By Rose Hoban

A bill that makes multiple tweaks to regulations in the adult care home industry made an easy transit through the General Assembly and is awaiting Gov. Roy Cooper’s signature to become law.

House Bill 657 is the product of people involved in the adult care home industry – some of them longtime foes – sitting down together and working out some compromises.

“It seems like one of those rare pieces of legislation that I could run that everybody is on the same page of,” said bill sponsor Rep. Justin Burr (R-Albemarle).

Burr was quick to admit that he had little to do with the actual crafting of the bill. He credited a group of stakeholders, led by the Department of Health and Human Services’ Division of Health Service Regulation, that asked him to shepherd it through the legislative process.

“They worked on it for five or six months before they brought it to me,” Burr said. “I’ve not heard one complaint.”

Tightening up on bad actors

Issues in the adult care home industry have been around for years: The facilities are intended for people who can’t live independently in the community yet who don’t really need the skilled care of a nursing home. By statute, the medical care for people in adult care homes is “usually occasional or incidental.”

Adult care homes were at the center of a 2010 conflict between the state and the U.S. Department of Justice over using the facilities to inappropriately house people with severe mental health issues alongside frail seniors. That dispute was settled in 2012.

Sometimes problems in the homes can be shocking, as demonstrated by violations listed on the DHSR website. There have been deaths, wandering incidents and incidents such as one in 2014 where managers of facilities in Montgomery and Guilford Counties cleaned out the offices, walking off with computers, televisions and fax machines before residents awoke.

Megan Lamphere, the adult care home section chief at DHSR said just this month, managers at a home in Caldwell County gave just days’ notice to residents to find a new place to live.

Until now, such operators received only a slap on the wrist , they could return and receive a new license to operate only 12 months later.

In the past, the most egregious violations came before a Penalty Review Board. But legislators eliminated that body last year, in a move that surprised many.

The new bill restricts those operators from receiving another license for five years. It also places new restrictions on operators who have so many problems that state inspectors are compelled to shut things down.

“This is the most severe action to take, it’s the most disruptive to the residents and to the staff,” Lamphere said. “This is the licensure action we take when there’s imminent danger to residents’ health and safety and we come in and immediately revoke those licenses.”

“And they could come back in six months and reapply for a new license.”

Lamphere said those folks will now have to wait for five years to get the green light to operate a facility again.

She said the new bill increases all types of prohibitions and gives the Division more power if an owner has outstanding fees or fines.

“Right now, a licensee, if they have $30,000 in penalties that are outstanding for a facility that they had, they can still apply for a new license and we can’t deny them.” Lamphere explained. “They don’t have to pay those fines before we license them again.”

But under the bill, owners will have to pay up before getting a new license.

Give and take

In exchange for more oversight, the state granted the adult care home industry some concessions. Owners had asked for a new, informal process to resolve disputes over inspection findings that could be used before receiving a penalty.

The new law will also create something of a peer review process, where facility owners can work things out with state and county inspectors before being fined or having their star ratings affected.


The other concession was around that star review system created in 2009.

Facility owners complained that if they were cited for a problem and their star rating dropped, it was hard to get the rating back up, even if problems were minor and had been resolved. A new informal process will allow for problem resolution without affecting ratings.

Bill Lamb, head of the Friends of Residents of Adult Care Homes, said he was afraid that reviewing the star ratings would make the system more complicated.

“There was frankly some discussion about doing away with star ratings entirely,” Lamb said. Instead the division agreed to take a second look at the star rating system to see how useful it’s been.

“While I will admit there are problems to the star ratings, I’m not ready to throw the baby out with the bathwater,” said Lamb who said he was pleased with the decision.

“Health care agencies should not have to go through the whole [star rating] process even if they’ve got a good record or if it’s a minor issue and they corrected it,” said bill co-sponsor Donna White, who worked at the DHHS Division of Aging and Adult Services before being elected to the legislature.

“We waste… so many good resources trying to invent the new wheel when we really just need to improve the spokes and take care of the wheel that we’ve already got.”

Division personnel will perform an evaluation and report on the star rating system to the legislature by next February.

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...