North Carolina Residential Alzheimer’s Care (Memory Care): Rules, Costs & Financial Help

Legal Definition of Assisted Living / Memory Care in North Carolina

North Carolina law says that assisted living residences include adult care homes that house and care for people with dementia. Often called memory care, these residences must be specially licensed as an adult care home with a special care unit. Among the requirements for these homes are 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 care services including assistance with personal needs, transportation, stimulating activities, and housekeeping. Adult care homes are 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. The state does not have regulations on admission to these homes for people with 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 close to 200 memory care homes in North Carolina. There are also more than 500 board and care homes. These offer the same services as assisted living 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.

How Much Does Memory Care Cost in North Carolina?

The average cost of memory care per month in North Carolina is $5,248 in 2024. Statewide there is a large difference in the price of care. The most expensive place for memory care in North Carolina is in the state capitol in Raleigh, running $7,036 per month. The least expensive is in Fayetteville, which costs families $3,936 per month. In Charlotte, memory care costs $5,764 monthly.

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 lower than North Carolina’s, at $4,730 per month, but costs vary widely. About an hour from the state line, for example, is Greenville, SC, where memory care only costs about $4,889 monthly. Tennessee, to the west, has similar monthly memory care running $5,367. Virginia, to the north, is more expensive, costing on average $6,877 per month. Other major cities and their memory care costs are:

North Carolina Assisted Living Laws & Regulations

Admissions Process & Requirements

A memory care residence in North Carolina must provide specific details in writing to all residents. This includes:

– 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: an initial assessment within 72 hours of moving in, and a more complete assessment on Department-approved forms within 30 days (and then again 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 things like deep cleaning and painting a new resident’s room. The assessment determines whether the home is an appropriate fit by determining whether they can handle your loved one’s medical and personal needs. This also creates 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 conditions cannot be admitted into memory care:

– Mental illness or alcohol or drug abuse
– Maternity care
– Need nursing care or round-the-clock medical supervision
– Needs do not meet the scope of care of the facility
– Posing a direct health threat to themselves 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 still possible to find a residence.

Facility / 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, 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 no other dementia-friendly design features required, 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.

Staff & Training

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 ten 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.

Memory care staff must additionally complete:

– 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

Evictions & Discharges

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.

The reasons for eviction from a North Carolina memory care facility are:

– The resident’s needs cannot be met at the home
– The safety of others is endangered
– Failure to pay bills on time

State regulations 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. For more on memory care evictions, including what to do if you receive an eviction notice, click here.

Financial Assistance for Residential Alzheimer’s Memory Care

North Carolina Personal Care Services (PCS)

North Carolina Personal Care Services is a Medicaid program that provides additional long-term care services. Participants can live in their own homes, that of a loved one, or an assisted living community. These long-term care benefits via the PCS program can aid with activities of daily living, including eating, using the bathroom, and putting on clothes. Other assistance, including laundry and housekeeping, may be provided. Currently, enrollees can receive a maximum of 130 care hours monthly. Eligibility requirements in 2024 include a monthly income under $1,255, countable assets less than $2,000, and a documented medical need for assistance with activities of daily living. More information is available on the PCS website. To apply, contact your local Department of Health and Human Services. Click here for more information about North Carolina’s Medicaid eligibility requirements or here to take a Medicaid eligibility test.

Community Alternatives Program For Disabled Adults Wavier

The Community Alternatives Program for Disabled Adults Wavier (CAP/DA Waiver) is a Medicaid program that provides home and community-based services to qualified applicants. This program is designed to assist independent living and prevent the need to move into a nursing home. Benefits in the form of long-term supportive care services are given and range from assistance with activities of daily living, laundry, chore service, meal delivery service, adult daycare, and transportation. The eligibility requirements for Medicaid in North Carolina in 2024 include a monthly income under $1,255, countable assets less than $2,000, and a documented medical need for a nursing home level of care. More information is available here, including details on how to apply. A waitlist can occur because there is a cap on the annual enrollment, which is currently limited to 13,588 participants.

Special Assistance for Adult Care Home Special Care Unit Program

This North Carolina program is a monthly financial assistance to help cover the cost of room and board in memory care homes. 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.

State/County Special Assistance Program for Adult Care Home Residents

This program provides funds to help Medicaid-eligible North Carolinians cover the costs of adult care homes and adult foster care homes. The Special Assistance Adult Care Home Program 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.

Veterans Affairs (VA)

Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.

VA Pensions

There are three types of VA Pensions available. The benefits change annually and are valid from December 2023 to December 2024. The benefits (and their maximum allowance) are as follows:

1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:

– Veterans without spouses or children up to $16,551

– Veterans with dependent spouses or children up to $21,674

– Surviving spouses without dependent children up to $11,102

2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:

– Veterans without spouses or children a maximum of $27,609

– Veterans with dependent spouses or children a maximum of $32,729

– Surviving spouses without dependent children a maximum of $17,743

3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:

– Veterans without spouses or children a maximum of $20,226

– Veterans with dependent spouses or children a maximum of $25,348

– Surviving spouses without dependent children a maximum of $13,568

Veterans Homes

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.

Neighboring states have more veterans’ homes, so a loved one might consider looking there for more options as there are no requirements that one must live in the state. For example, South Carolina has five veterans homes statewide and several are located relatively close to their shared border. Additionally, Tennessee has four facilities and Virginia has two more homes. More info.

Other Options

1)Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.

2) 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 can include assisted living costs.

3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.