In North Carolina, assisted living residences can 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 specialized disclosure rules and training for staff (see below). The state agency responsible for memory care regulation is the North Carolina Department of Health and Human Services’ Division of Health Service Regulation. Adult care homes with a special care unit must provide 24-hour supervision and care 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 average cost of memory care per month in North Carolina is $5,265, which breaks down to about $173 per day and $63,180 annually. Part of the disclosure statement that is supposed to be given to anyone considering living in an adult care home with a special care unit (memory care) is a full disclosure of charges for services there, so there should never be surprise costs or charges. 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 Durham, running $7,299 per month and $87,588 annually. The cheapest are Goldsboro and Jacksonville, which both cost families about $3,271 per month and $39,252 annually. In Charlotte, North Carolina’s most populated city, memory care costs about $6,023 per month and $72,276 annually. North Carolina’s second-largest city is Raleigh, where memory care runs about $7,299 per month and $87,588 annually.
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 rates 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).
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.
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.
Smoke detectors are required in every corridor, no more than 60 feet apart.
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
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. Among the other qualifications is monthly income less than $1,561. 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.
There are also Veterans homes in North Carolina, which are residential care facilities that provide long-term care for veterans. 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. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there.
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.