ATTENTION: NC SENIOR LIVING ASSOCIATION
COVID-19 UPDATE 7/14/2020
A note from Executive Director Jeff Horton -
NCSLA has been proud to offer these helpful updates routinely the past few months as a service to ALL Assisted Living Communities across the state. If you believe these updates have been helpful to you, your staff and residents, we ask that you to consider
joining NCSLA
. Our whole reason for being is to advocate and provide education to North Carolina's Assisted Living Communities and we need your help and support to continue our mission. Thank you for all that you do!
Below are recent developments regarding COVID-19. Providers are encouraged to check the
NC DHHS COVID-19 webpage
for the latest updates
regarding the virus and the state's response.
- NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 89,484 cases, which is a 2.2% increase in cases from Monday (7/13 had 87,528 cases). In addition, there are 1,109 currently hospitalized and there have been 1,552 deaths related to the virus. Hospitalizations are also at a record high with 1,109 people currently hospitalized with COVID-19. As of July 13th, there have been 67,124 Patients Presumed to be Recovered. You can view the number of cases and other data Here.
- NEW: NC DHHS Likely To Revise Visitation, Dining, and Activities Guidelines This Week - NC DHHS last week worked on revising guidance for residential care facilities (includes Adult Care Homes) in the areas of visitation, dining, and activities. While outdoor visitation is still recommended, the NC DHHS is likely to allow looser restrictions regarding dining and activities inside the facility. Although the guidelines are not final, you can view and download the DRAFT document Here. The guidelines for outdoor visitation essentially remain the same, however, the new guidelines will allow communal dining and group activities as long as social distancing is maintained. (For further information on previous guidance on visitation, please see below article regarding Executive Order No. 147.)
To be eligible to apply, the applicant must meet all of the following requirements:
- Must not have received payment from the $50 billion General Distribution (note: earlier payments can be returned to preserve eligibility - to find out if you have received earlier payments, you can call the CARES Provider Relief line at (866) 569-3522); and
- Must have directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; and
- Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or healthcare clinic); and
- Must have provided patient care after January 31, 2020; and
- Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
- If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee
- NEW: NC DHHS Announces Pop-Up Testing Sites for COVID-19 - Yesterday (7/9), NC DHHS announced a number of Pop-Up testing sites across the state for COVID-19 for today and the next number of days ahead. You can view the sites and further information Here. In addition, NC DHHS recommends that "Anyone interested in getting tested should contact the test site before they go to confirm testing criteria, availability, hours and registration."
- (Re-print from earlier communication) NC DHHS to Deploy Up to 300 Free Testing Sites for COVID-19 in Underserved Communities - NC DHHS announced 7/7/2020 the launch of the Community testing in High-priority And Marginalized Populations (CHAMP) Initiative to increase access to no-cost COVID-19 testing for African American, LatinX/Hispanic and American Indian communities that currently have limited testing sites. According to NC DHHS, "A disproportionately high percentage of North Carolina’s confirmed cases of COVID-19 have occurred among historically marginalized populations. Mounting evidence shows the members of these populations experience higher rates of COVID-19 mortality and serious complications."
- "As many as 300 temporary testing sites will be deployed throughout the month of July, including drive-thru and walk-up sites. North Carolina has identified two vendors to begin this work, Vidant Health and Orig3n, Inc. Both vendors will deploy new no-cost testing sites to underserved communities identified by DHHS and bring additional lab capacity to the state. The initiative will increase testing capacity in more than 100 ZIP codes, providing testing access for 2.2 million African American, LatinX/Hispanic and American Indian individuals."
- The NC DHHS also issued a Statewide Standing Order that allows testing sites to collect and submit samples to a laboratory for COVID-19 testing without requiring a specific (physician) order and authorizes testing sites to receive results directly from laboratories. This will facilitate community-based testing sites and reduce barriers to testing, especially for members of historically marginalized populations who may be less likely to have a medical home. You can view/download the Statewide Standing Order Here.
- UPDATE: NC Medicaid Issues Medicaid Bulletin Informing Providers That Enhanced Reimbursement Rates for COVID-19 to Remain in Effect Until At Least September 2020 - Wednesday (7/8), NC Medicaid Issued Special Bulletin COVID-19 #107 (Click Here) that keeps enhanced Medicaid rates related to COVID-19 in place through September 2020. For Medicaid PCS providers, this means the current rate of $4.51/15 minute unit or $18.04/hour remains in effect. NCSLA has worked hard the past number of months with both NC DHHS and the North Carolina legislature to keep enhanced Medicaid funds in place for adult care home and family care home providers as they take care of our high risk resident population. Of course if an adult or family care home has a COVID-19 outbreak (defined as two or more COVID-19 positive residents, staff or combination thereof), it will received a further enhance rate of $30/hour and additional PCS hours (See below article regarding "Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients").
- (Re-print from earlier communication) NC DHHS Division of Health Service Regulation (DHSR) Informs Adult Care and Family Care Homes of Mandatory Training - DHSR Adult Care Licensure Section (ACLS) sent out information to certain adult care and family care homes this past Monday, 7/6, of the following mandatory training:
- If the facility had "received a citation/violation in any infection control rule or statute from September 9, 2019 to March 9, 2020, you (the provider) will be receiving notification from the Adult Care Licensure Section today regarding training that all employees of the facility will be required to completed pursuant to section 3E.3.(b) of Session Law 2020-3."
- Providers are asked to "Please pay close attention to the letter, training requirements, and requirements for submitting verification of completed training to ACLS. This training shall be completed no later than August 5, 2020."
- If a provider did not receive notification from ACLS yesterday, then the facility is exempt from this required training.
- (Re-print from earlier communication) Community Care of North Carolina Issues Easy to Understand COVID-19 Testing Guide - Community Care of North Carolina recently released an easy to understand COVID-19 Testing Guide (Click Here). Given the fact there is so much information available regarding COVID-19 and testing, we find their guide provides answers to question, such as when someone should get a viral test or if an antibody test is indicated, in a simple and easy to understand format.
- (Re-print from earlier communication) Governor Cooper Holds Press Conference and Issues Executive Order No. 147 - On June 27th, Governor Cooper held a press conference and announced the following:
- Because of the continued upward trends in COVID-19 related metrics, along with concern for both the public health and for our hospital capacity, North Carolina will remain in Phase 2 (Information Here) until at least Friday, July 17; and
- North Carolina is adopting a face covering requirement to help slow the spread of COVID-19, making it mandatory for people to wear a cloth covering over your nose and mouth when they are indoor and in outdoor public places, where staying 6 feet from people who are not part of their households is impossible.
- Executive Order No. 147 - The Governor also issued a new Executive Order (Click Here) effective June 28th at 5 p.m. that contains new requirements for Long Term Care Facilities and states: "All workers in Long Term Care ("LTC") Facilities, including skilled nursing facilities ("SNF"), adult care homes ("ACH"), family care homes ("FCH"), mental health group homes, and intermediate care facilities for individuals with intellectual disabilities ("ICF-IID"), must wear Face Coverings while in the facility, and those Face Coverings must be Surgical Masks, as long as Surgical Mask supplies are available." To determine what constitutes a "Surgical Mask" we should point out it is NOT an N95 mask but a one time use face mask. You can view/download Centers for Disease Control (CDC) guidance regarding masks Here.
- You can view/download Frequently Asked Questions (FAQs) to Executive Order No.147 Here.
- Executive Order No. 147 also only extends long term care visitation restrictions to nursing homes and nursing homes with assisted living beds (combination homes) and therefore, REMOVES VISITATION RESTRICTIONS FOR ALL OTHER LONG TERM CARE PROVIDERS INCLUDING ADULT CARE HOMES AND FAMILY CARE HOMES.
- As a result, on 6/25 the NC DHHS this released outdoor visitation guidance for adult care homes (Click Here) and indoor and outdoor visitation for family care homes (Click Here). (Note: The family care home guidelines allow for indoor visitation as long as a specially designated area is identified.)
- Since the criteria for allowing outdoor visitation is strict, we strongly encourage providers to read the guidance very closely and only consider allowing outdoor visitation when they are confident they can provide a safe visitation experience for their residents that reduces or eliminates potential exposure and spread of the COVID-19 virus.
- For questions regarding any of the above information, please contact Jeff Horton at jeff@ncseniorliving.org
- (Re-print from earlier communication) Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients - As reported previously, NC Medicaid is directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID-19 residents in a congregate care setting. This targeted assistance is retroactive to April 1, 2020.
- UPDATE: NCSLA vendor member Richard Rutherford has been working through the process of getting the practical details on the Hardship Advance and the increased Medicaid PCS rate and hours and is willing to provide help, free of charge to NCSLA members, any provider that qualifies due to a COVID-19 outbreak in their facility. Richard's contact information is: Email: Medicaidwiz@gmail.com or Cell: (919) 264-2398
- Templates are now available on the Cost Reports and Assessments web page and contain the following documents:
- NC Medicaid COVID Outbreak Report Template Cover (Click Here) provides guidance on completing the following form which is:
- the NC DHB Outbreak Facility Reporting Date Provider Name Template (Click Here)
- For more information, please see SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients
- As noted in earlier NCSLA communications, NC Medicaid will pay providers an Expedited Hardship Advance (payment) based on the adult care home's PCS billings for January and February 2020 and multiplied by a factor of 1.25, the provider can receive a Hardship Advance to help offset the increased costs of caring for COVID-19 residents.
- ACH COVID-Outbreak Site PCS Reimbursement Increase -
- An ACH COVID-Outbreak site will be assigned NPI-specific rates that allow them to be reimbursed the increased rates for services provided. The current 15-minute unit rate will be increased to $7.50 per unit ($30/hr) for all Medicaid PCS beneficiaries in an ACH COVID-Outbreak site. Providers should bill their usual and customary charges.
- An ACH COVID-Outbreak site may bill up to 100 additional service hours per month for each beneficiary with current prior approval up to 80 hours per month.
- An ACH Outbreak site may bill up to 40 additional service hours per month for each beneficiary with current prior approval greater than 80 hours per month.
- (Re-print from earlier communication) Submitting Documents Regarding One-time Payment of $1325 for Each SA Resident - As communicated previously, NCSLA has worked with officials at the NC DHHS and with legislators to communicate our industry's needs during these unprecedented times. As a result, Session Law 2020-4 (Click Here) that contained a provision for a one-time payment of $1325 to providers for each State/County Special Assistant (SA) resident was passed and signed into law on May 4th by Governor Cooper. The NC DHHS Division of Aging and Adult Services, which administrates the SA program, issued the following notifications.
- PLEASE NOTE: Although the forms embedded in the below "Letter to Owners/Operators" were due June 11th, we have since confirmed with NC DHHS that since the $1325 SA payments are scheduled in five increments with the last one being in October, the final cutoff to submit the W-9 and payment verification form will be Wednesday, September 30, 2020. This allows 10 days for the NCDHHS Controller’s Office to process this information. Everything has to be keyed by the 10th of each month to process the payment for that month.
- Letter to Owners/Operators of Facilities Licensed to Accept Special Assistance Payments (Click Here), which covers when the payments will be issued and provides sample scenarios regarding eligibility and distribution.
- List of Frequently Asked Questions about the payments resulting from House Bill 1043/Session Law 2020-4 (Click Here)
- (Re-print from earlier communication) CDC Web-based Training Available - The CDC is offering web-based training on their Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs) webpage which can be found Here. If you scroll to the bottom of the webpage, you will find a number of short (5-7 minute) videos that can be used for staff training on basic infection control practices.
- COVID-19 Webinars Still Available on the NCSLA Website - Webinars from April 9th and the 14th are still available on the NCSLA Coronavirus Updates webpage. The April 9th webinar focused on "Infection Prevention in Assisted Living Facilities" and the April 14th webinar was on "COVID-19 Pandemic Legislative and Regulatory Changes: An Assisted Living Facility’s Guide." Both webinars are free of charge.
- (Re-print from earlier communication) Centers for Disease Control (CDC) Issues "Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities" - On 5/29, the CDC issued guidance for preventing spread of COVID-19 in assisted living facilities (Click Here). Most of the guidance has been covered in previous NC DHHS communications that NCSLA has disseminated but we new CDC guidance reiterates important issues such as:
- Identify a point of contact at the local health department to facilitate prompt notification of suspected or confirmed COVID-19 infections of residents or staff;
- Educate residents, family members, and personnel about COVID-19;
- Have a plan for visitor and personnel restrictions;
- Encourage source control of PPE;
- Encourage social distancing;
- Provide access to supplies and implement recommended infection prevention and control practices; and
- Rapidly identify and properly respond to residents with suspected or confirmed COVID-19.
- (Re-print from earlier communication) Additional Personal Protective Equipment (PPE) Resources - In order to save space, NCSLA has now put it's list of PPE resources into a PDF document which can be viewed/downloaded Here. The document contains embedded links to emails and websites as were found in previous communications.
- Providers can also request PPE (usually only provider to facilities with COVID-19 outbreaks) via the NC DHHS website Click Here
- UPDATE: Puratize LLC - Has developed a portable, two mask sanitizer using UV/LED technology. It will sanitize two masks every 5 minutes. Contact William Rodgers, Email: brodgers@chantengineering.com www.puratize.com
- (Re-print from earlier communication) Requesting Additional PPE from the Local Emergency Management Agency - For providers that are running low or exhausting their supplies of PPE (masks, gowns, gloves, etc.) that they have contacted their County Emergency Management Agency and have been told the PPE supplies are limited.
- **We encourage members that need PPE to keep checking in with your County Emergency Management Agency on at least a weekly basis to re-emphasize the need for PPE to protect your staff and residents. **
- The COVID-19 Healthcare Coalition for Critical Equipment and Supplies recently provided the following forms (Healthcare Guidance for PPE and PPE Request Process) for providers to use when determining their burn rate of PPE and the request process for PPE. According to the state's Healthcare Coalition for COVID-19, if a long term care facility has a resident with COVID-19 and is at risk of exhausting their supplies of PPE, immediately contact your County Emergency Management Agency, it is imperative that you explicitly communicate this information to the Agency so they can work with their Healthcare Coalition to locate PPE and help get it to your facility.
- All long term care providers are encouraged to refer to these resources, particularly in the event a COVID-19 outbreak is discovered in a facility.
- (Re-print from earlier communication) NC DHHS Releases Flow Chart For Discharge from Hospital to Long Term Care - NC DHHS released a number of updated guidance documents on their website in the past week (Click Here) including a flow chart to follow when discharging someone from a hospital to a long term care facility. You can view/download the flow chart Here. While the guidance allows for transfer of patient with COVID-19 or a patient recovering from COVID-19 to a long term care facility, strict CDC guidelines (Click Here) must be adhered to as noted below:
- Patients can be discharged from the healthcare facility (hospital) whenever clinically indicated. If discharged to a nursing home or other long-term care facility (e.g., assisted living facility), AND
- Transmission-Based Precautions are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.
- Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.
- Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.
- (Re-print from earlier communication) Governor Signs Executive Order to Provide Regulatory Flexibility for Health Care System During Response to COVID-19 - On June 26, 2020 Governor Cooper extended Executive Order No. 139 (Click Here), via Executive Order No. 148 (Click Here), which provides additional regulatory flexibility to help ensure capacity in the state’s health care system and improve its ability to effectively respond to the COVID-19 pandemic. (Please note the Executive Order is in addition to the waiver of DHSR licensure rules as noted in the article below titled "DHSR Waives Certain Licensure Rules As a Result of COVID-19" which is still in effect).
- The Executive Order temporarily gives the Secretary of the Department of Health and Human Services (“DHHS”) the ability to waive or modify regulations for accreditation for asbestos and lead testing professionals, accreditation of local health departments, and regulations impacting child care and high-risk health care facilities, which would include adult care and family care homes.
- The Executive Order ensures that DHHS can utilize certain authority provided by the federal government to respond to the COVID-19 pandemic. The goal of the temporary flexibility will be to ensure capacity and continuity in services in North Carolina’s health care system while the state continues to respond to COVID-19.
- Executive Order 139 remains in effect until 5:00 pm on July 17, 2020. If you have questions regarding how to submit a waiver request, please contact Jeff Horton at NCSLA at: jeff@ncseniorliving.org or Richard Rutherford with SembraCare at: Medicaidwiz@gmail.com or by phone at: (919) 264-2398
- (Re-print from earlier communication) DHSR Waives Certain Licensure Rules As a Result of COVID-19 - As the situation surrounding COVID-19 continues to change rapidly, DHSR approved statewide waivers this past Friday (4/24) for certain licensing requirements applicable to Adult Care Homes and Family Care Homes licensed pursuant to N.C.G.S. § 131D, Article 1, and rules 10A NCAC 13F and 10A NCAC 13G. The waivers will remove the need for providers to make individual requests, subject to the Waiver Terms and Conditions included in the attached Notice (Click Here), waivers are granted pursuant to N.C.G.S. § 131D-7 and the Director of Emergency Management’s request for waiver of certain regulations. This statewide waiver will expire at the conclusion of the Governor’s emergency declaration or sooner as determined by the Department and is subject to the terms and conditions set forth in the Notice. The waivers address the following areas:
- Personnel Requirements and Hiring New Staff
- Tuberculosis Testing
- Criminal Background Checks
- Personal Care Training and Competency
- Training on Care of Diabetic Residents
- Family Care Home Administrator Renewal
- Resident Admissions and Other Requirements
- Tuberculosis Testing Upon Admission
- Annual Medical Exam
- Care Plan
- Medication Orders
- Pharmaceutical Care
- Licensed Health Professional Support Quarterly Reviews and Evaluations
- Visitation and Activities
- Visitation
- Group Activities & Outings
- Nutrition and Food Service
- Disposable Place Settings
- Meal Times & Communal Dining
- Menus
- For questions regarding the Waivers, DHSR asks that providres email them at DHSR.AdultCare.Questions@dhhs.nc.gov .
- (Re-print from earlier communication) DHSR Announces Additional Temporary Testing Sites for Medication Aide and Administrator Exams - In order to assist adult care home and family care home providers in ensuring there is adequate staff to meet the needs of residents during these challenging times due to COVID-19, the Division of Health Service Regulation Healthcare Personnel Education and Credentialing Section (HCPEC), the DHSR Adult Care Licensure Section (ACLS), and several county Departments of Social Services are partnering to offer additional temporary testing site locations for the medication aide and administrator exams. Throughout the remainder of April and through the end of May, DHSR will be offering multiple testing site locations across the state, on Monday, Wednesday and Friday’s at most sites listed below. Site locations, dates and times are being posted on the HCPEC Branch website https://www.ncnar.org/index1.jsp. Testing schedules can be found at https://info.ncdhhs.gov/dhsr/news.html#hcpr . All individuals who wish to take an exam must register and pay the normal required testing fee. In addition, for the safety of all testers and test proctors, we are taking the following safety and infection prevention measures:
- Tests will be limited to no more than 5 people per scheduled exam.
- Testers will be screened prior to entering the testing location. Any person who exhibits signs or symptoms of respiratory illness or has tested positive for COVID-19 will not be permitted to take the exam and will be asked to reschedule.
- All testers are asked to wear a facemask or other face covering upon entering the exam location and wear the face covering for the duration of the exam.
- Exam proctors will be disinfecting all tables and writing instruments between exams.
- Testers will need to remain in the testing room and will not be permitted to travel in other areas of the testing site.
- Below are the temporary additional testing sites. All locations will offer the medication aide exam. Select locations will offer the administrator exam. Again, please refer to the HCPEC website for details and schedules.
- Buncombe County – DHSR Black Mountain Office - 952 Old US Hwy 70, Building 17, Black Mountain, NC 28711
- Gaston County DSS - 330 Dr. Martin Luther King Way, Gastonia NC 28052
- Davie County Senior Services - 278 Meroney Street, Mocksville, NC 27028
- Mecklenburg County DSS - Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
- Guilford County DSS - 1203 Maple St. Greensboro, NC 27405
- Cumberland County DSS - 1225 Ramsey Street, Fayetteville, NC 28301
- No testing on Fridays.
- Jones County Civic Center - 832 North Carolina Hwy 58, Trenton, NC 28585
- Pitt County Cooperative Extension - 403 Government Circle Suite 2, Greenville, NC 27834
- Wake County – DHSR, Brown Building, Room 104, Dorothea Dix Campus - 801 Biggs Drive, Raleigh
- (Re-print from earlier communication) Free Music for Resident Listening Activities - North Carolina composer Dave Combs asked NCSLA to share his music with the adult care home and family care home communities as a way to offer residents music listening activities. Dave's soothing and relaxing instrumental music videos are free to use at no charge and many residents in the Winston-Salem area are already familiar with his music, particularly, Rachel’s Song. Dave is a long-time resident of Winston-Salem and a composer of many albums of instrumental music and considers this offer as one way for him to give back. Below are the YouTube links for Dave's video playlists. Feel free to forward this information to any residents that you think might like to watch the YouTube videos on their own devices. For large video screens in your public areas there are four videos that are long-playing (over 6 hours). These videos can be streamed to have beautiful, relaxing music playing in the background all day long. The videos have beautiful photography accompanied by soothing, relaxing instrumental music composed by Dave Combs and arranged and performed by Gary Prim. When you click on the following link it will take you to the YouTube playlist that looks like the below image. Choose your video, and enjoy - https://www.youtube.com/playlist?list=PLGNq0Ky_ylCTwo-jfcxx9k8QBgR2M22HR
- (Re-print from earlier communication) NC DHHS Launches Program to Match Health Care Workers to Facilities Seeking Staff - Due to COVID-19, many health care facilities in North Carolina, particularly long-term care facilities, are seeking to hire staff for temporary, part-time or full-time roles. There is an urgent need for Registered Nurses and Certified Nursing Assistants, among other roles to supplement current workers and in some cases fill in for workers affected by COVID-19. Interested health care employees with the ability to pick up extra shifts or who may have been laid off from facilities and are seeking full-time roles can register at https://nc.readyop.com/fs/4cjq/697b. Local Health care Facilities affected by COVID-19 and in need of support can request assistance through their local (county) Emergency Management agencies (Click Here), which have the ability to fulfill the support requested within the county. You can read more about the program Here.
- (Re-print from earlier communication) NCDHHS to offer relief to essential workers for child care, bonuses to child care staff - The NCDHHS is providing financial assistance to help essential workers afford child care and bonuses to child care teachers and staff who provide care during the COVID-19. Information about the program including the COVID-19 Parent Application for Financial Assistance for Emergency Child Care can be found Here. Since adult and family care home staff are considered essential workers, many adult care home staff with children may be eligible to use this service to assist with child care needs during the COVID-19 pandemic.
Reducing resident exposure to individuals who are potentially infected with COVID-19 is of paramount importance since our residents are among the highest risk group for infection and mortality from this virus. Thank you and your staff for all you are doing to provide care to our residents during this difficult time in what we all hope will be a temporary event.
If you have questions concerning any aspect of this document, please do not hesitate to contact me at
jeff@ncseniorliving.org
or 919-787-2526.
Jeff Horton, Executive Director
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North Carolina Senior Living Association
4010 Barrett Dr., Ste. 102
Raleigh, NC 27609
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