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Senior care rules in North Carolina, in plain language

North Carolina regulates senior care differently from most states. These are the rules that change decisions.

Quick answer

North Carolina licenses assisted living and memory care as a single adult care home category, with memory care requiring a Special Care Unit disclosure rather than a separate certification.

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How North Carolina licenses assisted living. NC uses one license type -- 'adult care home' -- under Chapter 131D, with no Type A/B/C tiering. Read the full explanation →

Guides to North Carolina's rules

How North Carolina Licenses Assisted Living

North Carolina uses a single adult care home license category, with no acuity tiering, issued under Chapter 131D and 10A NCAC 13F by the Division of Health Service Regulation.

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Memory Care: Disclosure or Certification in North Carolina?

North Carolina requires a Special Care Unit disclosure statement under G.S. 131D-8 -- not a separate license or certification -- before a community can market secured memory care.

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How to Verify a Facility's License

The state tools that show license status and inspection history, and why a clean review page means nothing about the regulatory record.

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Medicaid Expansion vs. Long-Term Care Medicaid

North Carolina expanded Medicaid under the ACA effective December 1, 2023 -- a separate eligibility pathway from long-term-care Medicaid for seniors, which has its own income and asset tests.

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North Carolina's Assisted-Living Medicaid Support, Explained

North Carolina has no Medicaid HCBS waiver for assisted-living-style care. State/County Special Assistance -- a cash program, not a waiver -- fills that role instead.

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North Carolina's In-Home Medicaid Waiver (CAP/DA), Explained

CAP/DA is North Carolina's Medicaid HCBS waiver for adults who need a nursing-facility level of care but want to stay in their own home.

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PACE: North Carolina's Program for Dual-Eligibles, Explained

PACE (Program of All-Inclusive Care for the Elderly) is North Carolina's Medicaid program for adults 55+ who need nursing-home-level care but want to stay in the community.

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The Local Ombudsman and Filing Complaints

Two different systems: the free, independent long-term care ombudsman, and the state health department complaint line. Here is when to use each.

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You can check any facility's record free. NC DHSR's Regulated Facilities search shows license status; its ACLS tool shows inspection history and penalties. Read the full explanation →

Questions families ask

How do I check if an assisted living community in Cary is actually licensed?

Use the NC Department of Health and Human Services' Division of Health Service Regulation (DHSR) Regulated Facilities search at info.ncdhhs.gov/dhsr/facilities/search.asp, which lets you search by county (Wake) or facility name and confirms the current license status, address, and bed capacity for any licensed adult care home. Every community operating as assisted living in Cary must be licensed under N.C.G.S. Chapter 131D and 10A NCAC 13F, regardless of how it markets itself.

Does North Carolina license assisted living facilities as Type A, B, or C like some other states?

No. North Carolina uses a single licensure category called 'adult care home' under N.C.G.S. Chapter 131D and 10A NCAC 13F, adopted by the N.C. Medical Care Commission, rather than an acuity-tiered Type A/B/C system some other states use. A facility can add a Special Care Unit designation to that same license for memory care, but this is not a separate license class.

What's the difference between a 'family care home' and a regular adult care home in Durham?

A family care home is licensed to serve 2 to 6 unrelated residents in a residential-style setting, while a larger adult care home (7 or more beds) operates under the same statute and rules but with a different fee and penalty schedule based on bed count. Both are licensed by DHSR's Adult Care Licensure Section under the identical Chapter 131D / 10A NCAC 13F framework — a family care home is a subset of the adult care home category, not a separate license type.

What has to be disclosed if a memory care unit in Wake Forest calls itself a 'Special Care Unit'?

Under G.S. 131D-8 and 10A NCAC 13F .1300 (the Special Care Unit rules), a facility operating a dementia/Alzheimer's unit must file a disclosure statement with DHSR describing the unit's philosophy of care, staffing and training specific to dementia care, physical environment, admission and discharge criteria, and programming — this disclosure must also be made available to prospective residents and families. The required content and format are published on DHSR's Special Care Unit disclosure page (ncdhhs.gov, ACLS).

How do I find inspection reports and violation history for a nursing home in Durham?

Nursing homes (skilled nursing facilities) are licensed and certified by DHSR's Nursing Home Licensure and Certification Section and are also surveyed under federal Medicare/Medicaid rules, so their inspection results, deficiencies, and CMS Five-Star Quality Rating are published on Medicare's Care Compare website (medicare.gov/care-compare) alongside the underlying survey (Form 2567) reports. You can cross-reference the same facility's NC license status through DHSR's Regulated Facilities search at info.ncdhhs.gov/dhsr/facilities/search.asp.

Is the same state agency in charge of licensing both nursing homes and assisted living communities in Raleigh?

Yes, both fall under the NC Department of Health and Human Services' Division of Health Service Regulation (DHSR), but two different sections handle them: the Adult Care Licensure Section (ACLS) licenses adult care homes and family care homes (what most people call assisted living), while the Nursing Home Licensure and Certification Section (NHLCS) licenses and federally certifies nursing homes (skilled nursing facilities). They operate under different statutory and rule frameworks and use different inspection/rating tools.

Where do I file a complaint about care quality at an adult care home in Apex?

Complaints about a licensed adult care home or family care home anywhere in North Carolina, including Apex, go to DHSR's Complaint Intake Unit at 1-800-624-3004 (in-state) or 919-855-4500, staffed weekdays 9:00 a.m.–12:00 p.m. and 1:00 p.m.–4:00 p.m. except holidays. DHSR's Complaint Intake Unit often forwards complaints about specific resident conditions to the local county Department of Social Services for investigation, since Adult Protective Services in NC is county-administered.

What are DHSR's complaint line hours, and does it cover a facility in Fuquay-Varina?

DHSR's Complaint Intake and Health Care Personnel Investigations Section can be reached at 1-800-624-3004 (in North Carolina) or 919-855-4500, weekdays from 9:00 a.m. to 12:00 p.m. and 1:00 p.m. to 4:00 p.m., excluding state holidays. This line covers complaints about any DHSR-regulated facility statewide, including licensed adult care homes, family care homes, and nursing homes in southern Wake County towns like Fuquay-Varina.

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