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Nursing Home vs. Assisted Living

North Carolina licenses nursing homes and adult care homes (assisted living) under separate frameworks, with two very different levels of medical care.

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Short answer

North Carolina licenses nursing homes separately from adult care homes (assisted living), under different rule chapters, and only nursing homes carry the federal CMS Five-Star rating. A resident whose medical needs exceed a community's admission/retention policy -- typically requiring 24-hour skilled nursing rather than personal care assistance -- moves to a nursing home.

You can check any facility's record free. NC DHSR's Regulated Facilities search shows license status; its ACLS tool shows inspection history and penalties. Read the full explanation →

Questions families ask

Does a Special Care Unit disclosure requirement apply to every dementia unit in the Triangle, or only some facilities?

The Special Care Unit disclosure requirement under G.S. 131D-8 applies to any licensed adult care home that operates, markets, or advertises a distinct unit or program for residents with Alzheimer's disease or a related dementia (or mental health/developmental disability population); a facility that simply serves individual residents with dementia within its general population without designating a special unit is not required to file the SCU disclosure. This distinction is why some Triangle memory-care marketing language should prompt families to specifically ask whether an SCU disclosure has been filed.

Are adult care home license fees and penalties the same for a small facility in Zebulon as a large one in North Hills?

No — while both are licensed under the same single 'adult care home' category, DHSR's fee schedule and civil penalty tiers differ by bed count, generally distinguishing facilities with 9 or fewer beds from those with 10 or more. This is a difference in fee/penalty structure within one license type, not a separate license classification.

How do I verify licensing for a continuing-care retirement community near Fearrington Village in Pittsboro?

The assisted living and skilled nursing components of a continuing-care retirement community (CCRC) are each separately licensed and searchable through DHSR's Regulated Facilities search (info.ncdhhs.gov/dhsr/facilities/search.asp) — the adult care home portion under Chapter 131D/10A NCAC 13F and any nursing facility portion under the separate nursing home licensure framework — while the independent-living housing itself is not a DHSR-licensed health care facility.

What should I ask a facility in Smithfield about its 'admission and retention' policy?

Adult care homes operate under 10A NCAC 13F rules governing which residents they may admit and continue to serve based on assessed level of care — facilities are generally required to use a state-approved assessment (commonly the FL-2 medical form completed by a physician) to determine whether a resident's needs fall within what the facility is licensed and staffed to provide, and to discharge or transfer residents whose needs exceed that scope. Ask the facility directly what level-of-care threshold would trigger a required move, since this varies by facility and by whether the resident is in a general unit or a licensed Special Care Unit.

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