In North Carolina regulations, assisted living residences include adult care homes (ACHs) that house and care for people with dementia. These are often called “memory care,” and must be specially licensed as an adult care home with a special care unit. Among the requirements for these homes is dementia-friendly design features, extra training for staff, and specialized rules about what information is disclosed to potential residents before they move in (see below).
Adult care homes with a special care unit must provide 24-hour supervision and services including assistance with personal needs, transportation, stimulating activities, and housekeeping. ACHs are typically not allowed to admit residents who need nursing-home-level care (exceptions are approved by the state on a case-by-case basis). Another type of assisted living in North Carolina is multi-unit assisted housing with services (MAHS), but the state does not have regulations on admission to these homes for people with dementia. ACHs, therefore, are probably the best bet for your loved one with Alzheimer’s disease or a related dementia.
The state agency responsible for memory care regulation is the North Carolina Department of Health and Human Services’ Division of Health Service Regulation. There are 194 memory care homes in North Carolina. There are also more than 500 board and care homes, which offer the same services as assisted living (sometimes including memory care) in a smaller house-like setting, usually for fewer than 12 residents. Free assistance to find a memory care of any size to meet your family’s needs and budget is available here.
The average cost of memory care per month in North Carolina is $4,484, which breaks down to about $53,808 annually. Assisted living, without the additional services required for memory care, costs North Carolina residents about $4,023 per month and $48,276 annually.
The most expensive place for memory care in North Carolina is Wilmington, running $6,923 per month and $83,067 annually. The least expensive is Jacksonville, which costs families about $3,157 per month and $37,884 annually. In Charlotte, memory care costs about $5,488 per month and $65,856 annually. In Raleigh, memory care runs about $5,668 per month and $68,016 annually.
If you live near North Carolina’s borders, it may be possible to find more affordable memory care outside the state. Southern North Carolinians might look in South Carolina, where the state average is slightly higher than NC’s, at $4,699 per month, but costs vary widely. About an hour from the state line, for example, is Greenville, SC, where memory care only costs about $3,300 monthly. Tennessee, to the west, has similar monthly memory care costs as NC, at about $4,771. Virginia, to the north, is more expensive at about $5,704 per month. Other NC cities and memory care costs:
|North Carolina Memory Care / Assisted Living Costs (updated Feb. 2021)|
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A memory care residence in North Carolina must provide specific details in writing to all residents, including:
– All house rules and facility policies
– The home’s procedures for filing a grievance
– A Declaration of Residents’ Rights
– Resident contract details including costs for services and accommodations
– A list of health needs or conditions that the home says it cannot meet
Two assessments are required of new residents in memory care in North Carolina: an initial assessment within 72 hours of moving in, and a more complete assessment on Department-approved forms within 30 days (and then annually). These assessments are performed by a medical professional working for the residence. Many memory care homes do not charge for the assessment, but there may be a “community fee” that covers all move-in costs, including assessing and also things like deep cleaning and painting a new resident’s room. The assessment determines whether the home is an appropriate fit (whether they can handle your loved one’s medical and personal needs) and also helps create a care plan that tells staff about the resident’s unique needs and preferences. Any residents who experience a change in their health status must be reassessed within 10 days of the change.
People with the following issues or conditions cannot be admitted into North Carolina memory care:
– Mental illness or alcohol or drug abuse
– Maternity care
– Professional nursing care under round-the-clock medical supervision
– Needs do not meet the scope of care of the facility
– Posing a direct health threat to self or others
– Ventilator dependency is only allowable if approved by a physician
North Carolina regulations say a person needs to be diagnosed with Alzheimer’s or related disease like vascular, frontotemporal, and Lewy body dementia in order to move into memory care. This might not be necessary, however: Dementias are difficult to diagnose, with symptoms that change and vary, and if your loved one is showing all the signs of needing memory care without a diagnosis confirmed by expensive tests like PET scans, it is likely still possible to find a residence.
Single-person living units must be at least 100 square feet. A room with two people needs to be at least 80 square feet per person. Two is the maximum number of people allowed per bedroom in North Carolina ACHs, unless the residence was licensed before 2004. A toilet and sink must be provided for every five residents, and the home must have one bath or shower for every 10 residents. A secured outdoor area must be provided, where mechanical noises are minimized. There must be security monitoring and/or locks that meet the state’s safety regulations.
There are not other dementia-friendly design features required in NC regulations, like soft paint colors, easily navigated layouts, and hallways that run circular to avoid dead ends. In some states this is required, and it’s a good idea to inspect a home you’re considering with an eye on whether someone with dementia will feel comfortable within the spaces.
The staff-to-resident ratio in North Carolina memory care residences is one employee for every eight people during the waking hours and one for every 10 during sleeping hours. A care coordinator (trained to help manage residents’ healthcare needs) must be on-duty at least eight hours per day, five days per week. Staff who provide hands-on care for residents must complete an 80-hour training program within six months of being hired. At least one administrator must be on-duty at all times. Administrators must be at least 21 years old, with at least a high school diploma or GED, and relevant experience including a 120-hour administrator-in-training program and subsequent test.
Staff in memory care (or adult care homes with a special care unit) must have the following training:
– Six hours of orientation within a week of hiring
– Twenty hours of dementia-specific training within six months of hiring
– Twelve hours of continuing education annually
A residence in North Carolina must give 30 days notice before enforcing an eviction, unless there is a threat to the health and safety of others who live there. The process for appealing an eviction is not explained in regulations, but a good place to start for anyone dealing with this issues is the NC Long-Term Care Ombudsman’s office (click here), which advocates for residents in assisted living and can advise on next steps or even investigate an eviction if there’s question about whether it’s appropriate.
These are the reasons a person can be evicted from North Carolina memory care:
– The resident’s needs cannot be met at the home
– The safety of others is endangered
– Failure to pay bills on time
State regulations, as you can see, are not very specific about what justifies an eviction, but the residence itself should have clearer guidelines. When moving into memory care, ask what can cause a person to be evicted and what the process of appeal is, and get the answer in writing. This is important because unfair evictions are a big problem in assisted living around the country.
Unlike in other states, North Carolina’s Medicaid program covers some costs of assisted living. North Carolina Personal Care Services (PCS) is a Medicaid program, operated under the Division of Medical Assistance, for people in personal care homes who need help with activities of daily living (ADLs), including eating, using the bathroom, and putting on clothes. Other assistance, including money for housekeeping, may be provided. Applicants must be eligible for Medicaid and must be assessed for their abilities by the Liberty Healthcare Corporation of North Carolina, to determine the extent of their needs. (Download the request for this assessment here.) A physician’s referral is required for this assessment. For more information, including application paperwork, click here.
This North Carolina program is for monthly financial assistance to help cover the cost of room and board in adult care homes’ special care units (memory care). To qualify, a person needs to be diagnosed with Alzheimer’s disease or a related dementia. The maximum benefit amount a person in this program can receive monthly is $1,561, depending on their own countable monthly income. To apply, contact your local Department of Social Services. For a brochure with more information, click here.
This program, formerly called the Special Assistance Adult Care Home Program (SA/ACH) provides funds to help Medicaid-eligible North Carolinians cover the costs of adult care homes and adult foster care homes. Specifically, it helps pay for rent or room and board. The maximum benefit is about $1,228 per month. People who need full-time nursing care are not eligible. This program is managed by the Division of Aging and Adult Services via North Carolina’s Department of Health and Human Services. To apply, contact your local Department of Social Services.
Because of their frequency of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) veterans are statistically more likely to develop dementia. Relevant in all states including North Carolina is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pension. A&A is also called the Income Improvement Pension and the Enhanced Monthly Benefit. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. Cash assistance from these pensions can be used however the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive as much as $14,928. Learn more here.
There are also four veterans’ homes in North Carolina, which are residential care facilities that provide long-term care for veterans. They are located in Fayetteville (central NC in the inner coastal plain), Kinston (coastal plain), Black Mountain (western mountainous region), and Salisbury (central NC south of Winston-Salem). In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. For contacts and more information, click here.
Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should their spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.