Adult Care Homes

Nurse taking care of an old woman

Adult care homes (assisted living facilities) offer 24-hour supervision but not 24-hour care like a nursing facility. In addition, they offer medication management and/or assistance with personal care needs such as bathing, dressing and grooming. The Division of Health Service Regulation’s Adult Care Licensure Section (DHSR ACLS) is the licensure agency for these facilities. It also oversees the work of the Adult Home Specialists in each county. 

The Adult Home Specialists with Wake County Senior and Adult Services are required to monitor these facilities and complete complaint investigations in cooperation with DHSR ACLS. Facilities that violate licensure rules can be subject to sanctions including fines, as well as licensure actions. 

When there is a concern about an Adult Care Home, first consider discussing it with the facility staff. Give facility staff an opportunity to address the problem. If not satisfied with the results, contact one of the following:  

(1) Division of Health Service Regulation’s Complaint Intake Unit (DHSR CIU)  

(2) Regarding Residents’ Rights please contact Wake County’s Long-Term Care Ombudsman - Aimee Kepler, at 919-558-2719 or the Ombudsmen Toll-Free Hotline 1-800-310-9777.  

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 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. 

What do Adult Care Homes provide?

Adult care homes provide 24-hour supervision, assistance with personal care and/or medication management.

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 homes assists individuals who do not need nursing care, but cannot live at home independently and have their care needs safely met. 

Is there financial assistance available to help pay the cost of care in an adult care home and, if so, how do I apply for it?

There is a financial program available called State/County Special Assistance that pays for services provided by the home which include personal care, health care, food services, medication administration, activities, transportation, housekeeping and laundry. Please note: residents paying privately may be 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 can be. 

The adult is eligible for the State/County Special Assistance 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 Health & Human Services).  

Apply for Medicaid

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.

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 the 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).

Other types of Adult Care Facilities

Supervised Living Group Home

 A supervised living group home is required to be licensed if it serves two or more adult residents and it is for the care, habilitation or rehabilitation of adults who have a mental illness, developmental disability and/or substance abuse disorder. Facilities usually serve a maximum of six residents. 

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

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 and/or primary diagnosis of substance abuse. 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. 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. 

Continuing Care Retirement Community (CCRC)

A Continuing Care, or Life Care, community offers a full range of housing options, from independent living to skilled nursing care, all within the same community setting. Having several facilities on the same grounds, continuing care retirement communities can accommodate older people who are relatively active, as well as those who have serious physical and mental disabilities. 

The cost of living in CCRCs can be quite high. Most communities require an entrance fee and monthly payments.  The entrance fees alone can range anywhere from $20,000 to well over $500,000 and are out of reach for most families.  


Long Term Care Ombudsmen

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. Please contact Aimee Kepler, at 919-558-2719 or Ombudsmen Toll-Free Hotline 1-800-310-9777

Wake Network of Care

The Wake Network of Care is a comprehensive, up to date service directory to locate needed services, organizations, and supports throughout Wake County  

Resources for Seniors

Resources for Seniors serves older adults and adults with disabilities in Wake County  by providing home and community-based services and information so that they can maximize their choices for independence, comfort, safety, security and well-being.