Understanding Different Types of Senior Housing

If you are in the process of searching for senior housing for yourself or a loved one, it’s important to understand the differences in types of housing available for older adults with varying needs. Choices include independent and assisted living facilities, continuing care communities which are also known as life plan communities, family care homes, and nursing homes which are also known as skilled nursing facilities.

You aren’t just looking for a roof over your or your loved one’s head – you are searching for a place that has the facilities, staff and services to meet your needs now and in the future. Understanding the types of housing available, the industry lingo and pertinent state regulations – which vary from service level to service level and state to state – can help ensure you make the right move.

As the name states, independent living refers to a community of apartments and/or singlefamily homes where residents – typically restricted to people 55 years old or older – live on their own without assistance. Some allow you to buy your unit, some are rent only and some offer a choice of either option.

Along with apartments and homes, many of these communities provide amenities such as scheduled social activities, recreational facilities, transportation to and from appointments, housekeeping and laundry services, and full-service dining. Some of these amenities may be included in the facility’s regular monthly fee while others may cost extra.

Independent living facilities are not licensed to provide medical care, home care or home health care, but they can invite a licensed provider to offer on-site care and contract individually with residents. As a resident, you can choose to use the on-site provider or a provider of your choice. Independent living facilities also may be called congregate living or retirement communities.

Assisted living in North Carolina can refer to state-licensed adult care homes, statelicensed family care homes and non-licensed multi-unit assisted housing with services.

Adult care homes, which are defined as having more than seven beds, offer 24-hour supervision and assistance to residents. Licensed by the North Carolina Division of Health Service Regulation, they provide meals, housekeeping, personal care services, medication supervision and management and nursing services as needed.

Family care homes are also licensed by the state. They have from two to seven beds and offer 24-hour supervision, meals and personal care to residents. They operate as any regular family home does and are not required to have nursing staff. Caregivers live on-site, adding to the family atmosphere and providing residents with a consistency of care not usually achievable in more traditional assisted living facilities.

Multi-unit assisted housing with services sites are registered with the state but are not licensed. These facilities are only required to provide housekeeping and one meal a day. All other services — like personal care, extra meals, transportation, activities and medication management — can be charged for individually. These facilities must maintain an agreement with one licensed home-care or hospice-care agency to provide personal care and nursing services to residents on-site. However, residents are always free to choose their own providers.

Most of these establishments offer a full schedule of activities on-site and opportunities for off-site events. A few also have special wings for dementia care. Be aware, however, that just because an assisted living facility says it has a memory care unit does not guarantee that the staff is well trained in managing dementia or that state-of-the-art activities are offered. Be sure to ask for staff training and program specifics and spend some time observing the unit.

Assisted living facilities also may be called rest homes or homes for the aged. Whatever name they go by, it is important to know if they are licensed or registered and exactly which services come as part of their standard care and fee and which are charged at an extra cost.

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Nursing homes – also known as skilled nursing facilities – also are licensed by the North Carolina Division of Health Service Regulation. They offer the highest level of residential care and are the right choice for short-term inpatient rehabilitation for people recuperating from an accident or illness or for those who are chronically ill and need longterm care.

In addition to a bed and meals, these homes provide round-the-clock monitoring, personal care, nursing care, rehabilitation, medication management and social-work services. Most also offer a schedule of activities and opportunities for socialization.

Continuing care retirement communities, which are also known as CCRCs or life plan communities, offer all three levels of care – independent living, assisted living and nursing home or skilled nursing – all on one campus. Typically, these communities require a buy-in or entrance fee. For this investment, residents are guaranteed the level of care they need at a regulated rate for life. Most CCRCs require that residents be able to live independently at the time of buy-in.

Buying into a CCRC can simplify financial planning and allows residents to establish

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peace of mind for everyone in the family. Each community must issue and provide potential residents with a disclosure statement on their financial health.

If you or your loved ones are considering a CCRC, it is imperative that you not only understand the terms of your contract but that you also understand the community’s disclosure statement. These contracts usually fall into one of the following categories: • Extensive contracts are full-service contracts that provide for residents to transfer from on-site independent living to on-site assisted living or skilled nursing when needed for an unlimited time and at little to no additional cost. The CCRC bears the majority of the burden of the residents’ long-term care. • Modified contracts obligate the CCRC to provide health-related services for a specified number of days at no additional cost or at a subsidized fee. Thereafter, the financial responsibility for long-term care shifts to the resident. • Fee-for-service contracts give residents guaranteed admission to on-site assisted living or a skilled nursing facility when needed but residents must pay extra for these additional services when used. With this type of contract, the resident bears the full financial burden of additional long-term care needs. • Equity contracts involve a true real estate purchase. Be aware that the health-related services with these contracts differ.

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• Rental contracts provide for housing, services and guaranteed access to healthrelated services in exchange for monthly rent and service fee. Typically, as part of these fees, residents are guaranteed healthcare services at a discounted fee for a certain number of days. After that, full rates are charged.

Regardless of how well you understand these documents, it may be prudent to take them to an elder law attorney or a CPA who can explain them to you.

Making a move to senior housing involves research and planning. Do not be shy about asking questions, requesting to dine with a current resident or asking to spend a weekend or up to a week at any community you or your loved ones are considering. The more information you gather about different properties and their services, their policies and rights as a resident, the better choice you or your loved one will make.

Check on the licensing, inspections, ratings, penalties and more for assisted living and skilled care facilities at the N.C. Division of Health Service Regulation at

Visit Medicare’s Nursing Home Compare at Medicare.gov/

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For a list of licensed assisted living facilities by county, to check on any violations and penalties and to see their star ratings from the N.C. Division of Health Services Regulation, visit

To see licensed family care homes listed by county, visit NCDHHS.gov/

A list of licensed nursing homes in North Carolina by county can be found at NCDHHS.gov/DHSR/

A Medicare star rating and facility comparison of nursing homes/skilled nursing facilities including those that are part of continuing care retirement communities or life plan communities can be found at Medicare.gov/

According to the North Carolina Dept. of Insurance, entrance fees for North Carolina CCRCs can range from a few thousand dollars to more than $1 million with a typical entrance fee ranging from $68,000 to $370,000. NCDOI says monthly fees for CCRCs in North Carolina can range from $1,000 to more than $8,000 but typically fall within the $2,000 to $4,000 per month range.

Because CCRCs require a long-term financial investment from residents, they are regulated by the North Carolina Dept. of Insurance. Their skilled-nursing units are licensed by the North Carolina Division of Health Service Regulations.

The N.C. Dept. of Insurance publishes a CCRC reference guide that can be accessed at https://Files.NC.gov/

CCRC-Reference-Guide.pdf. Other information including a list of licensed facilities in North Carolina and their related disclosure statements can be found at NCDOI.gov/ Documents-Disclosures and https://

Communities/CCRCList.pdf.

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