Licensing authority in North Carolina

Division of Health Services Regulation, part of DHHS

ADULT CARE HOMES include both of the above types of facilities and are often called Assisted Living (AL) facilities, though the state and county refer to them as Adult Care Homes. This is different than a Group Home, which is typically for people with mental health issues and/or disabilities. All facilities must renew their license annually. Family Care Homes are not allowed to accept residents with mental health issues, e.g. schizophrenia. Adult care facilities and family care homes typically decline applicants with mental health issues. This does include people taking anti-depressants or anti-anxiety medications.

Independent Living (IL) facilities (e.g. Durham Regent, Emerald Pond) are NOT regulated by the state, so there is no oversight for them. Typical amenities at IL facilities include living accommodations, activities, local transportation and a meal plan. Personal assistance needed by residents is not provided by the facility and must be arranged by the resident/family. Long-term care policies may provide financial support for assistance if the resident meets criteria for the policy. There are no reviews by the State or County conducted of these facilities. Families have a lot more responsibility for their residents who live in Independent Living, though the cost is much lower also!

In addition to DHSR, the county provides oversight and support to the Adult Care Homes in their purview. Both the State and County conduct unannounced reviews of the homes. The state is expected to conduct, at minimum, an annual review and the county conducts reviews based on direction from county leadership. Durham County conducts monthly reviews of all their homes. In addition, there is an Adult Care Home Advisory Committee, which is a volunteer committee. Members of the advisory committee visit Adult Care Homes annually and act as advocates for the residents of the homes. Although they have no legal authority, their written reviews of the homes are available on-line on the County website. These are good reviews to read when considering a particular home. (*Note: there is also a Nursing Home Community Advisory Committee, who also acts as advocates for residents of nursing home. Their reports are also available on-line.)

Regulations for Adult Care Homes: The Division of Health Services Regulation is responsible for creating regulations that provide guidelines for all aspects of operating an adult care home. These regulations are required to be reviewed every 10 years. The regulations for Family Care Homes and Adult Care Homes are very similar, though the 7+ bed facilities have a higher bar in some areas.

What differences you may see between Family Care Homes and +7 bed facilities:

+7 bed Facilities:

• May offer more amenities, like live music performances or excursions
• More people to interact with
• Wheelchair accessible
• Sprinkler systems
• May have an a la carte cost model
• Resident is financially responsible for additional care services

Family Care Homes:

• Smaller staff to resident ratio: 6:1 and 3:1 depending on shift
• Families can reach administration more easily
• May be more appropriate for residents with dementia
• Ambulatory and non-ambulatory facilities
• May not be wheelchair accessible
• All services are generally inclusive, though rates may increase as resident requires more care
• May not accept a resident with special health care needs if the resident has dementia and uses a CPAP or the resident is diabetic. This varies across facilities.

Questions you may want to ask when looking at these two options:

• What is your staffing ratio during the day and at night?
• How are medical visits conducted?
• Have you received any deficiencies during your last State review? If so, for what?
• Have you received any deficiencies for the county?
• What is your annual staff turnover?
• Do you provide all medical care in the facility?
• Do we have to call before we come to visit?
• Do you have a sprinkler system?
• Do you have a locked unit for people who want to “elope”?

Questions you want to answer about the potential resident’s needs:

• Is the person currently mobile? Able to walk on their own, uses a walker/cane; requires a wheelchair? Needs help standing?
• Assistance they need with Activities of Daily Living:
  • Assistance eating
  • Assistance toileting
  • Assistance dressing
• Whether they have any hearing and/or sight problems
• Are they having any cognition issues
• Do they have other significant health issues
• Are they likely to try and “elope” from the facility?