The short answer: A Florida nursing home is a medical setting with licensed nurses on duty around the clock and staffing minimums set in state law. An assisted living facility (ALF) is a home with help: meals, supervision, and assistance with bathing, dressing and medications, plus limited health services depending on its license. The dividing line is set by law, not by preference. An ALF may not admit or keep a resident who needs 24-hour nursing supervision, with one exception for residents receiving hospice care.
For families, that line decides two things: where a parent can safely live today, and whether they will have to move again when their needs grow.
Who regulates each one in Florida?
Both are licensed and inspected by the Agency for Health Care Administration (AHCA), but under different laws:
- Nursing homes are licensed under Chapter 400, Part II of the Florida Statutes. "A license issued by the agency is required for the operation of a nursing home in this state" (s. 400.062).
- Assisted living facilities are licensed under Chapter 429, Part I (s. 429.07), with day-to-day standards in the Florida Administrative Code, chapter 59A-36. Older guides cite the previous rule number, 58A-5.
Same agency, two different rulebooks. That is why the questions you ask on a tour should differ too.
How do the two compare side by side?
| Assisted living facility | Nursing home | |
|---|---|---|
| Florida law | Ch. 429, Part I; rule 59A-36 | Ch. 400, Part II |
| Built for | People who need help with daily activities and supervision | People who need skilled nursing care around the clock |
| Nursing on site | Not required under a standard license; more allowed with specialty licenses | Licensed nurses on every shift, with state minimums |
| Staffing minimums in law | No per-resident hours formula | 3.6 hours of direct care per resident per day (weekly average) |
| Notice before a facility can end residency | 45 days, with narrow exceptions | 30 days, with a right to a fair hearing |
| Florida median cost (2025) | $5,610 a month | $10,342 semi-private, $12,167 private |
| Medicare | Doesn't pay rent or personal care | Pays short-term rehab after a qualifying hospital stay, not long-term stays |
Cost figures are monthly medians from the CareScout 2025 Cost of Care Survey.
What staffing does Florida law require in a nursing home?
Florida sets minimums in s. 400.23(3). Each nursing home must provide:
- A minimum weekly average of 3.6 hours of care by direct care staff per resident per day.
- At least 2.0 hours of direct care by a certified nursing assistant (CNA) per resident per day, and never fewer than one CNA per 20 residents.
- At least 1.0 hour of direct care by a licensed nurse per resident per day, and never fewer than one licensed nurse per 40 residents.
Assisted living has no equivalent hours-per-resident formula. An ALF's staffing depends on how many residents it has and which services its license allows. That is the clearest way to see the difference: nursing home care is measured in required nursing hours, assisted living in the services a facility is licensed to provide.
Which residents can an assisted living facility not accept or keep?
Florida law says that, except for a resident receiving hospice services, "a facility may not admit or retain a resident who is bedridden or who requires 24-hour nursing supervision" (s. 429.26). A resident who becomes bedridden may stay for no more than 7 consecutive days, or 14 in a facility licensed for extended congregate care.
The state rule adds more detail (59A-36.006). Among other things, a resident must:
- not be a danger to themselves or others;
- not need 24-hour licensed professional mental health treatment;
- not have stage 3 or 4 pressure sores;
- not need tube feeding, artificial airway management (CPAP and BiPAP machines are allowed), blood gas monitoring or blood products;
- in a standard-licensed facility, not need dialysis or IV therapy inside the facility.
The rule also says the criteria for staying are the same as the criteria for moving in. If your parent's needs cross one of these lines, the facility is required to act, even if everyone would prefer they stay.
How do ALF licenses change what a facility can handle?
Every ALF holds a standard license, and some add specialty licenses that let them care for residents with higher needs:
- Limited Nursing Services (LNS) lets a facility provide nursing care to residents who don't need 24-hour nursing supervision (59A-36.022).
- Extended Congregate Care (ECC) is designed to let residents stay as they become more impaired, and doubles the bedridden limit to 14 days.
- Limited Mental Health (LMH) is for facilities serving residents who receive mental health services in the community.
On a tour, ask directly: "Which licenses do you hold, and what would make my mother no longer eligible to live here?" Two communities on the same street can hold very different licenses, and that difference decides how long a parent can stay.
How much notice does each give before a resident must leave?
This is one of the biggest practical differences.
An assisted living facility must give at least 45 days' notice of relocation or termination of residency (s. 429.28(1)(k)). The only exceptions are a physician-certified emergency move to a facility providing a more skilled level of care, or a resident whose conduct is harmful or offensive to other residents. The reasons must be in writing, and the notice must include the toll-free number of the State Long-Term Care Ombudsman Program (1-888-831-0404).
A nursing home must give 30 days' notice, but the resident is entitled to a fair hearing, and asking for one within 10 days puts the transfer on hold (s. 400.0255). Florida ALF residents have no equivalent hearing right in Chapter 429.
Who pays for each?
Medicare pays for neither as long-term housing. It covers up to 100 days of skilled nursing facility care per benefit period, but only after a qualifying inpatient hospital stay of at least three days and only while daily skilled care is needed (Medicare.gov). Our guide Does Medicare pay for assisted living? breaks down the 2026 costs.
Florida Medicaid is the bigger lever. Under s. 409.98, long-term care plans must cover, at a minimum, "nursing facility care" and "services provided in assisted living facilities." Enrollment in the Statewide Medicaid Managed Care Long-Term Care program can involve a waitlist, so start early. See Does Medicaid pay for assisted living in Florida?
Everything else is private pay, long-term care insurance, or VA benefits. At the 2025 Florida medians, a semi-private nursing home room costs about $4,700 a month more than assisted living.
What are the signs a parent needs a nursing home rather than assisted living?
The clearest sign is a need for licensed nursing supervision around the clock, not just hands-on help with daily tasks. Others to watch for:
- Repeated hospital stays or emergency visits in a short period.
- A new feeding tube, IV therapy, or a wound that needs daily skilled care.
- Being unable to move, turn or get into a chair without total physical help for more than a week.
- Medication routines that need a nurse's judgment, such as frequent dose changes.
- The assisted living community telling you the care plan is beyond what its license allows.
Don't make the call alone. Ask your parent's physician and the facility's nurse to review the care plan together, and get the recommendation in writing; you will need it for Medicaid and admission paperwork.
How many assisted living options does Florida have?
More than most families expect, and many are small. AssistedLivingFacility.com directory data counts 3,006 licensed, active assisted living facilities across 54 Florida counties as of October 2026, with 118,442 licensed beds. The median facility is licensed for just 8 residents, and 1,446 (48%) are licensed for six or fewer.
The counties with the most facilities are Miami-Dade (805), Hillsborough (263) and Broward (249). Browse by city or county in our Florida directory, and see our guide to large vs. small facilities for how the two differ day to day.
