Levels of Long-Term Care

man in front of a barnThere are two levels of long term care facilities here in North Carolina, adult care homes and nursing facilities. Levels of care needs are determined by a primary care physician and documented on a state form. Typically residents with more independence in either cognitive functioning or physical functioning need a lower level of care than those with more or greater cognitive or physical needs, but there are exceptions.

Listed below is some additional information and key distinguishers of the two levels of care, which might be helpful to you or your loved one that is seeking placement.

Adult Care Home commonly referred to as "Assisted Living"

An adult care home includes any facility that provides care twenty-four hours a day, but the residents are in need of custodial care instead of skilled care. There are two types of adult care homes, with the key distinguishing feature being the number of residents in each facility.

Rest Home (often referred to as an Assisted Living): Serves seven or more adults; doctor must certify need for this level of care

Family Care Home: Serves six or fewer adults, these homes are often part of residential communities and cannot be distinguished from other residences

These facilities are required to provide the following:

  • Personal services: assisting residents with grooming and toileting needs, assisting with access to the community including correspondence, shopping needs, and scheduling medical appointments; respond immediately to accidents or incidents; provide general supervision
  • Healthcare needs: physician of resident's choice, contact with physician is to be documented, have first aid supplies readily available, medication administration assistance
  • Food service: three meals a day with snacks, menus that are to be planned at least two weeks in advance with alternates
  • Activities program: promote the social, physical, intellectual, and spiritual well-being of the resident; program is to be designed to promote active involvement by all residents and should be personalized to individual interests
  • Transportation: can include community resources, public systems, and private alternatives including facility and family support
  • Laundry services and clean linens, to be provided at no additional fee.
  • Telephone access available in private area.
  • Personal lockable space available.

Nursing homes

Nursing homes were designed to meet the needs of adults recovering from surgeries as well as those with profound, chronic health problems that require continuous monitoring. A doctor must certify the need for this level of care. Within a nursing home there are two levels of care, and most facilities provide both of these levels in the same facility.

  • Intermediate Care: provide at least 8 hours of nursing care per day
  • Skilled Nursing: provide nursing care 24 hours per day

Nursing homes must provide all the services above for an adult care home in addition to the following:

  • Nursing services
  • Administering medications
  • Pharmacy Services (ordering/reordering prescribed medications)
  • Physician Services
  • Dietary Services
  • Dental Services (emergency and routine)
  • Specialized Rehabilitation Services (Physical, Occupational, Speech Therapies)