Adult Care Homes New Star Rating System

Editor’s Note:

By definition, an Adult Care Home is an assisted living residence that provides assistance with activities of daily living. These communities are currently monitored by the Department of Health Service Regulation and each local Department of Social Services.

During the last few years, there has been tremendous growth in assisted living providers as more consumers seek additional care options for loved ones. In response to this demand, there has been a request for more information regarding services, payment sources and tools for making more informed decisions.

Approximately three years ago, the NC Division of Health Service Regulation began to review the current survey process and monitoring system for Adult Care Homes. Previously, this had been a responsibility handled by each individual county. These reviews and recommendations were then developed in conjunction with the NC Division of Aging & Adult Services to become a Quality Assurance safeguard and NC went on to develop an annual survey process. An additional integral part of their recommendation was the proposal for, and development of, a new Star Rating System. This system was created in an effort to work collaboratively with consumers, advocates, families of Adult Care Home residents and all providers in order to provide the public with addition information regarding regulations and standards.

The Adult Care Home Star Rating System will be implemented January 2009.


Adult Care Home Rating System

During the 2007 Session of the North Carolina General Assembly Senate Bill 56 (SB 56) was ratified implementing a Rating System for Adult Care Homes. SB 56 mandated the Medical Care Commission to adopt rules for issuance of rated certificates to adult care homes. These rated certificates shall contain a rating based, at a minimum, on the following:

  1. Inspections and substantiated complaint investigations will be conducted by the Department of Health and Human Services to determine compliance with licensing rules.
  2. The initial ratings awarded to a facility pursuant to the rules adopted under this section shall be based on inspections, penalties imposed, and investigations of substantiated complaints that revealed non-compliance with statutes and rules.
  3. Adult care homes shall display the rating certificate in a location visible to the public.

    Since the passage of the bill draft, rules were developed by the Medical Care Commission and then went through a public hearing process. During this process, provider groups never spoke out against the provision of access to information about all services available to all seniors. We support efforts to disclose information about adult care homes to seniors and their families so an informed decision can be made. It is our belief the Star Rating system does not accomplish this goal. Would it not be more helpful to have access to current monitoring and survey data? Issues with the Star Rating system have been debated at length and it still appears flawed based on the following:

  4. The system is based on a 0-4 Star Rating. At least for the first two years there will be NO 4 Star communities in North Carolina. Achievement of the 4th Star requires two consecutive years of receiving 100% on the rating survey.
  5. Once a rating is received it will remain in place for one year. Circumstances change for the better or the worse during a year and assignment of a rating becomes obsolete and meaningless prior to the next survey.
  6. Even if a community requests a re-inspection prior to the next annual survey it can only be accomplished based on “availability of state staff” to provide the re-inspection.
  7. Instead of rewarding rapid correction of problems and quality improvement for the benefit of existing and future residents and families, the rating system provides only a one day in time snapshot of the actual care provided by this community.

All this being said, the Star Rating system will become a reality and initial ratings will be assigned beginning January 2009. It is our hope that consumers will educate themselves about selecting an adult care home utilizing more than a single data point. It is imperative that time is made for visits and observations, questions are asked and decisions are made based on an overall impression of the adult care home. As a provider organization, we recommend using the checklist in the front part of the Assisted Living Section of All for Seniors, which is provided by Centralina Area Agency on Aging. This is the best way to get an overall and comprehensive perspective for any adult care home considered.

Jerry L Cooper
Executive Director North Carolina Assisted Living Association
1306 Annapolis Dr., Suite 120
Raleigh, NC 27608
Phone: (919) 467-2486
Fax: (919) 467-5132