What are the NCSTHL's Legislative Priorities?

The NCSTHL meets three times a year to study issues, to hear from subject matter experts and state officials, and to develop legislative recommendations to present to the NC General Assembly. 

These are called the “LEGISLATIVE PRIORITIES,” or the “PRIORITIES.”

Mirroring the cycle of the NCGA, the NCSTHL develops legislative priorities in even-numbered years for submission to the NCGA in odd-numbered years.  

In the spring and summer of even-numbered years, the NCSTHL members explore the current challenges facing older adults that are the most critical and relevant.  The goal is to distill from among the many important issues those that are most worthy of legislative consideration in the upcoming legislative cycle.

The Resolutions Standing Committee oversees the work of six “Issues Committees.”  Every member of the NCSTHL is assigned to an Issues Committee for deliberation on the proposals that fall into their category of issues.  The Issues Committees meet to weigh the merits and importance of each proposal, voting on their final slate of proposals to submit to the Resolutions Committee.  

Click here to view the news releases about the latest work of the Issues Committees.  

In October 2022, the NCSTHL will finalize its PRIORITIES for the 2023-24 legislative cycle.

Stay tuned for details.


There were five priorities submitted by the NCSTHL to the NC General Assembly for consideration in the 2021-22 cycle.

Increase Funding for HCCBG

The North Carolina Home and Community Care Block Grant is vital in assuring the availability of cost-effective home- and community-based services to those age 60+ who are elderly, malnourished, homebound, dependent, and those who are socially and economically needy.

  • The older population continues to increase. The 2020 population of 2.4 million residents age 60 and older, 23% of the total population of 10.46 million, is projected to increase to 3.4 million by 2040, 27% of the total population of 12.7 million. 
  • Approximately 10,000 citizens are currently waitlisted for vital services such as home-delivered meals, congregate meals, in-home aide, adult day care, and transportation for medical appointments and medications, senior center activities, and shopping for essentials such as groceries and personal care items.
  • The rapidly increasing older adult population will place even greater pressure on an already overburdened service delivery system.
  • The STHL requests the NCGA increase the Home and Community Care Block Grant funding by $8 million dollars in recurring funds.
  • The NCSTHL is grateful to the NCGA for the approval of state budget HCCBG allocations that include $4M in SFY 22 and an additional $2.4M for SFY 23, for a total of $6.4 M in recurring funds for FY 2022 and 2023.

Maintain and Increase Funding for Senior Centers


There are 169 senior centers in 95 counties that provide programs and services to enhance the health and wellness of older adults.

  • These services are of significant benefit to help elders remain independent, thus delaying their potential for costlier services or housing options.
  • To maintain operation, senior centers must leverage resources from a variety of sources that include federal, state, and local governments, special events, participant contributions, grants, and volunteer hours.
  • Even with leveraging, funding for senior centers has not been able to meet the needs of the state’s increasing aging population who now constitute more than two-thirds of the age fifty and over population.
  • The STHL requests that the NCGA maintain the current senior center general purpose funding and increase this funding by a recurring $400,000 to continue to meet the vital needs of North Carolina’s growing population of older adults.
  • No action was taken on this request.

Increase funding for Project CARE

By mandate of the NCGA, Project CARE (Caregiver Alternatives to Running on Empty) was developed by recommendation of a statewide, multi-stakeholder task force to address Alzheimer’s disease and related dementias.

  • In 2020, an estimated 180,000 North Carolinians diagnosed with Alzheimer’s were cared for by 479,000 family caregivers. By 2025, estimates project a 16.7% increase in the number of Alzheimer’s cases, to 210,000 people.
  • Funded by the state through the NC Department of Health and Human Services, Division of Aging and Adult Services, Project C.A.R.E. provides caregiver support, care management, and referrals to available services.
  • Project C.A.R.E has become a national best practice model for providing respite services to family members who are caring at home for a loved one with Alzheimer’s disease or related dementia.
  • The STHL requests that the NCGA increase funding for Project CARE in 2022 by $575,000 and in future years increase funding by ten percent annually for expected growth.
  • No action was taken on this request.

Strengthen and Fund North Carolina’s Adult Protective Services Program

North Carolina’s Adult Protective Services Program (APS) must be strengthened and funded to respond to the accelerated growth in the State’s aging population. APS is a core of services provided to vulnerable and older adults who are at risk of abuse, neglect, and exploitation.

  • By 2025, 88 counties in North Carolina are projected to have more people age 60 years of age than 17 years and Many of these adults will be at risk of becoming victims.
  • NC General Statute 108A, Article 6, Protection of the Abused, Neglected, or Exploited Disabled Adult Act, mandates county departments of social services provide APS to vulnerable and older adults who have been abused, neglected, or exploited.
  • The number of APS reports is expected to continue to increase as North Carolina’s aging population In state fiscal year (SFY) 2019-2020 county departments of social services received 30,779 APS reports alleging the abuse, neglect, or exploitation of vulnerable adults. In comparison, in SFY 2005-2006, APS received 14,001 reports. This is an increase of 120% in five years.
  • In SFY 2019-20 counties expended approximately $31.4 million, 0% state, 81.55% county, and 18.45% federal, for the provision of APS.
  • Counties are struggling to locate funding to provide these mandated services and are relying on funding from county governments and a decreasing federal Social Services Block Grant that is used to fundmanyservicesprovidedby
  • A comprehensive evaluation/review is needed to better reflect the challenges counties currently face in meeting the changing needs of vulnerable and older adults who have been abused, neglected, or exploited and are in need of protective services.
  • The STHL urges the NCGA recognize and value its vulnerable residents by making available $8 million in recurring funds in the State budget to meet the growing need for Adult Protective Services in North Carolina and conduct a comprehensive evaluation/review of these services to ensure this protection is adequate.
  • The NCSTHL is grateful to the NCGA for the allocation to Adult Protective Services of Coronavirus Response and Relief Supplemental Appropriations (CRRSA) of $2.8M for 4/1/21-9/30/22 and $2.6M for 8/1/21-9/30/23, a total of $5.4M, to enhance infrastructure and provide seed funding for essential services.

Staff-to-Patient Ratios in Nursing Homes

The positive relationship between nurse staffing levels and the quality of nursing home care has been demonstrated widely over many years of research.  It is proven that increasing nurse (RN, LPN, and CNA) staffing levels enhances the outcomes of nursing homecare.

  • The federal Nursing Home Reform Act (NHRA),as part of the Omnibus Budget Reconciliation Act (OBRA) of 1987, requires minimum staffing levels for registered nurses (RNs) and licensed practical nurses (LPNs), and a minimum educational training for nurse’s aides (NAs), but fails to establish a specific requirement for minimum caregiver/resident ratio or a minimum standard for the number of hours per patient day that a resident should be receiving.
  • In a nursing home, the CNA is the true point-person when it comes to providing adequate one-on-one care to the resident.  The quality of care that facilities provide to their residents is frequently evaluated across three domains including structure (resources used to provide care; e.g., staffing), process (actions used to provide care; e.g., restraints) and outcomes (end results for patients; may be bad outcomes or good outcomes).
  • The STHL recommends that the NCGA enact legislation, which establishes either a mandatory standardized HPPD (hours per patient daily) or minimum staff-to-patient ratios for direct patient care, including enforcement standards and consequences to ensure quality care in nursing homes in the state of North Carolina, regardless of whether they are a for-profit or non- profit organization.
  • No action was taken on this request.


In preparation for the deliberations of the 2022 June General Session, the NCSTHL Executive Committee presented three virtual Issues Information Sessions featuring an overview of major issues impacting older adults in NC.  

This education was provided to help prepare STHLs to submit informed, timely resolutions this summer and to determine priorities this fall.

Links to these recordings will be made available in 2022.

Addition “Issues Information Sessions” will be added in 2022 as needed.  Check this space for those events.