Hawes and colleagues surveyed adult care homes in North Carolina and found high levels of mental and physical impairment among residents; 64% of the residents evaluated had moderate-to-severe cognitive impairment, and 41% received hands-on help for one or more ADLs. In addition, 23% of the residents were incontinent of feces and 39% were incontinent of urine; 25% wore incontinence pads or briefs