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North Carolina Division of Aging and Adult Services

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Adult Care Homes and Nursing Homes	Employment
Help with Finances	Home and Community Services
Family Caregiver Support Program	Housing
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The Ombudsman Program

Nursing Homes and Adult Care Homes

How do I choose a nursing home?

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.

With the newly refined list, you can check with your long-term care ombudsman and the Division of Health Service Regulation for the latest facility survey information, complaint activity, and resolution of any identified issues.

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.

How do I get help with a complaint about care in a nursing home or adult care home?

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:

medical and personal services being provided to residents such as problems with medication, nutrition and hygiene;
financial concerns such as handling of residents' funds, Medicare, Medicaid, and Social Security;
rights of residents, such as the right to be treated with courtesy and to have individual requests
and preferences respected; and
administrative decisions such as admission to or discharge from a nursing home.

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.

What are my rights as a resident of a long-term care facility?

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.

Employment

I need a job--where can I get help?

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:

AARP: http://www.aarp.org/work/job-hunting/info-06-2009/job_search_resources.html
Quintessential Careers: http://www.quintcareers.com/mature_jobseekers.html

For older persons with low income, the Senior Community Service Employment Program may be helpful.

I know I lost my job because my boss feels I'm too old. What can I do?

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.

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Help with Finances

I can't pay my heating bill. . . can someone help?

The Low-Income Energy Assistance Program may be a source of help. Even if you are not eligible for assistance, the worker in your local county department of social services may have some other ideas.

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Home and Community Services

Where can we get the funds to build a senior center?

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.

Where do I get information about starting an Adult Day Care/Day Health Program?

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.

Are there funds available to start an Adult Day Care/Day Health Program?

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.

Are there other sources for start-up funding for an Adult Day Care/Day Health Program?

Possible sources include: charitable foundations or such organizations as United Way. Local hospitals, civic groups, and church organizations may be willing to donate money or equipment.

Where can I (or a family member) get In-Home Aide Services in North Carolina?

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 services.

What can an In-Home Aide do?

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.

How much service can I get? When is it available? Can I get 24 hour or live in care?

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.

How much does the service cost?

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 service.

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.

Will Medicare cover this type of care?

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.

Can a family member become a person's In-Home Aide?

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.

Housing

Does North Carolina offer special housing tax benefits for older citizens?

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.

What types of retirement housing are available in NC?

Retirement housing for independent living can be divided into two general categories. They are:

Independent housing/congregate housing for older adults that may or may not provide supportive services. Such housing may be privately owned with market rate rentals only, or it may be subsidized housing for persons who qualify based on income. Contact the Area Agency on Aging serving the county in which you are interested for a list of such properties.
Continuing Care Retirement Communities (CCRCs), which offer independent living (apartments, villas, some detached homes), meals and other services and amenities for active retirees. In addition, licensed nursing home care and/or licensed assisted living is available if needed. Because CCRCs guarantee certain health and/or personal care through a contractual agreement, they are regarded as an insurance product and regulated by the NC Department of Insurance. Contact the Area Agency on Aging serving the county in which you are interested for a list of such properties; or for detailed information, contact the Department of Insurance, Box 26387, Raleigh, NC 27611, 919-733-5633.

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Retiring to North Carolina

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 to "re-relocate!"

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.

Where can I find information about available retirement housing in North Carolina?

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.

What about leisure-living retirement communities for active retirees which are comparable to "Sun City" in Florida and certain other states?

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.

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Last updated April 29, 2013