Long Term Care

Adjusting to life in a long-term care facility can be challenging, and sometimes, there can be resident or family concerns about care and services.  If an individual is residing in a nursing home, adult care home (also called assisted living) or a family care home, there is potential help available from a trained advocate called a long-term care Ombudsman.

The Ombudsman Program gives long-term care facility residents and their families a voice. Ombudsmen advocate on behalf of long-term care facility residents to uphold their rights and address quality of care and quality of life issues through information, education and mediation.  Ombudsmen monitor the implementation of federal, state and local laws governing long-term care facilities and work to educate the public, residents, family members and facility staff regarding long-term care issues and elder abuse prevention, detection and reporting requirements. 

 

To locate a skilled nursing facility or adult care home, visit the NC Division of Health Services Regulation at https://info.ncdhhs.gov/dhsr/families.html

 

Ombudsmen do not have regulatory power- any suspected abuse or neglect by a long-term care facility should be reported to the NC Division of Health Services Regulation and/or local law enforcement for investigation.  

To file a complaint by phone:
Complaint Hotline: 1-800-624-3004 (within N.C.) or 919-855-4500
Complaint Hotline Hours: 9:00 a.m. - 12:00 p.m. and 1:00 p.m. - 4:00 p.m. weekdays, except holidays

 

 To file a complaint by mail:
Complaint Intake Unit
2711 Mail Service Center
Raleigh, NC 27699-2711

 

If you want to find out more about long-term care or recognizing and preventing abuse, neglect or exploitation of older and frail adults, the following information may be of help.  Our long-term care Ombudsman are also available if you need help or have questions.

Contact a Regional Long-Term Care Ombudsman

Community Advisory Committee Volunteers

Elder Abuse, Neglect and Exploitation

Paying for Long-Term Care

Care Transitions and Discharges

 

Long-Term Care

 

 

Contact a Regional Long-Term Care Ombudsman

Ombudsman Program Toll Free Line: 800.310.9777
Ombudsman Program Secure FAX Line: 919.998.8101

Aimee Kepler, 919.558.2719
Wake County Adult Care Homes

Autumn Cox, 919.558.9401
Chatham County Nursing & Adult Care Homes, Lee County Adult Care Homes, Orange County Nursing and Adult Care Homes

Carolyn Pennington, 919.558.2703
Johnston County Nursing & Adult Care Homes, Moore County Nursing & Adult Care Homes

Jennifer Link, 919.558.9404
Wake County Nursing Homes, Lee County Nursing Homes

Pam Palmer, 919.558.2714
Durham County Nursing & Adult Care Homes

Keegan Cheleden, 919.558.9396
AAA Program Associate

 When contacting an Ombudsman, please note that they are often out of the office.  You may need to leave a message and they will return your call.  Also, for your own protection, please do not send private or confidential information through unsecured emails.  We can respond by phone or talk with you in person if you have confidential information to share with us.

 

Community Advisory Committee Volunteers


There are volunteers in each county who are appointed by the county commissioners to serve on the nursing home and adult care home Community Advisory Committees.  These volunteers are  trained by the regional long-term care Ombudsmen and certified by NC's state Ombudsman.  The primary purpose of of these volunteer advocates is to maintain the intent of the Nursing Home and Adult Care Home Residents" Bill of Rights in facilities across the state, and to promote community involvement and cooperation with these home to promote quality of care.  The Community Advisory Committees are responsible for advising the board of county commissioners of the general conditions existing in the long term care facilities within each county.  The committees fulfill this obligation through formal and informal visits to facilities, submitting quarterly and annual reports of their observations to the Ombudsmen and to the county.  The Essential Guide explains more about the long term care Community Advisory Committees and their work.  

 

Elder Abuse, Neglect and Exploitation

In general, elder abuse, neglect and exploitation refers to any knowing, intentional or negligent by a person that causes harm or serious risk of harm to a vulnerable adult.  Elder abuse and mistreatment can happen in any setting and is not limited to long-term care homes.   It can happen to individuals of any age, but often the elderly are the most vulnerable to abuse. 

 Abuse generally consists of:

  • Physical abuse
  • Sexual abuse
  • Neglect 
  • Self-neglect that poses a risk to health or safety
  • Exploitation
  • Emotional abuse
  • Abandonment

Warning signs of physical abuse include unexplained bruises, abrasions, hand prints, broken bones or other unexplained physical trauma.  Individuals may show signs of fear, flinching or withdrawal form normal activities  if they are being intimidated.  A change in financial circumstances or previously unknown, controlling caretakers can be signs of exploitation.  Escalating tensions between caregiver and care recipient, including bullying or verbalizing threats, may indicate an abusive situation is developing.  Bedsores, poor hygiene and unexplained weight loss can also be warning signs that the situation is becoming abusive or neglectful.  Self-neglect is most often seen in individuals living alone and may be indicative of cognitive changes.  Modern concerns such as drug addiction and human trafficking are increasing the number of situations where abuse can occur.  

If you suspect someone is experiencing abuse, neglect or exploitation, it is important to speak up.  Not every sign, above, indicates an abusive situation, but it is silence that allows abuse to continue unabated.  In North Carolina, the Departments of Social Services has been designated in each county to investigate reports of abuse in the community or in group homes through their Adult Protective Service program.  You do not have to give your name in order to report suspected abuse, neglect or exploitation to the Department of Social Services.   Reports of abuse in skilled nursing facilities can be made directly to the NC Division of Health Services Regulation for investigation.

 

Paying For Long-Term Care

A stay in a long-term care facility can cost quite a bit of money.  The average cost of room, board and nursing care  in a skilled nursing facility in Raleigh NC (Wake County) in 2019 is estimated at $7,148 a month for a semi-private room.  An average monthly stay is an Assisted Living Facility (also called adult care home) can run $5,325.  If you have savings or insurance coverage, you are fortunate.  But how does one afford long-term care when financial means are not readily available?

  Skilled Nursing Facility:

Traditional Medicare (Part A) can cover up to a 100 days per benefit period in a skilled nursing facility but only if the individual meets certain criteria for a qualified stay, and only as long as Medicare deems such care necessary.   

More information about the Medicare skilled nursing care benefit 

How hospital "observation status" affects Medicare coverage 

Medicare Advantage plans (Part C) may also cover skilled nursing facility care but admission and coverage is determined by the Medicare Advantage provider, usually after discussion with the assigned care manager.

In order to receive long-term financial assistance paying for a skilled nursing facility, one must apply and qualify for NC Medicaid, be approved as needing skilled level of care, and be placed in a qualified bed within a facility that accepts Medicaid.   Applications for Medicaid are made at your local county Department of Social Services

Begin the Medicaid application online

If you need assistance locating a local nursing facility that accepts Medicaid, a regional long-term care Ombudsman may be able to help.

If your family member has Medicaid in another state and wants to relocate to NC, be aware that Medicaid benefits are not transferable between states.  A NC application must be submitted for approval and will require establishment of residency in NC.  Contact your  local Department of Social Services representative for more details.

Medicaid may also cover skilled care alternatives to nursing homes.  The Community Alternatives Program (CAP)  and the Program of All-Inclusive Care for the Elderly (PACE) are two possible alternatives.  Individuals must require skilled nursing level of care and have the ability to receive this care at home or in an adult day health program.

More information about the Medicaid CAP waiver

More information about PACE programs

 

 Adult Care Home:  (includes Assisted Living and Family Care Homes)

State-County Special Assistance is the program that helps qualifying NC residents pay for a stay in an adult care home. It is program similar to Medicaid in that financial need and the need for this level of care must be established.  The individual must also be admitted into in a facility that accepts the Special Assistance reimbursement.

Learn more about State-County Special Assistance

If you or a loved one is relocating from another state, NC residency must also be established before a Special Assistance application can be approved.  Contact your local Department of Social Services representative for more details.

 

Care Transitions and Discharges

When a nursing home or adult care home resident has to go to the hospital, Medicare and Medicaid do not pay to hold the resident's bed in the nursing or adult care home.  An individual or family can often make arrangements to pay privately to hold a bed, in order to assure the individual can return to the same room.  However, this is not a viable financial option for many residents as the length of hospital stay or date of return may be uncertain.

The rights of residents of NC nursing homes and adult care homes are acknowledged and protected by state law, and this includes protections about involuntary transfers or discharges.  It is important to understand these rights, especially in transfer and discharge situations.  Discussing pending transfer and discharge situations with a knowledgeable long-term care Ombudsman is critical, especially if the resident or family doesn't understand why this is occurring.

National Consumer Voice fact sheet about nursing home involuntary transfers and discharges 

Nursing Home Discharge-Now What?

Transitions between care settings is also a well-known cause of medical errors.  it is important to always ask questions about anything you or your family member doesn't understand, and to be prepared to offer relevant information to the staff in a new care setting.  Do not assume that all of the individual's medical history and preferences has been conveyed in the transfer or discharge records.

A discharge checklist can help with care transitions

 
 
Lastly, if one believes a transfer or discharge is not appropriate, there are processes for appeals.  The long-term care Ombudsman can assist with understanding the appeals process and how to get started.
 
Learn more about NC Medicaid's  Administrative Hearings process