Assisted Living

 

Assisted Living (in North Carolina) is a type of residential housing with services divided into four separate categories:

      • Adult Care Homes
      • Family Care Homes
      • Alzheimer's & Dementia Care
      • Housing With Services

This definition may vary slightly from state to state but will be basically the same.

 

Adult Care Homes

These homes were formerly called Domiciliary Homes, Rest Homes, Personal Care Homes, or Homes for the Aged. Some states call this type of housing "board and care." They must provide 24-hour personal care services (bathing, dressing, grooming, etc.) and supervision. However, this type home is not required to have nurses on duty within the home. These homes are structured to provide a more social model of care versus a medical model of care. Most offer private or semi-private rooms with private or shared baths.

NC Seven beds is the minimum qualification for this type of home. Under seven beds qualify as Family Care Homes (see below). They are licensed by the NC Division of Health Services Regulation. The state contracts with each county Department of Social Services (DSS) to monitor these homes on a bi-monthly basis, but many are monitored monthly. The DSS Adult Home Specialist is responsible for this monitoring process.


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Family Care Homes

These are Adult Care Homes that are licensed for two to six beds.

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Alzheimer's Disease and Dementia Care

An Adult Care Home that advertises itself as providing specialized dementia care must meet certain staffing requirements. On 1st shift (7 am to 3 pm) and 2nd shift (3 PM to 11 PM), the facility is required to have 1 staff person for every 8 residents. Third shift (11 PM to 7 am) should have 1 staff person for every 10 residents.

NC The Special Care Unit Disclosure Act allows consumers to make informed decisions when choosing a Special Care Unit. The Bill requires that any Adult Care Home or Adult Day Care which advertises itself as providing Specialized Dementia Care must disclose the following information to consumers:

  • philosophy and mission statement
  • criteria for admission, transfer, and discharge
  • assessment and care planning
  • staff to resident ratio
  • staff training
  • physical environment
  • activity programming
  • family involvement in care
  • cost of care and additional fee

There is another type of Adult Care Home bed available for those with Alzheimer's disease or dementia. These beds are within a "locked unit". Beds within a locked unit are not covered by the Special Care Unit Disclosure Act described above and are not subject to the same staffing ratios as described above for facilities that indicate they provide specialized dementia care. If a locked unit is being considered as an option, consider asking questions about resident care and assessment, staff to resident ratios, staff training, etc. before making a decision.

 

USA Alzheimer's residents require more oversight that other residents to ensure safety. Be sure to inquire about your state regulations and know the level of supervision and care provided within different facilities. Check with the local chapter of your Alzheimer's Association. Your local Ombudsman Program will also know what laws are in effect in your state. Locate them through your Area Agency on Aging.

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Multi-Unit Housing With Services

This type of housing includes apartments or other independent residential arrangements where services are offered to enable residents with special needs to live as independent a life as possible in a multi-unit setting. Residents usually sign a lease and pay monthly rent. At a minimum, one meal a day, housekeeping services and personal care services must be available. Personal care and nursing services are arranged for by the housing management, using a licensed home care provider. Individuals needing 24-hour supervision are not appropriate residents for this type of housing.

NC These facilities are not required to be licensed, but they must register with the NC Division of Health Services Regulation and provide them with service and financial information.

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Finding an Assisted Living Facility

If it has become evident that your family member needs more oversight than you can provide, an assisted living facility may be the best option. If you are undecided about whether or not making that move is the right decision, contact your local caregiver specialist. He or she can go over your options and can guide you related to what questions to ask of yourself and your family as you make this important decision.

 

Many Area Agencies on Aging maintain lists of long-term care facilities to assist caregivers and older adults as they make these life changing decisions. The Ombudsman (usually part of the Area Agency on Aging) can be very helpful in helping you to ask the right questions as you begin to look at facilities.

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What to Look for When Choosing a Facility

Making the choice to live in an Assisted Living facility can be a difficult one. To recognize that an environment with supervision and assistance is a better option can be traumatic. However, choosing the right facility can offer all involved peace of mind and can help preserve dignity and self-esteem. Keep in mind that you are evaluating the facility for its ability to offer acceptable quality of life and quality of care. Often your five senses provide a good yardstick for quality of life and quality of care. Be aware of what you experience when you visit a facility.

Visit the facilities several times, at different times of day. Talk to other residents and don’t feel shy about asking questions.

Check with your Ombudsman and/or the local Department of Social Services (Adult Home Specialist) or Human Services Agency, for information on recent citations and complaints for a facility being considered. Understanding how an Assisted Living facility is monitored, and by whom, may help you understand if a citation is an important consideration or not. Below are links to help you find that information.

 

NC The NC Division of Health Services Regulation posts penalties for Adult Care Homes that they monitor.

 

Use a
checklist
to help you evaluate each facility.
Checklist

 

 

Consumer Reports offers information on choosing an assisted living facility that may be useful. The information is part of a publication by Consumer Reports called "Complete Guide to Health Services for Seniors" that is available for purchase in bookstores and by phone at 1-800-500-9760. They also offer an online cost calculator to help you understand potential hidden costs of care.

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Moving From Home to Assisted Living

When you have selected a home and/or found a home, there are many things to consider to help ease the transition to the home for both you and your family member. Click below for helpful hints to make this transition as smooth and as stress-free as it can be.

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What to do if You Have a Problem....

Specialist
 Sometimes, caregivers of family members residing in assisted living facilities are not satisfied with the care their loved one is receiving, the condition of the facility, or other areas of concern. Your long-term care Ombudsman Program can be a great help.

 

 

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