The challenges of regulation in long-term care.

R egulatory oversight of long-term care services has evolved over the past 20 years to include a matrix of activities focused on the safety and well-being of those served by an array of long-term care providers. Basic oversight involves regular survey visits of providers and investigation of complaints, both of which are carried out by the state agency responsible for the licensing of the various long-term care providers. In North Carolina that responsibility resides with the Division of Health Service Regulation (DHSR) in the Department of Health and Human Services. The survey process for residential providers is very similar in that surveys are conducted annually, are focused on compliance with rules and regulations, and, to a large extent, determine whether the care systems that providers have in place are meeting the health and safety needs of the residents they serve. The three types of long-term care providers that fall under DHSR’s oversight authority include skilled nursing homes, adult care homes—including assisted living facilities and family care homes—and residential facilities for people who are mentally ill, developmental disabled, and/or substance abusers. Each of the oversight programs are discussed in more detail below.