The result: Adult care homes across North Carolina are experiencing a financial crisis. And it is a crisis that threatens to affect the quality of care if it is not addressed quickly.

Focusing on the importance of providing high standards of safety and health at facilities that care for older adults is the right issue but the wrong solution. The reality is that adult care home operators across North Carolina are not making money at the expense of caring for residents. They are losing it.

Adult care homes are stretching every available dollar to maintain high standards of care for their residents. Sometimes they still fall short. That is what happens when the state requires one standard of care, but pays for another.

The state has conducted study after study that shows adult care homes must spend $70 a day or more to provide appropriate care for their residents. Yet North Carolina pays less than $44 a day for this care, with residents contributing an additional $16 a day. The Medicaid reimbursement rates have remained relatively unchanged for more than four years, creating a significant financial burden on care providers. And of the 40,000 North Carolina residents who currently live in an adult care home, more than 25,000 rely on Medicaid.

Here's one example of the very real challenges facing adult care homes: Studies show that residents require two hours of personal assistance each day. This might include help getting dressed, taking medication, bathing, etc. But the state pays providers to provide only 1.1 hours of personal assistance each day.

Over the course of the year, that is more than 325 hours of additional care that adult care homes must provide for each resident without any reimbursement. For a home with 20 residents, it can take three full-time employees to provide that additional care.

Despite these challenges, adult care home providers are committed to providing residents with the competent, compassionate and quality care they deserve. The new star rating program launched by the state in January shows that adult care homes are doing a good job. More than 92 percent of the homes inspected so far this year (156 of 169) have received three stars -- the highest possible rating.

But that doesn't change the fact that the system is broken and must be fixed.

Providing adequate reimbursement to adult care homes will dramatically improve care by providing the additional resources that care homes and their residents so desperately need.

Adult care homes have become a default safety net for aged, disabled and mentally ill citizens. If the industry continues to become financially unbearable, then it will be left to the state to find new ways to care for these 40,000 North Carolinians who now live in adult care homes.

The way we spend our money says a lot about our priorities. So what message is North Carolina sending when it spends less than $44 a day to house, feed and care for older adults, even though the state knows it costs much more than that to provide adequate care?

We must work together to provide older adults with the quality care they deserve. That is the goal of Friends of Adult Care Homes, a new advocacy group established by residents, their families and the employees who care for them.