How North Carolina regulates memory care, and what to ask in Winston-Salem

Does North Carolina license memory care separately?

No. An adult care home that wants a dementia unit applies to DHSR for special care unit beds under 10A NCAC 13F .1300, and the approved beds become part of its existing license; a nursing home can hold special care unit beds in the same way.

In the five counties, 23 adult care homes hold special care unit beds (789 in total on DHSR's October 28, 2026 list), and 4 nursing homes hold another 104.

Because the phrase “memory care” on a website has no legal meaning, the special care unit count on the state's list is the quickest way to tell whether a secured dementia program really exists. Our memory care list is built from that count, not from advertising.

What written disclosure must a memory care unit give Winston-Salem families?

N.C.G.S. 131D-8 requires every special care unit to have a disclosure statement, reviewed as part of DHSR's approval, describing what makes the unit special so that families can compare programs on paper.

Expect it to cover the unit's philosophy, how residents are admitted, transferred and discharged, how care plans are written, dementia staffing and training, the physical layout and security, activities, the family's role and the costs. Ask for it before you visit and then use the visit to test it. If the statement promises structured activities every afternoon, ask to see this week's calendar and look for the activity in progress.

How are special care units staffed at night?

The rules require staff assigned to the unit who have dementia-specific orientation and training, but the number that matters to a family is one you have to ask for: how many people are physically inside the unit on third shift, and who covers when one of them is with a resident.

Night is when residents with dementia are most likely to be awake and restless, and when buildings run their leanest. Ask to see last month's actual third-shift schedule for the unit, not a ratio quoted at the front desk, and ask whether night staff are regular employees or agency workers. A unit where the same aides work nights week after week will know your parent's habits; a rotating cast will not.

What happens if a resident's dementia gets worse?

The disclosure statement must spell out the conditions that would lead to a transfer or discharge, and those conditions, not the brochure, decide whether a resident can stay as dementia advances.

Common turning points are aggression staff cannot redirect, a need for two-person help with every transfer, or medical needs that call for licensed nursing around the clock. Some residents in that position move to a nursing home with its own special care unit; in our five counties, a few nursing homes hold those beds. Ask, before moving in, which of those situations the unit has handled and what happened to the residents involved.

How does Special Assistance work in a memory care unit?

A resident of a special care unit who qualifies for State/County Special Assistance is paid at the Enhanced Rate rather than the Basic Rate, a higher monthly amount set each January, but each home decides whether to accept Special Assistance residents at all.

Source: NCDHHS Dear County Director letter EFS-SA-04-2025 (2026 Special Assistance rates), effective January 1, 2026. Each income limit is the rate plus the $70 allowance.

Ask early, and ask in writing, whether the unit takes Special Assistance, how many of its beds are held by residents using it and what happens if a private-pay resident's money runs out. A family that plans for that conversation a year ahead has many more options than one that raises it the month savings hit zero.