Frequently Asked Questions (FAQs)
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Q. When is it time to consider placement for a loved one into a long-term care facility? A. 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.
Q. How do I choose an adult care home?
A. 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.
Q. How much does it cost to live in an adult care home?
A. 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.
Q. What services are covered by my monthly cost of care payment?
A. 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.
Q. What levels of care are offered in adult care homes?
A. 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.
Q. What is the difference between an adult care home and a nursing home?
A. 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.
Q. 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?
A. 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 Services 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).
Q. 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?
A. 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.
Q. What should I do if my loved one has a grievance or complaint about the Adult Care home he/she is living in?
A. 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:
- The adult homes specialist with the local county Department of Social Services (Wake County Human Services) responsible for monitoring the facility
- A consultant with the Adult Care Licensure Section at the Division of Health Services Regulations
- The regional ombudsman with your local Area Agency on Aging
- A member of your local Adult Care Home Community Advisory Committee.
Q. Can an adult care home discharge a resident for filing a grievance or complaint?
A. 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:
- Inability of the facility to meet the resident’s needs
- Improvement in the resident’s condition so that he/she no longer needs the services of an adult care home
- A change in the resident’s condition so that he/she poses a danger to himself/herself or poses a direct threat to others
- The safety and health of individuals in the facility would otherwise be endangered
- Failure to pay cost of care for services and accommodations according to the resident contract.