Giving Long-Term Care Facility residents and their families a voice.
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 CPRC Ombudsman Program gives long-term care facility residents and their families a voice by:
- Advocating 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.
- Monitoring the implementation of federal, state and local laws governing long-term care facilities
- Educating the public, residents, family members and facility staff regarding long-term care issues and elder abuse prevention, detection and reporting requirements.
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
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
Angela Woodard, 919.558.9404
Wake County Nursing Homes, Lee County Nursing Homes
Durham County Nursing and Adult Care Homes
Notes: When contacting an Ombudsman, they are often out of the office. Leave a message and they will return your call. 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.
Elder Abuse, Neglect and Exploitation
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
- Self-neglect that poses a risk to health or safety
- Emotional abuse
Warning signs 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.
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 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.
How does one afford long-term care when financial means are not readily available?
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.
Traditional Medicare (Part A) can cover up to a 100 days per benefit period in a skilled nursing facility if the individual meets certain criteria for a qualified stay and if Medicare deems such care necessary.
Medicare Advantage plans (Part C) may cover skilled nursing facility care but admission and coverage is determined by the Medicare Advantage provider, usually after discussion with the assigned care manager.
- Information about the Medicare skilled nursing care benefit
- How hospital "observation status" affects Medicare coverage
You 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 to receive long-term financial assistance. Apply for Medicaid at your local Department of Social Services or online.
Contact a Long-Term Care Ombudsman if you need assistance identifying a qualified facility.
Relocation to North Carolina
Medicaid benefits are not transferable between states. An NC application must be submitted for approval and will require establishment of residency in NC. See directions above for submitting an application
Skilled Care Alternatives
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.
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.
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?
- A discharge checklist can help with care transitions
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.
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.
Community Advisory Committee Volunteers
Each county appoints volunteers 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. Their primary role is to advocate is to maintain the intent of the Nursing Home and Adult Care Home Residents" Bill of Rights in facilities, promote promote quality of care, and advise County Commissioners on facility conditions within their county. Volunteers conduct formal and informal visits to facilities, and submit quarterly and annual reports of their observations to the Ombudsmen and to the county.