Commentary: Proposed assisted living facility inconsistent with Marco culture

Teri Sommerfeld
Teri Sommerfeld

The culture of Marco Island is to provide an environment where individuals can enjoy a quality of life consistent with “aging in place” gracefully. I believe establishing a 210-bed licensed assisted living facility (ALF) on the island is inconsistent with that culture.

Living in a 210-bed facility poses a number of serious disadvantages to the individual as well as the community. Voting for an ALF because you “have a friend who could benefit from one,” is superficial and begs a more detailed analysis of how an ALF of this size could impact its citizens in an intimate way; how “off island” relationships could affect density and how regulatory violations in care could jeopardize the person as well as the community’s reputation.

Usually, a for-profit organization’s primary goal is achieving profit margin targets, not assuring Marco citizen needs are met.

Marco Island has a population of 17,361. Its population density is 1,428 per square mile which is 386 percent higher than the Florida average and 1476 percent higher than the national average. Despite this density, the lifestyle of Marco citizens is enhanced by the amenities of the island, supporting recreation, socialization and supportive assistance.  According to the National Institute of Health, most people want to remain in their homes as they “age in place,” and I believe this is the first preference of Marco citizens.  As more assistance is required, ALFs become attractive alternatives. However, I don’t believe Marco residents are seeking institutional living but rather an environment that would be more “home like.” The project proposed is NOT home-like.

The average size of the 3,079 licensed Florida ALFs is 80 beds. Less than 1 percent (20) of Florida’s ALFs are licensed for 210 beds or more ( This makes the proposed Marco Island ALF a “mega facility,” more than three times larger than the average ALF in the state.

Large ALF institutions such as this can look a lot like nursing homes and encounter many of the same problems in providing safe, effective care. People who were once admitted to nursing homes are now being referred to ALFs, with fewer, less trained staff. Despite fewer regulations, the Florida Agency for Health Care Administration survey findings reflect an unprecedented 90 percent Class 3 violation rate for ALFs over 210 beds in 2017-18 (Class 3 represents violations that indirectly or potentially threaten health, safety or welfare of patients or residents).

National statistics indicate the average length of stay in an ALF is 28 months with a median of 21 months (National Center for Assisted Living). The proposed Marco ALF is not a Continuous Care Retirement Community model, and, therefore, residents would likely be transferred to a skilled nursing facility should they develop complex needs not covered under ALF licensure criteria.

There are no regulations giving ALF admission preference to Marco island citizens.  There are no laws protecting ALF residents from eviction. It is unknown how many ALF residents are evicted annually as privacy laws prevent this information from being made public. However, the corporation involved in this project was publicized for evicting 200 seniors from their independent living community in 2016 ( eviction-notices-posted-on-retirement-homedoors-shock-seniors).

Having a relationship with Naples Community Hospital would likely provide an ALF discharge resource for NCH (and Physicians Regional Medical Center) as they seek placement for patients that no longer meet acute care criteria. These patients may have no previous island residency, adding density and EMS burden to our island’s emergency system.

Zoning and ordinance changes are requested to accommodate this 210-bed facility, yet the other five Florida facilities managed by this corporation have fewer licensed beds than the 210 proposed for our barrier island.

This project is fundamentally contrary to the Marco Comprehensive Plan goals the first of which is:

“To enhance Marco Island’s quality of life, environmental quality, and tropical small town and resort character by managing growth and assuring a stable residential community.”

I want Marco citizens who would benefit from assisted living to have an opportunity to select a facility that is right-sized to meet their needs without risk to their health and safety.

Recent lessons learned from hurricane evacuation of ALFs should inform decisions to avoid “herding” 210 fragile elders and transporting them for hours on buses to undefined locations. Evacuation plans executed in preparation before Irma demonstrated vulnerabilities in carrying out the best of developed plans.

A growing body of academic research shows the stress of hurricane evacuations will lead to dozens of deaths among those who have been hastily relocated.

Marco’s Board and Council decision to succumb to this “Mega ALF” would likely benefit the proposing corporation, but I believe it would also compromise our “culture,” expand our density, and disregard the Comprehensive Plan “envisioned” for our tropical Island and its residents many years ago.

Teri Sommerfeld is a registered nurse; a certified rehabilitation registered nurse; a licensed nursing home administrator in the state of Illinois; and more, with more than 40 years of experience in healthcare executive positions.