North Carolina Adult Care Homes


North Carolina Adult care homes: How to pay for, Laws and Regulations and Questions to ask…

North Carolina is a beautiful place full of majestic scenery, a cheerful climate and is home to 1.75 million senior citizens. It’s an ideal place for seniors and retirees to enjoy their lives. From the Smoky Mountains to the Cape Hatteras National Seashore, people from all around seek out North Carolina for the incredible fresh air and scenery. It is natural our senior and aging adult population may require care at some point. An adult care home may be ideal for a senior who can no longer manage their health and safety in their own home, and may need care. Adult care homes are an excellent housing option for aging adults because they offer private residencies in a home-like environment. These residences are not nursing homes.

Adult Care Homes in North Carolina

These are private residences that provides a home-like setting, and typically care for 2 to 6 residents (There are facilities like assisted living in North Carolina that house up to 100 residents and may be called adult care homes. Typically residents in a nursing home require a higher level of care. In an adult care home, residents may require very light assistance or may be more dependent with several care needs. It is best to ask individual locations as you look for care about their specific policies and licenses.

What are the terms you may here to describe adult care homes

These homes are found in normal residential neighborhoods. You may drive past an adult care home each day on your commute. As you look for adult care homes in your community, it is good to know the other terms/names you may hear: 

  • Residential care home
  • Care Home
  • Adult family home 
  • Board and care home 
  • Adult foster home
  • Nursing Home (although this is an outdated and not an accurate term for this level of care)
Adult care homes offer a comfortable environment for seniors to receive care

North Carolina adult care home licensing

There are over 1,200 adult care homes in North Carolina. The Division of Health Service Regulation is responsible for all licensing of adult care homes. The Department of Human Resources oversees these residences in the state of North Carolina. There are statutes in place which allow county department of social services to supervise all adult care homes in the state.


For the safety of residents, operators must be licensed in their state and participate in on-going training.
Staff must have hands-on experience providing care for the population they intend to serve, as well as on-going training. 


The Long-term care Ombudsman Program is there to support all residents of adult care homes in North Carolina. They are there to assist with grievances.

Adult care home care services in North Carolina

  • The adult care home provider will typically provide meals, housekeeping, and limited activities.
  • Caregivers may perform several functions: personal hygiene and mobility and eating and dressing and toileting and behavior management.
  • Similar to a nursing home, residents receive 24-hour care all in a single-family environment.
  • And in addition each home has an operator who may employ additional caregivers to support with the care of residents. 

Caregivers in an adult care home may assist with activities of daily living and other needs

  • Personal care
  • Housekeeping
  • Activities
  • Group meals
  • Mobility
  • Behavior management
  • Eating
  • Dressing
  • Toileting
  • Personal hygiene
  • Cognitive support and redirection

How much should you expect to pay for an adult care home in North Carolina?

The average cost per month for an adult care home in North Carolina is about $3,100 per month. The cost will vary throughout the state, as is common with all senior care. By comparison, one month of care in assisted living community is above $4,800 per month. Nursing homes average $7,000 or more per month in North Carolina.

How to pay for an adult care home?

Paying for Senior Living and Care will vary depending on a few factors. For instance, the level of care needed; the income and savings of the resident; the state and location of the community; or if the resident is a veteran. In the United States there are over 400 programs that may offer some monetary relief for senior care, but often the majority of costs are covered by private funds and family assistance. These funds come from our Federal, State, and Local Governments. 

It is important to take your time when exploring payment and coverage options.

Medicare – NO:

  • Medicare does NOT pay for Assisted Living.
  • People 65 years and older and individuals with end stage renal disease are eligible for Medicare benefits, no matter their income.
  • Coverage is meant for people in need of short-term care.

Private pay – YES:

  • Many families pay for assisted living with private funds.
  • Private pay can be a combination of retirement funds, personal savings, and pension payments.
  • Family members may contribute funds to pay for assisted living or other senior housing and care.

Medicaid – MAYBE:

  • Medicaid provides health coverage to millions of Americans. Eligible participants include: low-income adults, elderly adults and people with disabilities.
  • Medicaid is administered by state, according to federal requirements. The program is funded jointly by each state and the federal government.
  • Every state has their own individual Medicaid assistance program.
  • National guidelines are in place do decipher how states must spend Medicaid money, but with allowances toward the guidelines.
  • The state determines what levels of care will be covered by Medicaid, who is eligible, and how much the state will reimburse the care community.
  • If you are unsure whether you qualify for Medicaid, you should apply. You may be eligible depending on your household income, family size, age, disability and other factors.

Long-term Care Insurance – MAYBE:

Long term care insurance is a great way to pay for assisted living, and planning ahead is important when considering how to pay for senior housing and care. Nearly 75% of people over the age of 65 will require long-term care and services at some point. Buying into long-term care insurance when a person is in their 50s and 60s is the most common time to do so.

  • Long-term care insurance helps cover the costs of chronic medical conditions.
  • Individuals and couples with the ability to pay into long-term care insurance have the advantage of a head start in allocating funds for senior care.

Veteran Aid and Assistance – MAYBE:

This benefit is available to some military veterans and surviving spouses who live in an assisted living community and those who have in-home care.

  • There are specific guidelines, but a veteran may qualify for as much as $2,050 each month.
  • A veteran with a sick spouse may be eligible for $1,600 per month.
  • If a veteran has passed, their surviving spouse can qualify for $1,300 per month.

Questions to ask when Looking for Senior Living

Finding an assisted living community, can be overwhelming. Here are some tips on things to be observant of:

  • Does the facility have the right atmosphere for your needs?
  • Make sure the facility is clean and well maintained. You can tell a lot about the operation by noting What is clean and maintained. Are doorknobs loose or damaged? Do you see any frayed carpet or trip hazards?
  • Visit during lunch hour to observe what the residents are eating. Ask questions about the nutrition program. Is there diversity in meals, healthy fruits and vegetables served at all meals, drink options?
  • Speak to residents and/or family members to learn their perspective.
  • Ask about staff and resident engagement. Get a feel for how staff interact with residents.
  • Ask about the life enrichment programs. Activities are crucial when it comes to quality of life and play a key role in care for older adults.
  • And finally (there is a plethora of more things to consider), get to know the leadership in the building. If you feel good around the executive director, head nurse, lead activities director and even the chef or janitor, it is a good sign you can trust them with the care of your loved one.

Eldercare Locator is a nationwide service that connects older Americans and their caregivers with trustworthy local support resources. Connect with services such as meals, home care or transportation, or a caregiver education or respite from caregiving responsibilities. The Eldercare Locator is a public service of the Administration on Aging (AoA), an agency of the U.S. Administration for Community Living.

Medicare provides a search feature to find & compare providers near you, most senior housing and care providers are included on Find & compare plans in your area. Determine if you qualify for premium savings

Medicaid offers information on how to apply for Medicaid, eligibility criteria, links to local state offices, and additional resources.

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research. Whether you are living with Alzheimer’s or caring for someone with the disease, information and resources are available. 

NCDHHS Division of Aging and Adult Services

North Carolina Health and Social Services

Search other areas Adult Care Homes

Not finding what you’re looking for? Take a look below.

Search other care and housing options

Care Availability

Care Availability

Written by The Care Availability Team
Experts in the senior care & retirement living industries

Keep Me Informed

Receive checklists, articles, guides and news. We will email you relevant information about once a month.

"*" indicates required fields