North Carolina Division of Aging and Adult Services
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Nursing Homes and Adult Care Homes
Planning ahead is one of the best ways to ease the stress that accompanies choosing a nursing home. Unfortunately, such decisions are often thrust upon us in times of crisis. Nevertheless, there are several steps you should always consider before selecting a nursing home. To begin with, you must determine what services are needed. There are many care and service options aside from the more intensive nursing home care. These include home health care, adult day care, adult care homes, and assisted living facilities. After you have determined the needs of the prospective resident and the type of lifestyle he or she will want to enjoy, it is a good idea to seek referrals. These referrals may come from friends and acquaintances who have been in similar situations, or they may come from your family physician, religious organizations, hospital discharge planners/social workers, state nursing home associations, and the Ombudsman Program.
Once you have an initial list of facilities, you should contact them and inquire if they are Medicaid and Medicare certified, if there are available beds, what type of care is offered, what is the typical resident profile, and what are the admission requirements.
Now you are ready to visit your remaining facilities. Try to visit the facilities at different times and on multiple occasions in order to determine what the nursing home is really like. When visiting you should talk to residents. Finding out what they think of the facility, what types of activities are available, and if they have a resident council will be invaluable. Also note how the nurses and aides treat the residents. Are residents addressed in a respectful manner? Are the residents well groomed and dressed? Be careful to evaluate the physical nature of the home. Is there an odor, are there clearly marked exits, are residents aimlessly sitting or wandering the halls, and are the bathrooms well lighted and conducive to impaired individuals? Another key concern is how favorable is the location of the facility for visits from family and friends. There is really no substitute for attentive family and friends visiting with the resident.
During your visit, you should meet with the administrator. When you meet with this person be sure to cover such areas as restraint use, the number of personal care staff per resident, staff turnover, visiting policies, roommate pairing procedures, how often physicians visit, and how they view care plans. Be sure to ask to see a list of the meals for the month. You may want to sample or at least see a meal. Noting the activity list and number of residents engaged is also important. Finally, you will want to know the facility's cost and financing options to know if it is in your price range.
After you have selected your nursing home, be sure to carefully read the contract. It might be a good idea to have an attorney or ombudsman read it over before you sign. Make sure the home is a place that will suit the lifestyle and needs of the individual. Going with your intuition and gut feeling is perhaps the most important step in the process.
The North Carolina Long Term Care Ombudsman Program investigates and attempts to resolve the concerns or complaints of residents and families as effectively as possible. The ombudsmen work with facility staff and with public and private agencies on behalf of residents who need assistance. Residents and others making complaints are involved to the extent they choose to be. Identities of residents and complainants, along with the information shared with the Ombudsman Program are kept confidential unless the person making the complaint consents to such information being released. The ombudsman provides guidance and assistance on concerns including:
For regulatory complaints within nursing homes, the Division of Health Service Regulation also maintains a Complaints Investigation Unit. This unit investigates regulatory complaints within nursing homes [919 855-4500 or call toll free 1-800-624-3004]. For regulatory complaints within adult care homes, there are Adult Home Specialists within each county department of social services available to look into complaints and concerns.
Complaints of immediate life-threatening conditions as well as abuse, neglect and misappropriation are also referred to Adult Protective Services within each county department of social service.
When an individual enters a nursing home or adult care home, he or she is guaranteed certain fundamental rights. Under North Carolina State Law these rights are found in the Nursing Home Residents' Bill of Rights and the Adult Care Home Residents' Bill of Rights. A copy of these rights should be posted within the facility. Any representative of the Ombudsman Program can help you understand these rights.
The Division of Workforce Solutions (formerly the Employment Service Division of the Employment Security Commission) is a valuable resource for people seeking work, including Older Workers, and employers looking to hire. For assistance, call or visit your local office: http://www.ncesc1.com/locator/ShowMaps.asp
Adults seeking employment might also want to consider these websites for job search resources:
For older persons with low income, the Senior Community Service Employment Program may be helpful.
Age discrimination in employment is illegal. The U.S. Congress enacted the Age Discrimination in Employment Act (ADEA) in 1967 to prohibit age discrimination on the job. Employers that have 20 or more employees are prohibited from using age in decisions involving hiring, firing, compensation, benefits, work assignments, promotions, training, demotions, or lay-offs. Workers age 40 or older who believe that they have been adversely treated in one of these areas because of their age may file a complaint with the Equal Employment Opportunity Commission (EEOC), at 919-856-4064. To go forward with an age discrimination complaint, you must be able to show there is no other reason other than age for the employer’s adverse actions. It is very important to file a charge with EEOC within 180 days of the act of discrimination. In a very few instances, age may be a lawful job qualification if it meets the test for a bona fide occupational qualification.
Senior Centers have a unique base of support in each local community. Many are supported by county or municipal government and others by private, non-profit organizations. United Way, foundations, and civic, religious and social groups, along with fundraisers, bond referendums, and participant donations and fees are all used to build and operate senior centers. Contacting established senior centers and learning from their experience should prove useful. See http://www.ncdhhs.gov/aging/scenters/sccty.htm for a directory of NC Senior Centers. The Division's contact persons are Judy Smith and Leslee Breen.
Contact Glenda Artis at the North Carolina Division of Aging and Adult Services. Request a copy of the North Carolina Adult Day Care and Day Health Standards for Certification. Along with the standards, you will receive a current list of all certified programs and a letter containing the name of the local contact person (Adult Day Care Coordinator) at the county Department of Social Services. You may also want to consult with the North Carolina Adult Day Services Association and the National Adult Day Services Association.
The 1999 Session of the General
Assembly appropriated $250,000 non-recurring funds for SFY 1999-2000 for
start-up grants for adult day care programs; however, these funds were
reallocated by the Office of State Budget and Management to assist with
Hurricane Floyd recovery efforts. At this time, there are no State funds
available for start-up grants for adult day care programs.
Possible sources include:
charitable foundations or such organizations as United Way. Local hospitals,
civic groups, and church organizations may be willing to donate money
This service is provided by
a variety of organizations in each county. They may be private for profit,
private non-profit and public agencies. Examples are home health and home
care agencies, councils or departments of aging, departments of social
services, and hospitals. They are frequently listed under "Home Health
Services" in the Yellow Pages of your telephone book. Or you may call
your local senior center, council or department of aging, or department
of social services to get assistance in finding the most appropriate resource
for you. You may want to begin by checking our Aging
Services Directory. You might also want to consult the Home
Care/Hospice Agency Locator of the National Association for Home Care.
Donna White and Mary
Jo Littlewood are the Division's contact persons for in-home aide
Depending on your particular
needs and assuming you can no longer do these things for yourself, the
aide can provide assistance with home management tasks such as: cooking,
cleaning your immediate living area, laundry, shopping, bill paying and
reminding you to take your medications. If you have lost all or part of
your ability do your own personal care, the aide can help you with tasks
such as: dressing, grooming, bathing, toileting and moving from place
to place. If you have become forgetful, the aide can also assist you with
both the home management and personal care tasks by reminding you and
assisting you with them.
The amount of service you
receive will depend primarily on how much service you need (within limits),
and, almost as importantly, on how much funding is available from private
or public resources. Usual amounts of service received range from 1 to
2 hours once or twice a week to 8 hours per day 5 to 7 days per week.
Usually, agency service provision
is available from 8 to 5 on weekdays; some agencies also offer "after
hours" and weekend care. Twenty-four (24) hour care is almost never available
from an agency, as it would cost more than nursing home care. Any "live
in" care would need to be arranged privately; however, most aides prefer
to reside in their own homes and need time off from constant caregiving.
Currently the average real
cost of the service provided by an agency runs about $11 to $15 per hour.
This includes the wages received by the aide, any benefits provided ,and
the cost of supervision and related expenses of the agency to provide
The cost may be covered privately
by the individual or family. A very limited number of insurance policies
help to cover this cost. If the person is assessed to be in need of the
service and is eligible under certain types of public funding (such as
Medicaid, Medicare, and other types of federal, state, or county resources),
this funding may pay, or help pay for the service. For some types of funding
there are waiting lists.
Only in very limited situations,
such as a brief period directly following an acute care hospitalization.
You may also want to review the responses of the Health
Care Financing Administration to frequently asked questions about
Medicare and home care.
In some limited situations
a family member may be paid as a person's aide. That person would need
to meet all the training and competency testing requirements of any other
aide, and the agency providing and supervising the service would have
to be willing to hire the family member. Some agencies choose not to use
family members as paid service providers at all.
Often it is not in the best
interest of either the person needing help or the family member for that
person to be the paid aide. He/she may have care responsibilities outside
the paid period, and the caregiving stress can become too great. Often
a person's care needs are best met by a combination of care by family
and friends and by unrelated paid caregivers.
North Carolina offers older
and disabled homeowners the Homestead Exemption, which allows
qualifying homeowners a reduction on their property tax. The first $20,000
in appraised value of a permanent residence owned and occupied by a qualified
owner is excluded from taxation.
A qualifying owner: (1) is
at least 65 years of age or totally and permanently disabled; (2) has
an income for the preceding calendar year of not more than $15,000; and
(3) is a North Carolina resident. For more information, contact your local
county tax office.
Retirement housing for independent
living can be divided into two general categories. They are:
I have never been to NC, but I have heard that it is a good place to retire. So I'm making plans to move there now. Do you have any advice?
Relocating for retirement is a big step. Such a major move has the greatest
potential for success when retirees move to an area with which they are
already well-aquainted, and where family members or close friends can
serve as a support network. It is important to have well-planned arrangements
for housing, transportation, medical care, living costs, social needs,
and finances before making a move.
We strongly urge that potential
retirees arrange for an extended stay in any area they are considering
before making a commitment. This allows an opportunity to develop a realistic
sense of surroundings, differences in climate, cost of living, available
services, and day-to-day life before making firm plans. Many rural areas
and even cities may not offer the public transportation options that one
may now depend on. Medical facilities and costs may differ in various
parts of the country. Our best advice is look before you leap. Out of
state relocation can be expensive and complicated if you end up needing
I am planning to retire to North Carolina. Where would be the best areas to look for a retirement community for someone on a fixed income?
Cost of living rates vary
considerably across the state, with highly urbanized areas such as the
Triangle (Raleigh, Durham, and Chapel Hill) generally having higher costs.
Unfortunately housing demand by growing numbers of older North Carolinians
has created waiting lists for many retirement communities, particularly
those of moderate cost. We highly recommend spending some time in the
area you are considering so that you can visit potential communities and
learn about them first hand.
For detailed information on
housing specifically planned for older adults, including subsidized housing,
we recommend that you first narrow your search to one or two areas of
the state. Then contact the Area
Agency on Aging for the county(ies) in which you are interested. The
Area Agency on Aging can direct you to various local sources of information
or send you a listing of types of housing in the area. You may also want
to review our North Carolina Elder Housing Locator
Service. Because we may not have access to information on all retirement
housing in a given area, you may still wish to contact the Area Agency
on Aging for further details.
In North Carolina, there are a few leisure-living communities for active retirees, although at this point, we are not aware of any NC retirement communities on the scale of Sun City. The exisiting communities may offer building sites, single family homes, condos or manufactured homes. Because such communities are not required to be licensed or registered with the state, they are not as easy for our office to identify and update. For such properties and for other single family homes, townhomes or apartments, contact a private real estate agency in the town of your interest, or the local chamber of commerce.
Last updated April 29, 2013