North Carolina's DHSR licenses two community-care categories split by SIZE, not acuity — here's how an Adult Care Home differs from a Family Care Home, and where memory-care Special Care Units fit.
By Charlotte Senior Advisor Care Team — Licensing & Memory Care Team · March 28, 2026
In North Carolina, one state division licenses all of residential senior care: the NC Division of Health Service Regulation (DHSR), part of NCDHHS. This is a key difference from some other states that split licensing across two separate departments — North Carolina does not. Within DHSR, the Adult Care Licensure Section licenses two community-care categories under G.S. 131D: the Adult Care Home (7 or more beds, sometimes called a 'home for the aged and infirm') under 10A NCAC 13F, and the Family Care Home (2 to 6 beds) under 10A NCAC 13G. The line between them is drawn by SIZE and bed count — not by acuity tier or a higher versus lower level of care.
In everyday marketing, many communities across Mecklenburg, Cabarrus, Gaston, Union, and Iredell counties simply call themselves 'assisted living' regardless of which license they actually hold — so the marketing name alone doesn't tell a family which regulatory category applies. A Family Care Home is often a converted house with a handful of residents and a high caregiver-to-resident ratio; an Adult Care Home is a larger community with more amenities. Always ask directly: 'Are you licensed by DHSR as an Adult Care Home or a Family Care Home, and how many beds?' and verify the answer against the DHSR facility search.
Nursing homes are a separate category, but — and this is the part families find surprising — they're licensed by the SAME division, DHSR, through its Nursing Home Licensure and Certification Section under 10A NCAC 13D, plus CMS certification. So it's one division, different sections and rule chapters: adult care and family care homes under the Adult Care Licensure Section, nursing homes under the Nursing Home Licensure and Certification Section. When checking a facility's record, you use one DHSR facility search that covers all of them, rather than hunting across two different agencies.
Memory care in North Carolina isn't a separate license category — it's delivered through a Special Care Unit (SCU) designation, a distinct DHSR designation for an Alzheimer's or dementia unit within a licensed Adult Care Home. An SCU carries added staffing, training, and disclosure requirements beyond a standard adult care home. When touring a memory-care unit, ask specifically whether it carries the SCU designation and what dementia-care disclosure the community provides, since that's what distinguishes a genuine secured memory-care setting from a general adult care home that simply accepts residents with mild cognitive issues.
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