Adult Care Facilities

Adult care facilities include residences and day services for elderly and disabled adults who may require supervision, medication management and /or assistance with personal care needs such as dressing, grooming and assistance with medications. The Adult Care Licensure Section licenses and regulates adult care homes and provides supervision, and consultation.  

Frequently Asked Questions

When is it time to consider placement for a loved one into a long term care facility?

There is not an easy or definitive answer to that question. The decision should be based on your loved one's desires in addition to factors such as physical health, ability to meet his/her own care needs, cognitive status, ability to take medications as directed, safety of the home environment and neighborhood, availability of a social support system and ability to handle finances.

How do I choose an adult care home?

  • Find out as much as you can about the adult care home.  
  • Check out the home’s compliance status and complaint history.  
  • Talk with residents and families of residents who live at the home to find out if they are satisfied with the care and services offered.
  • Interview doctors, social workers, the ombudsman and anyone else you can think of who might be familiar with the home. 
  • Visit the home at least twice. Be sure that one of those visits is unannounced. Pay attention to the way the residents are dressed, their cleanliness, the interaction between residents  
  • and staff, visibility of staff, types of meals served, cleanliness of the building, unpleasant odors, noise levels, lighting and building security.

How much does it cost to live in an adult care home?

Charges can vary considerably from home to home. Medicaid recipients can expect to pay about $1,200 a month. Private pay residents pay monthly fees varying from $1,500-$4,000+, based on individual service needs and room accommodations.

What services are covered by my monthly cost of care payment?

For one monthly cost of care fee, Medicaid recipients may use all services provided by the home. Those services usually include personal care, health care, food service, medication administration, activities, transportation, housekeeping and laundry. Private-pay residents are usually expected to pay separate fees for each service used; therefore, the more care a private-pay resident needs, the higher his/her monthly cost of care payment.

What levels of care are offered in adult care homes?

Adult care homes offer only ONE level of care - assisted living. Some adult care homes advertise different levels of care but are actually referring to a tiered payment system based on number of services used by the resident.

What is the difference between an adult care home and a nursing home?

A nursing home is a health care facility that provides nursing or convalescent care to persons who are not sick enough to be in the hospital, but who need services provided by licensed nursing staff.

An adult care home provides personal care assistance to individuals who do not need nursing care but cannot live at home independently and have their care needs met.

Is there financial assistance available to help pay the cost of care in an adult  care home? How do I apply for it?

There is a financial program available called State/County Special Assistance. An adult is eligible for this program if he/she meets all of the following criteria: 

  • age 65 and older 
  • between the ages of 18–64 and disabled based on Social Security’s definition of disabled 
  • a US citizen or legal alien 
  • a North Carolina resident 
  • a current resident, or in the process of becoming a resident, of an adult care home that is licensed by the North Carolina Division of Health Service Regulation, and is authorized to receive State/County Special Assistance payments 
  • meets the allowable income and resource limits 

If an adult receives State/County Special Assistance, he/she is automatically eligible for Medicaid, a health insurance program that helps pay for medical expenses, treatment and personal care services. An application for State/County Special Assistance may be made at the local county Department of Social Services (Wake County Human Services) 

If my loved one is paying privately at an adult care home and exhausts his/her resources, can he/she switch over to State/County Special Assistance and continue living in the home?

Not necessarily. Adult care homes are not mandated to accept State/County Special Assistance payments; therefore, a resident may be asked to leave a facility if personal resources are exhausted and he/she can no longer pay a private-care rate. Check with facilities individually to find out what their policies  are. You might want to also ask for written confirmation that your loved one can continue living in a facility if he/she becomes a State/County Special Assistance recipient.

What should I do if my loved one has a grievance or complaint about the Adult Care home he/she is living in?

The first thing to do is to discuss the concern with facility staff. Work your way up the chain of command if you have to, but make sure that your concern is heard. Then, give facility staff an opportunity to address the problem. If you are not satisfied with the results, don’t give up. Take your concern to one or more of the following people/groups: 

  1.  The adult homes specialist with the local county Department of Social  Services (Wake County Health & Human Services) responsible for monitoring the facility. 
  2.  A consultant with the Adult Care Licensure Section at the Division of Health Service Regulations. 
  3. The regional ombudsman with your local Area Agency on Aging.

Can an adult care home discharge a resident for filing a grievance or complaint?

No. General Statute 131D-21, the Residents Bill of Rights, ensures each resident freedom to make complaints and suggestions without fear of coercion or retaliation. Resident discharge or transfer may only be initiated by a facility when specific conditions exist. These conditions include the following: 

  1. inability of the facility to meet the resident’s needs  
  2. improvement in the resident’s condition so that he/she no longer needs the services of an adult care home 
  3. a change in the resident’s condition so that he/she poses a danger to himself/herself or poses a direct threat to others 
  4. the safety and health of individuals in the facility would otherwise be endangered 
  5. failure to pay cost of care for services and accommodations according to the resident contract. 
  6. the discharge is mandated under G.S. 131D-2 (a1). 

Learn more about all the types of Adult Care Facilities

Supervised Living Group Homes

Supervised living group homes are often confused with family care homes. A supervised living group home is a mental health facility that provides 24-hour residential services to individuals in a home environment. 

The primary purpose of these services is the care, habilitation or rehabilitation of individuals who have a mental illness, developmental disability or substance abuse disorder. 

A supervised living group home is required to be licensed if it serves two or more adult clients or one or more children. Supervised living group homes are located throughout Wake County and are growing rapidly in numbers. Facilities usually serve a maximum of six clients. 

Each supervised living group home is licensed to serve individuals in a specific disability group, e.g. primary diagnosis of mental illness, primary diagnosis of developmental disability, primary diagnosis of substance abuse. Disability groups are generally not commingled, and child and adult clients are not permitted to reside in the same facility. 

Supervised living group homes are licensed and regulated by the state Division of Health Service Regulation Mental Health Licensure and Certification Section in accordance with General Statute 122C, Mental Health, Developmental Disabilities and Substance Abuse Act of 1985. 

The Division monitors each facility’s compliance with licensure rules and implements negative actions up to and including license revocation for substantial failure to meet minimum standards. 

Nursing Home

A nursing home is a facility that is advertised or maintained for the express purpose of providing nursing or convalescent care to three or more persons unrelated to the licensee. Nursing homes provide care for persons who are not sick enough to require general hospital care but do need nursing care.  Nursing homes are NOT Adult Care Homes. When admitted, residents are not usually acutely ill and do not require special facilities such as an operating room, x-ray or laboratory facility. 

Nursing homes generally provide 24-hour medical care as well as room, meals, activities and some personal care. Nursing homes are required to have licensed nurses on site, and usually offer two levels of service – skilled nursing and  
intermediate care. 

Many times, both services are offered within the same nursing home.  

  • Skilled Nursing Facilities (SNF) offer 24-hour, continuous service by registered nurses, licensed practical nurses and nursing assistants who provide care based upon treatment prescribed by the resident’s physician. The emphasis is on nursing care with restorative, physical and occupational therapies available.  
  • Intermediate Care Facilities (ICF) offer less direct nursing care than that afforded by SNFs. They provide some medical, social and rehabilitative services in addition to room and board for persons who are not capable of fully independent living. 

A nursing home that offers more than one level of care is called a combination home. Combination homes may include a mixture of skilled nursing, intermediate care and assisted living. Residents eligible for placement in the assisted living  
section of combination homes include aged and disabled adults whose principal need is a home with the shelter or personal care their age or disability requires. Continuing planned medical and nursing care to meet the resident’s needs may be provided under the direct supervision of a physician, nurse or home health agency. Nursing homes are licensed and regulated by the state in accordance with General Statute 131E, Health Care Facilities and Services. 

To be admitted to a nursing home, an individual must be in need, per physician’s statement, of 24-hour nursing care and supervision. Payment for monthly cost of care is made in one of two ways: 

  1. Financially needy adults may be eligible for financial assistance through the Medicaid program. Application for Medicaid is made through the Wake County Adult Medicaid at the local county Department of Social Services (Wake County Health & Human Services). 
  2. Residents who are not Medicaid recipients negotiate their monthly cost of care charge on an individual basis with the care provider. Rates are set at the discretion of the provider and are usually determined by the personal and health care needs of the resident.  

Nursing Home Facilities

Adult Home Specialist

Adult Home Specialists with Senior and Adult Services are required to monitor these facilities and complete complaint investigations in cooperation with the Division of Health Service Regulation.  

Facilities that violate licensure rules (adult care home and family care home) can be subject to sanctions, including fines.   

How to file a complaint about a facility

The Complaint Intake Unit is available to receive complaints regarding the care and services provided to patients/residents/consumers by health care facilities/agencies/homes licensed by the Division of Health Service Regulations. Complaints may be shared with our unit by telephone, by fax or by postal mail. 

DHSR Adult Care Licensure Section is only able to investigate complaints regarding incidents that have occurred in the past year and issues that are regulated by federal regulations or state statutes. 

Complaint form is available for written complaints but is not required to be used. 

Complaint Hotline
Call:  1-800-624-3004 (within N.C.) or 919-855-4500 

Fax: 919-715-7724

Mail: 2711 Mail Service Center, Raleigh, NC 27699-2711 

MONDAY–FRIDAY(except holidays) 

8:30 a.m.–4 p.m.


Long Term Care Ombudsman Program

Long Term Care Ombudsmen assist residents of long term care facilities in exercising their rights and attempt to resolve grievances between residents, families and facilities. The regional ombudsmen help support the efforts of Adult Care Home and Nursing Home Community Advisory Committees (N.C.G.S. 131E-128 and 131D-3).