Long-term Healthcare Facilities (Part I)
A Legal Moment

An Introduction to Long-term Healthcare Facility Regulation in North Carolina.

   As our population ages, more of our loved ones will find themselves living in one of a host of long-term health care facilities subject to the oversight and regulation of the State. This is the first in a series that takes a look at this growing industry.

  In 2011, the oldest baby boomers ‒ Americans born between 1946 and 1964 ‒ will start to turn 65. Today, 40 million people in the United States are ages 65 and older, but this number is projected to more than double to 89 million by 2050. Although the “oldest old” ‒ those ages 85 and older ‒ represent only 15 percent of the population ages 65 and older today, their numbers are projected to rise rapidly over the next 40 years. By 2050, the oldest old will number 19 million, over one-fifth of the total population ages 65 and older.
  Linda A. Jacobsen et al., America’s Aging Population,
Population Bulletin 66, no. 1 (2011)

     What are the options for our loved ones as they need residential and healthcare services greater than their friends or family can provide?  North Carolina is home to a variety of distinct types of Adult Care facilities, each category of which varies in terms of the specific health and personal care services provided to their respective residents.  Adult Care Facilities in North Carolina are licensed and categorized based on size, services provided and the population served.  The purpose of this article is to explain what those categories are.  Future articles will look more closely at the oversight of those facilities by North Carolina and the federal government.
   North Carolina recognizes the following four types of Adult Care facilities:  Adult Care Homes, Supervised Living Group Homes, Nursing Homes, and Continuing Care Retirement Communities.  Additionally, many services may be obtained via home healthcare programs.
Adult Care Homes
     An "Adult Care Home" is an assisted living residence that provides 24-hour scheduled and unscheduled personal care services to its residents, either directly or through formal agreements with licensed home care or hospice agencies.  Some licensed Adult Care Homes provide Special Care Units that supervise, protect and care for people with Alzheimer’s, dementia or other cognitive impairments whose decisions, if made independently, may jeopardize the safety or well-being of themselves or others.
   Adult Care Homes and Family Care Homes (fewer than six residents) are subject to licensure by the Division of Health Service Regulation.  Adult Care Home services usually include personal care services, medication administration (but no skilled nursing), transportation, meal preparation, activities, housekeeping and laundry.
   North Carolina has enacted an Adult Care Home Residents' Bill of Rights.  Additional oversight for adult care homes in North Carolina includes the State’s 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.

Supervised Living Group Home
    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 a Supervised Living Group Home is the care, habilitation or rehabilitation of individuals who have a mental illness, developmental disability or substance abuse disorder.  Each Supervised Living Group Home is licensed to serve residents within a specific disability group. Disability groups are generally not mixed under the same roof; nor are child and adult clients permitted to reside in the same facility.
   A Supervised Living Group Home is required to be licensed and regulated by the state Division of Health Service Regulation Mental Health Licensure and Certification Section if the Home serves two or more adult clients or one or more children. Facilities usually serve a maximum of six clients.

Nursing Home
   A “Nursing Home” is a healthcare facility 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.  Nursing homes provide 24-hour medical care as well as room, meals, activities and some personal care services. Nursing homes are required to have licensed nurses on site, and usually offer two levels of service – skilled nursing and intermediate care.
  • 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 
   Similar to Adult Care Homes, North Carolina has enacted a Nursing Home Residents' Bill of Rights.   The Long-Term Care Ombudsman Program, the Regional Ombudsman Program and the Nursing Home Community Advisory Committee monitor Nursing Home activities and compliance with the Residents Bill of Rights.

Continuing Care Retirement Community (CCRC)
    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. Most CCRCs offer a full continuum of care so residents can move from one housing option to another as the need arises.
State Oversight
   Each of the foregoing categories of Adult Care homes is subject to oversight and regulation by the Division of Health Service Regulation.  (Nursing Homes are licensed and regulated specially by Division of Health Service Regulation Nursing Home Licensure and Certification.)  The Division enforces compliance with licensure rules and may pursue negative licensure actions up to and including license revocation when a facility fails to maintain minimum standards.
   Reports generated by both state and county staff are public record, and are available to anyone upon request.  As we’ll see later in this series, such reports are important to consumers of these services.

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Clifford C. ("Kip") Marshall is a trial attorney with, and President of, Marshall, Roth & Gregory, PC.  Recognized as a "Best Lawyer"™ (Government Relations Practice) for the past six years -- most recently in 2017 -- Kip's practice encompasses all forms of land and title litigation, commercial litigation and catastrophic injury.
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