The short answer: "Levels of care" isn't a term in Florida law. It's how most assisted living facilities price: a base monthly rate, plus a care fee that rises as your parent needs more help. Florida's rules decide three things that matter to families: how your parent's needs are measured (a medical exam and the state's Form 1823), what the contract must disclose about extra charges, and the ceiling of care a facility's license allows before your parent has to move. Ask for the fee schedule in writing before you sign.
What does "level of care" mean in assisted living?
It's a pricing system. Every resident pays for the room, meals, activities and basic supervision. Residents who need more hands-on help, such as help showering, dressing or getting out of bed, pay more on top.
Public filings from national operators show how this works. Brookdale Senior Living says all its assisted living and memory care residents are "eligible to receive the basic care level," which includes meals, health assessments and "24-hour staff assistance." Then, "for an additional cost," it offers "higher levels of personal care services to residents who are more physically frail or require more frequent or intensive physical assistance." Memory care residents "pay higher monthly service fees" (Brookdale 10-K for 2025). Across its assisted living and memory care communities nationally, Brookdale's average monthly revenue per occupied unit was $6,632 in 2025.
Care fees are also rising faster than rent at some chains. Sonida Senior Living, which gets about a tenth of its resident revenue from Florida, reported that its level-of-care revenue grew 9.7% year over year in the second quarter of 2026, compared with 8.7% for private rent (Sonida investor presentation, August 2026). For a family, that means the care fee deserves as much attention as the base rate. Our Florida cost breakdown covers what families pay.
Facilities structure care fees differently. Some use a few numbered levels, some use tiers with names, and some include all care in one all-inclusive price. Ask each facility which model it uses.
How does a Florida facility decide what level your parent needs?
Florida makes the facility responsible for deciding whether a resident fits, both at admission and over time. The decision must be based on "an evaluation of the strengths, needs, and preferences of the resident, a medical examination, the care and services offered" (s. 429.26). The medical exam must happen "within 60 days before admission to the facility or within 30 days after admission."
Most facilities record the exam on the state's Form 1823, the Resident Health Assessment. A doctor, physician assistant or nurse practitioner rates how much help your parent needs with seven tasks: walking, bathing, dressing, eating, grooming, toileting and transferring (for example, from bed to chair). Each task gets one of four ratings (AHCA Form 1823):
| Rating | What the form says | In everyday terms |
|---|---|---|
| I | Independent | Does it alone |
| S | Needs supervision | Needs reminders, cueing or someone nearby |
| A | Needs assistance | Needs hands-on help for part of the task |
| T | Total care | "Staff completes the action for the resident" |
The form also covers medications. It records whether your parent can take medicines alone, needs help with self-administration (a staff member hands over the pill organizer and reminds them), or needs a nurse to administer them. A resident rated "A" on bathing and dressing who needs medication help will usually land in a higher care level than one who is mostly "I." Ask for a copy of the completed form, and ask the facility to show you which ratings put your parent in which level.
For context, help is the norm, not the exception. Nationally, 75% of residential care residents needed help with bathing, 71% with walking, and 62% with three or more daily activities, according to federal data for 2022 (NCHS Data Brief 506).
When does the level change?
Whenever your parent's needs change, which is why the price can rise between contract renewals. Florida requires the administrator to monitor whether a resident's placement is still appropriate at all times. A new face-to-face exam is required "at least every 3 years after the initial assessment, or after a significant change, whichever comes first" (rule 59A-36.006).
A "significant change" means "a sudden or major shift in the behavior or mood" of the resident, or a decline in health "such as unplanned weight change, stroke, heart condition, enrollment in hospice, or stage 2, 3 or 4 pressure sore." Gradual decline with aging is "not considered" a significant change (rule 59A-36.002).
In practice, facilities review care plans more often than the law requires. One chain's annual report says each resident's care plan "is reviewed periodically to determine whether a change in the level of care is needed" (Sonida 10-K for 2025). Common triggers are a fall, a hospital stay, new medications or a dementia diagnosis. If your parent is coming back from the hospital, expect a reassessment. Our guide to returning to assisted living after a hospital stay explains what happens.
What must the contract say about care fees?
Florida rules protect families here, but only if you read the paperwork:
- Before move-in, the admission package must state the "personal care services that the facility is prepared to provide to residents and additional costs to the resident, if any" (rule 59A-36.006).
- The contract must list the "daily, weekly, or monthly rate" and "a list of any additional services and charges to be provided that are not included" in it, or refer to a separate fee schedule (rule 59A-36.018).
- No double charging. The facility "may not levy an additional charge" for anything already included in the base rate.
- New services in writing. Before adding a service, the facility must give an itemized written statement, and the change goes into a signed, dated addendum to the contract.
- Notice of increases. The contract must provide "at least 30 days' written notice of a rate increase." However, "a new service or accommodation added to, or implemented in, a resident's contract for which the resident was not previously charged does not require a 30-day written notice" (s. 429.24).
That last point matters. Ask each facility in writing: if my parent moves up a care level, do we get 30 days' notice, or does the new fee start right away? Our guides to contract clauses to check before signing and rate increases go deeper.
What's the highest level of care assisted living can provide?
That depends on the facility's license, not its price list. Every Florida assisted living facility holds a standard license. Some also hold specialty licenses that allow more care. Statewide, only 171 of 2,989 facilities held an Extended Congregate Care (ECC) license in early 2026, 396 held Limited Nursing Services (LNS) and 703 held Limited Mental Health (Senate bill analysis, SB 1404).
| Setting | What it can provide | The limit |
|---|---|---|
| Standard license | Help with daily activities, supervision, help with medications | No resident who is bedridden or needs 24-hour nursing supervision |
| Limited Nursing Services | Routine nursing such as "dressings and care of casts, braces, and splints" (s. 429.02) | Same 24-hour nursing limit; monthly nursing assessment |
| Extended Congregate Care | "Total help with bathing, dressing, grooming and toileting" and supervision of residents with dementia (rule 59A-36.021) | May not serve residents "who require 24-hour nursing supervision" |
| Memory care services | New license created in 2026; rules due by June 1, 2027 (s. 429.076) | At least one awake staff member at all hours |
| Nursing home | Round-the-clock nursing care | Staffing must average at least 3.6 hours of direct care per resident per day (s. 400.23) |
Under Florida law, an assisted living facility "may not admit or retain a resident who is bedridden or who requires 24-hour nursing supervision." A resident may stay if bedridden for no more than 7 consecutive days, or 14 in an ECC facility (s. 429.26). Residents on hospice are the exception, when a licensed hospice provides the extra care. Our guides to license types, nursing homes vs. assisted living, hospice in assisted living and discharge rules explain each step.
If your parent's needs are likely to grow, a facility with ECC or LNS may save a second move. The top care level at a standard-only facility still has to stay under the same legal ceiling.
How does Medicaid define level of care?
Differently. If your parent applies for Florida Medicaid's long-term care program, a state assessment team called CARES decides whether they medically qualify. CARES "is responsible for determining medical eligibility (level of care)," and "assessments are completed at no cost to applicants" (Elder Affairs).
To enroll, an older adult generally must be found to need "nursing facility care" (s. 409.979), even if they will receive that care in assisted living. CARES then assigns one of three Medicaid levels. Level 1 is someone "residing in or who must be placed in a nursing home," and Level 3 is someone at risk of nursing home placement who is "mildly medically or physically incapacitated" (s. 409.983). These Medicaid levels set what the state pays the managed care plan. They don't change the facility's own care fees. Medicare doesn't pay for long-term care at all (Medicare.gov).
Our guides to Medicaid and assisted living and the pre-enrollment waitlist explain the program.
Questions to ask on every tour
- How many care levels do you have, and what does each one cost per month?
- Which tasks and ratings on Form 1823 put a resident in each level?
- Who does the assessment, and how often do you reassess?
- If my parent moves up a level, how much notice do we get?
- What is your highest level of care, and which licenses do you hold (ECC, LNS, LMH)?
- What were your last three years of increases, for both rent and care fees?
Bring our tour checklist, and check each facility's license and inspection record with our 10-minute license check. You can browse all 3,006 licensed Florida facilities in our directory.
