By Raleigh Senior Advisor Care Team · July 2, 2026
North Carolina doesn't issue a separate memory care license — it's a disclosure added to an existing adult care home license. Here's what that means in practice, and what physically and operationally changes in a secured memory care unit.
The Licensing Confusion, Cleared Up
Many families searching for care assume 'memory care' is its own regulatory category, separate from assisted living, the way a hospital and a nursing home are separately licensed. In North Carolina, that's not how it works. The state uses a single licensure category — 'adult care home' — under N.C. General Statutes Chapter 131D and 10A NCAC 13F, administered by the NC DHSR Adult Care Licensure Section (ACLS). There is no separate memory care license.
Instead, when a community operates a dedicated dementia care unit, it adds a Special Care Unit (SCU) designation to its existing adult care home license, governed by 10A NCAC 13F .1300 and the disclosure requirement in G.S. 131D-8, which was enacted through 1999 legislation. A community must file and receive state approval of a required disclosure statement describing the unit before it can market itself as offering a Special Care Unit for Alzheimer's, dementia, or related conditions.
What the Special Care Unit Disclosure Actually Requires
The disclosure statement a community files isn't marketing copy — it's a formal document, per the format specified on NC DHSR's own disclosure page, describing specifics of the unit including its programming philosophy, staffing patterns, physical environment features, and admission and discharge criteria for the unit. Families have a right to ask any community for a copy of this disclosure statement before touring or signing an agreement, and reading it closely is one of the most useful, underused steps in comparing memory care options, since it lays out exactly what the operator has committed to on paper.
One important nuance: this disclosure is a required transparency mechanism, not a quality certification. Filing an approved SCU disclosure statement confirms a community has met the state's structural and documentation requirements to call its unit a Special Care Unit — it is not the same as the state vouching for the quality of care delivered inside that unit day to day.
What Physically Changes in a Secured Memory Care Unit
Beyond the paperwork, real physical and operational differences typically distinguish a memory care unit from general assisted living within the same community. The most obvious is secured entrances and exits — controlled access points, often with keypad or badge entry, designed to prevent residents with dementia from wandering off the unit unsupervised, since wandering is one of the most serious safety risks associated with Alzheimer's and related dementias. Common areas within a Special Care Unit are also typically monitored more closely than in general assisted living, and many communities design memory care wings with simplified, consistent layouts, clear sightlines, and visual cues intended to reduce disorientation.
Staffing models often differ too. Memory care units frequently have staff trained specifically in dementia-care techniques — sometimes with credentials like Certified Dementia Practitioner status — and programming built around structured daily routines, sensory-based activities, and smaller group sizes than a general assisted living floor might use. Dining is often adapted as well, with modified textures, simplified table settings, or smaller dining groups designed for residents who may struggle with the sensory overload of a large dining room.
Same Building, Two Different Experiences: Triangle Examples
Several well-known Triangle communities operate both assisted living and memory care within the same license, illustrating how the SCU disclosure system works in practice. Sunrise of Raleigh, part of the national Sunrise Senior Living chain, offers both assisted living and a dedicated memory care program on the same campus. Spring Arbor of Cary similarly offers general assisted living alongside a specialized memory care neighborhood. TerraBella Knightdale offers assisted living and memory care within one community as well. In each case, a resident could in theory start in general assisted living and transition into the memory care unit later if cognitive decline progresses — without changing communities, just moving to a different, more secured part of the same building or campus.
This 'same roof, two programs' model is common throughout the Triangle, including at communities like Kingswood Reserve in Clayton and Dunmore Senior Living of Siler City in Chatham County, both of which offer assisted living alongside a purpose-built memory care or secured living option on one campus.
When a Community Is Memory-Care-Only
Not every memory care community is attached to a general assisted living wing. Some, like Clayton House in Johnston County, operate as dedicated memory care communities without a general assisted living population at all. These stand-alone memory care communities are built entirely around the secured-unit model from the ground up, rather than carving out a wing of a larger, more general assisted living building — which can mean a more thoroughly dementia-adapted physical environment throughout the entire building, since there's no need to accommodate a mixed population.
How Costs Typically Compare
Memory care within a licensed Special Care Unit generally costs more per month than general assisted living in the same community, reflecting the higher staffing ratios and specialized programming involved. The exact premium varies significantly by operator and market, so families should get a specific quote for the memory care level of care rather than assuming a general assisted living 'starting at' price applies. For a broader breakdown of how senior care costs are typically structured across the Triangle, see our guide to what senior care costs.
One Medicaid-related detail worth noting: North Carolina's State/County Special Assistance program, which helps low-income adult care home residents pay for room and board, pays a separate, higher rate specifically for Adult Care Home residents with Alzheimer's disease or a related disorder who reside in a licensed Special Care Unit — a distinction that doesn't exist for general assisted living residents under the same program.
Questions to Ask on a Memory Care Tour
Given that North Carolina's SCU system is a disclosure requirement rather than a quality rating, the burden falls on families to evaluate quality themselves during a tour. Useful questions include: What is the staff-to-resident ratio during day and overnight shifts specifically within the memory care unit? Can I see the current Special Care Unit disclosure statement? How does the community handle a resident whose needs progress beyond what the unit is equipped to manage — is there an in-house nursing option, or would the resident need to transfer elsewhere? What specific dementia-care training do direct-care staff receive, and how often is it refreshed? Asking these questions consistently across every community toured makes it far easier to compare programs that, on paper, all check the same regulatory box.
Verifying Compliance, and When Memory Care Isn't Enough
Before choosing between a general assisted living placement and a memory care unit, families can check any North Carolina adult care home's licensing status and inspection history — including the memory care wing specifically, since SCU compliance issues show up in the same inspection records — through NC DHSR's Adult Care Home Facility Inspections, Ratings and Penalties search tool. This state-specific compliance record is a narrower tool than the federal CMS Five-Star system used for nursing homes, since adult care homes aren't covered by CMS Five-Star, but it remains the most direct way to see a facility's documented compliance history before signing an agreement.
Even a well-run memory care unit has limits. As dementia progresses into its later stages, some residents develop medical needs — significant mobility loss, feeding difficulties, complex wound care, or behavioral symptoms that exceed what an adult care home's staffing model is designed to handle — that require a move to a skilled nursing facility with a dedicated dementia unit, such as Harnett Woods Nursing & Rehabilitation Center in Dunn, which pairs a 5-star CMS rating with a dedicated memory care unit within a licensed nursing facility. Asking a memory care community directly what its discharge criteria are, and whether it has a formal relationship with a nearby skilled nursing facility for this kind of transition, is one of the more overlooked questions families should ask early — ideally before move-in, not after a crisis forces the question.
