Neglected to Death

Neglected to Death: Key Events


• Landmark U.S. Supreme Court decision bans states from confining citizens to institutions if they are non-dangerous and capable of living by themselves or with relatives — leading to the closing of psychiatric facilities and leaving a large number of people in need of housing.

• Licensing of Adult Congregate Living Facilities in Florida begins, with passage of state law setting basic standards for people living in boarding-house settings with a staff to prepare meals and manage medications for residents.


• The Florida Legislature passes the first comprehensive regulations for ACLFs, establishing licensing standards, a fraud enforcement unit to protect Medicaid funds, and a bill of rights for group-home residents.


• Federal legislation creates a program allowing states to use long-term care money available through Medicaid to pay for residents’ room and board at group homes.


Amendments are passed in Florida drawing clear distinctions between nursing homes and assisted-living facilities, where people need help with everyday chores but not 24-hour nursing care.


• The state has 1,400 assisted-living facilities housing 42,000 people.


Florida’s population nearly doubles between 1970 and 1990 — from 6.7 million to 12.9 million — creating waves of elderly and disabled people in need of housing and care.


• The creation of the Florida Department of Elder Affairs with Bentley Lipscomb as the director. One of the agency’s goals: protect the rights of the elderly in assisted-living facilities and nursing homes.


• Agency for Health Care Administration becomes chief regulator of ACLFs after splitting from the state Department of Health and Rehabilitative Services.

• There are now 1,568 ACLFs throughout the state.


• The Florida Legislature refuses to increase funding for inspections of ACLFs despite their growth across the state. As a result, inspections are reduced from once a year to once every two years.


• The state renames Adult Congregate Living Facilities as Assisted Living Facilities (ALFs), an emerging housing model that’s expected to surpass nursing homes as the signature facilities for elderly and mentally ill people.

• A newly revamped Elder Abuse Law in the Florida Legislature makes it easier for prosecutors to push for felonies against people who abuse or exploit elderly and disabled people.


• The state adopts a law requiring ALFs housing people with mental illness to obtain a special license. It also requires facilities that care for people with Alzheimer’s disease and other disorders to meet standards of operation, including requirements that homes with 17 or more residents have an awake staff member on duty at all hours, and that all employees have a minimum level of training.

• The state is now home to 1,922 ALFs.


Operation Spot Check: Attorney General Bob Butterworth expands a program that draws together multiple agencies to carry out surprise inspections of troubled homes that received Medicaid funding. The agencies include the state attorney general’s Medicaid Fraud Control Unit, AHCA, the Department of Children & Families, Florida’s Long Term Care Ombudsman Council, state attorneys, and local fire and code inspectors. The goal: rooting out neglect and abuse.


• Florida now has 2,305 ALFs.


• State legislators pass sweeping tort reforms that slash the amount of insurance ALF owners are required to carry, set limits on lawsuits — making it more difficult for lawyers to sue facilities — and end the practice of awarding attorneys’ fees in cases that do not involve death or serious injury.

• The state House of Representatives passes a bill that


Florida adopts new laws raising the penalty for aggravated abuse of elderly and disabled people to a first-degree felony.


The state now has 2,850 ALFs housing more than 80,000 people.