A nursing home in Johnston County announced 11 people were COVID-19 positive Wednesday and by Thursday, that number had jumped to 18.
Local health officials said they're working to stop the spread in these settings, but it's hard.
LATEST: Coronavirus pandemic in North Carolina
There are 21 outbreaks in congregate settings across North Carolina; 18 of those are in long-term facilities.
Five people have become sick at the Louisburg Nursing Center in Franklin County.
At the Springbrook Nursing Center in Johnston County, two people have died after contracting the virus and more than a dozen are fighting COVID-19.
In Orange County, there are at least 60 positive cases at PruittHealth - Carolina Point and three at Signature Healthcare at Chapel Hill.
WATCH: Dr. Tilson answers your questions about the nursing home outbreaks
The Butner Federal Correctional Complex is also seeing a cluster of cases. US Bureau of Prisons (USBOP) said it had 76 confirmed COVID-19 cases across the Butner complex--breaking down to 59 inmates and 17 staff members.
"In response to COVID-19, the Bureau of Prisons (Bureau) has instituted a comprehensive management approach that includes screening, testing, appropriate treatment, prevention, education, and infection control measures," USBOP said in a statement Thursday afternoon.
Loved ones with family members serving time at the institution are concerned.
"They're still sending inmates to work, having them serve food and everything," Phylicia Ward said.
Her brother, who is inside the facility, told her he was given a mask to wear just this week.
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She's concerned about his safety and says inmates are still allowed to hang out in common areas like before.
"I know it's hard to practice social distance in a prison, but you can take more precautions. Don't let them have group TV time when you know social distancing is the main thing to keep the virus from spreading," Ward said.