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We're stuck between two communities

The questions that break a tie once the tours all start blurring together.

Quick answer

The questions that break a tie once the tours all start blurring together.

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Home›By Situation›We're stuck between two communities

By this point you have toured enough that the buildings have merged. These are the questions that still separate them.

Short answer

The questions that break a tie once the tours all start blurring together.

What to do, in order

  1. Compare the all-in numbers, not the base rents. Ask each community for the total monthly cost at your parent's assessed care level, in writing.
  2. Compare the rate increase histories. Three years of actual increases from each.
  3. Compare overnight staffing, not daytime. Daytime ratios look similar everywhere. Overnight is where they diverge.
  4. Pull both state inspection records. Read the surveyor narratives rather than counting citations.
  5. Ask the Medicaid waiver question of both. If private funds might run out, a community that does not hold a waiver provider agreement is a future forced move.
  6. Go back unannounced. Same building, evening on a weekday.

Questions families ask

I live in Seattle and my mother lives alone in Raleigh — how do I manage her care from across the country?

Start by identifying a local point of contact: a geriatric care manager, a trusted neighbor, or a home-care agency that can do in-person check-ins, since phone calls alone won't reveal safety issues at home. Contact the Central Pines/Triangle J Area Agency on Aging (1-800-310-9777) for free options counseling covering Wake County, and ask your mother's primary care provider (WakeMed, UNC REX, or Duke-affiliated practices all offer patient portals) whether you can be added as an authorized contact so you can join telehealth visits remotely. Establishing power of attorney for healthcare and finances now, while she's able to sign, will make it far easier to act quickly if a crisis happens.

My father's savings are almost gone after 18 months in an adult care home near Raleigh — what happens next?

Before his funds run out entirely, apply for North Carolina's State/County Special Assistance (SA) program through Wake County DSS, which is a state- and county-funded cash supplement (not a Medicaid waiver) that helps pay room-and-board costs for eligible low-income adult care home residents. SA recipients are automatically eligible for Medicaid, which then covers his personal care and medical needs. Start the application at least a month or two before his assets are projected to hit the $2,000 asset limit, since processing takes time and a gap in payment can jeopardize his placement.

My wife is in assisted living in Cary but her dementia has progressed — does she need to move to memory care?

If she's showing signs like wandering, exit-seeking, or needing more supervision than the general assisted living staff can safely provide, ask the facility directly whether they have a licensed Special Care Unit (SCU) on-site or whether a transfer to a memory-care-designated community is recommended. In North Carolina, a Special Care Unit is a distinct designation added to a facility's adult care home license, requiring a specific state-approved disclosure statement about staffing, programming, and physical safety features — ask to see that disclosure before deciding. If you're the community spouse and finances are a concern, know that Medicaid rules protect a minimum monthly income allowance for you even if she eventually needs Medicaid-covered nursing facility care.

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