Adult Care Licensure Section

I. Pertinent Excerpts from General Statute 131D-2

1. "Assisted living residence" means any group housing and services program for two or more unrelated adults, by whatever name it is called, that makes available, at a minimum, one meal a day and housekeeping services and provides personal care services directly or through a formal written agreement with one or more licensed home care or hospice agencies. The department may allow nursing service exceptions on a case-by-case basis. Settings in which services are delivered may include self-contained apartment units or single or shared room units with private or area baths. Assisted living residences are to be distinguished from nursing homes subject to provisions of G.S. 131E-102. Effective October 1, 2005, there are two types of assisted living residences: adult care homes and group homes for developmentally disabled adults. Effective July 1, 1996, there is a third type multi-unit assisted housing with services.
2. Effective July 1, 1996, "multi-unit assisted housing with services" means an assisted living residence in which hands-on personal care services and nursing services which are arranged by housing management are provided by a licensed home care or hospice agency, through an individualized written care plan. The housing management has a financial interest or financial affiliation or formal written agreement which makes personal care services accessible and available through at least one licensed home care or hospice agency. The resident has a choice of any provider, and the housing management may not combine charges for housing and personal care services. All residents, or their compensatory agents, must be capable, through informed consent, of entering into a contract and must not be in need of 24-hour supervision. Assistance with self-administration of medications may be provided by appropriately trained staff when delegated by a licensed nurse according to the home care agency’s established plan of care. multi-unit assisted housing with services programs are required to register with the Division of Health Service Regulation and to provide a disclosure statement (PDF, 26 KB). The disclosure statement is required to be a part of the annual rental contract that includes a description of the following requirements:
   1. Emergency response system;
   2. Charges for services offered;
   3. Limitations of tenancy;
   4. Limitations of services;
   5. Resident responsibilities;
   6. Financial/legal relationship between housing management and home care or hospice agencies;
   7. A listing of all home care or hospice agencies and other community services in the area;
   8. An appeals process; and
   9. Procedures for required initial and annual resident screening and referrals for services.
   Continuing care retirement communities, subject to regulation by the Department of Insurance under Chapter 58 of the General Statutes, are exempt from the regulatory requirements for multi-unit assisted housing with services programs.
3. Persons not to be cared for in multi-unit assisted housing with services. Except when a physician certifies that appropriate care can be provided on a temporary basis to meet the resident’s needs and prevent unnecessary relocation, multi-unit assisted housing with services shall not care for individuals with any of the following conditions or care needs:
   1. Ventilator dependency;
   2. Dermal ulcers III and IV, except those stage III ulcers which are determined by an independent physician to be healing;
   3. Intravenous therapy or injections directly into the vein, except for intermittent intravenous therapy managed by a home care or hospice agency licensed in this state;
   4. Airborne infectious disease in a communicable state that requires isolation of the individual or requires special precautions by the caretaker to prevent transmission of the disease, including diseases such as tuberculosis and excluding infections such as the common cold;
   5. Psychotropic medications without appropriate diagnosis and treatment plans;
   6. Nasogastric tubes;
   7. Gastric tubes except when the individual is capable of independently feeding himself and caring for the tube, or as managed by a home care or hospice agency licensed in this state;
   8. Individuals requiring continuous licensed nursing care;
   9. Individuals whose physician certifies that placement is no longer appropriate;
   10. Unless the individual’s independent physician determines otherwise, individuals who require maximum physical assistance as documented by a uniform assessment instrument and who meet Medicaid nursing facility level-of-care criteria as defined in the State Plan for Medical Assistance. Maximum physical assistance means that an individual has a rating of total dependence in four or more of the seven activities of daily living as documented on a uniform assessment instrument;
   11. Individuals whose health needs cannot be met in the specific multi-unit assisted housing with services as determined by the residence; and
   12. Such other medical and functional care needs as the Social Services Commission determines cannot be properly met in multi-unit assisted housing with services.
4. "Compensatory agent” means a spouse, relative or other caretaker who lives with a resident and provides care to a resident.
5. "Resident" means a person living in an assisted living residence for the purpose of obtaining access to housing and services provided or made available by housing management.
6. "Registration" means the submission by the housing management to the Division of Health Service Regulation of a disclosure statement containing all the information as outlined in G.S. 131D-2.1.

II. Definitions of Other Key Terms

The following definitions, in addition to the terms defined in G.S. 131D-2.1, apply to this registration and disclosure information for multi-unit independent housing with services:

1. "Financial or legal relationship" means any corporate or business relationship, contract, or connection, legal and or financial, existing between the housing management and a home care agency.
2. "Home care agency" means a private or public organization which provides home care services.
3. "Housing management" means any corporation, partnership, proprietor, individual, or other legal entity owning the enterprise, business, or service operating as multi-unit assisted housing with services as defined in Chapter 131D of the General Statutes.
4. "Household tasks" means such tasks as using the telephone, managing money, paying bills, taking prescription medications, shopping, housekeeping, doing laundry and preparing meals.
5. "Just cause" means reasons conforming to a standard of what is reasonable, correct, prudent, or legally defensible.
6. "Personal care services" means hands on services allowed to be performed as outlined in department rules.
7. "Personal care tasks" means such tasks as bathing, dressing, eating, toileting and ambulation.
8. "Relevant household tasks" means those household tasks which the resident is no longer capable of independently performing and is currently receiving no assistance in performing these needed tasks.
9. "Rental contract" means a written lease, contract, or agreement by which the housing management conveys real estate, equipment, or facilities for a specified term not to exceed one year and for a specified rent.

III. Registration

At the time of or prior to the provision of housing with services, any facility operating as multi-unit assisted housing with services as defined in G.S. 131D-2.1 will register with the Division of Health Service Regulation by submitting a disclosure statement (PDF, 26 KB) to the division containing all of the information as outlined in these requirements. The Division of Health Service Regulation will provide a standardized format for the disclosure statement (PDF, 26 KB) and a means of updating disclosure information.

IV. Disclosure Statement

1. At the time of, or prior to, the execution of a rental contract for tenancy in multi-unit assisted housing with services, the housing management will provide a current disclosure statement (PDF, 26 KB) to the person with whom the rental contract is to be entered.
2. The disclosure statement (PDF, 26 KB) must contain at least:
   1. identification of the type of emergency response system that will be available to each resident;
   2. the charges for services including:
      1. a list of all services that are not stipulated in the rental contract which may be purchased directly from or through the housing management and the associated fee for each service;
      2. the housing management's policy, if any, for resident payment of any contract service(s) the resident chooses not to use during the term of the service contract;
      3. the housing management's policy regarding any compensation to be made to residents' for contracted service that are not subsequently provided by the housing management in accordance with the terms of the service contract; and
      4. the policy for termination of services prior to the end of the written services contract period for just cause by either the housing management or the resident or for the convenience of the resident.
   3. written policies regarding limitations of services including:
      1. a statement indicating any conditions for the provision of services that may be purchased or arranged for directly through the housing management;
      2. a statement indicating the residents' right to obtain services from any other provider other than the housing management or affiliated providers; and
      3. a statement that assistance with self-administration of medications may be provided by appropriately trained staff as provided for in G.S. 131D-2.1;
   4. written policies regarding limitations of tenancy including:
      1. a statement that the housing management does not provide 24-hour supervision;
      2. a statement that residents are responsible for arranging assistance with unscheduled personal care needs that are not of an emergency nature;
      3. a statement that the housing management may not care for individuals with any of the conditions or care needs stipulated as prohibited for multi-unit assisted housing with services to provide pursuant to G.S. 131D-2.1 and a list of those conditions, care needs and exceptions as provided for in G.S. 131D-2.1; and
      4. a statement regarding any other resident entry restrictions which relate to functional limitations;
   5. a statement identifying any other resident responsibilities which are not otherwise stipulated in the rental agreement or service contract between the housing management and the resident;
   6. information regarding the nature of the financial and legal relationship between the housing management and each home care agency or hospice agency with which the housing management has a financial or legal relationship;
   7. information which includes at a minimum:
      1. a listing of all licensed home care agencies providing services in the county;
      2. the address and telephone number of:
         • County Department of Social Services;
         • Local Aging Agency (if available);
         • County Health Department;
         • Area Mental Health Authority;
         • Public Transportation available;
         • Public library;
         • Public Recreation Department (if available);
         • Local colleges and universities;
         • Local information and referral line (if available); and
         • Senior Centers in the county (if any); and
   8. housing management's written policies concerning tenant grievances and procedures for review and disposition of resident grievances.

V. Revision of Disclosure Statement

1. The facility may revise its disclosure statement (PDF, 26 KB) filed with the Division of Health Service Regulation at any time. If in the opinion of the facility, revision is necessary to prevent an otherwise current disclosure statement from containing a material misstatement of fact or omitting a material fact required to be stated therein, it may submit a revised statement to the Division of Health Service Regulation. Only the most recently recorded disclosure statement will be considered current.
2. The facility will make any revised disclosure statement available to all the residents of the facility prior to or upon the effective date of revisions.

VI. Statement of Screening Procedures

1. Housing management will provide prospective residents or their compensatory agents a copy of the procedures that housing management will use to screen potential residents. Screening is required prior to tenancy and at least annually once tenancy is established.
2. Procedures must address:
   1. the purpose of screening which will, at a minimum, be:
      1. to provide the prospective resident or compensatory agent with the opportunity to request assistance from housing management with referral for needed supportive services through mechanisms defined in the disclosure statement;
      2. to identify prospective and existing residents’ need for referral for an in-depth assessment by a licensed home care agency to determine the facility's suitability relative to the prospective residents’ need for assistance. Suitability shall be based on limitations of tenancy established for multi-unit assisted housing with services settings in accordance with G.S. 131D-2.1 as well as any other limitations of tenancy disclosed by the facility; and
      3. to identify prospective residents who may have unmet needs with regard to the ability to manage, either independently or with help, relevant household tasks as well as personal care tasks.
   2. what housing management staff positions will be responsible for overseeing the screening process;
   3. what information will be collected through the screening process as well as the form that housing management will use to collect the information;
   4. how screening information will be collected (i.e. questionnaire completed by the resident; interview conducted by housing management staff, etc.);
   5. when initial and annual screening will be conducted;
   6. assuring confidentiality of screening information;
   7. criteria to be used by housing management in evaluating the need for referral for an in-depth assessment by a licensed home care agency;
   8. how housing management will refer residents for an in-depth assessment by a licensed home care agency other than as a result of initial or annual screening if necessary;
   9. how to obtain authorization for an in-depth assessment from the prospective resident or compensatory agent;
   10. how to select the licensed home care agency that will conduct the assessment;
   11. criteria to be used by housing management for determining the facility’s capacity and legal authority as stipulated in G.S. 131D-2.1 to meet the needs of prospective residents based on the screening or in-depth assessment conducted; and
   12. how to notify prospective residents of housing management’s decision regarding the suitability of the facility for the prospective resident based on the limitations of tenancy established for multi-unit assisted housing with services in accordance with with G.S. 131D-2.1 and any other limitations of tenancy disclosed by the facility.