Are NC Assisted Living Facilities Required to Have Care Plans?

Yes — and the requirements are specific. North Carolina law mandates that every resident of a licensed adult care home (the legal term for assisted living facilities in NC) have a written, individualized care plan. This page explains what the law requires, when plans must be updated, and what families can do when a facility isn't meeting these standards.

The Legal Authority

Care planning requirements for NC adult care homes are found in:

G.S. § 131D-2.15 — statutory framework for resident care in adult care homes
10A NCAC 13F .0801 — Resident Assessment
10A NCAC 13F .0802 — Resident Care Plan

These rules apply to all licensed adult care homes in North Carolina, regardless of whether they accept Medicaid, Medicare, or private pay only.

What a Care Plan Must Include

Under 10A NCAC 13F .0802, a resident's care plan must:

Be based on the results of the resident's assessment
Be individualized — specific to this resident's needs, not a generic template
Describe the services, supervision, and tasks the facility will provide
Identify the level of assistance required for each service
State the frequency of each service
Include any tasks to be performed by licensed health professionals
For residents receiving services from external mental health or developmental disability providers, include contact information for those providers (including after-hours emergency contacts) to be used when significant behavioral changes occur

The care plan must be signed by the physician or physician extender within 15 calendar days of completion.

Initial Care Plan: Timeline

The facility must:

Complete a resident assessment within the required timeframe after admission
Develop a care plan based on that assessment within 30 days of admission

The care plan must be documented in the resident's record and available to staff who provide direct care.

When Must the Care Plan Be Updated?

Under 10A NCAC 13F .0801 and .0802, the care plan must be updated:

1. At annual reassessment The resident's assessment must be repeated at least annually. After reassessment, the care plan must be reviewed and updated to reflect any changes in the resident's condition or needs.

2. After a "significant change" When a significant change in the resident's baseline condition occurs, the facility must:

Monitor the change for up to 10 days to determine whether it represents a real change in baseline
If it does, complete a new assessment
Update the care plan based on that assessment
Have the physician or physician extender sign the updated plan within 15 calendar days

What constitutes a "significant change" under the rules:

| Category | Examples | |---|---| | Activities of Daily Living | Deterioration in two or more ADLs (bathing, dressing, toileting, eating, transferring) | | Mobility | Change in ability to walk or transfer; repeated or new-onset falls; fall with neurological change | | Pain | New onset or worsening pain in severity, duration, or new location | | Behavior/Mood/Cognition | New onset agitation, combativeness, or decision-making impairment | | Weight | Unplanned weight loss or gain above defined thresholds | | Diagnosis | New diagnosis affecting physical, mental, or psychosocial well-being | | Other | Loss of bowel/bladder control; new skin wounds or infection; significant decline in oral health |

What does NOT count as a "significant change":

Slight fluctuations that resolve within a few days
Predictable cyclical changes (e.g., seasonal mood variation in a diagnosed condition)
Acute illness that fully resolves
Changes that do not affect overall baseline function

What Families Can Do

Request a copy of the care plan. NC law gives residents (and their authorized representatives, including POA agents and guardians) the right to access the resident's care records. Ask the facility administrator directly. If they refuse or delay, that is itself a compliance concern.

Request a care plan meeting. Families can request a meeting with facility staff to review the care plan, raise concerns, and request specific changes. These meetings are a standard part of the care planning process in reputable facilities.

Document unmet needs. If the care plan is not being followed — if staff aren't providing services the plan says they will, or if the plan doesn't reflect the resident's actual needs — document this with specific examples and dates.

File a complaint with DHSR. The NC Division of Health Service Regulation (DHSR) licenses and inspects adult care homes. Complaints can be filed online at ncdhhs.gov/dhsr or by phone. DHSR will investigate and facilities can face deficiency citations and civil penalties for violations.

Use care plan records in legal proceedings. If guardianship, APS, or other legal proceedings are involved, the resident's care plan — and any gaps between the plan and actual care — can be subpoenaed as evidence.

The information on this page is for educational purposes only and does not constitute legal advice. Please consult a licensed North Carolina attorney for guidance specific to your situation. Learn more about ElderAdvocate.law.

Physical Safety Equipment: What NC Regulations Require

Physical safety equipment — wheelchair lap belts, bed rails, vest restraints, Hoyer lifts, and other assistive devices — is regulated in NC adult care homes under 10A NCAC 13F. The rules distinguish between protective devices (used for the resident's safety) and physical restraints (which limit movement and require greater justification).

For protective devices (e.g., lap belts used to prevent falls from wheelchairs):

Under NC regulations, protective devices may be used only with:

A physician or other authorized provider order
Written informed consent from the resident or their authorized representative
Documentation in the care plan explaining why the device is being used

The care plan must address: what the device is, why it's needed, what alternatives were considered, and how frequently the need will be reassessed.

For Hoyer lifts and mechanical lift equipment:

NC regulations require that facilities using mechanical lifts:

Assess whether the resident requires a mechanical lift as part of the admission and ongoing care planning process
Train staff on proper lift usage before they operate the equipment
Document lift usage and any incidents

If a facility says a resident requires a Hoyer lift for all transfers but has not documented the clinical basis for this determination or trained staff adequately, this is a potential regulatory violation.

What families can demand:

As the resident's responsible party or authorized representative, you have the right to:

Receive a copy of any orders for protective devices or physical restraints
Participate in care plan meetings where these devices are discussed
Refuse consent to a restraint or protective device (though the facility may then need to reassess whether it can safely care for the resident)
Request documented evidence of staff training on specific equipment

If a device is being used without your knowledge, without a physician order, or without documentation in the care plan, report this to the facility administrator in writing and, if not resolved, file a complaint with DHSR.