{"id":99793,"date":"2025-07-28T16:23:28","date_gmt":"2025-07-28T16:23:28","guid":{"rendered":"https:\/\/www.europesays.com\/us\/99793\/"},"modified":"2025-07-28T16:23:28","modified_gmt":"2025-07-28T16:23:28","slug":"rural-nc-county-sees-rapid-rise-in-unregulated-care-homes","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/99793\/","title":{"rendered":"Rural NC county sees rapid rise in unregulated care homes\u00a0"},"content":{"rendered":"

By Jaymie Baxley<\/strong><\/p>\n

In the winter of 2021, social workers in rural Wilson County were overwhelmed by a surge in reports of adults with disabilities being abused.<\/p>\n

In a typical month, the county\u2019s Department of Social Services receives about 30 such complaints. But that February, the agency fielded 33 reports in just seven days.<\/p>\n

When Nichole Atkinson, manager of the department\u2019s Adult and Family Services program, began to investigate, she noticed a common thread: The reports all originated from residences known as Multi-unit Assisted Housing with Services, or MUAHS.\u00a0<\/p>\n

Unlicensed and largely unregulated, the houses occupy a gray area in North Carolina\u2019s long-term care system. They are broadly defined by state law<\/a> as facilities where patients can choose their own service providers and where personal care is \u201carranged by housing management.\u201d<\/p>\n

That essentially makes them independent living settings \u2014 places where residents retain autonomy and are free to come and go, hire their own caregivers and manage their own finances. Yet many of the complaints received by Atkinson\u2019s office described situations in which residents with behavioral health conditions were being denied access to their money, food stamps and medication \u2014 basic resources they were supposed to control themselves and have rights to.<\/p>\n

After some digging, she learned that several MUAHS houses in Wilson County had been misleadingly advertised to residents\u2019 families and doctors as assisted living communities, which in the public imagination can conjure up visions of dining rooms and plentiful recreation, along with assistance with health needs.\u00a0<\/p>\n

These facilities were anything but. Atkinson said MUAHS operators are only legally required to provide residents with a daily meal. In some houses, simple furnishings like bed frames are considered amenities.\u00a0<\/p>\n

But the deceptive advertising, she said, is technically allowed under state law, which confusingly classifies the houses as one of three types of\u00a0 \u201cassisted living residence[es]\u201d recognized in North Carolina.\u00a0\u00a0\u00a0<\/p>\n

\"TextText on the N.C. Division of Health Service Regulation\u2019s website, top, notes that MUAHS houses are not licensed assisted living facilities, but state law defines them as assisted living. Credit: Jaymie Baxley\/NC Health News<\/p>\n

The houses are not subject to routine inspections and monitoring like assisted living facilities, nor are their residents protected by the state\u2019s Care Home Bill of Rights.<\/a>\u00a0<\/p>\n

\u201cThese homes have no oversight,\u201d Atkinson said. \u201cNo one is required to go in to make sure that they have proper zoning and proper construction, or that proper rules are in place. There\u2019s no vetting of who owns or operates them.\u201d<\/p>\n

The hospital incident\u00a0<\/strong><\/p>\n

In the years since that rash of reports, the houses have been a persistent problem in Wilson County.\u00a0<\/p>\n

Then came the hospital incident.\u00a0<\/p>\n

On the weekend of Aug. 12, 2023, a local MUAHS operator brought all 34 of his residents to the 20-bed emergency department of Wilson Medical Center. All of them had behavioral health issues.\u00a0<\/p>\n

Chris Munton, then CEO of the hospital, said the department\u2019s emergency staff typically treat three to four behavioral health patients a day. It usually takes six more days, he said, to find a place that can provide those patients with an \u201cappropriate level of care\u201d after they\u2019ve been discharged.<\/p>\n

Hospital staff and administration scrambled to meet the needs of a large group of people with lots of needs. The influx of patients forced Wilson Medical Center to activate a special command center typically used during hurricanes and other natural disasters.\u00a0<\/p>\n

\u201cIt was discovered that an owner of multiple MUAHS in the area had gone out of town and did not have anyone to provide the required one meal a day for their residents,\u201d Munton told the city council in Wilson, the county seat, during a June 2024 meeting. \u201cTo solve this dilemma, the owner brought all their residents to the ED.\u201d<\/p>\n

The incident led to an audit that revealed more than 60 percent of all behavioral health patients seen at Wilson Medical Center from 2021 to 2023 had been residents of MUAHS houses. An \u201calarming\u201d number of those patients had traveled from other states to live at the facilities, according to Munton.<\/p>\n

Some MUAHS operators, he added, appeared to be using the hospital as a \u201cholding station\u201d for residents who \u201cbecome too aggressive or unstable.\u201d<\/p>\n

\u201cThese patients often do not require immediate health care assistance but are left at our facility to alleviate unwanted disruption within the MUAHS house,\u201d he said. \u201cWithout any accountability or guardrails to how these MUAHS operate, Wilson Medical Center is left to care for and find placement for these patients, even if they do not require emergency care.\u201d<\/p>\n

Munton left Wilson Medical Center less than two months<\/a> after his remarks to the council. The hospital did not respond to written questions from NC Health News.<\/p>\n

Unwitting epicenter<\/strong><\/p>\n

MUAHS houses have existed in the state since 2001, when the N.C. General Assembly passed legislation recognizing them as part of a broader effort to expand residential options for older adults and people with disabilities.<\/p>\n

The goal was to provide a flexible model of care that would allow residents to live more independently than in traditional adult care homes or nursing facilities, while still having access to support services. These settings were intended for individuals capable of directing their own care, and the state placed fewer regulatory requirements on them than on licensed facilities.<\/p>\n

Over time, however, the lack of oversight has made the houses a \u201cregulatory black hole,\u201d said Corye Dunn, head of public policy for Disability Rights North Carolina.\u00a0<\/p>\n

Unlike adult care homes, which must meet staffing and quality standards, MUAHS facilities operate with minimal state involvement.\u00a0<\/p>\n

Kimberly Irvine, director of Wilson County DSS, said this regulatory gap, combined with growing demand for affordable housing and supportive care, has created a system ripe for abuse.\u00a0\u00a0\u00a0<\/p>\n

\u201cThis program was developed to be an alternative to more expensive, restrictive nursing home care,\u201d she said. \u201cBut with the lack of regulations and [no] licensing requirement, that has kind of opened the door for people that want to exploit our disabled and elderly.\u201d<\/p>\n

\u201cThe state has very little power, but very vulnerable people are often housed there,\u201d said Dunn, whose organization also has access to the facilities. <\/p>\n

The number of MUAHS houses in North Carolina grew significantly in the wake of the COVID-19 pandemic, which exacerbated the nation\u2019s ongoing mental health crisis and intensified demand for community-based housing for people with disabilities. An NC Health News analysis found that just 87 of the state\u2019s 141 registered houses<\/a> were in business before 2020.<\/p>\n

Wilson County, which had no MUAHS houses before the pandemic, has become the unwitting epicenter of that growth. Fourteen facilities have set up shop there over the past five years, more than any other county in the state over the same period.\u00a0<\/p>\n

And that\u2019s just counting the ones that are registered. Irvine said several houses in the county \u2014 ranked as the state\u2019s 25th most populous by the U.S. Census Bureau \u2014 are being run off the books with near impunity.\u00a0<\/p>\n

\u201cOperating one of these facilities without being registered is the lowest misdemeanor with the lowest fine,\u201d she said. \u201cThey\u2019re going to pay the fine and continue to operate, so there really is no penalty.\u201d<\/p>\n

Atkinson, the DSS program manager, noted that some houses in Wilson County are \u201cactually run properly.\u201d But for reasons she and others don\u2019t fully understand, the community has become a hot spot for unscrupulous operators.<\/p>\n

Behind closed doors<\/strong><\/p>\n

Many of the so-called facilities in Wilson County are little more than aging single-family dwellings scattered across residential neighborhoods \u2014 indistinguishable from the homes around them.\u00a0<\/p>\n

The operators make their money, she said, by withholding residents\u2019 Social Security benefits. They also claim any payments made to residents through the state\u2019s Special Assistance In-Home program<\/a>.<\/p>\n

\u201cThe individuals are really not seeing any benefit from their Social Security check, in addition to their Special Assistance In-Home payment,\u201d Atkinson said, adding that some operators collect as much as $1,900 a month per resident.\u00a0<\/p>\n

Dunn said she has seen operators charge \u201csurprisingly high rental rates for surprisingly poor conditions with poor access to food and services.\u201d<\/p>\n

There have also been cases, she said, in which the owners of licensed facilities with more oversight, such as family care or adult care homes, have opened MUAHS houses.<\/p>\n

\u201cThey recruit someone to the licensed facility and then after a while, if they\u2019re the right profile, they let the person know, \u2018Hey, there\u2019s another opportunity and do you want to move in?\u2019\u201d Dunn said.\u00a0<\/p>\n

\u201cThese are options that are designed to extract as much money as possible from people with disabilities,\u201d she added. \u201cOnce that bed opens up in that licensed facility, they have a pipeline of people to come in to the more profitable MUAHS.\u201d<\/p>\n

County social workers have documented troubling conditions inside the homes.\u00a0<\/p>\n

In several cases, Atkinson said, residents were found sleeping on bare mattresses placed directly on the floor. Others were living four or more to a room, crammed into tight quarters with no privacy.<\/p>\n

An NC Health News review of incorporation filings and local tax records found that several houses in Wilson County are not even owned by the entities that operate them.<\/p>\n

\u201cWe\u2019ve had some encounters where we found out operators were renting from rental properties,\u201d Atkinson confirmed. \u201cDuring our evaluations, we learned that some of the landlords did not know that the properties were being used as businesses. They thought they were renting to one person.\u201d<\/p>\n

Wilson Mayor Carlton Stevens did not respond to messages seeking comment from NC Health News, but local elected officials have indicated they\u2019re aware of the issue.\u00a0<\/p>\n

During the June 2024 board meeting, Councilman Donald Evans acknowledged that Wilson had been experiencing \u201cproblems with these facilities for quite some while.\u201d\u00a0<\/p>\n

\u201cThey can move into any neighborhood, set up homes anywhere they want to without notifying anybody, and that\u2019s a real problem that I have,\u201d he said of the houses\u2019 operators. \u201cThey should not be allowed to move anywhere they want to within our city without us having any control over it.\u00a0<\/p>\n

But the city\u2019s hands were tied, Evans said, because the houses are authorized by the state.<\/p>\n

\u2018Basic human standard\u2019<\/strong><\/p>\n

As chairman of the board that oversees<\/a> Wilson County Department of Social Services, Dante Pittman is well acquainted with the community\u2019s MUAHS predicament.<\/p>\n

Last November, the 29-year-old Democrat was elected to represent the district that covers Wilson County in the N.C. House of Representatives, giving him a legislative platform to tackle the issue.<\/p>\n

\u201cI told our board that I\u2019m tired of just talking about it,\u201d he said in an interview with NC Health News. \u201cIt\u2019s time that we at least introduce some legislation and work with our partners at the state level.\u201d<\/p>\n

In April, Pittman filed a bill<\/a> that seeks to enhance regulation of MUAHS houses. Among other things, it would prohibit the houses from being advertised as assisted living facilities and would ban operators from accepting residents with significant cognitive or functional impairments.\u00a0<\/p>\n

When discussing the proposed legislation with his fellow lawmakers, Pittman is quick to point out that he doesn\u2019t want to eliminate the houses. His goal, he said, is simply to ensure they\u2019re subject to some level of oversight.<\/p>\n

\u201cI\u2019m careful when I speak with folks because I don\u2019t want them to think that I don\u2019t see housing, or the lack thereof, as a tremendous problem,\u201d Pittman said. \u201cI understand that, and I\u2019m working with others to try to address it, but there\u2019s got to be a basic human standard that\u2019s a part of this solution.\u201d<\/p>\n

State Rep. Sarah Crawford (D-Raleigh) is co-sponsoring the bill. Outside of politics, she serves as CEO of TLC, a Wake County nonprofit, formerly known as the Tammy Lynn Center, that provides residential services to adults with intellectual and developmental disabilities.\u00a0<\/p>\n

\u201cWe\u2019re regulated by everybody and their brother, sister and second cousin,\u201d she said of her organization. \u201cWe have many, many eyes on us, and we have to make sure that we\u2019re following all the rules because every individual deserves the right to live in a safe environment.\u201d<\/p>\n

\"StateState Reps. Dante Pittman, left, and Sarah Crawford have sponsored legislation that would enhance regulation of MUAHS facilities. Credit: NC General Assembly<\/p>\n

Crawford doesn\u2019t think the changes proposed in Pittman\u2019s bill would harm MUAHS facilities that are being run the way they were originally intended to be. She said it might, at worst, create \u201csome additional paperwork\u201d for operators, but the burden \u201cshould be very minimal.\u201d<\/p>\n

\u201cIf they\u2019re doing the right thing, they shouldn\u2019t have any fear,\u201d she said. \u201cBut we need to have a process for getting bad actors either out of the business or helping them make reformation so that they can provide better care.\u201d<\/p>\n

Once filed, though, the bill has not progressed at the legislature.\u00a0<\/p>\n

Stopping a spread<\/strong><\/p>\n

Most of the state\u2019s MUAHS facilities are not run like the ones in Wilson County. In fact, they stand in stark contrast.<\/p>\n

Cambridge Village Optimal Living has 422 units across three campuses in Wake and New Hanover counties, making it by far the largest MUAHS operator<\/a> in North Carolina. The company\u2019s newest site, The Cambridge at Brier Creek in Raleigh, boasts 132 one-bedroom and 63 two-bedroom units \u2014 the most of any facility registered with the state.<\/p>\n

Its other facility in Wake County, Cambridge Village of Apex, is a 121-unit campus that has been registered since 2011. Cambridge Village of Wilmington, the site in New Hanover County, launched in 2017 with 106 units.\u00a0<\/p>\n

At each facility, residents have access to a wide range of amenities and on-site health care services<\/a> from licensed providers.\u00a0<\/p>\n

But Cambridge, which did not respond to a request for comment from NC Health News, advertises the campuses as independent living communities, not assisted living settings. Their website boasts of chef-driven restaurants, salons and heated swimming pools \u2014 a far cry from the houses in Wilson County, which don\u2019t even have websites.<\/p>\n

Nash County, which neighbors Wilson and is also represented by Pittman in the General Assembly, is home to 16 MUAHS facilities \u2014 the most of any county in the state. In an email to NC Health News, Denita DeVega, director of the Nash County Department of Social Services, said her office hasn\u2019t \u201cencountered any significant problems\u201d with the houses there.<\/p>\n

But Pittman believes it\u2019s only a matter of time before the issues reported in Wilson County begin occurring in other communities.<\/p>\n

\u201cIf we don\u2019t take care of this now, I\u2019m afraid we will see it replicated all across our state,\u201d he said.<\/p>\n

This article has been updated to clarify that Disability Rights North Carolina has access to MUAHS facilities. \u00a0<\/p>\n

Republish This Story<\/p>\n

\"Creative<\/a><\/p>\n

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