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
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
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
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.
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.
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.
- 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
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.
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
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