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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.

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

The following rules and guidelines were obtained from the NC Department of Health and Human Services website, as well as other state-level government sites. Among others, these rules apply to adult care homes/assisted living, behavioral health/IDD, intermediate care facilities, psychiatric residential treatment facilities. Specifically excludes any assisted living that’s connected to a skilled nursing facility (combination homes).

This data has been most recently updated on 7/15/20, but keep in mind that COVID-19 is a rapidly evolving crisis, so all of the below information can change at any time. For additional questions and up-to-date information, you can contact your loved one’s senior living facility or your local Area Agency on Aging.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?Yes, outdoors (conditions apply) 
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?N/A
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?No
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, but they are discouraged from doing so
Are residents of senior living facilities who leave and return required to self-quarantine?NA
Are senior living facilities required to cancel all group outings?Yes
Are residents still eating together in the dining hall?NA
Are facilities still allowed to host group activities within the community?No, or with restrictions

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
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

Paying for Senior Living in North Carolina

The Cost of Senior Living in North Carolina

Assisted living is an affordable option for seniors in North Carolina. At $4,000 a month, living in an assisted living facility comes close in price to both in-home care and homemaker services, which both cost an average of $3,813 a month in North Carolina. Adult day care in the state costs an average of just $1,170 per month, though care in a semi-private room at a nursing home can cost seniors an average of $7,057 a month.

$4000

Assisted Living

$3813

In-Home Care

$3813

Home Health Care

$1170

Adult Day Care

$7057

Nursing Home Care

The Cost of Assisted Living in North Carolina

Compared with nearby states, assisted living costs in North Carolina are close to the middle range for many seniors, according to Genworth Financial’s 2019 Cost of Care Survey. Monthly costs in Virginia are significantly higher, at $4,800, versus the $4,000 seniors can expect to pay in North Carolina. At the other end of the cost spectrum, Georgia’s seniors pay an average of $3,335 a month for assisted living, while similar services in South Carolina run to $3,500, or $500 a month less than North Carolina’s average cost. Seniors in Tennessee pay an average of $3,900 a month for assisted living, which falls within $100 of the average North Carolina rate.

$4000

North Carolina

$4051

United States

$3335

Georgia

$3500

South Carolina

$3900

Tennessee

$4800

Virginia

The Cost of In-Home Care in North Carolina

Seniors in the Tar Heel State who are thinking of hiring an in-home care company to alleviate the burden of housework and assist with personal care matters may appreciate that these services are affordable in North Carolina, adding up to only $3,813 per month. The United States average for in-home care is higher at $4,290 as is the same care in Virginia: $4,195. It also may be reassuring for seniors to know that there is no need to move to afford care since three nearby states, South Carolina, Tennessee and Georgia, all report the same fee as North Carolina.

$3813

North Carolina

$4290

United States

$3813

South Carolina

$3813

Tennessee

$3813

Georgia

$4195

Virginia

The Cost of Nursing Home Care in North Carolina

When assisted living and in-home care are no longer an option because one’s needs have exceeded the limited capacity of ALFs and home care providers, seniors and their families may have to spend more for nursing home care, the most expensive care type. Luckily, in North Carolina, nursing home care falls $456 below the national average of $7,513. At $7,057 per month, this type of care in North Carolina is more affordable than in Virginia ($7,350) and South Carolina ($7,123). Seniors looking to reduce costs may want to consider Tennessee ($6,836) and Georgia ($6,684). 

$7057

North Carolina

$7513

United States

$7123

South Carolina

$6836

Tennessee

$6684

Georgia

$7350

Virginia

Financial Assistance for SeniorLiving in North Carolina

Community Alternatives Program for Disabled Adults (CAP/DA)

Community Alternatives Program for Disabled Adults (CAP/DA) is one of two North Carolina Medicaid waiver programs that are intended to help seniors who need assistance with activities of daily living. CAP/DA pays for the cost of a personal caregiver for seniors with a diagnosed disability or medical need for assistance. Seniors enrolled in this waiver program may choose between facility-directed care and personal care options. Under the personal direction option, beneficiaries may hire and retain the caregiver of their choice, including family members and friends. Though the CAP/DA program is primarily intended for seniors who remain independent in their own homes, benefits can be continued after the recipient enters a residential adult care home.

To qualify for assistance under the CAP/DA waiver, seniors in North Carolina must meet the income and asset restrictions for participation in the North Carolina Medicaid program. Additionally, seniors must also be U.S. citizens or permanent legal residents with a medical need for assistance with activities of daily living.

Contact: Call the Medicaid Contact Center at (888) 245-0179 for more information about CAP/DA benefits. Interested seniors can also apply online or reach out to the program office by mail at: NC Medicaid Division of Health Benefits 2501 Mail Service Center Raleigh, NC 27699-2501.

Personal Care Services (PCS)

Personal Care Services (PCS) is the second waiver program that North Carolina Medicaid offers seniors who need caregiver assistance. PCS benefits are available to eligible seniors who need help with activities of daily living and chore assistance while living in a residential senior living community. These benefits are also available to seniors who live independently, as well as those who permanently reside in a facility registered with the state as an adult care home. Seniors living in group homes and memory care facilities are also potentially eligible for PCS caregiver assistance.

To qualify for PCS benefits, seniors must meet the basic eligibility requirements of North Carolina Medicaid. Income and asset restrictions apply, as do residency and citizenship requirements. In addition to Medicaid requirements, applicants for PCS benefits must also be evaluated in person by a case worker who determines their level of disability and need for assistance.

Contact: Call (888) 245-0179 for information about PCS benefits and to request an application packet. Seniors can also apply by mail at the address of the NC Medicaid Contact Center, listed on the state website.

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

North Carolina SeniorLiving Free Resources

Area Agencies on Aging in North Carolina

Area Agencies on Aging (AAA) are free resources North Carolina seniors can use to locate and to sign up for programs and benefits that can help them age in place or find adequate senior care. In addition to referral and support services, many AAA districts organize community events and classes to keep seniors active.

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Veteran Affairs Offices in North Carolina

The Department of Veteran Affairs maintains a headquarters unit in Winston-Salem and satellite locations around the state to help North Carolina veterans find senior living resources. Veterans who need a pre-admission health screening for senior living can visit a VA health center for an appointment, and a VA benefits coordinator may be able to help find resources to pay some of the costs associated with senior living.

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Social Security Offices in North Carolina

Offices of the Social Security Administration can be invaluable resources for seniors who need financial and other assistance for senior living. Local offices may be found online, where benefit coordinators can assess seniors’ needs and assist with applications for SSI/SSDI, cash assistance, Medicare, Medicaid and many other low-income assistance programs.

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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.

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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