Nursing home or assisted living? How North Carolina defines them
"Assisted living" is a marketing term. In North Carolina, the law has three main kinds of home, and they are inspected — and published — very differently.
| Nursing home | Adult care home | Family care home | |
|---|---|---|---|
| Size | Any | 7 or more residents | 2 to 6 residents |
| Care | 24-hour nursing care, rehab after a hospital stay | Help with daily living — bathing, dressing, medicines, meals — and supervision; no round-the-clock nursing | The same as an adult care home, in a house-sized setting |
| Licensed and inspected by | NC DHSR, Nursing Home Licensure and Certification — and on Medicare's behalf if it takes Medicare or Medicaid | NC DHSR, Adult Care Licensure Section; county social services monitor them too | The same as adult care homes |
| Ratings | Medicare's 1–5 stars | NC's 0–4 star rating | NC's 0–4 star rating |
| Published staffing and quality data | Yes, from Medicare | None | None |
| Who usually pays | Medicare for short rehab stays; Medicaid or private pay for long stays | Mostly private pay; Medicaid can cover some personal care for people who qualify | The same as adult care homes |
Nursing homes
Almost every nursing home takes Medicare or Medicaid, which brings federal inspections and Medicare's Care Compare data: star ratings, every inspection finding with its grade, fines, payroll-based staffing and quality measures such as falls and pressure sores. That makes nursing homes the most transparent kind of home. A few don't take Medicare or Medicaid; North Carolina still licenses and inspects them, but there is no federal data.
Adult care homes and family care homes
These are what most people mean by "assisted living" in North Carolina. The state inspects them and publishes inspection reports and a star rating, from 0 to 4, worked out from inspection findings and some good-practice points. There is no public record of staffing levels, falls, hospital visits, or prices.
The state grades the most serious problems by type:
- Type A1: the violation resulted in death or serious physical harm, abuse, neglect or exploitation.
- Type A2: a substantial risk that those would happen.
- Type B: a risk to residents' health, safety or welfare.
Type A violations, and Type B violations not corrected in time, can bring fines.
Some homes have a special care unit for people living with dementia, which must meet extra rules. Ask whether the unit is licensed as one.
Which is right?
That depends on how much care someone needs now, and is likely to need. A doctor, a hospital discharge planner, or a geriatric care manager can help you judge. Ask any home when a resident would have to move because their needs have grown — the answer is often the difference between the two.