Assisted Living in North Carolina

Agency: Department of Health and Human Services, Division of Health Service Regulation
Phone: (919) 855-3765
Website: http://ncdhhs.gov/dhsr/acls

Assisted living residences provide group housing with at least one meal per day and housekeeping services and provide personal care services directly or through a formal written agreement with a licensed home care or hospice agency. The department may allow nursing service exceptions on a case-bycase basis. One type of assisted living is adult care homes, which include 'family care' (housing two to six residents) and 'adult care homes' of seven or more residents. Both can choose to serve only elderly persons (55 years or older or any adult who has a primary diagnosis of Alzheimer's Disease or other form of dementia) and the license would indicate such. A second type of assisted living is MAHS, which is a residence in which hands-on personal care services and nursing services are arranged by housing management and provided by a licensed home care or hospice agency, through an individualized written care plan. The housing management has a financial interest or financial affiliation or formal written agreement that makes personal care services accessible and available through at least one licensed home care or hospice agency. The resident may choose any provider for personal care and nursing services.

Facility Scope of Care:
In MAHS, housing and assistance with coordination of personal and health care services through licensed home care agencies is permitted. In adult care homes, housing, personal care, and some specified health care services are provided by staff while licensed home care agencies may provide other health care services that unlicensed staff cannot perform. Adult care homes also have a requirement for 24-hour staff monitoring and supervision of residents.

Move-In/Move-Out Requirements:
MAHS providers are not permitted to care for residents who require, on a consistent basis, 24-hour supervision or are not able, through informed consent, to enter into a contract. Except when a physician certifies that appropriate care can be provided on a temporary basis to meet the resident's needs and prevent unnecessary relocation, a MAHS provider may not care for individuals with any of the following conditions or care needs: (1) Ventilator dependency; (2) Dermal ulcers III or IV, except when a physician has determined that stage III ulcers are healing; (3) Intravenous therapy or injections directly into the vein, except for intermittent intravenous therapy managed by a home care or hospice agency licensed by the state; (4) Airborne infectious disease in a communicable state that requires isolation or requires special precautions by the caretaker to prevent transmission of the disease; (5) Psychotropic medications without appropriate diagnosis and treatment plans; (6) Nasogastric tubes; (7) Gastric tubes except when the individual is capable of independently feeding himself and caring for the tube, or managed by a state licensed home care or hospice agency; (8) Individuals who require continuous licensed nursing care; (9) Individuals whose physician certifies that placement is no longer appropriate; (10) Residents requiring total dependence in four of more activities of daily living as documented on a uniform assessment instrument unless the resident's independent physician determines otherwise; (11) Individuals whose health needs cannot be met by the MAHS provider; and (12) Other medical and functional care needs that the Medical Care Commission determines cannot be properly met by a MAHS provider. In adult care homes, a more mentally or physically dependent population is housed and 24-hour supervision and assistance with scheduled and unscheduled personal needs are required. An individual with the following conditions or requiring the following may not move into an adult care home: (1) Treatment of mental illness or alcohol or drug abuse; (2) Maternity care; (3) Professional nursing care under continuous medical supervision; (4) Lodging, when the personal assistance and supervision offered for the aged and disabled are not needed; (5) Posing a direct threat to the health or safety of others; (6) Ventilator dependency; (7) Individuals whose physician certifies placement as no longer appropriate; (8) Individuals whose health needs cannot be met as determined by the residence; or (9) Such other medical and functional care needs as the Medical Care Commission determines cannot be properly met in an adult care home. A 30-day discharge notice by the facility is required in adult care homes except for situations of threat to health and safety of residents.

Resident Assessment:
MAHS providers must screen prospective residents to determine the facility's capacity and legal authority to meet the needs of the prospective residents and to determine the need for an in-depth assessment by a licensed home care agency. In an adult care home, an initial assessment is required within 72 hours of moving into the facility, and an assessment of each resident must be completed within 30 days following admission and at least annually thereafter on a form created or approved by the department.

Medication Management:
In MAHS, assistance with self-administration of medications may be provided by appropriately trained staff when delegated by a licensed nurse according to the home care agency's established plan of care. In adult care homes, medications are required to be administered by staff whose competency is validated by a registered nurse and who pass a written exam administered by the state.

Physical Plant Requirements:
In adult care homes, private resident units must be a minimum of 100 square feet and shared resident units must provide a minimum of 80 square feet per resident.

Residents Allowed Per Room:
In adult care homes, a bedroom may not be occupied by more than two residents in facilities licensed after July 1, 2004.

Life Safety:
In adult care homes, smoke detectors must be in all corridors, no more than 60 feet from each other and no more than 30 feet from any end wall. There must be heat or smoke detectors in all storage rooms, kitchens, living rooms, dining rooms, and laundries. All detection systems must be interconnected with the alarm system.

Alzheimer's Unit Requirements:
In adult care homes of seven beds or more that advertize special care units, more detailed rules applying to Alzheimer's units became effective in January 2000 and include requiring additional staffing and staff training in dementia care and a disclosure statement of policies and special services.

Staff Training for Alzheimer's Care:
In adult care homes, the staff in special care units must have the following training: (1) Six hours of orientation within the first week of employment; (2) 20 hours of dementia-specific training within six months of employment; and (3) 12 hours of continuing education annually.

Staffing Requirements:
Adult care homes have specific staffing requirements and ratios for the type of staff (aide, supervisor, and administrator or administrator in charge), first, second or third shift, and the number of residents.

Staff Education Training:
Staff in adult care homes of seven or more beds who perform or directly supervise staff who perform personal care tasks must complete an 80-hour training program within six months of hire. Family care home staff must have at least a 25-hour personal care training program within six months of hire, unless a resident needs a certain health care task listed in rule that requires 80 hours of training.

Medicaid Policy and Reimbursements:
A state plan service through Medicaid covers personal care services in adult care homes.