Scandals Prompt Florida Senate to Call for Revamped Assisted Living Oversight

In response to a Miami Herald investigation into Florida assisted living facilities that uncovered sordid cases of elder abuse and neglect, the state Senate professional staff released a report calling for both increased and reorganized ALF regulatory oversight.

Currently, the Agency for Health Care Administration (AHCA) is in charge of licensing and inspecting ALFs, and may impose administrative fines for certain types of violations. In certain circumstances, it has the authority to revoke or deny licenses depending on cited violations, or suspend services, if any condition related to the licensee presents a threat to the health, safety, or welfare of a client.

However, the Herald’s three-part series revealed that in many cases, the agency neglected to revoke licenses or shut down facilities even after multiple complaints and reports of abuse.


This led the Senate professional staff to recommend “the establishment of a workgroup that includes members of the various state agencies having ALF oversight responsibilities to determine those functions that are performed by more than one agency.”

Until the workgroup comes about, the Senate staff advises the Legislature to require each agency to establish a direct line of communication to the AHCA to immediately communicate a complaint received or observed deficiency concerning an ALF, and that the AHCA must immediately report each complaint.

Other recommendations include requiring quarterly reports from ALFs to the AHCA on occupancy rates and demographic and resident acuity information and increased surveys and inspections by the AHCA.


The report also details specific training and qualification recommendations for both ALF administrators and staff, and includes the possibility of requiring increased staff ratios for facilities with specialty licenses.

As far as penalties go, the report suggests limiting the AHCA’s discretionary powers in favor of requiring them to take certain measures based on certain actions.

“For example, the Legislature could require the AHCA to fine an ALF in increasing increments after certain recurring deficiencies,” the report reads. “The Legislature could also remove the AHCA’s discretion to impose a moratorium or revocation of license when residents’ health, safety, or welfare is at stake. The AHCA could be required to automatically revoke a license when a resident dies at a facility because of intentional or negligent conduct on the part of the facility.”

Increased oversight is necessary as ALFs prepare to meet the greater needs of residents and provide sufficient quality of care as a result of the aging population and a shift toward community-based care, including assisted living, says the report.

By 2030, nearly 20% of the United States’ population will be aged 65 or older, and within Florida, that age group is expected to nearly double from 3.3 million in 2010, to 6.2 million, U.S. Census data projects. Currently, 17% of Florida’s population falls into this age range—the highest percentage in all 50 states.

This report’s recommendations will help lead to improved resident care and oversight, said Emmett Reed, executive director of the Florida Health Care Association, in a statement obtained by SHN.

“We are pleased to see the Agency for Health Care Administration already taking strong action against those facilities not in compliance with state regulatory requirements, which reflects poorly on those facilities that are committed to delivering high quality care to their residents,” says Reed. “We believe that focus on quality care starts at the top, and we support ALF administrator licensure and reviewing educational standards.”

For its part, the AHCA acknowledges that the report addresses several opportunities for improvement in the assisted living regulatory structure, including several that would require statutory change, says a spokesperson.

“We have reviewed the report and have shared it with the Assisted Living Workgroup during their meeting last Friday,” she told SHN. “The workgroup is charged with examining and making recommendations regarding assisted living facility regulation and oversight.”

View the Florida Senate’s Interim Report here.

Written by Alyssa Gerace