Caregiver Books/Videos.

, caregivers may borrow this book and others from one of the local , which have been established in community locations by the Caregivers REST Project, the grant-funded program which also developed this web site. For more information, see .

Also check the public libraries, as some locations are adding new caregiver books and videos to their collections. To search the catalogs and reserve books online in Pinellas County, Florida, visit the , .

  • Residential Care: A Guide for Choosing a New Home is an Alzheimer’s Association publication to help families in make choices about residential care for persons with Alzheimer’s. For a free copy, call the national toll-free number, 1-800-272-3900, or visit the web site, www.alz.org. To find this publication online, select Resource Center followed by Fact Sheets. This is listed under the fact sheets on Caregiving.
  • American Association of Homes and Services for the Aging (AAHSA) is a national organization made up of not-for-profit nursing homes, continuing care retirement communities, senior housing, assisted living facilities, etc. committed to affordable, healthy, and ethical long term care. Visit their web site, www.aahsa.org, and select For Consumers and Family Caregivers for information about types of facilities ranging from government-funded senior housing to nursing homes, contact information for state affiliates, and a directory of members.