Fining the right facility for Mom can be a little more challenging than people realize, but there are some key factors to help you add structure to the search. Among the many are three main ones:

  1. Understanding the level of care that your Mom Needs
  2. How will you pay for the care, now and in the future?
  3. What are the legal concerns?

(Please be aware that most facilities are now calling themselves “communities,” and there is some merit to that. Once you start searching, you’ll see for yourself if it feels more like a community than a facility.)

Key One. Understanding the Level of Care that Your Mom Needs

Finding the right community for your Mom begins with understanding the level of care that your Mom needs to be sure that you’re shopping for a community that provides the appropriate level of care. The basic levels are 1) Independent Living, 2) Independent Living with Available On-Site Care Support, 3) Licensed Assisted Living, and 4) Skilled Nursing. Please note you should also understand whether your Mom will need “Memory Care” services or a “Memory Care Secure Environment” (locked entry/exit).

Independent Living: This is exactly as it sounds.  Your Mom is able to live “independently” with no additional support. She should be able to attend to all of her regular “Activities of Daily Living” (ADLS) such as bathing, dressing, toileting, walking, and the things that we usually take for granted.  An Independent Living community provides a “protective environment” with staff available for minor needs, from time to time.  There is usually a red-pull cord or “call system” should there be an emergency. A wide range of social and community activities are provided, transportation is available for short trips to a local shopping area, and a meal plan is provided for a community dining area.

Independent Living with “On-Site Care Support”: This type of community provides all the basics of an Independent Living Community, but also contracts with outside vendors to provide a team of CNAs or Non-Medical Aides available to assist with such things as Medication Reminders, Transferring to the toilet, bathing, dressing, and getting to the dining area (or having a meal brought to the room when necessary). Such additional support is available as part of a “Plan of Care” which costs an additional monthly fixed amount, or on an à la carte basis.

Licensed Assisted Living:  Assisted living provides a similar environment and social activities as the above Independent Living, options, but is focused on helping those who need more than just one or two ADLs. More importantly, the support personnel are employees of the community and the community is overseen and regulated by the State, and there is usually at least one medical professional (typically a certified nurse practitioner), on call, 24 hours a day.

Both independent living and assisted living communities have recreation schedules that are unique to each communities residents and their abilities. Common activities include game nights, field trips, support and discussion groups, holiday celebrations, exercise classes and continuing education courses. They also provide transportation services for shuttling residents to and from doctor’s appointments, the grocery store, and other errands.

Skilled Nursing:   Skilled Nursing communities will provide all that a Licensed Assisted Living Community provides but with more intensive hands-on care or “skilled nursing” care for those with serious mental or physical ailments. The environment is clearly not as “homey” or vibrant as an Independent Living or AL community since all residence has a high need for care.

Continuing Care Community: Continuing care retirement communities are retirement communities with accommodations for independent living, assisted living, and nursing home care, offering residents a continuum of care. A person can spend the rest of his life in a CCRC, moving between levels of care as needed. These facilities usually require a significant cash payment for entry, and extended obligations and commitments, which may limit your future options, and which should be carefully considered and reviewed before putting your mom in a CCRC.


While each community will offer, and in most cases require, an “assessment,  it would be a good idea for your Mom’s personal physician or a geriatric care manager to make recommendations as to the level of care needed. This discussion will also help you understand the “jargon” and language of community care. In addition, be aware one type of community can “mimic” another type.  This means that one community can provide the care of the next higher care community, but it may be more cost effective to “move up” to the high level of care community to meet your Mom’s needs.  This will be part of your “shopping” analysis.

Key Two. How will you pay for the care, now and in the future?

Once you’ve found what seems to be the appropriate community, the next important factor is how will you pay for the care?

The costs for care in North Carolina can range from:

Independent Living:                          $1,500 – $3,500/Month

Assisted Living:                                  $3,500 – $6,000/Month

Skilled Nursing:                                  $5,000 – $11,000/Month

So, with the average monthly income of an elderly person being only $2,000/Month, how dose one pay this now, and for the long run.

Independent Living:  The only available source will be whatever income is available on a monthly basis, plus withdrawals from savings or a retirement plan, or the  sale of a home or other assets. This is called “Private Pay” and may need to be supplemented with contributions from the family.

Independent Living + Supportive Services:   Again, private pay (as outlined above), but in addition there may be benefits available from The Veterans Administration if your Mom was a “War Time” Veteran who served during World War II, Korea or Vietnam, or married to one. This VA Benefit can provide $1,176/Month of additional income to pay for care or even more if Mom was the veteran. If your Mom is fortunate to have a Long Term Care policy, it may pay for the “support services’ needed, but it will not likely pay for the Room and Board costs.

Licensed Assisted Living. In addition to the above Private Pay options, including VA Benefits and help from a LTC Policy, some Licensed Assisted Living Communities may accept full payment from the State’s Medicaid Waiver Program. This is a VERY COMPLEX benefit and little understood.  Most important to know is that is it sometimes possible to retain a large portion of your Mom’s assets and home (to the family) and still qualify for the Medicaid Waiver Program to cover the cost of Licensed Assisted Living.  Again, this is a complex program with little-understood rules, but don’t dismiss the possibility without close examination of its possibilities.

Skilled Nursing: In addition to the above Private Pay options, VA Benefits and LTC Insurance, Medicaid for a skilled nursing facility is a generous program in North Carolina and is in most cases a good option to pursue. Again, it is a VERY COMPLEX benefit and little understood, with many loopholes and qualification strategies. As a result, many families end up losing all of Mom’s assets without knowing a lot or even all could have been saved.

Key Three. What are the legal concerns I should have?

There are many, but the three important ones are 1) legal documents, and 2) personal guarantees, 3) you may only get “one bite” at a strategy, and mistakes can be costly.

Basic Legal Documents: Most people don’t know that it is important to have in place the following documents for Mom before the situation deteriorates:

  • Financial/Durable Power of Attorney
  • Health Care POA
  • Living Will
  • Current (North Carolina) Compliant Will expressing ALL of your Mom’s estate desires.

There is always a temptation to simply get store forms or download them from the Internet. It is probably worthwhile to have an attorney assist with preparing these documents up front to make sure all contingencies are covered, the proper witnesses sign off, and even just to make sure there is an attorney who can attest to Mom’s legal competence to sign documents should the question ever come up.

Personal Guarantees: Even with these documents in place, moving your mom you into a community will involve a blizzard of paperwork that will resemble a real estate escrow closing. Be very careful that if you, as your Mother’s representative sign anything, sign only as your mom’s Power of Attorney. This means that you are obligating your Mother for any commitments or financial obligation, but not you and your family. Never sign as a personal guarantor. To do so would mean that YOU are legally responsible for any obligation your Mother incurs at the community.

Costly Mistakes: Unfortunately, like many other things in life, you may only get one chance to get things right, and mistakes can be extremely costly. Many people have heard about a five year Medicaid spend down, and some have heard it takes two months to process a Medicaid application. One client took it upon himself to mix those two and so he filed an application for his mother to receive Medicaid four years and ten months after she transferred substantially all of her assets to the kids. However, Medicaid looks back five years from the date the application is turned in, not from when they get around to making a decision. So Mom had about seven (7) years of ineligibility for Medicaid assessed because her son got the filing date wrong. So either be sure or let professionals handle it. When looking at what could be seven or eight thousand dollars or more each month that Medicaid could handle, it pays to get the strategy right.

This short article provides only a basic outline of things to consider when your Mom can no longer live by herself. If you need further help, we at the Care Assistance Center have a team which includes Registered Nurse, Geriatric Care Manager, Certified Medicaid Planners, VA Accredited Agents, and a legal team to help you understand and address these and many other issues. Please call us 919-518-8237 or visit us on the web at .