Long-Term Care

The Florida Agency for Health Care Administration is the chief health policy and planning group for the state and licenses and regulates health care facilities and health maintenance organizations (HMOs) in Florida.  The Agency also manages the Medicaid program that provides health care to Florida’s low-income and disabled citizens.  The mission of the Agency is better health care for all Floridians.  As part of this mission, we publish the Consumer Awareness Series, a variety of brochures to help the public make informed health care decisions.

This brochure introduces you to a variety of long-term care providers.  Other resources to help you learn about long-term care include contacts listed in this brochure.

Note: This brochure is not designed to offer medical or legal advice.  Please talk with your doctor for medical advice and an attorney for legal advice.

Information in this brochure is current as of September 2009.

Introduction

This brochure provides information about long-term care providers who offer healthcare and other types of support in the home or in a residential facility.  The services they offer might be needed temporarily, like during recovery after a hospital stay, or a person may need ongoing care and support.

The providers described in this brochure include:

• Adult Day Care Centers
• Adult Family Care Homes
• Assisted Living Facilities
• Continuing Care Retirement Communities
• Home Health Agencies
• Homemakers and Companions
• Hospices
• Nurse Registries
• Nursing Homes

The type and level of care needed will determine which long-term care provider can best serve you or your loved one.

Adult Day Care Centers

Adult Day Care Centers provide programs and services for adults who need a protective setting during the day.  Participants live in their own homes, which can be a private home, assisted living facility, adult family care home, or another type of group home, and come to the day care center during certain hours of the day.

An adult day care center can be a freestanding program or services can be offered through a nursing home, assisted living facility, or hospital. 

The basic services include, but are not limited to:

• Leisure and social activities
• Self-care training
• Nutritional meals
• A place to rest
• Respite care (temporary supervision of an adult, giving relief to the primary caregiver)

A center might offer additional services such as health assessments; counseling; speech, physical and occupational therapy; modified diets; transportation; and referrals for follow-up services.  If you need these types of services, ask the adult day care center if they are provided.

Adult Family Care Homes

Adult family care homes provide full-time, family-type living in a private home for up to five elderly persons or adults with a disability, who are not related to the owner.  The resident may have their own room or may share with another person.  The owner lives in the same house as the residents. 

The basic services include, but are not limited to:

• Housing and nutritional meals
• Help with the activities of daily living, like bathing, dressing, eating, walking, physical transfer (moving from a bed to a chair, etc.)
• Give medications (by a nurse employed at the home or arranged by contract) or help residents give themselves medications
• Supervise residents
• Arrange for health care services
• Provide or arrange for transportation to health care services
• Health monitoring
• Social and leisure activities

A resident can also contract with a licensed home health care provider for nursing and other health care services, as long as the resident does not become more ill than is allowed in an adult family care home.

Assisted Living Facilities

Assisted living facilities provide full-time residential living in the least restrictive and most home-like setting.  Facilities can range in size from one resident to several hundred and can include individual apartments or rooms that a resident has alone or shares with another person.

The basic services include, but are not limited to:

• Housing, nutritional meals, and special diets
• Help with the activities of daily living, like bathing, dressing, eating, walking, physical transfer (moving from a bed to a chair, etc.)
• Give medications (by a nurse employed at the facility or arranged by contract) or help residents give themselves medications
• Supervise residents
• Arrange for health care services
• Provide or arrange for transportation to health care services
• Health monitoring
• Respite care (temporary supervision of an adult, giving relief to the primary caregiver)
• Social and leisure activities

An assisted living facility may employ or contract with a nurse to take vital signs (blood pressure, pulse, respiration, and temperature), manage pill organizers and give medications, give prepackaged enemas from a doctor’s order, and keep nursing progress notes. 

A resident can also contract with a licensed home health care provider for nursing and other health care services, as long as the resident does not become more ill than is allowed in an assisted living facility.

Along with a standard license, an assisted living facility might have one or more of the following special licenses:  Extended Congregate Care, Limited Nursing Services, or Limited Mental Health.  More information on these special licenses can be found in the brochure “Assisted Living in Florida.”  See the end of this brochure for order instructions.

Continuing Care Retirement Communities

Continuing care retirement communities offer different levels of care, allowing residents to move from one level to another, as their needs change.  The community can include independent living apartments or houses, as well as an assisted living facility and/or a nursing home.

You can read more information on assisted living facilities and nursing homes in those sections of this brochure.  The Florida Department of Financial Services (DFS) monitors continuing care retirement communities and you can find a list of these communities on their website www.fldfs.com or call the DFS toll-free number (800) 342-2762.

Home Health Agencies 

Home health agencies provide health care services in a private home, assisted living facility, or adult family care home.  Services may include:

• Nursing visits
• Give medications or help the patient give themselves medications
• Physical, occupational, respiratory, and speech therapy
• Home health aide services – help with the activities of daily living, like bathing, dressing, eating, walking, physical transfer (moving from a bed to a chair, etc.)
• Homemaker / companion services - housekeeping, shopping, help with meal preparation, trips outside the home
• Nutritional guidance
• Medical social services
• Medical equipment and supplies

Homemakers and Companions

Homemaker and companion companies provide services in the home.  These services can be offered by a homemaker/companion company, or by a home health agency, nurse registry, or hospice.  Services may include:

• Housekeeping
• Shopping and help with meal preparation
• Trips outside the home

Hospices

Hospices provide services in a private home, assisted living facility, adult family care home, hospital, or hospice facility for patients who are terminally ill.  The staff is specially trained to help the patient and family members who are dealing with death and dying.  Services may include:

• Nursing, physician, social work, and pastoral services
• Bereavement counseling (dealing with the grief of death and dying) for the patient and family
• Physical, occupational, speech, and massage therapy
• Home health aide and homemaker/companion services (as described in the Home Health Agency section of this brochure)
• Nutritional counseling
• Home medical equipment and supplies
• Respite care (temporary supervision of a patient, giving relief to the primary caregiver)

Nurse Registries

Nurse registries arrange private contracts for nurses, certified nursing assistants, home health aides, and homemakers/companions to provide services to patients in a private home, assisted living facility, or adult family care home.

Nursing Homes

Nursing homes are residential facilities where a person lives or where a person can stay temporarily.  A temporary stay may be for respite care or recuperation after being in a hospital.  Services include:

• Nursing care 24-hours a day
• Case management and health monitoring
• Personal care (help with bathing, dressing, eating, walking, or physical transfer)
• Nutritional meals and special diets
• Physical, occupational, and speech therapy
• Social activities
• Respite care (temporary supervision of an adult, giving relief to the primary caregiver)

Choosing a Long-Term Care Provider

If you or a loved one needs services from a long-term care provider you may want to compare several providers, to see which one will best serve your needs.  The following resources can help in your search: 

• Find a list of providers on the website www.FloridaHealthFinder.gov (click “Find Facilities”).
• Call the toll-free Elder Care Helpline at (800) 963-5337 for referrals to providers and other elder services. 
• The Florida Department of Elder Affairs has information on adult family care homes and assisted living facilities at www.FloridaAffordableAssistedLiving.org.  The site provides a variety of information, including “Find-a-Facility” where you can look for a facility based on location, cost, services provided, and housing preferences.
• If you want to learn more about a particular provider you can find survey results in the following ways:
  • Ask the long-term care provider to show you results from the most recent survey conducted by the Florida Agency for Health Care Administration.  (However, homemaker and companion companies are not surveyed).
  • View these same surveys at http://ahcaxnet.fdhc.state.fl.us/dm_web.
  • Request copies of surveys from the Agency's Public Information Office (there may be a fee).  For more information, call (850) 410-1197. 
  • View the “Nursing Home Guide” at www.FloridaHealthFinder.gov (click “Brochures and Guides”).
  • Compare hospices at www.FloridaHealthFinder.gov (click "Compare Hospice Providers").
  • To view survey information on nursing homes, home health agencies, hospitals, and dialysis facilities that serve Medicare patients go to www.Medicare.gov.  On the homepage click the links for comparison of Nursing Homes, Home Health Agencies, Hospitals, or Dialysis Facilities.
• You can find more information and tips in the consumer brochures “Home Health Care in Florida” and “Assisted Living in Florida.”  See the end of this brochure for order instructions.

      Questions You May Want to Ask a Long-Term Care Provider

Following are topics you might want to discuss with the provider, along with any other questions you may have.

• Ask to see the current license issued by the Agency for Health Care Administration.  
• Ask for a written description of the cost and services and ask that they be clearly explained.
• Ask what type of payment is accepted.  Long-term care services may be paid by private funds or some insurance policies.  If the person and the provider are eligible, services might be paid in full or in part by Medicaid, a Medicaid waiver program, Optional State Supplementation (for some residents in adult family care homes or assisted living facilities), Medicare, or other government programs. 
  
  To find out if you might be eligible for help from a government program you might want to contact the Department of Children and Families or Department of Elder Affairs (listed in the Resource Director of this brochure).  You can also check the listings for Medicare, Advocacy Center for Persons with Disabilities, or the National Council on Aging.
• Nursing homes are required to provide full-time nursing care.  However, other types of long-term care providers may offer only limited nursing services, periodic nursing visits, or no nursing services.  If you or a loved one needs nursing care, ask the provider what kind of nursing services they offer. 
  
  In addition, you can search for nursing homes that provide special services like care for Alzheimer’s, ventilators, children, and other types of special services by using the “Nursing Home Guide.”  You can find the Guide at www.FloridaHealthFinder.gov (click “Brochures and Guides”) or order it by calling the toll-free number (888) 419-3456.

Financial Resources

The following resources might be helpful when you or a loved one are ready to choose a long-term care provider and want to research programs that might help pay for some services.

• If you have a long-term care insurance policy, or are considering buying one, find out exactly what it covers, under what conditions you can receive coverage, any restrictions that might apply, and what you need to do when coverage is needed.  The Florida Department of Financial Services regulates insurance in Florida.  For questions or to request their consumer materials, call the toll-free number (800) 342-2762 or view the website www.fldfs.com.
• The CARES Program (Comprehensive Assessment and Review for Long Term Care Services) provides assessment of seniors or persons with disabilities to see what services they need and what programs are available.  To learn more call the Florida Department of Elder Affairs toll-free number (800) 963-5337 or view their website http://elderaffairs.state.fl.us/english/cares.php.  
• The SHINE Program (Serving Health Insurance Needs of Elders) is for seniors and people with disabilities and provides counseling on Medicare, Medicaid, long-term care insurance, prescription assistance programs, and other health insurance issues.  To learn more call the Florida Department of Elder Affairs toll-free number (800) 963-5337 or view their website www.FloridaShine.org.
• The Florida Department of Children and Families takes applications and determines who is eligible for Medicaid, Medicaid Waiver programs, and Optional State Supplementation (OSS).  Call the toll-free number (866) 762-2237 or view the website www.MyFlorida.com/cf_web.  
  
  Some residents in assisted living facilities and adult family care homes may be eligible for Optional State Supplementation or a Medicaid Waiver program.  Some other long-term care providers may participate in the Florida Medicaid Program or Medicaid Waiver.
• The Florida Agency for Persons with Disabilities helps people with developmental disabilities, including supportive living and Medicaid waiver.  View the website http://apd.MyFlorida.com, which includes a list of area offices, or call the toll-free number (866) 273-2273.
• The Clearinghouse on Disabilities provides referral to state and community based programs for persons with a disability.  Call the toll-free number (877) 232-4968 (voice and TTY). 
• The Florida Department of Veterans’ Affairs provides information and services, including an assisted living facility and nursing homes.  Call them at (727) 319-7400 or view the website www.FloridaVets.org.  

Important Phone Numbers

If you are concerned about the care or treatment you (or a loved one) are receiving from a long-term care provider, you can contact one or more of the following:

Agency for Health Care Administration – To file a complaint against health care providers listed in this brochure call the toll-free number (888) 419-3456.  To file a complaint against a continuing care retirement community, concerning financial matters, call the Florida Department of Financial Services toll-free number (800) 342-2762.

Florida Abuse Hotline – To report abuse, neglect, or exploitation of children, elderly, or adults with a disability call the toll-free Abuse Hotline at (800) 962-2873 or view the website www.dcf.state.fl.us/abuse.

Long-Term Care Ombudsman Council (Department of Elder Affairs) – Helps residents who live in assisted living facilities, adult family care homes, and nursing homes with their concerns and civil rights.  Call them toll-free at (888) 831-0404 or view the website http://ombudsman.MyFlorida.com.

Resource Directory

Advocacy Center for Persons with Disabilities
www.AdvocacyCenter.org
(800) 342-0823 or TDD (800) 346-4127

Family Caregiver Alliance
www.caregiver.org
(800) 445-8106

Florida Agency for Health Care Administration
http://ahca.myflorida.com
(888) 419-3456

Florida Assisted Living Affiliation
www.falausa.com
(850) 383-1159

Florida Association of Homes and Services for the Aging
www.faha.org
(850) 671-3700

Florida Department of Children and Families
www.MyFlorida.com/cf_web
(866) 762-2237
(Medicaid and Optional State Supplementation)

Florida Department of Elder Affairs
http://ElderAffairs.state.fl.us
(800) 963-5337

Florida Department of Financial Services
www.fldfs.com
(800) 342-2762

Florida Health Care Association
www.fhca.org
(850) 224-3907

Florida
www.FloridaHospices.org
(800) 282-6560

Florida Life Care Residents Association
www.flicra.com
(850) 906-9314

Home Care Association of Florida
www.ahhif.org
(850) 222-8967

Medicare
www.Medicare.gov
(800) 633-4227 or TTY (877) 486-2048

National Council on Aging
www.BenefitsCheckUp.org

Additional Consumer Brochures Include:

• A Consumer’s Guide to Health & Human Services Programs
• A Patient’s Guide to a Hospital Stay
• Assisted Living in Florida
• Emergency Medical Care
• End of Life Issues – A Practical Planning Guide
• Florida Medicaid – A Reference Guide
• Health Care Advance Directives (available only online)
• Home Health Care in Florida
• Patient Safety
• Understanding Prescription Drug Costs

For additional copies of this brochure, or others in the series, contact the AHCA Call Center’s toll-free number (888) 419-3456.  To view or print any brochure in the Consumer Awareness Series visit www.FloridaHealthFinder.gov.

This brochure may be copied for public use.  Please credit the Agency for Health Care Administration for its creation.

If you have comments or suggestions, call (850) 922-5771.

The Agency for Health Care Administration established the following websites to help Florida residents be well informed health care consumers.

www.FloridaHealthFinder.gov
This website provides tools to compare hospitals, ambulatory surgery centers, emergency rooms, health plans, and nursing homes.  The site includes the A.D.A.M. Health Encyclopedia with thousands of articles and illustrations.  The site also provides a list of health care facilities; information on insurance, medications, seniors, medical conditions, and resources for the uninsured; consumer publications; information for health care professionals; and much more.

www.MyFloridaRx.com
This website compares prices for the most commonly used prescription drugs in Florida.

www.fhin.net/eprescribe
Some doctors can send a drug prescription eletronically to the pharmacy.  To learn more visit the website or ask your doctor about e-Prescribing.

http://ahca.MyFlorida.com
This website includes information on health care facility regulation and licensing, the Florida Medicaid program, managed care (HMOs), and other topics related to the Agency for Health Care Administration.