Can a Hospice Patient Live in a Florida ALF?

A hospice diagnosis does not automatically mean a resident must leave assisted living. Florida law allows an individual receiving licensed hospice services to be admitted to or remain in an assisted living facility when specific safeguards are in place. The decision must be coordinated, documented, and realistic about who will provide each part of the resident's care.

Under Florida Statute 429.26, an ALF may admit or retain an individual receiving hospice services when the facility and resident agree to the arrangement, a licensed hospice provides the additional care, a physician agrees that the resident's physical needs can be met in the facility, and a plan of care explains how scheduled and unscheduled needs will be handled. This is one of the admission scenarios every owner needs to understand, whether they are already operating or still working through how to open an ALF in Florida.

Yes, but the Arrangement Is Not Automatic

A hospice patient may live in a Florida ALF, but hospice enrollment by itself is not enough. The administrator must determine that the placement is appropriate for the individual resident and that the facility can carry out its part of the care plan safely within the scope of its license.

The facility is not required to accept every hospice patient. The law requires agreement between the parties, which means the administrator must evaluate the resident's current condition, staffing needs, equipment, evacuation needs, medication support, personal care needs, and the services the hospice will actually provide before saying yes.

Four Conditions Must Be in Place

• The facility and the resident agree to the hospice arrangement. When applicable, the resident's legal representative participates in the decision.
• A hospice licensed in Florida provides the additional care and services the resident needs
• The resident is under the care of a physician who agrees that the resident's physical needs can be met in the assisted living facility.
• A plan of care identifies how the facility and hospice will meet the resident's scheduled and unscheduled needs, including nursing care staffing when applicable.

These elements work together. A facility should not rely on a verbal statement that hospice will handle everything. The responsibilities of the ALF and the hospice must be clear enough for staff, the resident, the family, and a surveyor to understand how care will be delivered.

Admission and Continued Residency Are Related but Different

The current Florida Administrative Code Rule 59A-36.006 addresses both admission and continued residency. It permits an individual who is enrolled in and receiving licensed hospice services to be admitted under the statutory hospice exception. It also permits a terminally ill resident who no longer meets ordinary continued-residency criteria to remain when the hospice requirements are satisfied.

For an existing resident, the rule requires the resident to qualify for, be admitted to, and consent to licensed hospice services. The resident or legal representative and the facility must agree to continued residency. The hospice, in consultation with the facility, must develop and implement an interdisciplinary care plan that distinguishes the services provided by hospice from those provided by the ALF.

Hospice Can Create an Exception to the Bedridden and 24-Hour Nursing Limits.

Ordinarily, an ALF may not admit or retain a resident who is bedridden or requires 24-hour nursing supervision. Florida Statute 429.26 creates an exception for a resident receiving hospice services when all hospice conditions are met. For the full rules on the bedridden limit and the 7-day and 14-day periods, see our post on bedridden residents in a Florida ALF.

The physician must agree that the resident's physical needs can be met in the facility, the licensed hospice must provide the additional care, and the care plan must address both scheduled and unscheduled needs. If those safeguards are not in place, the resident cannot be retained merely because a hospice referral was made.

What Must the Interdisciplinary Care Plan Explain?

The interdisciplinary care plan should make the division of responsibility unmistakable. It should identify the services the hospice will provide and the services the facility will provide, including how the parties will respond when the resident's needs arise outside a scheduled visit.

Depending on the resident's condition, the plan may need to address nursing care, medication management, pain and symptom concerns, personal care, repositioning, skin protection, nutrition and hydration support, toileting, equipment, emergency contacts, and who facility staff should call when the resident's condition changes. The plan must match the resident's actual needs, not a generic hospice template.

The ALF Must Stay Within the Scope of Its License

Hospice involvement does not expand the facility's license. Rule 59A-36.006 states that a hospice resident may receive only those services from ALF staff that are within the scope of the facility's license. Staff may provide nursing services permitted by that license and may provide total help with activities of daily living for hospice residents, but they may not exceed their professional license, role, or training.

A Hospice Patient Still Needs the Required Medical Examination

Hospice enrollment does not eliminate the resident health assessment requirement. The resident generally must receive a face-to-face medical examination within 60 days before admission or within 30 days after admission. For full detail on the timing and documentation requirements, see our post on medical examination requirements before admission in Florida.

The medical information assists the administrator in determining whether the facility can meet the resident's needs. The form is an informative tool, not a guarantee of admission or continued residency.

What Documentation Belongs in the Resident File?

The resident record should contain enough information to prove that the hospice arrangement satisfies the statute and rule. Rule 59A-36.015 specifically requires the interdisciplinary care plan and other documentation showing that the resident is a hospice patient:

• Documentation that the resident qualifies for and has been admitted to licensed hospice services
• The resident's consent and the facility's agreement to admission or continued residency
• The physician's agreement that the resident's physical needs can be met in the facility
• The interdisciplinary care plan showing the services assigned to hospice and the services assigned to the ALF
• Current medical assessment information, orders, medication records, and change-of-condition documentation
• Contact information and instructions for scheduled visits, unscheduled needs, emergencies, and after-hours concerns

A complete file protects continuity of care. It also helps the facility demonstrate during inspection that hospice status was not used as a shortcut around admission or continued-residency requirements.

You do not have to figure everything out alone. I created free ALF resources for aspiring assisted living owners to help you take the next step with more clarity, more confidence, and a better understanding of what Florida expects before licensure.

Hospice Is a Partnership, Not a Transfer of Responsibility

Every hospice arrangement is a little different depending on the resident's condition, the hospice provider, and the facility's staffing and license. If you want to think through how a specific hospice situation applies to your facility, schedule time with Carline to talk it through before you make the admissions decision.