Adult Care Home Rating System

During the 2007 session of the North Carolina General Assembly, Senate Bill 56 (SB 56) was ratified implementing a Rating System for Adult Care Homes. SB 56 mandated the Medical Care Commission to adopt rules for issuance of rated certificates to adult care homes. These certificates will contain a rating based, at a minimum, on the following:

1. Inspections and substantiated complaint investigations conducted by the Department of Health and Human Services to determine compliance with licensing rules.
2. The initial ratings awarded to a facility pursuant to this rule will be based on inspections, penalties imposed, and investigations of substantiated complaints that revealed non-compliance with statutes and rules.

Adult care homes will be required to display the rating certificate in a location visible to the public.

Since the passage of the bill, draft rules were developed by the Medical Care Commission and proceed through a public hearing process. During this process, provider groups never spoke against the provision of access to information about all services available to all seniors: we support efforts to disclose information about adult care homes to seniors and their families, so that informed decisions can be made. It is our belief that the Star Rating system does not accomplish this goal. Would it not be more helpful to have access to current monitoring and survey data? Issues with the Star Rating system have been debated at length, and it still appears flawed based on the following:

1. The system is based on a 0–4 Star Rating. At least for the first two years, there will be no 4-Star communities in North Carolina. Achievement of the 4th Star requires two consecutive years of receiving 100% on the rating survey.
2. Once a rating is received, it will remain in place for one year. Circumstances often change—for the better or the worse—during a year, meaning that a rating can become obsolete and therefore meaningless before the next survey is conducted.
3. Even if a community requests a reinspection prior to the next annual survey, it can only be accomplished based on “availability of state staff” to provide the re-inspection.
4. Instead of rewarding rapid correction of problems and quality improvement for the benefit of existing and future residents and families, the rating system provides only a one-day-in-time snapshot of the actual care provided by a community.

All of this being said, the Star Rating system will become reality, and initial ratings will be assigned beginning in January of 2009. It is our hope that consumers will educate themselves about adult care homes using more than this single data point. It is imperative that visits and observations be made, questions asked, and decisions be made based on an overall impression of an adult care home. As a provider organization, we recommend that consumers use the checklist to get an overall and current perspective of any adult care home they may be considering.