Types Of Senior Housing

Independent living. Assisted living.

Continuing Care Retirement Communities (CCRCs also known as Life Plan Communities). Family Homes. Nursing Homes. For-profit. Non-profit. If you are in the process of searching for senior housing for yourself or a loved one, then you know it is unlike any other housing search you’ve ever done.


You aren’t just looking for a roof over a 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.

Independent Living
As the name states, Independent Living refers to a community of apartments and/or single-family homes where residents—typically restricted to 55 years old or older—live on their own without assistance. Some allow you to buy your unit, some are rent only, some offer a choice.
Along with apartments and homes, many of these communities often provide amenities such as a full schedule of social activities, recreational facilities, transportation to appointments, housekeeping and laundry services, and full-service dining. Some of these amenities may be included in the facility’s regular monthly fee, some may be extra.
Independent Living facilities are not licensed to provide medical care, home care and home health care, but they can invite a licensed provider to offer care on-site 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
Assisted Living in North Carolina is a catchall phrase. It can refer to state-licensed Adult Care Homes, state-licensed Family Care Homes, and non-licensed Multi-Unit Assisted Housing with Services (MAHS).
Adult Care Homes are defined as having more than seven beds and offer 24-hour supervision and assistance to residents. Licensed by North Carolina Division of Health Service Regulation, they provide meals, housekeeping, personal care services, medication supervision and management, and nursing services as needed.
Also state licensed, Family Care Homes have from two to seven beds. They 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.
MAHSs 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—personal care, extra meals, transportation, activities, medication management—can be charged à la carte. 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, MAHS residents are always free to choose their own provider.
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 may also be called Rest Homes or Homes for the Aged. Whatever name they go by, it is important for you 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.
To view a list of licensed Assisted Living facilities by county, check on any violations and penalties, and see their star rating by North Carolina, go to www.ncdhhs.gov/dhsr/acls/. To see licensed Family Care Homes listed by county, visit www.ncdhhs.gov/dhsr/reports.htm.

Nursing Homes/Skilled Nursing
Also licensed by North Carolina Division of Health Service Regulation, Nursing Homes—also known as Skilled Nursing Facilities—offer the highest level of residential care. They are the right choice for short-term inpatient rehab for those recuperating from an accident or illness, or those who are chronically ill and need long-term 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 for residents who are well enough to participate. A list of licensed Nursing Homes in North Carolina by county can be found at www.ncdhhs.gov/dhsr/reports.htm.
A Medicare star rating and facility comparison of nursing homes/Skilled Nursing facilities including those that are part of CCRCs can be found at www.medicare.gov/nursinghomecompare.

Continuing Care Retirement Communities (CCRC also known as Life Plan Communities)
CCRCs offer all three levels of care—
Independent Living, Assisted Living, and Skilled Nursing—on one campus. Typically, these communities require a buy-in or entrance fee. Entrance fees for North Carolina CCRCs range from a few thousand dollars to more than $1 million with a typical entrance fee ranging from $68,000 to $370,000. A CCRC charges a monthly fee that can range from $900 to $5,000. 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 buy-in.
Buying into a CCRC can simplify financial planning and allows residents to establish peace of mind for everyone in the family.
Because CCRCs require a long-term financial investment from residents, they are regulated by the North Carolina Department of Insurance. Their skilled-nursing units are licensed by the North Carolina Division of Health Service Regulations. Each community must issue and provide potential residents with a disclosure statement on their financial health. If you 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
• 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 skilled nursing 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.
• Rental Contracts provide for housing, services and guaranteed access to health-related 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.
The North Carolina Department of Insurance publishes a CCRC reference guide that can be accessed at www.ncdoi.com/SE/Documents/CCRC/CCRC_Guide_2017.pdf. In it, you’ll find general information about CCRCs, as well as listings for all licensed CCRCs in North Carolina, complete with their amenities, fees, types of contracts offered, and contact information.

Careful Evaluation Is Key
Making a move to senior housing is a move you only want to make once. 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 are considering. The more information you gather on the properties you see, their services, their policies, and your rights as a resident, the better choice you will make for all concerned. A Medicare star rating and facility comparison of nursing homes/skilled-nursing centers (including those that are part of CCRSc) can be found at www.medicare.gov/nursinghomecompare.


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Brett Hulsey

Katie Cornwell
Business Development