1. (1) LICENSING.

   1. (a) Any facility intending to establish extended congregate care services must obtain a license from the agency before accepting residents needing extended congregate care services.
   2. (b) Only the portion of a facility that meets the physical requirements for extended congregate care in Chapter 4, Section 464 of the Florida Building Code as adopted in Rule 61G20-1.001, F.A.C., and is staffed in accordance with subsection (3), is considered licensed to provide extended congregate care services to residents who meet the admission and continued residency requirements of this rule.

2. (2) EXTENDED CONGREGATE CARE POLICIES. Policies and procedures established through extended congregate care services must promote resident independence, dignity, choice, and decision-making. The facility must develop and implement specific written policies and procedures that address:

   1. (a) Aging in place;
   2. (b) The facility’s residency criteria developed in accordance with the admission and discharge requirements described in subsection (4), and extended congregate care services listed in subsection (7);
   3. (c) The personal and supportive services the facility intends to provide, how the services will be provided, and the identification of staff positions to provide the services including their relationship to the facility;
   4. (d) The nursing services the facility intends to provide, identification of staff positions to provide nursing services, and the license status, duties, general working hours, and supervision of such staff;
   5. (e) Identifying potential unscheduled resident service needs and mechanisms for meeting those needs including the identification of resources to meet those needs;
   6. (f) A process for mediating conflicts among residents regarding choice of room or apartment and roommate; and,

   7. (g) How to involve residents in decisions concerning the resident. The services must provide opportunities and encouragement for the resident to make personal choices and decisions. If a resident needs assistance to make choices or decisions, a family member or other resident representative must be consulted. Choices must include at a minimum whether:

      1. To participate in the process of developing, implementing, reviewing, and revising the resident’s service plan,

      2. To remain in the same room in the facility, except that a current resident transferring into an extended congregate care services may be required to move to the part of the facility licensed for extended congregate care, if only part of the facility is so licensed,

      3. To select among social and leisure activities,

      4. To participate in activities in the community. At a minimum the facility must arrange transportation to such activities if requested by the resident; and,

      5. To provide input with respect to the adoption and amendment of facility policies and procedures.

3. (3) STAFFING REQUIREMENTS. The following staffing requirements apply for extended congregate care services:

   1. (a) Supervision by an administrator who has a minimum of two years of managerial, nursing, social work, therapeutic recreation, or counseling experience in a residential, long-term care, or acute care setting or agency serving elderly or disabled persons. If an administrator appoints a manager as the supervisor of an extended congregate care facility, both the administrator and manager must satisfy the requirements of subsection 59A-36.010(1), F.A.C.

      1. A baccalaureate degree may be substituted for one year of the required experience.

      2. A nursing home administrator licensed under Chapter 468, F.S., is qualified under this paragraph.

   2. (b) Provide staff or contract the services of a nurse who must be available to provide nursing services, participate in the development of resident service plans, and perform monthly nursing assessments for extended congregate care residents.
   3. (c) Provide enough qualified staff to meet the needs of extended congregate care residents in accordance with Rule 59A-36.010, F.A.C., and to provide the services established in each resident’s service plan.
   4. (d) Ensure that adequate staff is awake during all hours to meet the scheduled and unscheduled needs of residents.
   5. (e) Immediately provide additional or appropriately qualified staff, when the agency determines that service plans are not being followed or that residents’ needs are not being met because insufficient staffing, in accordance with the staffing standards established in Rule 59A-36.010, F.A.C.
   6. (f) Ensure and document that staff receive extended congregate care training as required in Rule 59A-36.011, F.A.C.

4. (4) ADMISSION AND CONTINUED RESIDENCY.

   1. (a) An individual must meet the following minimum criteria in order to receive extended congregate care services:

      1. Be at least 18 years of age;

      2. Be free from signs and symptoms of any communicable disease that may be transmitted to other residents or staff. However, an individual who has human immunodeficiency virus (HIV) infection may be admitted to a facility, provided that the individual would otherwise be eligible for admission according to this rule. In addition, an individual that exhibits signs or symptoms of or has been diagnosed with a respiratory illness that can be spread through droplet transmission, may be admitted, at the administrator’s discretion, if appropriate droplet precautions are implemented by facility staff. Appropriate droplet precautions include recommendations from nationally accepted standards, recommendations from the local county health department, and the facility’s infection prevention and control policies and procedures at the time of the individual’s admission. The individual must otherwise be eligible for admission according to this rule.

      3. Be able to transfer, with assistance if necessary. The assistance of more than one individual is permitted;

      4. Not be a danger to self or others as determined by a health care practitioner or mental health practitioner licensed under Chapter 490 or 491, F.S.;

      5. Not be bedridden, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.;

      6. Not have any stage 3 or 4 pressure sores;

      7. Not require any of the following nursing services:

      a. Artificial airway management of any kind except that of continuous positive airway pressure may be provided through the use of a CPAP or bipap machine,

      b. Nasogastric tube feeding,

      c. Monitoring of blood gases,

      d. Management of post-surgical drainage tubes or wound vacuums,

      e. Skilled rehabilitative services as described in Rule 59G-4.290, F.A.C., or

      f. Treatment of a surgical incision, unless the surgical incision and the condition that caused it have been stabilized and a plan of care developed. The plan of care must be maintained in the resident’s record at the facility.

      8. Not require 24-hour nursing supervision, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.; and,

      9. Have been determined to be appropriate for admission to the facility by the facility administrator or manager. The administrator or manager must base his or her decision on:

      a. An assessment of the strengths, needs, and preferences of the individual, the health assessment required by subsection (6) of this rule, and the preliminary service plan developed in subsection (7),

      b. The facility’s residency criteria, and services offered or arranged for by the facility to meet resident needs; and,

      c. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in rule Chapter 69A-40, F.A.C.

      10. Notwithstanding any other provision of this rule, as individual enrolled and receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S. may be admitted and receive extended congregate care services.

   2. (b) Criteria for continued residency in an extended congregate care services must be the same as the criteria for admission, except as specified below.

      1. A resident may be bedridden for up to 14 consecutive days.

      2. A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met:

      a. The resident qualifies for, is admitted to, and consents to the services of a licensed hospice that coordinates and ensures the provision of any additional care and services that may be needed,

      b. Continued residency is agreeable to the resident and the facility,

      c. An interdisciplinary care plan, which specifies the services being provided by hospice and those being provided by the facility, is developed and implemented by a licensed hospice in consultation with the facility; and,

      d. Documentation of the requirements of subparagraph (5)(b)2., is maintained in the resident’s file.

      3. The extended congregate care administrator or manager is responsible for monitoring the appropriateness of continued residency of a resident in extended congregate care services at all times.

      4. A hospice resident that meets the qualifications of continued residency pursuant to this rule may only receive services from the assisted living facility’s staff within the scope of the facility’s license.

      5. Staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice. Staff may not exceed the scope of their professional licensure or training in any licensed assisted living facility.

5. (5) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care practitioner pursuant to Rule 59A-36.006, F.A.C. A health assessment conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once receiving services, a new health assessment must be obtained at least annually.

6. (6) SERVICE PLANS.

   1. (a) Before receiving services, the extended congregate care administrator or manager must develop a preliminary service plan that includes an assessment of whether the resident meets the facility’s residency criteria, an appraisal of the resident’s unique physical, psychological and social needs and preferences, and an evaluation of the facility’s ability to meet the resident’s needs.

   2. (b) Within 14 days of receiving services, the extended congregate care administrator or manager must coordinate the development of a written service plan that takes into account the resident’s health assessment obtained pursuant to subsection (5); the resident’s unique physical, psychological and social needs and preferences; and how the facility will meet the resident’s needs including the following if required:

      1. Health monitoring,

      2. Assistance with personal care services,

      3. Nursing services,

      4. Supervision,

      5. Special diets,

      6. Ancillary services,

      7. The provision of other services such as transportation and supportive services; and,

      8. The manner of service provision, and identification of service providers, including family and friends, in keeping with resident preferences.

   3. (c) Pursuant to the definitions of “shared responsibility” and “managed risk” as provided in Section 429.02, F.S., the service plan must be developed and agreed upon by the resident or the resident’s representative or designee, surrogate, guardian, or attorney-in-fact, and must reflect the responsibility and right of the resident to consider options and assume risks when making choices pertaining to the resident’s service needs and preferences.
   4. (d) The service plan must be reviewed and updated quarterly to reflect any changes in the manner of service provision, accommodate any changes in the resident’s physical or mental status, or pursuant to recommendations for modifications in the resident’s care as documented in the nursing assessment.

7. (7) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive environment, and in a manner that respects the resident’s independence, privacy, and dignity.

   1. (a) A facility providing extended congregate care services may provide supportive services including social service needs, counseling, emotional support, networking, assistance with securing social and leisure services, shopping service, escort service, companionship, family support, information and referral, assistance in developing and implementing self-directed activities, and volunteer services. Family or friends must be encouraged to provide supportive services for residents. The facility must provide training for family or friends to enable them to provide supportive services in accordance with the resident’s service plan.

   2. (b) A facility providing extended congregate care services must make available the following additional services if required by the resident’s service plan:

      1. Total help with bathing, dressing, grooming and toileting,

      2. Nursing assessments conducted more frequently than monthly,

      3. Measurement and recording of basic vital functions and weight,

      4. Dietary management including provision of special diets, monitoring nutrition, and observing the resident’s food and fluid intake and output,

      5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care practitioner’s order. If the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons will be providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed written consent to provide such assistance as required in Section 429.256, F.S.,

      6. Supervision of residents with dementia and cognitive impairments,

      7. Health education and counseling and the implementation of health-promoting programs and preventive regimes,

      8. Provision or arrangement for rehabilitative services; and,

      9. Provision of escort services to health-related appointments.

   3. (c) Nursing staff providing extended congregate care services may provide any nursing service permitted within the scope of their license consistent with the residency requirements of this rule and the facility’s written policies and procedures, provided the nursing services are:

      1. Authorized by a health care practitioner’s order and pursuant to a plan of care,

      2. Medically necessary and appropriate for treatment of the resident’s condition,

      3. In accordance with the prevailing standard of practice in the nursing community,

      4. A service that can be safely, effectively, and efficiently provided in the facility,

      5. Recorded in nursing progress notes; and,

      6. In accordance with the resident’s service plan.

   4. (d) At least monthly, or more frequently if required by the resident’s service plan, a nursing assessment of the resident must be conducted.

8. (8) RECORDS. In addition to the records required in Rule 59A-36.015, F.A.C., a facility providing extended congregate care services must maintain the following:

   1. (a) The service plans for each resident receiving extended congregate care services;
   2. (b) The nursing progress notes for each resident receiving nursing services from the facility’s staff;
   3. (c) Nursing assessments; and,
   4. (d) The facility’s extended congregate care policies and procedures.
9. (9) DISCHARGE. If the facility and the resident are unable to agree on a service plan, the facility is unable to meet the resident’s needs as identified in the service plan, or the resident no longer meets the criteria for continued residency, the resident must be discharged or relocated in accordance with Sections 429.26 and 429.28, F.S.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 429.41 FS. History–New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-17-14, 5-10-18, Formerly 58A-5.030, Amended 9-9-21, 9-28-22, 11-27-25.