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Consumers’ Frequently Asked Questions

  1. What is Assisted Living?
  2. What is the Philosophy of Assisted Living?
  3. Who regulates assisted living communities in North Carolina?
  4. What are Typical Services Offered in Assisted Living Communities?
  5. Are Alzheimer’s and Dementia Care Provided in Assisted Living Communities?
  6. What services are available outside of an assisted living community? Can I get help in my home?
  7. Are Assisted Living Communities Regulated?
  8. What is the Cost of Assisted Living?
  9. Third-party Payments
  10. Hospitalized Resident’s & Medicaid Personal Care Rates
  11. How Do I Pay for Assisted Living?
What is Assisted Living?

Assisted Living is a long-term care option combining housing, personalized support services, and healthcare—as needed. This option of care is designed for individuals requiring assistance with activities of daily living—such as bathing, dressing, and toileting—while allowing them to retain dignity, privacy, and as much control as possible over their own lives in a “home-like” setting. Many assisted living communities also offer specialized care for those with Alzheimer’s disease or other forms of dementia. An assessment is completed upon moving in or at any time there is a change in condition. This assessment allows the staff to develop an individualized care plan specific to the person.

Care is provided 24 hours a day, seven days a week, on a scheduled and as-needed basis—always in a way that promotes maximum independence for each resident, often involving their family members, neighbors, and friends. The North Carolina Assisted Living Association (NCALA) supports a “residential” model that is flexible in design and operation, providing quality care services to individuals of all incomes. NCALA focuses on those assisted living communities serving seniors and frail elders.

The assisted living option has only been in existence over the past twenty-five years and today is the preferred and fastest growing long-term care option for seniors. Assisted living communities serve the fastest growing segment of our population: those 85 and older. Often individuals consider moving into an assisted living community when they can no longer safely live alone, experience some type of cognitive impairment, or require supervision and reminders regarding their daily routines.

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What is the Philosophy of Assisted Living?

The philosophy of assisted living is to provide person-centered care to meet individual preferences and needs. All residents are treated with dignity, privacy is provided, and independence and freedom of choice are encouraged. Family members and friends are encouraged to be involved in the assisted living community where their loved one lives. Residents are also often involved in the larger community through various activities arranged by the staff and volunteers.

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Who Regulates Assisted Living Communities in North Carolina?

The Adult Care Licensure Section (ACLS) of the Division of Health Service Regulation (a division of the Department of Health and Human Services) regulates assisted living communities, which are called “Adult Care Homes” (seven or more beds) or “Family Care Homes” (two to six beds) in the rules and regulations. ACLS is responsible for licensing of adult care homes and family care homes, and issuing and renewing adult care home and family care home administrator certificates and approvals, among other responsibilities. ACLS performs initial and annual inspections of licensed adult care and family care facilities, issues and renews adult care and family care facility licenses, takes administrative actions against licensees or facilities as warranted based on non-compliance with state rules and statutes, and assists with complaint investigations as needed or requested by county departments of social services or complainants, among other functions. You can find their Web site and learn more about the ACLS here:

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What are Typical Services Offered in Assisted Living Communities?

Assisted living communities provide several amenities and personal care services (scheduled and un-scheduled) and offer a less-expensive, residential approach to their delivery.

Typical Amenities:

  • Three meals a day served in common dining rooms
  • Housekeeping services
  • Transportation
  • 24-hour security
  • Laundry services
  • Social and recreational activities

Personal Care Services:

  • Assistance with scheduled and un-scheduled needs related to eating, bathing, dressing, toileting, and walking
  • Access to health and medical services (ie, physical therapy, occupational therapy, hospice)
  • Medication management
  • Care for individuals with Alzheimer’s disease, other dementia, and cognitive impairments

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Are Alzheimer’s and Dementia Care Provided in Assisted Living Communities?

Yes, in some cases, specific care for Alzheimer’s disease and other dementias may be provided in an assisted living community. This type of care is usually offered in what is noted as a “special care unit (SCU).” This part of an assisted living community will have additional security measures and other specific architectural features and are state-licensed and provide specific programming to the population being served. Staff members are specifically trained to work with individuals who have various forms of dementia.

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What services are available outside of an assisted living community? Can I get help in my home?

In-home care is available from several NCALA Partner members:

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Are Assisted Living Communities Regulated?

Assisted living communities are regulated in all 50 states. In North Carolina, the Department of Health and Human Services, Division of Health Service Regulation monitors mandatory services and procedures that must be provided or met. All assisted living communities offer 24-hour care for scheduled and unscheduled needs, as well as supervision.

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What is the Cost of Assisted Living?

Costs vary depending on the residence, apartment/room size, and types of services needed by the individual resident. Basic rates may cover all services or there may be additional charges for special services. Basic rates typically cover room and board and three meals a day. Additional charges may include entrance fees up to one month’s rent, deposits, and fees for other services such as housekeeping and laundry, although most providers include these services in their basic rate.

Most assisted living communities charge on a month-to-month lease arrangement, but some do require a more long-term arrangement. Currently, more than half of assisted living communities use a tiered pricing model with bundled services. Other possible pricing models include all-inclusive, a la carte, or fee-for-service. Providers regularly review service and care plans to ensure residents’ needs are being met. Billing typically occurs on a monthly basis. In comparison, assisted living is often less expensive than in-home care or nursing home-level of care.

As of 2010, according to the National Investment Center Investment Guide, the median monthly rate in an assisted living community is $3,326.00 per month. In comparison, the median monthly rate in a nursing home is $7,001.00 per month.

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Is it possible for an adult care home to accept payments for room and board from a third party, in addition to the maximum rate established by the General Assembly, on behalf of State/County Special Assistance (SA) residents residing in the facility?

Yes, under the following conditions:

  1. The payment is made directly by the third party (family member, church, charity, etc) to the facility. Money paid directly to the facility to supplement the cost of room and board under the conditions below will not be counted as income and will not affect SA eligibility or the SA payment amount.
  2. The payments made by the third party are made voluntarily and result in one of the following:
    1. a private room is provided; or
    2. a private or semi-private room in a special care unit is provided.
  3. Accepting payments from a third party on behalf of a SA recipient, where the SA recipient resides in a regular semi-private room, is not permitted.
  4. Money given directly to the SA recipient, regardless of intent, is counted as income in determining SA eligibility and establishing SA payment amounts.

10A NCAC 13G .0704

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May a facility require a hospitalized resident’s family to pay the personal care rate Medicaid pays the facility?

No. While the facility is not getting the Medicaid personal care payments during the resident’s hospitalization, neither is the resident receiving personal care services in the facility for which the Medicaid payments are intended. SA payment for room and board does continue during hospitalization for bed hold purposes.

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How Do I Pay for Assisted Living?

Typically, individuals pay for the cost of assisted living through private financial resources.

It is important to clarify that Medicare doesn’t cover room and board or services in an assisted living environment. Rather, Medicare A is considered insurance coverage for hospitalizations and certain expenses related to skilled nursing facilities.

Medicaid provides federal healthcare assistance to low-income Americans. Many, but not all, states cover some assisted living services under their Medicaid programs. These programs fluctuate widely in terms of eligibility requirements and the amount of coverage offered to individuals. Currently, with many facing budget deficits for years to come states (North Carolina being one of them), states are more likely to cut, rather than expand, these programs.

Seniors with annual incomes under $12,000.00 may qualify for US Department of Housing and Urban Development 202 and Section 8 senior housing—providing rent subsidies that can help pay for the room-and-board portion of assisted living communities in some cases.

The Department of Veterans Affairs may also offer benefits through their Aid & Attendance Pension Program. This program may help with costs related to activities of daily living (ie, eating, bathing, dressing, toileting, and medication management) as they pertain to a veteran or surviving spouse. Qualification for this program is not dependent upon service-related injuries for compensation.

Long-term care insurance may be the best way to ensure one can afford to privately pay for most choices in housing environments as one ages. Experts suggest that consumers begin looking at long-term care insurance in their early 40s and purchase by age 50. If you’ve already experienced an insurable healthcare event over age 85 (usual age limit for insurers), it’s too late to purchase this type of coverage. Also, note that this type of insurance coverage is more expensive to purchase as one gets older.

Cost of Assisted Living: How do residents pay for assisted living?
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