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SEPTEMBER / OCTOBER 2014 :: 75(5)
Long-Term Care in North Carolina

As North Carolina’s population ages, an increasing number of elderly individuals will need long-term care. Fortunately, a variety of options are available for older adults, including nursing homes, assisted living, and home- and community-based resources. This issue of the NCMJ also covers topics such as fall prevention, advance care planning, caregiver support, adaptive leadership and person-directed care, and behavioral interventions for dementia.


Resources for Choosing a Nursing Home

Cindy H. DePorter

N C Med J. 2014;75(5):338-339.PDF | TABLE OF CONTENTS

We have over 420 nursing homes in North Carolina. The majority of these nursing homes receive funding from Medicare and Medicaid to provide services for people who need nursing home care. Because these nursing homes receive federal and state support, they are required to be inspected by the state under a contract with the Centers for Medicare & Medicaid Services (CMS). In North Carolina, the Nursing Home Licensure and Certification Section of the Division of Health Service Regulation (DHSR) conducts these inspections, or surveys. The state is required by federal contract to maintain a 12 month average between nursing home inspections.

The state also investigates complaints that are reported to our Complaint Intake Unit via a secure telephone number. All received complaints are triaged as outlined by federal regulations. Anyone may contact the Complaint Intake Unit at 800-624-3004 and register a complaint about a nursing home. The state investigates complaints that are within our regulatory authority. The results of annual surveys and complaint investigations are public information.

North Carolina, like all other states in the United States, posts this information online. State-specific information is available on the North Carolina DHSR Web site, and information for both North Carolina and other states is available on a federal Web site called Nursing Home Compare. Survey findings are called statement of deficiencies, which notify the facility of areas that are not in compliance with federal regulations. The statements of deficiencies that are posted online include both standard surveys and complaint investigation surveys; at times, both types of surveys are combined. Reviewing posted surveys can give the public an indication of the types of issues that need attention at a particular nursing home.

Since March 2012, all survey findings have been posted on our Web site ( This Web site also contains other valuable consumer resources including information related to facility licensure information, the informal dispute resolution procedure (the facility’s right to contest our findings), the independent informal dispute resolution procedure, regulated facilities and statements of deficiencies, fines and survey findings (types of fines the nursing home may have), the Regulatory Focus Bulletin and frequently asked questions, rules and federal regulations (state and federal nursing home regulations), self-survey modules (how different survey areas are considered), staff and contacts, and training information (training program resources). In addition to information provided on our Web site, the CMS Web site ( allows consumers to compare nursing homes both in North Carolina and across the United States.

Nursing homes are ranked through a star system that is based on objective criteria including the facility’s health inspections, staffing levels, and quality measures that are based on the population of residents in the nursing home. The Web site utilizes the facility’s most recent health inspections. The staffing indicator is based on nursing hours per day and nursing care provided per day; this includes the facility’s staffing of registered nurses, licensed practical nurses, and nurse aides. The quality measures look at both long-stay indicators and short-stay indicators. Long-stay indicators consider the facility over a period of time and use the nursing home’s data on falls, urinary tract infections, residents’ self-reported pain, the number of residents at risk of incontinence, the number of residents at high risk for pressure ulcers, use of restraints, activities provided to residents, influenza and/or pneumococcal vaccinations, weight loss, depression, and use of antipsychotic medications. Short-stay indicators look at the resident’s stay in the facility for the first 30 days; these indicators utilize data related to pain, influenza and/or pneumococcal vaccinations, new pressure ulcers, and residents who are newly admitted with a prescription for antipsychotic medications. All of these are factored into an individual facility’s rating. Five stars is the best rating, and 1 star is the worst rating. Reviewing a facility’s quality measures, health deficiencies, and staffing patterns—and then taking this information when visiting the facility—helps consumers to assess a facility and determine whether they want their family member to receive care there.

The Nursing Home Compare Web site also provides other resources—such as a link to all state survey agencies and instructions on how to make a complaint against a nursing home—as well as information on what consumers should consider when choosing a nursing home, alternatives to nursing homes, Medicare coverage in nursing homes, and other data such as who owns a specific nursing home.

In the end it is always best to visit the facility before a loved one is admitted for care. The transfer to a nursing home is a stressful time, but looking at facilities and deciding on options prior to the transfer helps to lessen the stress.

Potential conflicts of interest. C.H.D. is an employee of the Division of Health Service Regulation.

Cindy H. DePorter, MSSW acting assistant section chief, Division of Health Service Regulation, Acute Home Care Section and Nursing Home Licensure Section, Raleigh, North Carolina.

Address correspondence to Ms. Cindy H. DePorter, Division of Health Service Regulation, Acute Home Care Section and Nursing Home Licensure Section, 2712 Mail Service Center, Raleigh, NC 27699 (