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Adult Care Homes
Licensing & Monitoring

Adult Care Homes, commonly referred to as Rest Homes, Family Care Homes, or Assisted Living, are homes which provide residential care for aged and disabled adults. These homes provide around-the-clock or live-in staff who prepare meals, supervise medications, provide assistance with bathing, grooming and other personal care needs.

Adult Care Homes not only provide care for the elderly, but also for those with mental illnesses, developmental disabilities and substance abuse problems. Family Care Homes provide care for up to six people in a family-like setting. These homes are usually found in residential areas. Adult Care Homes are larger facilities, serving seven or more people. Also, there are homes for Developmentally Disabled Adults which serve developmentally disabled individuals who participate in approved day programs. These homes are licensed and monitored by Mental Health. Questions or concerns should be directed to the Division of Health Service Regulation - Mental Health Section. All three types of homes provide assistance with meeting the residents' daily needs and have staff on duty 24 hours a day.

Nurses are not required in Adult Care Homes, although some do have nurses and certified nursing assistants on staff. Aides provide assistance with the activities of daily living such as bathing, dressing, grooming and feeding. Adult Care Homes are different from nursing homes in the level of care they provide and the qualifications of staff.

NC Department of Facility Services is responsible for licensing these Adult Care Homes.

Buncombe County Social Work Services is responsible for providing an Adult Home Specialist to monitor the facilities provision of services to the residents as set forth by the State standards.

Adult Home Specialist:

The Adult Service unit provides Adult Home Specialists (AHS), whose purpose is to monitor, investigate complaints, and provide assistance to facilities who work with a very challenging and diverse population.

If there are any problems identified during the routine monitoring of the facility, the AHS is responsible to assure that a corrective plan is completed and signed by facility administrator and the problem is corrected.

If you have any questions you may call our Intake line at 250-5800 between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday and after hours if needed.

Adult Care Home Licensing and Monitoring Services Include:

  • Assist the State with Initial Licensure Process
  • Investigations on "Unlicensed Facilities"
  • Technical Assistance
  • Routine Monitoring
  • Complaint Investigation
  • Negative Actions

AHS are responsible for completing routine monitoring in the following areas:

  • Medication
  • Activities
  • Resident Funds
  • Food Service
  • Admission and Discharge
  • Physical Environment
  • Management and Personnel
  • Health Care
  • Resident Rights

Frequently Asked Questions

Group housing and services program for two or more unrelated adults that makes available at a minimum, one meal and house-keeping services and provides personal care services directly or through a formal written agreement with one or more home care agencies.

A residential facility for an older or disabled adult who is not able to live independently, but who does not need nursing home care. The purpose of an Adult Care Home is to provide assistance with activities of daily living.

Family Care Homes provide care for up to six people in a family-like setting. Adult Care Homes provide care for seven or more people. Both have around-the-clock or live-in staff who prepare meals, supervise medications and provide help with dressing and other needs.

Nursing Homes provide care to persons who are chronically ill or recuperating from an illness or injury and need regular nursing care and other medical services but not hospitalization.

Your physician will determine your level of care based on your personal care and medical needs and complete the FL2.

A medical form completed by your physician describing your diagnoses, medications, and care needed. This form is required prior to admission.

Residents can be elderly adults, developmentally disabled adults, mentally ill adults or any combination of these.

Call the local Social Work Services to obtain a current list of homes in your county.

Rates will vary by facility depending upon accommodations, services provided, resident’s income and eligibility for assistance. See each facility for rates. Those unable to pay privately, may apply for special assistance at the local Social Work Services.

The license is issued by the State of North Carolina through the North Carolina Division of Health Service Regulation and monitored by The County Social Work Services for compliance with licensing standards under the supervision of the North Carolina Division of Health Service Regulation

Medicare does not cover residential care in an Adult Care Home or Assisted Living facility.

Call the Social Work Services in the county in which the home is located.

Yes, a Medication Technician who has been certified to administer medication.

Yes, unless their physician has determined that they would be at risk and need 24 hour supervision.

Most facilities will not allow pets; however, some facilities feel that having pets is beneficial to the residents.

The Administrator must provide transportation to necessary resources and activities, including transportation to the nearest appropriate health facilities, Social Work Services agencies, shopping, recreational facilities, and religious activities of the resident's choice. The Administrator is also responsible for providing or arranging transportation for any mental health day treatment programs if the physician makes it a part of the resident's treatment plan.

Special Assistance

Special Assistance (SA) provides a cash supplement to help low-income individuals residing in licensed Adult Care Homes (such as rest homes) pay for their care. Adult Care Homes are unlike nursing homes in that medical care is not provided by home staff. Designated staff may administer medications and provide personal care services such as assistance with bathing, eating, and dressing. Medical Assistance (Medicaid) is also provided to Special Assistance recipients to help pay medical bills.

A personal monthly allowance is provided for all recipients, in addition to a small exemption on any income. From this, recipients purchase such items as soap, deodorant, snacks, clothing and hair cuts.

Aged and disabled adults (over age 18) in Adult Care Homes receive their supplement from State/County Special Assistance. Adults and children who are visually impaired receive their supplement from Special Assistance for the Blind.

If you or someone you know require this service, you should apply for assistance at your county Social Work Services. You may send a representative to apply on your behalf.


This checklist was taken from the US Department of Health and Human Services.

Part I - Basic Information

  1. Medicaid Certified?
  2. Admitting New Residents?
  3. Convenient location?
  4. Is home capable of meeting your special care needs?

Part II - Quality of Life

  1. Are residents treated respectfully by staff at all times?
  2. Are residents dressed appropriately and well groomed?
  3. Does staff make an effort to meet the needs of each resident?
  4. Is there a variety of activities to meet the needs of each resident?
  5. Is the food attractive and tasty?(sample a meal if possible)
  6. Are resident rooms decorated with personal articles?
  7. Is the home's environment "homelike"?
  8. Do common areas and resident rooms contain comfortable furniture?
  9. Does the facility have contact with outside groups of volunteers?

Part III - Quality of Care

  1. Does staff encourage residents to act independently?
  2. Does facility staff respond quickly to calls for assistance?
  3. Are residents and family involved in resident care planning?

Part IV - Safety

  1. Are there enough staff to appropriately provide care to residents?
  2. Are there handrails in the hallway and grab bars in bathrooms?
  3. Is the inside of the home in good repair and exits clearly marked?
  4. Are spills and other accidents cleaned up quickly?
  5. Are the hallways free of clutter and well lighted?

Part V - Environment

  1. Are the linens, walls, floors, windows and bathrooms clean and free of odors and insects?
  2. Is lighting comfortable and appropriate?
  3. Is temperature comfortable and bedrooms free of drafts?

Part VI - Other Concerns

  1. Does the home have outdoor areas (patios,etc.) for resident use?
  2. How are concerns or complaints addressed?

Locate & Contact

Adult Care Homes


Placement Support Services

P. (828) 250-5800

Hours of Operation

Monday - Friday
8:00 a.m. to 5:00 p.m.

Email Us

Division of Health Service RegulationThe North Carolina Division of Health Service Regulation offers information about adult care facilities including violations and penalties, facility STAR ratings and lists of all licensed facilities.

For more information visit the North Carolina Division of Health Service Regulation links below:

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