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Guide to Senior Living in North Carolina

Located firmly on the eastern edge of the New South Sun Belt, the state of North Carolina has a lot to offer its aging citizens. Seniors make up over 16% of North Carolina’s 10.5 million residents, and at least 568 senior living communities operate statewide to care for their needs. In summer, North Carolina averages daily temperatures in the high 80s, though this cools off toward the interior high country, which is popular with tourists and seniors who enjoy outdoor activities. The lakes and woods of central North Carolina are inviting to seniors who hunt and fish, while several tourism-heavy outposts provide the comforts of city life in the mountainous countryside.

For seniors who prefer a more urban community, North Carolina has nine cities with more than 100,000 residents. The largest of these, Charlotte, tops 900,000 and is home to the cultural and financial hub of the state. In just a single neighborhood, Uptown, Charlotte hosts the Levine Museum of the New South, which explores post–Civil War history, as well as engaging hands-on science displays at Discovery Place. Just blocks away, Uptown is also the site of the NASCAR Hall of Fame, one of the most heavily visited attractions in the South.

Senior Living in North Carolina is somewhat less expensive than the average nationwide. Still, paying for senior living can be a challenge; fortunately, seniors in North Carolina have many options available that can help cover the cost. This guide discusses senior living costs and resources available to help pay for the cost of senior living in North Carolina.

The Cost of Senior Living in North Carolina

Note: There currently isn’t authoritative data on the average cost of Independent Living Facilities nationwide, so instead, we use the cost of Assisted Living to estimate it. Since the cost of Independent Living is typically 30-40% lower than the cost of Assisted Living, the numbers below were calculated by subtracting 35% from the cost of Assisted Living.

Note: Memory care is typically provided in communities licensed as assisted living facilities, and in general, costs 20-30% more than standard assisted living services. No authoritative cost data is available for this type of care, so we estimated memory care rates by adding 25% to assisted living fees in the Genworth 2021 Cost of Care Survey.

Seniors in the Tar Heel State have a wide range of living experiences, from fully independent and financially well off to low-income and disabled individuals and every stage in between. Independent living communities in the state cater to seniors who don’t need any medical or personal care services. Assisted living facilities offer help with daily activities in a community setting, and memory care provides additional services to adults with Alzheimer’s disease or other types of dementia usually within an assisted living facility. Seniors who need round-the-clock medical attention and supervision can get the extensive care needed in North Carolina’s nursing homes. 

North Carolina’s senior living options are reasonably priced when compared to the rest of the country, but they are in the middle of the pack when compared to the region. Independent living is the most affordable option at $2,607 per month. Assisted living is about $1,400 more expensive due to the additional services and support. Memory care is even more expensive at $5,013 per month. Since nursing homes offer the highest level of care, they’re the most expensive option with a monthly average of $7,483. These figures come from Genworth Financial’s Cost of Care Survey for 2021

$4010

Assisted Living

$2607

Independent Living

$5013

Memory Care

$7483

Nursing Home Care

The Cost of Assisted Living in North Carolina

The average cost for assisted living in North Carolina is $4,010 per month, making it about $500 less per month than the national average. In neighboring Tennessee, assisted living costs are very similar at $4,105 per month. To the north in Virginia, costs rise significantly to $5,250 monthly. Assisted living in South Carolina ($3,612) and Georgia ($3,535) is slightly less expensive than in North Carolina. 

$4010

North Carolina

$4500

The United States

$3612

South Carolina

$5250

Virginia

$4105

Tennessee

$3535

Georgia

The Cost of Nursing Home Care in North Carolina

There is less variation in costs for nursing homes than in many other types of senior living. The average rate in North Carolina is $7,483, which is $425 less than the national average. Virginia ($8,213) has the most expensive nursing home prices in the region, and Georgia ($7,011) has the least expensive. Both Tennessee and South Carolina have slightly less expensive nursing homes than North Carolina. They have median prices of $7,148 and $7,285 per month, respectively. 

$7483

North Carolina

$7908

The United States

$7285

South Carolina

$8213

Virginia

$7148

Tennessee

$7011

Georgia

Can You Use Medicaid to Pay for Senior Living in North Carolina?

Seniors and families on limited incomes and investments can find it difficult to pay for long-term care. With funding support from the federal government, Medicaid in North Carolina is able to relieve some of this financial burden for older adults with disabilities. North Carolina Medicaid does not pay for room and board in assisted living facilities or memory care settings, but the state offers a waiver program that can cover certain services provided in these communities. 

As mandated by federal law, Medicaid in North Carolina covers most aspects of nursing home care for low-income seniors, including room and board, medical services and personal care services. Families are expected to cover any costs they can afford, and Medicaid will cover the rest. 

Medicaid coverage in North Carolina is aimed at health services, so the system does not cover any aspect of independent living communities. Seniors in independent living may qualify for Medicaid for health services they receive at hospitals, clinics and other medical settings. 



Medicaid Coverage LevelType of Medicaid CoverageEntitlement?* 
Assisted LivingPartialMedicaid WaiverYes
Independent LivingNoneN/AN/A
Memory CarePartialMedicaid WaiverYes
Nursing Home CareFullMedicaid Yes

*Note: Entitlement programs mean that everyone who qualifies will receive coverage and be accepted into the programs. If the program is not “entitlement,” then participant caps could be in place, and there may be a waiting list. 

Medicaid’s Coverage of Assisted Living & Memory Care in North Carolina

North Carolina’s primary Medicaid system does not cover any aspect of assisted living or memory care for seniors. It offers one waiver program that may cover some services within assisted living and memory care settings for adults who qualify for a nursing home level of care. 

Community Alternatives Program for Disabled Adults (CAP/DA)

The CAP/DA waiver program gives physically and mentally disabled adults the opportunity to remain in a community setting, such as an assisted living facility or memory care unit, rather than a nursing home. The program fulfills this objective by covering services a resident needs to stay in their community, including coordinated caregiving, meal preparation, durable medical equipment, environment modifications, assistive technology, personal assistance, financial assistance and case management. Once you’re enrolled in Medicaid, you can apply for benefits through this waiver by contacting a local CAP/DA case management entity.

Medicaid’s Coverage of Nursing Home Care in North Carolina

Medicaid pays for the cost of room and board and some of the medical services provided in North Carolina’s licensed nursing facilities. In addition to regular Medicaid eligibility requirements, beneficiaries will need to get prior approval for nursing home care from a physician. The recipient must use their own income to pay for care, and Medicaid will cover the rest. Beneficiaries may keep $30 per month for personal needs. Services that are covered include:

  • All dietary, medical, nursing and psychiatric services
  • Personal toiletries
  • Medical supplies, such as soap, shampoo and lotions
  • Special dietary supplements
  • Mobility equipment, such as canes, walkers, crutches and wheelchairs
  • Grooming and laundry services

Medicaid will not pay for televisions, private phone lines, private duty nurses or sitters in nursing homes. 

Eligibility for Medicaid in North Carolina

Eligibility for Medicaid in North Carolina is determined by your local Department of Social Services based on your age, health needs, resources and income. Single households can earn up to $12,888 per year and own $2,000 in assets, and two-person households can earn up to $17,424 and have $3,000 in assets when both people are applying. If you already receive Supplemental Security Income (SSI), you’re automatically eligible for Medicaid. 

2022 North Carolina Medicaid Income Limits 



Income Limits*Asset Limits
Single Person$12,888$2,000
Two-Person Household
(Only one applicant) 
$12,888  $2,000
Two-Person Household
(Two applicants) 
$17,424$3,000

*Per Year

In addition to the financial requirements, Medicaid requires proof of your:

  • U.S. citizenship or eligible immigration status
  • Residency in North Carolina
  • Social Security number or application for a Social Security number

Applying for Medicaid in North Carolina

You can apply for Medicaid coverage in North Carolina by:

Before You Apply

Whether you apply online, over the phone, in person or by mail, you’ll need detailed personal information to finish your application, including:

  • Proof of age
  • Proof of North Carolina residency
  • Income statements, such as pay stubs
  • Social Security card, or proof of application
  • Copies of life and medical insurance policies
  • List of vehicle assets
  • Bank and investment statements
  • List of owned real estate

How to Get Help

If you need assistance filling out an application or cannot apply using one of the listed methods above, you may get help with Medicaid issues or processes by contacting one of the following resources. 

ResourceContactService
North Carolina Medicaid Health Broker(833) 870-5500This health broker service helps families file applications for Medicaid, answers questions about coverage and hosts events that provide valuable information to Medicaid beneficiaries.
OCPI/Fraud Waste and Abuse(919) 527-7700North Carolina’s Office of Compliance and Program Integrity ensures that providers who accept Medicaid as payment are properly credentialed and deliver services that are medically necessary and in the best interests of patients. 
Legal Aid of North Carolina(866) 219-5262Seniors in North Carolina having trouble getting the Medicaid benefits they’re entitled to can contact Legal Aid of North Carolina for help. You can use the self-help library to resolve an issue or apply for legal representation by phone or online form. 

Can You Use Medicare to Pay for Senior Living in North Carolina?

Unfortunately, Medicare does not cover the cost of assisted living, independent living, or memory care. Unlike nursing homes, these care types are not considered to be “clinical settings” and so are not eligible for Medicare coverage. That being said, those who live in these communities can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

When it comes to nursing home care, it gets much more complicated. Medicare does provide limited coverage for a qualified stay in a nursing home,but there are strict rules and requirements of which you should be aware. This benefit is available to seniors who have been hospitalized for at least three days, excluding the date of discharge.

Once you’ve met the hospitalization requirement, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). While the first 20 days are covered in full, there is a daily coinsurance rate that must be paid starting on day 21. After day 100, seniors are responsible for the entire cost.


Medicare CoverageMedicare Coverage DurationCoinsurance Requirement?
Assisted LivingNoneN/AN/A
Independent LivingNoneN/AN/A
Memory CareNoneN/AN/A
Nursing Home CareLimited100 Days Per Benefit PeriodYes – After 20 Days

What Nursing Home Care Services Does Medicare Cover?

Medicare covers a number of specific services, including:

  • Meals
  • A semiprivate room
  • Medications
  • Skilled nursing services
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Audiologist care
  • Medical supplies
  • Medical social services
  • Nutritional counseling
  • Ambulance transportation

What Nursing Home Care Services Aren’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

Medicare Support & Resources in North Carolina

Apply for benefits, expand your coverage with supplemental insurance or find health care providers in your community by using the following resources. 

ResourceContactService
Medicare and Seniors’ Health Insurance Information Program (SHIIP)(855) 408-1212SHIIP helps new Medicare beneficiaries get the most out of their benefits and helps seniors pay for health care expenses that Medicare doesn’t cover. The program is staffed by trained and knowledgeable volunteers who can help beneficiaries resolve a wide range of problems.
Medicare.gov(800) 633-4227Learn about what Medicare covers, estimate your yearly costs and find supplemental plans that fit your senior living needs through Medicare.gov. This federally run resource also operates a hotline that you can use to talk to a real person about your benefits. 
Medicare Resource Center(800) 722-1350The Medicare Resource Center is a source of advocacy and assistance for Medicare providers in North Carolina. It helps practices deliver the best possible care to beneficiaries through education, training, events and other membership services. It’s operated by the North Carolina Medical Society.

Are There Other Financial Assistance Options for Senior Living in North Carolina?

Depending on your unique situation, there may be other financial assistance options to partially or fully cover the cost of senior living in North Carolina. Below, we cover some of the common ways that seniors can make senior living options such as assisted living or memory care more affordable.


How to Get StartedWhat You Should Know
Aid and AttendanceApply online at va.gov.If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse MortgagesResearch and learn about the different types at ftc.gov.If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) InsuranceLearn about how to receive LTC insurance benefits at acl.gov.While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Senior Living Resources for Seniors in North Carolina

Residents in senior living communities and families considering long-term care options can take advantage of the free resources listed below.

ContactService
Long Term Care OmbudsmanList of LocationsLong-Term Care Ombudsmen for North Carolina address reports of neglect, exploitation and other types of abuse in long-term care communities throughout the state. Staff and volunteers ensure facilities resolve issues quickly and help communities deliver the best care possible. The Ombudsman Program for North Carolina consists of a statewide office in Raleigh and 16 regional offices that are part of local Area Agencies on Aging (AAA). AAAs offer an array of other free services to seniors in their service areas. 
Legal Assistance for Older Adults(800) 662-7030Adults aged 60 and older who cannot afford or access legal assistance on their own can contact the state’s Aging and Adult Service legal program for aid. Representation can address a variety of non-criminal topics, such as health care, long-term care, housing, defense of guardianship, abuse and age discrimination. Priority is given to disadvantaged seniors, including those with physical and cognitive disabilities, low incomes and a high risk of institutional placement. 
N.C. Department of Military & Veterans Affairs(844) 624-8387North Carolina’s Department of Military & Veterans Affairs provides outreach services to veterans and other eligible VA beneficiaries. Agents help vets find long-term care options that meet their needs and obtain financial benefits that can pay for that care, including VA pensions and Aid & Attendance. There are also several special programs that help veterans facing difficult situations. 
Dementia Alliance of North Carolina(919) 832-3732Families in need of memory care can get useful information and assistance from the Dementia Alliance of North Carolina. It offers support groups for families, caregiver resources, memory activities and educational materials. The alliance also helps fund research and clinical trials aimed at improving dementia treatments. You can participate in events to get answers to questions or learn more about dementia resources in the community. 
AARP North Carolina(866) 389-5650AARP strives to improve the lives of North Carolina residents in all types of senior living communities through educational materials, support groups, online classes and information about long-term care. While many resources offered by AARP are available for free, a low-cost membership can give you access to rewards and discounts on local products and services. There are five local AARP offices within North Carolina, serving 1.1 million members in the state.

COVID-19 Rules and Restrictions for North Carolina Senior Living Facilities

The following information is based on research done on several government websites, including covid19.ncdhhs.gov and cms.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?Yes
Can I visit my relative in person for end-of-life compassion care?Yes
Will my loved one be required to self-quarantine after I visit him or her?No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?Yes
Are Hairdressers and other non-medical contractors still allowed in senior living facilities?Yes
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives? Yes
Are visitors being screened for elevated temperatures?Yes
Are visitors being asked questions about health, travel, and potential virus contact?Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?Yes
Are residents of senior living facilities who leave and return required to self-quarantine?No (Conditions Apply)
Are senior living facilities required to cancel all group outings?No
Are residents still eating together in the dining hall?Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?Yes (Conditions Apply)

Safety Measures for Staff & Contractors

Are staff members and contractors being screened for elevated temperatures?Yes
Are staff members and contractors being tested for Coronavirus?Yes (Conditions Apply)
Are staff members and contractors being asked questions about health, travel, and potential virus contact?Yes

Safety Measures for Residents

Are staff members required to regularly screen residents for coronavirus symptoms?Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?No
Are staff members required to take residents’ temperatures?Yes
Are residents being tested for coronavirus?Yes (Conditions Apply)

Senior Living Laws and Regulations in North Carolina

Note: All these rules typically apply to non-clinical senior living facilities, such as independent living, assisted living, and memory care facilities. Nursing homes and other senior living facilities with a clinical setting may have additional or slightly different requirements and regulations.

Adult care homes and overnight respite facilities in the state of North Carolina are licensed, regulated and inspected by the NC Division of Health Service Regulation Adult Care Licensure Section. To ensure the safety and care of the state’s seniors, this division sets and maintains strict standards for how licensed care facilities must operate. Areas of regulation include admission requirements, Alzheimer’s disease and memory care standards, medication policies and staffing requirements for all licensed care homes in the state.

Admissions Requirements

Seniors in North Carolina may be admitted to a licensed adult care home if they have a need for personal care services and assistance with activities of daily living as defined by the state. Prior to admission, all applicants must undergo a physical and mental health screening to determine whether senior living is the appropriate placement option for them, as well as to identify potential health risks from communicable diseases. Medical conditions that may prevent a licensed facility from admitting a senior include:

  • Ventilator dependency
  • Any medical need for continuous licensed nursing care, not including short-term nursing care and rehab services lasting less than 60 days
  • Specific health conditions that the state division determines may not be adequately treated in adult residential care or in the individual facility being considered, as judged by the admitting facility and the Medical Care Commission
  • A negative recommendation from the applicant’s personal physician, attesting that another level of care is required to follow the senior’s prescribed treatment plan

Exceptions to these rules can be made on a case-by-case basis for residents who need hospice care, in consultation with a licensed medical doctor.

Memory Care Regulation

The state of North Carolina allows delivery of two forms of memory care in a residential care setting. First, a facility that primarily delivers caregiver assistance and personal care to seniors without Alzheimer’s disease or other impairments may designate a specific wing or hallway a “special care unit” under its existing license. Facilities that specialize in providing memory care services or that market themselves as providing Alzheimer’s care and other dementia services must obtain a special license from the Medical Care Commission.

Medication Management

Medication aides who work in North Carolina’s senior living facilities must pass an annual certification course for administering medication. Topics include infection control, safe practices for injections and other procedures that may cause bleeding, and best practices for blood glucose monitoring. Medications may be purchased and brought into a residential care facility if they are over-the-counter or prescribed for the individual, and limited assistance may be given preparing a dose for self-administration, as when grinding a pill or mixing it with applesauce. Non-clinical and non-licensed staff are not permitted to administer scheduled medications or to perform other invasive medical interventions.

Staffing Requirements

Adult care home staff and supervisors share the same annual training and certification requirements to remain licensed. Those requirements include:

  • At least eight hours of initial training to be completed within 60 days of hire
  • A minimum of 32 hours of basic training within six months of hire
  • At least 24 hours of post-basic training within six months of the initial basic training program
  • A minimum of 8 hours of complaint investigation training in the first six months of employment
  • A minimum of 16 annual hours of training by the Division of Health Service Regulation

Learn More About Senior Living in North Carolina

For more information about specific types of senior living in North Carolina read our Guide to Assisted Living.

Frequently Asked Questions

How much does assisted living cost in North Carolina?

Assisted living in North Carolina costs seniors an average of $4,000 a month. This is $51 a month less than the average national cost for similar care services. Depending on which area of the state the care is delivered, costs for assisted living may range as high as $5,563 or as low as $3,193 a month.

Does North Carolina Medicaid pay for assisted living?

North Carolina Medicaid does not offer benefits specifically for assisted living, though many seniors in residential care are eligible for Medicaid benefits and receive some assistance. Medicaid benefits do not include the monthly cost of care, though medication and various services may be included in coverage limits. NC Medicaid does offer two waiver programs, Community Alternatives Program for Disabled Adults (CAP/DA) and Personal Care Services (PCS), one of which pays for an in-home caregiver, while the other provides caregiver benefits to seniors in assisted living communities.

Does Medicare pay for assisted living?

Medicare provides health insurance coverage for millions of U.S. citizens aged 62 and over. Under Original Medicare, Part A benefits pay for many of the expenses of inpatient care, though no direct aid is provided for the monthly cost of assisted living. Some secondary medical needs, such as orthopedic devices and medical supplies, may be covered under Part B benefits. Some seniors have the option to pay for extra coverage under a Part C, or Medicare Advantage, plan, though details vary and assisted living is rarely included as a benefit.

What are “activities of daily living”?

The term “activities of daily living” has a specific definition in North Carolina. NC Medicaid recognizes five activities as being eligible for assistance from a personal caregiver. Activities of daily living for senior care matters in North Carolina include eating, dressing, bathing, toileting and mobility assistance.

What is the difference between assisted living and nursing homes?

Assisted living is a less medically intensive level of senior care than the care seniors receive in a nursing care home. As a rule, seniors can expect short-to-medium-term care in a nursing home, where licensed medical staff can administer medication and monitor residents’ health. Assisted living is usually a long-term living option, where non-licensed staff assist seniors with activities of daily living.

Learn More About Senior Living in North Carolina

For more information about specific types of senior living in North Carolina read our Guide to Assisted Living and Independent Living.

The Top Cities for Senior Living in North Carolina

Learn more about the cost of senior living in the top North Carolina cities. Additionally, find reviews and information about assisted living facilities and other senior living communities across the state.

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