Official terminology in North Dakota is different than in other states, and people looking to find a home for someone with dementia should know the difference. “Assisted living facilities” in North Dakota is a term for communities where mostly elderly people live together, but these cannot offer care to people with Alzheimer’s disease or a related dementia. The type of residence that can offer the personal and health care required by people with dementia is a “basic care facility.” Basic care facilities are licensed by the state’s Department of Health to provide housing, food, and 24-hour health and personal assistance. If a basic care facility offers memory care, also called “Alzheimer’s units,” these must be specially licensed based on written policies that specify practices specifically good for people with dementia.
Basic care facilities generally provide help with activities of daily living (ADLs), like eating and bathing, and instrumental activities of daily living (IADLs) like managing money and housekeeping. These homes must also arrange for health care as needed by any resident.
The average cost of memory care in North Dakota is $4,467 per month, which breaks down to about $147 per day and $53,604 annually. Regulations do not require basic care facilities in North Dakota to provide potential residents with a list of all costs, so it’s important you ask for this in writing, to file as defense against unexpected charges.
Assisted living, without the additional services required for memory care, costs North Dakotans about $3,414 per month and $40,968 annually. The state’s largest city is also its most expensive for memory care: In Fargo, the costs are about $5,225 per month and $62,700 per year. The least expensive location for memory care in North Dakota is Grand Forks, where costs are about $2,553 per month and $30,636 annually.
Every person who moves into a North Dakota basic care facility must be assessed by a healthcare professional within 14 days of moving in. The assessment must be updated at least every four months, and include:
– Health needs
– Ability to socialize
– Functional abilities
– Nutritional needs
– Personal care needs
– Medical history
– Social interests
– Preferred activities
Unlike most other states, there is not a rule in North Dakota about how large a living unit or bedroom must be. The standard minimum size for a single person is about 100 square feet, so you should look for something at least that size (excluding bathrooms and closets). Basic care facilities are required to have a toilet for every four residents, and a bath or shower per every 15 residents. Automatic sprinkler systems for fire surpression are required in these residences, and a fire drill must be conducted at least once per month.
An administrator must be in charge of general administration in a North Dakota memory care residence. Administrators must complete at least 12 hours of continuing education annually. There are no staff-to-resident ratios in North Dakota, but someone must be on-duty and awake 24 hours per day, 365 day per year. All employees must have in-service training every year on these topics:
– Fire and accident prevention and safety
– Managing behavior problems
– Fulfilling mental and physical health needs
– Infection control and prevention
– Resident rights
Staff who prepare food must attend at least two dietary educational programs annually. Staff who run activities for residents must attend at least two activity-related educational programs annually. Staff who work in memory care with people who have dementia must have at least eight hours of dementia-specific training upon hiring, and then four hours every year after.
North Dakota Medicaid State Plan Personal Care services (MSP-PC) is specifically for people who need help with activities of daily living (ADLs), like eating and bathing, and instrumental activities of daily living (IADLs) like money or medications management. There are multiple levels of functional need, but consistent in them all is a need for ADL and IADL help, and a level of care that might require moving into a more-expensive nursing home without the benefits of MSP-PC. Depending on needs, there might be a cap on the number of hours of help a person can receive each month. Recipients must be on Medicaid (click here for information on how to enroll and eligibility). For a printable fact sheet, click here. To apply, contact your local North Dakota Human Services office.
Veterans are statistically more likely to develop dementia. Relevant in all states including North Dakota is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive $14,761. Learn more here.
There is a state veterans’ home in North Dakota located in Lisbon (approximately 75 miles from Fargo). 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 service. Because there is often a waiting list, contact a home before visiting to ensure the residence has rooms available for the veteran.
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 claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that might 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 the spouse move, the reverse mortgage would become due.
Elder care loans are for families to cover 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.