Types of Senior Care in Buncombe County: A Plain-Language Guide
One of the first obstacles families run into is terminology. Assisted living, memory care, skilled nursing, adult care home, continuing care retirement community — these terms are often used loosely, sometimes interchangeably, and occasionally in ways that obscure more than they reveal. Getting them straight makes everything else easier.
This guide explains each major type of senior care available in Buncombe County: what it is, who it is designed for, what it typically costs, and how it is regulated in North Carolina. Use it as a starting point before reading any of our more detailed guides.
Independent living communities (also called senior living, retirement communities, or 55-plus communities) provide housing, meals, activities, and social community for older adults who are largely self-sufficient. Residents live in private apartments or cottages and participate in community life as they choose. Staff are not present to assist with personal care — residents who need help with bathing, dressing, or medications must arrange that separately through in-home care services or by transitioning to a higher level of care. Independent living is regulated lightly in NC compared to care facilities and does not require state licensure in most forms.
Assisted living facilities in North Carolina are licensed by the NC Division of Health Service Regulation (DHSR) as Adult Care Homes at the state level, though they are commonly marketed as assisted living. They provide housing, meals, personal care assistance (bathing, dressing, grooming, medication management), and social activities in a residential setting.
Buncombe County has 16 licensed assisted living facilities ranging from small family-owned homes to larger communities with over 100 residents. Residents retain their own rooms or apartments and typically move to a higher level of care (memory care or skilled nursing) when their needs exceed what the facility can provide. NC Special Assistance can offset approximately $1,228/month of cost for income-eligible residents. Read our full guide to NC Special Assistance.
North Carolina licenses small adult care homes separately from larger assisted living facilities. These are typically residential homes serving two to six residents, providing personal care assistance in a home-like environment. Staff ratios are often higher relative to resident count than in larger facilities, and the environment is quieter and more intimate. They are a good fit for people who find large facilities overwhelming. Buncombe County has a number of these smaller homes, and they are eligible for NC Special Assistance. They are licensed and inspected by DHSR under the same framework as larger facilities.
Read our full guide to small adult care homes in Buncombe County.
Memory care is a specialized care environment for people with dementia, typically housed in a dedicated secured unit within or adjacent to an assisted living facility. It offers higher staff-to-resident ratios, dementia-specific programming, physical environments designed to reduce disorientation, and a secured perimeter to prevent wandering. In North Carolina, memory care units are licensed as Special Care Units under the adult care home framework. Not every assisted living facility has a dedicated memory care unit — our Facility Directory identifies which ones do. Read our full memory care guide.
Skilled nursing facilities (SNFs), also called nursing homes, provide the highest level of residential care outside a hospital. Licensed nurses are on duty around the clock, and residents typically have more complex medical needs than can be managed in assisted living. SNFs serve two distinct populations: short-term residents recovering from a hospitalization through Medicare-covered rehabilitation, and long-term residents with chronic care needs who may rely on Medicaid for payment.
Buncombe County has 18 licensed skilled nursing facilities. They are regulated by DHSR and also certified by Medicare and Medicaid for federal payment. Inspection reports are publicly available through Medicare’s Care Compare website. Read our guide to NC Medicaid for long-term nursing care.
A continuing care retirement community (CCRC), now often called a Life Plan Community, is a campus that encompasses independent living, assisted living, memory care, and skilled nursing in one location. Residents typically enter at the independent living level and can transition to higher levels of care as needs change, often with contractual guarantees of access. CCRCs typically require a substantial entrance fee and monthly fees. The entrance fee structure varies — some are fully refundable, partially refundable, or non-refundable. North Carolina regulates CCRCs under a separate statute from traditional care facilities. Buncombe County has several CCRC options, and their combination of continuum and campus life appeals particularly to the independent retiree population that Asheville attracts.
In-home care agencies send aides into a person’s home to assist with personal care, meal preparation, light housekeeping, medication reminders, and companionship. This is distinct from skilled home health care, which involves licensed nurses or therapists and is covered by Medicare under specific clinical conditions. Non-medical in-home care is primarily private pay. The practical limits of in-home care — caregiver turnover, geographic coverage gaps in rural parts of the county, and cost at high hours of service — are worth understanding before relying on it as a long-term plan. Read our full guide to in-home care vs. facility placement.
Adult day programs provide structured daytime care — activities, meals, social engagement, health monitoring, and personal care support — at a center the person attends during the day and returns home from in the evening. They serve two purposes simultaneously: meaningful engagement for the older adult and respite for the family caregiver. Adult day services are licensed by DHSR in North Carolina and are considerably less expensive than full-time in-home care or facility placement. They are a good fit for people in early to moderate stages of dementia or physical decline who still live at home. The Council on Aging can provide referrals to local programs.
Read our full guide to adult day services in Buncombe County.
Hospice is a philosophy and a model of care, not a place. It can be delivered at home, in a nursing facility, in an assisted living setting, or in a dedicated inpatient hospice facility. Hospice shifts the goal from curative treatment to comfort and quality of life. A team of nurses, social workers, chaplains, and aides provides regular visits and is available around the clock for guidance and crisis support.
Medicare Part A covers hospice fully — including nursing visits, medications related to the terminal diagnosis, equipment, and aide services — when a physician certifies a life expectancy of six months or less if the illness runs its expected course. A person can remain on hospice longer than six months if they continue to meet the eligibility criteria. Buncombe County has several hospice organizations serving the area. Families consistently report that they wish they had engaged hospice sooner than they did.
| Care Type | 24-Hr Staff | Personal Care | Nursing On-Site | Public Benefit |
|---|---|---|---|---|
| Independent Living | No | No | No | None |
| Assisted Living | Yes | Yes | Limited | Special Assistance |
| Memory Care | Yes | Yes | Limited | Special Assistance (some) |
| Skilled Nursing | Yes | Yes | Yes | Medicare / Medicaid |
| In-Home Care | Arranged | Yes | No | None (non-medical) |
| Adult Day | Daytime only | Yes | Varies | Medicaid (varies) |
| Hospice | On-call | Yes | Yes (visits) | Medicare / Medicaid |
In North Carolina, assisted living facilities (including memory care units and small adult care homes) and skilled nursing facilities are licensed and inspected by the Division of Health Service Regulation (DHSR). Inspection reports — including any deficiencies cited — are public record and available on the DHSR website and through Medicare’s Care Compare tool.
Our Facility Directory links directly to DHSR records for each licensed facility in Buncombe County, along with ownership type, capacity, and contact information. It is a useful starting point before calling or touring any facility.
Related guides
A quick note: This page is general information, not medical, legal, or financial advice. Rules, rates, and eligibility change, and every family’s situation is different. Please confirm details with the facility, the relevant agency, or a licensed professional before making a decision. See our Disclosure.