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Guide to Senior Living in North Dakota

Almost all of North Dakota is covered by ranches and farms with rich deposits of oil, coal and gas underneath. Home to just over 750,000 people, North Dakota is the nation’s fourth most sparsely populated state, with wide-open Great Plains vistas and plenty of land where active seniors can hunt and fish. Just over 15% of North Dakota’s people are seniors aged 65 and over, with 53 senior living facilities in the state to care for them. These communities tend to be located close to North Dakota’s three sizable cities, but some can be found on the large stretches of Native American lands that cover much of the state.

Cost of care in comparison to the national average varies in North Dakota. For instance, assisted living at $3,405 a month is more than $600 less than the national average, according to the Genworth 2019 Cost of Care Survey. However, both in-home care and nursing home care are more expensive than the national average.

The cost of care can be daunting for many seniors on fixed incomes, which is why this guide goes over many of the likely costs seniors in North Dakota face for assisted living. It also identifies many resources seniors in North Dakota can use to help manage the cost of senior care at every level.

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

The following rules and guidelines were obtained from the North Dakota Department of Health website, as well as other state-level government sites. Among others, these rules apply to skilled nursing, basic care, and assisted living facilities.

This data has been most recently updated on 7/13/20, 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 (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?NA
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 (varies by facility)
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?NA
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?Sometimes (case-by-case basis)
Are senior living facilities required to cancel all group outings?Yes
Are residents still eating together in the dining hall?Yes, with social distancing
Are facilities still allowed to host group activities within the community?Yes, with social distancing

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 Dakota

Assisted living is one of the more affordable options for senior living in North Dakota. At $3,405 a month, assisted living in North Dakota is significantly less expensive than nursing home care, where a semiprivate room averages $11,875 a month. In-home care and home health services are intermediate in cost, at $5,148 and $5,331 a month, respectively. Adult day care in North Dakota is somewhat less expensive than assisted living, at $2,059 a month.


Assisted Living


In-Home Care


Home Health Care


Adult Day Care


Nursing Home Care

The Cost of Assisted Living in North Dakota

Assisted living in North Dakota costs an average of $3,405 a month, which is $645 a month less than the national average of $4,051. For assisted living, North Dakota is one of the least expensive states in the northern Great Plains. Assisted living in South Dakota, for example, costs nearly $100 a month more, at $3,500 a month. Wyoming, Montana and Minnesota are all very similar in price, at $3,780, $3,820 and $3,800 a month, respectively.


North Dakota


United States






South Dakota



The Cost of In-Home Care in North Dakota

North Dakota’s in-home care services, priced at $5,148, are reasonable as compared to the neighboring states of South Dakota, $5,339; Minnesota, $5,529; and Wyoming, $5,339. Only Montana is more affordable for seniors at a cost of $4,576 a month. Unfortunately for bargain hunters, all of these prices are above the national average of $4,290 a month. 


North Dakota


United States


South Dakota







The Cost of Nursing Home Care in North Dakota

Nursing home care in North Dakota presents seniors with a staggering bill of $11,875 per month, a fee that stands more than $4,000 above the national average. Neighboring states South Dakota, Montana, and Wyoming offer significantly more affordable nursing home care at $6,844, $7,459 and $7,356, respectively. Minnesota is the closest in price to North Dakota at $10,076 a month but is still  about $1,800 cheaper. 


North Dakota


United States


South Dakota







Financial Assistance for Senior Living in North Dakota

HCBS Medicaid Waiver

Medicaid beneficiaries in North Dakota may be eligible for help paying some of the cost of senior living through the Department of Human Services’ Home and Community-Based Waiver. This waiver pays for senior living costs for seniors with a medical need that would justify placement in a nursing care home but who opt out of the higher level of care and into a participating facility. HCBS waivers support seniors who choose to live in their own homes, in the homes of loved ones or in state-licensed senior living facilities.

The services offered under the waiver program are varied, with some direct monetary support for seniors and some benefits paid for less directly by the program. Covered benefits include:

  • Personal caregiver support in the home or facility
  • Nonemergency medical and disabled ride transportation
  • Lifeline emergency response hardware and medical technology for beneficiaries with limited mobility
  • Case management services that help seniors find all of the benefit programs they may be eligible for

To sign up for the HCBS waiver, seniors in North Dakota must be enrolled in Medicaid and have a diagnosis that could justify placement in a nursing care facility. A doctor must confirm that all of the beneficiary’s health needs can be met at the level of senior living provided by the specific facility admitting the resident. Applicants must be at least 65 years old or have a disability that limits their ability to live independently, and they must be capable of self-care in the community they are applying to.

Contact: Seniors can call the Aging and Disability Resource Center at 1-855-462-5465 for information or to apply by phone. Seniors can also download an application online.

Senior Living Laws and Regulations in North Dakota

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.

North Dakota licenses all senior living facilities through the state Department of Health, Division of Health Facilities. The Department of Health defines an senior living facility as any senior care residence with five or more full-time residents who are not related to each other or a facility that advertises itself as accepting seniors from the general public for board and care.

Senior living facilities in North Dakota are required to provide each new resident with a written lease or rental agreement that itemizes the cost of every service the facility offers. Residents may opt into or out of any service, which can only be charged if provided with the resident’s consent. State law permits these facilities to charge private insurance carriers for most or all of the cost of long-term care, provided the facility maintains a current license.

The Department of Health regulates facilities by setting admission standards, memory care guidelines, medication policies and staff training and retention requirements.

Admission Requirements

Seniors moving into a senior living facility in North Dakota must undergo a preadmission medical screening by a physician or nursing home staff member to evaluate their total medical and lifestyle needs. A plan of care must be developed that accounts for the resident’s medication, therapy and social needs, which must be updated as a resident’s condition changes. Medical staff must certify that all of the senior’s needs can be attended to within the scope of care provided by the specific facility being applied to.

Seniors may be admitted to senior living if they are capable of self-care with minimal to moderate assistance with two or more activities of daily living. An exception may be made for residents who need hospice care, provided the facility is able to “wrap around” the resident’s needs and provide full-time care in accordance with the revised care plan.

Memory Care Regulation

Senior living facilities may not admit residents with Alzheimer’s disease or other forms of dementia. Basic care facilities, which are separately licensed, may do so only if they are capable of attending to all of the resident’s needs. A special care unit must be set up to look after memory care-dependent residents, with secure windows and doors to prevent wandering and other disruptive behaviors. Staff assigned to a special care unit must have training to care for seniors with dementia, as well as briefing on emergency evacuation procedures. Facilities with a special care unit must schedule regular occupational and mental health therapy sessions, along with stimulating social events, for residents capable of participating.

Medication Management

Senior living residents who are capable of self-management may keep and take their own nonprescription and over-the-counter medications. Prescribed medications listed on the resident’s care plan may also be kept under the resident’s control if the resident can safely manage them. Nonmedical staff may prompt residents for dose times, log consumption and assist with dose preparation, such as grinding for mixing with applesauce or juice.

Staffing Requirements

Senior living facilities must appoint an administrator to manage the site on a full-time basis. A substitute administrator may be appointed to act in the primary administrator’s place during absences, provided they meet the same standards the state sets for principal administrators.

Facilities must maintain enough staff on site to adequately care for each resident’s needs. No specific ratio is mandated by law, but sufficient personnel must be available, awake and on duty to evacuate residents in emergencies and to care for their daily needs.

Facility administrators must be at least 21 years of age and pass a background screening check. Administrators must complete a minimum of 12 hours of training annually to maintain certification. Staff members must be at least 18 and also pass a preemployment background screening for hands-on care positions. In addition, new staff members must receive initial training in resident rights, fire and accident prevention, and mental and physical health needs for seniors, including behavior problems and infection control. Training in these areas must be repeated annually for as long as the staff member is employed in a resident-facing position.

North Dakota Senior Living Free Resources

North Dakota Agencies

North Dakota Medicaid

Medicaid offers basic health insurance services for seniors, adults with disabilities and low-income residents of North Dakota. Covered services include preventive care, necessary diagnostic services and needed treatment for beneficiaries who qualify for low- or no-cost services. The program also provides some prescription drug benefits. Some groups of applicants are automatically eligible for Medicaid in North Dakota, such as seniors with disabilities and beneficiaries of SSI/SSDI. Seniors in North Dakota may be eligible for Medicaid if they are U.S. citizens with less than $3,000 in countable assets and income within program guidelines. Seniors who earn up to 300% of the Federal Poverty Line may still qualify for Medicaid coverage, though a share of cost may be included.

Contact: Seniors can call 1-800-318-2595 to apply for Medicaid by phone or to request an application packet. Seniors may also apply for Medicaid online, through the Department of Human Services website.

Area Agencies on Aging in North Dakota

The North Dakota Department of Human Services operates a network of Area Agencies on Aging throughout the state. Seniors aged 60 and over can get help through an AAA office with referrals for counseling and medical services, caregiver support and many social support programs. AAA offices periodically organize social events for seniors to meet up in their local community, often for community meals and other nutrition supports. Seniors in North Dakota can find a local AAA office from the department’s online service area map.

Veterans Affairs Offices in North Dakota

North Dakota seniors who have served in the military can access a range of benefits through the Department of Veterans Affairs. Benefits that are available to honorably discharged veterans and their qualifying spouses include health services, such as preadmission medical screenings for veterans moving into senior living. The North Dakota VA also offers referrals for counseling,

Bismarck Vet Center619 Riverwood Drive
Suite 105
Bismarck, ND 58501
Fargo Vet Center3310 Fiechtner Drive, South
Suite 100
Fargo, ND 58103
Grand Forks Outstation3001 32nd Ave
Suite 6
Grand Forks, ND 58201
Minot Vet Center3300 South Broadway
Minot, ND 58701

Social Security Offices in North Dakota

Seniors can appeal to the Social Security Administration for help signing up for a number of social programs. These include Medicare, Medicaid, SSI/SSDI and various nutritional support programs. Staff at the SSA can assist seniors with filing initial applications and submitting appeals. Seniors in North Dakota can find a local Social Security office online or call to book an appointment.

BismarckSuite 100
4207 Boulder Ridge Road
Bismarck, ND 58503
Devil’s LakeSuite 1
221 2ND Street NW
Devils Lake, ND 58301
Fargo657 2nd Ave N
Fargo, ND 58102
Grand ForksSuite 300
402 Demers Ave
Grand Forks, ND 58201
JamestownSuite 134
300 2ND Ave NE
Jamestown, ND 58401
MinotMinot Metro Center
1414 20th Ave SW
Minot, ND 58701
WillistonSuite 102
1137 2nd Ave West
Williston, ND 58801

Frequently Asked Questions

How much does assisted living cost in North Dakota?

Assisted living in North Dakota costs an average of $3,405 a month. This is $645 a month less than the national average seniors pay elsewhere ($4,051), and it’s significantly lower than the cost of both skilled nursing in North Dakota and assisted living in many other states.

Does North Dakota Medicaid pay for assisted living?

Medicaid in North Dakota doesn’t directly pay for assisted living. The low-income health insurance program may, for many North Dakota seniors, pick up some or all of the cost of basic medical needs, but no Medicaid plan in the state currently pays for the board and care costs assisted living communities charge.

Does Medicare pay for assisted living?

Original Medicare provides both inpatient and outpatient services for eligible seniors aged 65 and over, but it doesn’t directly pay for the monthly cost of assisted living. While many seniors can use Medicare benefits to help pay for some of their needs, such as the Part D prescription drug benefit, no Medicare provision covers nonmedical board and care. Some seniors do get their health insurance through a Medicare Advantage plan. Because these plans are issued by private companies, the details of what they cover vary somewhat between programs. Consult with a plan representative about any possible residential care benefit.

What are “activities of daily living”?

Activities of daily living are the regular activities many seniors need assistance to perform and which personal caregivers are able to help with. In this category are personal care needs, such as bathing and dressing, as well as household chores, such as meal preparation and light housekeeping.

What is the difference between assisted living and nursing homes?

Assisted living and skilled nursing facilities differ in how medically intensive each level of care can be. Nursing homes in North Dakota frequently provide IV lines, wound care, therapeutic services and post-acute rehabilitation for seniors who have recently been discharged from a hospital. Assisted living facilities provide a much less clinical environment where seniors can live as independently as their health allows, with some nonmedical assistance from personal caregivers.

The Top Cities for Senior Living in North Dakota

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

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