Winston-Salem Senior AdvisorWhat is the main difference between an adult care home and a nursing home?
A nursing home provides licensed nursing care around the clock and is certified by CMS, while an adult care home provides supervision, personal care and medication help without daily skilled nursing; a resident who needs ongoing skilled care belongs in a nursing home.
Skilled care means tasks that require a licensed nurse or therapist: complex wound care, injections that staff cannot be trained to give, IV therapy, close monitoring after an unstable illness, or daily rehabilitation. The FL-2 that a physician completes records which level of care a person needs.
How do we know which level of care a parent needs?
Start with the FL-2 and the doctor's view, then list the daily tasks your parent needs help with and how often; frequent skilled tasks or two-person help around the clock point toward a nursing home, while help with bathing, dressing and pills points toward an adult care home.
Hospital discharge planners at Baptist, Forsyth Medical Center, Lexington or Davie Medical Center can tell you what level of care the team recommends after an admission. Ask them directly whether a short rehab stay first would help, and what would need to improve for an adult care home to work.
Who pays for an adult care home versus a nursing home in North Carolina?
Adult care homes are paid mostly privately, with Special Assistance for low-income residents and VA pension for some veterans; nursing homes are paid by Medicare for short skilled stays and by NC Medicaid for most long-term residents.
That difference shapes decisions. A family whose savings are modest may find that a nursing home becomes affordable sooner, through Medicaid, than an adult care home that does not take Special Assistance. CareScout's 2025 North Carolina medians are about $6,200 a month for assisted living and $9,733 for a shared nursing home room.
How are the two rated differently?
Adult care homes carry DHSR's state rating of zero to four stars; nursing homes carry CMS's one-to-five stars on Care Compare, with separate scores for inspections, staffing and quality; the two scales cannot be compared with each other.
Our directory shows each home's own rating, labelled by its source, and puts the survey or inspection results beside it. Compare adult care homes with adult care homes and nursing homes with nursing homes, never one against the other.
Are there campuses with both around Winston-Salem?
Yes. Several retirement communities in the five counties hold a nursing home license with adult care home beds on it, or sit at the same address as a licensed adult care home, so a resident can move between levels without leaving the campus.
That can be valuable for couples with different needs. Many of these are life-plan communities with entrance fees and their own admission rules, so ask whether someone from outside can be admitted straight to the nursing or assisted living side and whether Medicaid is accepted later. The Winston-Salem nursing homes page lists the combined campuses.
What it is, and what it is not
| An adult care home fits when | A nursing home fits when | |
|---|---|---|
| Care | Help with daily tasks and medications is enough | Skilled nursing is needed daily |
| Staff | Aides and supervisors, no nurse required on site | Licensed nurses around the clock |
| Ratings | DHSR stars, zero to four | CMS stars, one to five |
| Payment | Private pay, VA pension, Special Assistance | Medicare short stays, Medicaid long stays |
Based on N.C.G.S. Chapter 131D, 10A NCAC 13F and 13G, DHSR and NCDHHS documents, NC Medicaid, CMS, the VA, CareScout and the local agencies named above; see our editorial standards for how each is checked.
