By Raleigh Senior Advisor Care Team · August 13, 2026
Clayton and Smithfield anchor Johnston County's assisted living and memory care market, with options ranging from small family care homes to national chains, all backstopped by the UNC Health Johnston hospital system.
Johnston County's Growth Is Reshaping Its Senior Care Market
Clayton is one of the fastest-growing towns in North Carolina, sitting in Johnston County just east of the Wake County line, and that growth has pulled in a wider range of senior living operators than a town its size might otherwise attract. Smithfield, the county seat a bit further southeast, remains the county's institutional anchor — home to the main hospital campus and several of the county's largest nursing and rehabilitation facilities. Together, Clayton and Smithfield form the practical center of Johnston County's assisted living, memory care, and skilled nursing options.
Clayton's Assisted Living and Memory Care Options
Clayton has a notably wide range of care models packed into a small area. Kingswood Reserve is a larger senior living community offering independent living, assisted living, memory care, and a secured living option, drawing residents from as far as Fuquay-Varina, Wendell, Garner, Smithfield, Knightdale, Raleigh, and Selma. Gabriel Manor Assisted Living Center, operated by Saber Healthcare Group since 2013, sits near US-70 and offers assisted living and memory care in a smaller, more residential setting.
At the smaller end of the spectrum, Clayton has multiple licensed family care homes — a North Carolina licensing category for homes serving 2 to 6 unrelated residents — including Assurance Family Care Home, a 6-bed home with Certified Dementia Practitioners on staff, and The Enclave, part of a small multi-site eastern North Carolina operator capped at 6 residents per home. For families specifically seeking secured memory care, Clayton House is a dedicated memory care community that the operator states now accepts Medicaid, a notable point since Medicaid coverage for memory care beds isn't universal across Triangle-area communities.
For skilled nursing needs, Clayton Rehabilitation and Healthcare Center is a 90-bed facility offering short-term rehabilitation, long-term care, and respite stays, positioned by its operator, YAD Healthcare, as a suburban alternative to Raleigh- or Durham-based nursing facilities.
Smithfield: The County's Institutional Hub
Smithfield's senior care market centers around its proximity to the county's main hospital campus. Brookdale Smithfield, part of the national Brookdale Senior Living chain, offers assisted living and memory care with pet-friendly apartments and 24/7 emergency staffing. The Landings of Smithfield offers assisted living, memory care, respite care, and a secured living option, and — like Clayton House — the operator states it now accepts Medicaid, serving a broad catchment that includes Smithfield, Raleigh, Garner, Selma, Clayton, Princeton, Four Oaks, and Benson.
For skilled nursing care, Smithfield Manor Nursing and Rehab (also marketed as Smithfield Health and Rehab Center by the same operator) is a 160-bed facility located near the hospital campus, describing itself as part of the Johnston County healthcare community for over 40 years, offering short-term rehabilitation, long-term care, and respite stays.
UNC Health Johnston: The County's Hospital Backbone
Johnston County's hospital care runs through the UNC Health Johnston system, which operates its main campus in Smithfield along with a Clayton campus that gives residents of Clayton and eastern Johnston County local access to emergency and outpatient services without a drive to Smithfield or Raleigh. For seniors living in assisted living or at home in Clayton, having a UNC Health Johnston campus in town — rather than relying solely on Smithfield or Raleigh hospitals — is a meaningful factor in how quickly emergency and follow-up care can happen.
Clayton's location near US-70 and I-40 also means residents and families have a fast, direct route into Raleigh's larger hospital systems, including WakeMed and UNC REX Healthcare, when a situation calls for a higher level of specialty care than the local Johnston County facilities provide.
Comparing Family Care Homes to Larger Assisted Living Communities
One thing that stands out about the Clayton market specifically is how many small, licensed family care homes operate alongside larger assisted living campuses. Family care homes like Assurance Family Care Home and The Enclave cap out at 6 residents, and both operators market that scale as an advantage — more individualized attention, a genuinely home-like environment, and closer staff-to-resident relationships than a 60- or 100-bed community can offer. The tradeoff is usually fewer amenities, less programming variety, and in some cases higher per-resident staffing costs passed through to families.
There's no single right answer between the two models; it depends on the resident's personality, care needs, and budget. A resident who thrives on organized activities, dining variety, and a larger peer group may do better at a community like Kingswood Reserve or Brookdale Smithfield, while a resident who becomes overwhelmed by noise or crowds, particularly someone living with dementia, may do better in the quieter, smaller-scale environment of a licensed family care home.
Understanding Johnston County's Memory Care Options
North Carolina does not issue a separate memory care license — instead, an adult care home adds a Special Care Unit disclosure to its existing license when it operates a dedicated dementia unit, under G.S. 131D-8 and 10A NCAC 13F .1300. In Johnston County, that means communities like Clayton House, Gabriel Manor, Kingswood Reserve, Brookdale Smithfield, and The Landings of Smithfield are all operating under the same underlying adult care home license category, just with different disclosed service lines. Families should ask each community directly for a copy of its Special Care Unit disclosure statement, which is required to describe staffing ratios, programming, and physical security features for the dementia unit specifically. See our companion guide on assisted living vs. memory care in North Carolina for more on how this disclosure system works.
Paying for Care in Johnston County
As in the rest of North Carolina, there is no Medicaid HCBS waiver that pays room and board in an assisted living or family care home. Residents who exhaust private funds typically rely on the state- and county-funded Special Assistance program, layered with Medicaid Personal Care Services for hands-on care needs. Several Johnston County communities profiled here — notably Clayton House and The Landings of Smithfield — explicitly market Medicaid acceptance, which is worth confirming directly and asking how many Medicaid-funded beds are currently available, since availability shifts. For nursing-facility-level Medicaid, including the income and asset limits that apply, see our detailed guide to nursing home Medicaid eligibility in North Carolina.
Checking a Facility's Record, Reaching Outlying Towns, and Finding Local Guidance
Before touring any Clayton or Smithfield community, families can search the facility's licensing status, inspection history, and any penalties through the NC DHSR's Regulated Facilities search and the ACLS-specific Inspections, Ratings and Penalties tool. For skilled nursing facilities like Clayton Rehabilitation and Healthcare Center or Smithfield Manor, families can also check the federal CMS Five-Star Quality Rating on Medicare Care Compare, which — unlike the state's adult care home rating system — allows direct, standardized comparison against nursing homes outside North Carolina.
Clayton and Smithfield sit at the center of the county's care infrastructure, but Johnston County is large and includes smaller towns like Selma, Four Oaks, Benson, Princeton, Pine Level, and Kenly, many of which have little or no dedicated senior housing of their own. Several of the communities profiled here explicitly market to that wider catchment — both Kingswood Reserve and Clayton House list Selma among the towns they serve, and The Landings of Smithfield lists Princeton, Four Oaks, and Benson — which reflects the reality that families in these smaller towns are generally driving into Clayton or Smithfield for both assisted living placements and hospital-level care. Families in outlying Johnston County towns should factor that travel time into caregiving logistics, particularly for regular visits or emergency situations, and should ask any community they're considering how far its transportation services extend for medical appointments back toward a resident's original hometown.
Given how differently these Johnston County communities are structured — from 6-bed family care homes to 160-bed skilled nursing facilities, with varying Medicaid acceptance and different Special Care Unit programming — many families find it worthwhile to work with a local senior-living placement advisor who knows the current bed availability, pricing structures, and reputations of Clayton- and Smithfield-area communities firsthand. A knowledgeable local advisor can often save weeks of independent research, particularly for families coordinating a move under time pressure after a hospitalization, though families should confirm how any advisor is compensated, since many placement services are paid a referral fee by the community rather than by the family.
