Housing Choices: Assisted Living

Definition: Assisted Living Residence means “Any group housing and services program for two or more unrelated adults, by whatever name it is called.” – The State Division of Health Services Regulation 

The assisted living program makes available at a minimum one meal a day, housekeeping services and provides personal care services directly or through a formal written agreement with one or more licensed home health agencies. Nursing services provided to an individual in an assisted living residence may not exceed those allowed under Medicare home health regulations. There are two types of assisted living residences listed in this Guide:

  1. Adult Care Home is an assisted living residence in which the housing management provides 24-hour scheduled and unscheduled personal care services to two or more residents, either directly or for scheduled needs, through formal written agreements with licensed home care or hospice agencies. Formerly called Domiciliary Homes, adult care homes are commonly called “Rest Homes” and are licensed by the North Carolina Department of Health and Human Services to provide assistance with daily activities of living and are monitored by the County Department of Social Services for compliance with minimum regulatory standards.
  2. Multiunit Assisted Housing with Services provides hands-on personal care services and nursing services, which are arranged by housing management and are provided by a licensed home care or hospice agency through an individualized written care plan. The N.C. Department of Health and Human Services maintains a registry of these facilities. The State Division of Health Services Regulation DOES NOT LICENSE THEM.

Effective July 1, 1996, “multiunit assisted housing with services” means an assisted living residence in which hands-on personal care services and nursing services which are arranged by housing management are provided by a licensed home care or hospice agency, through an individualized written care plan. The housing management has a financial interest or financial affiliation or formal written agreement which makes personal care services accessible and available through at least one licensed home care or hospice agency. The resident has a choice of any provider, and the housing management may not combine charges for housing and personal care services. All residents, or their compensatory agents, must be capable, through informed consent, of entering into a contract and must not be in need of 24-hour supervision. Assistance with self-administration of medications may be provided by appropriately trained staff when delegated by a licensed nurse according to the home care agency’s established plan of care.

Multiunit assisted housing with services programs are required to register with the Division of Facility Services and to provide a disclosure statement. The disclosure statement is required to be a part of the annual rental contract that includes a description of the following requirements:

  • Emergency response system
  • Charges for services offered
  • Limitations of tenancy
  • Limitations of services
  • Resident responsibilities
  • Financial/legal relationship between housing management and home care or hospice agencies
  • A listing of all home care or hospice agencies and other community services in the area
  • An appeals process
  • Procedures for required initial and annual resident screening and referrals for services

Continuing care retirement communities, subject to regulation by the Department of Insurance under Chapter 58 of the General Statutes, are exempt from the regulatory requirements for multiunit assisted housing with services programs.

Source: Centralina Area Agency on Aging 

What to Look for in an Assisted Living Setting


  • Clean, hair tidy, shaved, odor-free
  • Communicating with one another
  • Involved in activities
  • Satisfied with the care being provided


  • Ample, nutritious, tasty
  • Appropriate temperature
  • Menus posted, choice of foods


  • Interacting with residents in cheerful manner
  • Promptly responding to resident’s needs
  • Adequate number to ensure proper care for all residents
  • Administrator’s availability with staff supervision and resident’s needs

Physical Plant:

  • Clean environment, beds made, clean and adequate supply of linens
  • Absence of insects
  • No safety hazards
  • Safe conditions, ample lighting, draperies clean and hanging properly


  • Activities posted on calendar
  • Varied and interesting activities
  • Participation of residents in activities
  • Single focus, designated Activity staff person

Medical Services:

  • Type of staff on duty full time
  • On-going training hours provided by facility
  • On-site medical visits by doctor, and specialists (foot doctor, dentist, therapists)
  • Pharmacy service (Can your pharmacy provider accommodate the facility system?)
  • Special Care for residents with dementia