A developer could set up a Raleigh home for twenty older people per acre with no special-use permit or waiting period and no need to locate such a project on five acres—as current law dictates—under proposed changes in Raleigh's zoning language.
Called a "text change" to Raleigh's unified development ordinance, or UDO, the measure would rename congregate care, life care communities, and rest homes as "community care retirement communities," or CCRCs. These CCRCs are typically highly regulated centers for older people, with spots often sold for large chunks of money to people who want guaranteed care for a lifetime. Under the proposed ordinance, that term would extend beyond the facilities traditionally considered CCRCs and take in a new class of developments, some of which might not be regulated by the state.
Two questions have arisen about the change, which will get a hearing before the Raleigh City Council on January 2. The most important centers on whether the new language could result in the crowding of older people into low-end and even unsafe dwellings that now get to call themselves CCRCs.
"I've got concerns about it," says Bill Lamb, executive director of the nonprofit Friends of Residents in Long-Term Care. "Having affordable housing alternatives is an important consideration, but we also have to be very careful about identifying the providers. That's completely under the radar now. Those things are popping all over."
Meanwhile, some consumers may be confused by the use of the phrase "community care retirement communities." While CCRCs licensed by the state are regulated by the departments of insurance and health and human services, some homes set up under Raleigh's ordinance would require little to no oversight.
As of October, the Department of Insurance listed fifty-nine licensed CCRCs in North Carolina. The DHHS lists six hundred adult care homes, or assisted living facilities, in the state, along with about seventy facilities in a category called "multi-unit assisted housing with services," where only the work of outside caregivers is licensed.
In a 2015 RTI International report on unlicensed care homes, researchers said no state level estimates were available for North Carolina.
A Department of Insurance spokesman referred questions about the facilities to the Department of Health and Human Services. A DHHS spokeswoman sent the INDY back to the insurance department, with no result.
While critics worry that the terminology may lead some older adults to contract with less-reputable companies, David W. Owens, the Gladys H. Coates professor of public law and government at the UNC's School of Government, writes in an email that the language change "does not have any impact on social services licensing or any aspect of the management of the facilities."
Allowing the development of these facilities in dense areas, without permits that can take a year to obtain, also seems sensible to Owens. "Changing the requirement to get a special-use permit in the [high-density] districts simplifies the approval process in those districts," he writes.
State- and federally regulated CCRCs, such as Springmoor Life Care Retirement Community and SearStone in Wake County, include some or all of these elements: independent living, assisted living, and highly skilled care or nursing homes.
Because a CCRC contract is in large part a health insurance policy, the Department of Insurance keeps and makes public highly detailed information about them. After all, a person who spent six figures for a place in a CCRC might, after decades have passed, have lost the ability to determine the quality of his or her care.
A study released in July by researchers from RTI and Texas A&M produced troubling, though preliminary, findings about unlicensed care homes, called UCHs. "Many informants described conditions in UCHs as abusive, financially exploitative, and neglectful of residents' basic needs," the researchers found.
The study also cited accounts of unsanitary and uncomfortable places to live, with bedbugs and a lack of utilities; unsafe and inaccessible housing; bad medication management; and failure to meet codes resulting in unsafe wiring and a lack of smoke detectors.
If the city allows unregulated developers to build CCRCs with no oversight, the same sort of thing could happen here, critics warn.
Travis Crane, Raleigh's assistant director of planning and zoning, says city staff crafted the ordinance at the request of real estate developer Joe Whitehouse. It was Whitehouse who suggested that the city use the term CCRCs, calling it the "term of art."
Whitehouse did not return a call for comment Monday.