This page contains descriptions about all the types of Adult Care Facilities that are available to adults and family members facing the decision to seek placement outside the home for a loved one.
Adult Care Facilities are licensed and categorized based on:
The decision to choose a specific facility should be well researched and thoroughly discussed with the adult who will be living there. In today's world, people are living longer, so the facility you choose now could be your loved one's home for many years to come.
An adult care home is an assisted living residence in which the housing management provides 24 hour personal care services (such as bathing, dressing, grooming, medication administration) to two or more residents either directly or through formal written agreement with licensed home care and hospice agencies.
Residents of adult care homes live in their own rooms or apartments and have some or all of their meals together. Assistance is provided to them according to their individual needs.
Services that are provided usually include personal and health care, medication administration, transportation, meal preparation, activities, housekeeping and laundry.
Adult care homes vary in size and in number of residents served.
Larger facilities, also called rest homes, homes for the aged and disabled or assisted living facilities.
- serve 7 or more residents (sometimes as many as 150 residents)
- buildings are often quite large and can be multi-story
- staff members provide residents with 24-hour care and services on a shift basis
Smaller facilities, also called family care homes, serve 2–6 residents.
- these facilities are located in single-family dwellings in residential neighborhoods
- a live-in staff person provides residents with 24-hour care and services
Elderly and disabled adults with a variety of disabilities receive care in adult care homes, often within the same facility. Care is provided to those who are elderly and frail with numerous physical impairments, individuals with Alzheimer’s disease and other forms of dementia, younger adults with severe and persistent mental illness, adults with developmental disabilities, individuals with HIV/AIDS and adults with substance abuse problems. Adult care homes are NOT required to have licensed nurses on site, however, and provide only one level of care - assisted living.
Adult care homes are part of the continuum of long-term care and services available to older and disabled adults. This continuum ranges from care an adult receives in his/her own home, such as in-home aide services, to care during the day in a community setting such as an adult day care or day health program, to 24-hour residential care in an adult care home, nursing home or acute care setting.
Routine monitoring of adult care homes is conducted at the county level by staff (adult homes specialists) of the local Department of Social Services (Wake County Human Services). Adult home specialists determine if facilities are in compliance with licensure rules and the Residents' Bill of Rights
, and make recommendations to the Division of Health Service Regulation based on their findings.
The Division of Health Service Regulation enforces compliance with licensure rules and may pursue negative licensure actions up to and including license revocation when necessary. Reports generated by both state and county staff are public record, and are available to anyone upon request.
Other programs that have oversight responsibilities for adult care homes include the state Long-Term Care Ombudsman Program
, the Regional Ombudsman Program and the Adult Care Home Community Advisory Committee. These three programs work together under the auspices of the North Carolina Division on Aging and Adult Services to maintain the intent of the Residents Bill of Rights, to promote community involvement and cooperation with adult care homes, to help adult care home residents and providers resolve complaints and concerns, and to educate the public about the long-term care system.
The Adult Care Home Community Advisory Committee
is composed of volunteer members appointed by the Wake County Board of Commissioners to visit each adult care home with 10 or more beds at least quarterly and family care homes at least annually. The committee makes recommendations to adult care home administrators, the Regional Ombudsman and the local Department of Social Services (Wake County Human Services) based on their findings. Committee reports are public record and are available to anyone upon request.
To be admitted to an adult care home, an adult (18 years and older), must be in need, per physician’s statement, of 24-hour care and supervision. Payment for monthly cost of residential care is made in one of two ways.
1) Financially needy adults may be eligible for a financial assistance program called
State/County Special Assistance. Application for this program is made through the Adult
Medicaid section at the local Department of Social Services (Wake County Human
Services). Recipients of State/County Special Assistance qualify for full Medicaid
2) Residents who are not recipients of State/County Special Assistance 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 personal and health care
needs of the resident and room accommodations.
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
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.
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.
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 Division of Health Service Regulation Nursing Home Licensure and Certification Section in accordance with General Statute 131E, Health Care Facilities and Services.
The Division of Health Service Regulation also carries out the routine monitoring of nursing homes to determine compliance with state/federal licensure and certification rules. Failure to comply with state and federal rules may result in loss of Medicare/Medicaid certification in addition to other sanctions up to and including license revocation.
Reports generated by state surveyors are public record and are available to anyone upon request. Current compliance information about any licensed nursing home can be viewed online at www.medicare.gov.
Other programs that have oversight responsibilities for nursing homes include the state Long-Term Care Ombudsman Program, the Regional Ombudsman Program and the Nursing Home Community Advisory Committee. These three programs work together under the auspices of the North Carolina Division on Aging to maintain the intent of the Residents Bill of Rights, to promote community involvement and cooperation with nursing homes, to help nursing home residents and providers resolve complaints and concerns, and to educate the public about the long-term care system.
The Nursing Home Community Advisory Committee is composed of volunteer members appointed by the Wake County Board of Commissioners to visit each nursing home quarterly. The committee makes recommendations to nursing home administrators and the Regional Ombudsman based on their findings. Committee reports are public record and are available to anyone upon request.
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 Adult Medicaid section at the
local county Department of Social Services (Wake County 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
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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.
To some people, the appeal of a continuing care retirement community (CCRC) is that entrance is usually a once in a lifetime choice.
Most CCRCs offer a full continuum of care so residents can move from one housing option to another as the need arises.
Many have large campuses that include separate housing units for those who wish to live independently, as well as assisted living facilities for those who need some help with activities of daily living, and nursing homes for those needing skilled or intermediate nursing care.
The cost of living in CCRCs can be quite high. Most communities require an entrance fee and monthly payments.
Entrance fees can range anywhere from $20,000 to well over $300,000 and are out of reach for many low or moderate income families. The entrance fee may be partially refundable in certain situations, however.
Monthly payments vary in amounts, as some residents own their living space while others rent theirs. Monthly payments may range from $200 to $2500. Frequently, several different fee schedules and contracts are available.
Extensive contracts offer unlimited long-term nursing care at little or no increase in monthly fee. Modified contracts include a specified amount of long term nursing care. Beyond that specified time, the individual is responsible for payments.
Fee-for-service contracts in which the individual pays full daily rates for long term nursing care.