Official names for assisted living and memory care in North Dakota regulations are 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. Those practices include activities that encourage socialization. Interestingly, these homes also need to give residents the freedom “to control their schedules and activities,” as well as eat whenever and wherever they want within the residence.
Basic care facilities more 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.
There are 16 memory care homes in North Dakota. These residences range in size from apartment-complex-style communities serving more than 100 people to smaller house-like settings (called board and care homes) serving 12 or fewer people at a time. For free help finding the right memory care home to fit your family’s needs and budget, click here.
The average cost of memory care in North Dakota is $4,843 per month, which breaks down to about $53,604 annually. This is slightly less expensive than the national average of around $5,000 per month. Memory care generally costs about $1,000 more per month than regular assisted living.
The state’s largest city is also its most expensive for memory care: In Fargo, the costs are about $5,453 per month and $65,436 per year. The least expensive location for memory care is also along the Red River Valley bordering Minnesota: Grand Forks, where costs are about $3,049 per month and $36,588 annually. In the Missouri Plateau (central ND), memory care in Bismarck costs about $4,089 monthly and $49,068 per year.
It might be possible to find more affordable memory care in states bordering North Dakota, but their costs are similar. Southern ND residents might look in South Dakota, where the average monthly price of memory care is $4,305. To the west, Montana’s memory-care costs run about $4,950 per month. Eastern North Dakotans could look in Minnesota, where the average monthly bill is about $5,058.
Every person who moves into a North Dakota basic care facility must be assessed by a healthcare professional who works for the residence within 14 days of moving in. The assessment is used to create an individualized plan for care and treatment, and must be updated at least every four months. It includes:
– Health needs
– Ability to socialize
– Functional abilities
– Nutritional needs
– Personal care needs
– Medical history
– Social interests
– Preferred activities
The cost of assessing a new resident might be free when a person agrees to sign a move-in contract, or it may be covered by a one-time “community fee” that pays for one-time up-front costs like the assessment and also deep cleaning a new resident’s room. Community fees typically run between $1,000 and $2,500.
Regulations do not require that a person be diagnosed with Alzheimer’s or a related disease like frontotemporal, vascular, or Lewy body dementia in order to move into ND memory care. Dementias are difficult to diagnose as symptoms change and vary, and the process includes expensive tests like PET brain scans. The degree of memory loss and what specific actions staff can take to help your loved one will be determined during the assessment.
And while it is possible to find memory care on short notice in North Dakota, this is not a good idea. You should start looking at residences before a move is necessary, to allow for time for thorough investigation, including asking questions of staff and other residents. Also, the sooner you begin your search the more input the person with dementia can have on the final decision.
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. Residents also have the freedom to decorate their rooms as they see fit, within the parameters of residence policies.
Regulations also require a secure outdoor area, because studies show time in the open air is beneficial for people with dementia. There are not other rules regarding dementia-friendly designs, so things like easily navigated layouts and hallways that run circular (to prevent someone with dementia from encountering a dead end) are not required like in other states. For this reason, be sure to thoroughly inspect any memory care home you are considering, with an eye on whether your loved one will be comfortable within the spaces. Soft paint colors and clear sight lines are also ideal.
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 regulations say that every basic care facility may establish its own rules about how and why to evict a resident. Very broadly, a home cannot keep a resident whose medical needs cannot be handled there. If staff isn’t trained to help someone who is non-ambulatory, for example, then a person who loses their ability to walk cannot live there. More specific rules, however, depend on the home. Can your loved one be evicted for nonpayment of bills on time? Does aggressive or insulting behavior get someone evicted?
It’s important to ask these questions before agreeing to a move-in contract, because unfair evictions are a major problem in assisted living nationwide. Ask for the reasons a person can be evicted, whether advanced notice must be given by the home (30 days is standard), and what the process for appealing is. Get the answers in writing. If you receive an eviction notice and need to know next steps, click here.
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.
Due to high rates of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), 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 income improvement 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 (2021) maximum amount a veteran can receive through A&A is $27,540 per year, and surviving spouses can receive $14,928. Learn more here.
There is also one state veterans’ home in North Dakota, located in Lisbon (in the southeast, approximately 75 miles from Fargo). In addition to nursing home care and assisted living, memory care is available in a secure unit with specially trained staff. 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 are limited beds available, contact a home before visiting to ensure the residence has rooms available. Contacts and more information are at this link.
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.