In-Home Care in North Carolina

North Carolina is home to over 10 million people, including a large senior community that makes up nearly 17% of the population. It has the ninth-largest senior community in the nation, and seniors are the fastest-growing demographic in the state. Many of North Carolina’s cities and counties are listed on the AARP Network of Age-Friendly States and Communities, but no matter where you live in the state, you can find access to community-based services that help you maintain your independence and quality of life throughout your retirement years. 

North Carolina is an affordable option for those seeking in-home care. Overall, the state’s cost of living comes in about 10% below the national median. Seniors don’t pay state taxes on their Social Security income, which may help those who rely primarily on this form of income to afford long-term care. In-home care is relatively affordable at $4,385 per month.  

This guide outlines what you can expect to pay for in-home care throughout that state and how rates compare to other senior care options. It also covers some ways that you may be able to pay for care, highlights local agencies that serve seniors and provides answers to frequently asked questions regarding in-home care.

The Cost of In-Home Care in North Carolina

The 2021 Genworth Cost of Care Survey reports that seniors in North Carolina pay competitive in-home care rates of $4,385 per month. This is nearly $600 lower than the national median rate of $4,957 and cost-effective compared to most of North Carolina’s bordering states. In Virginia, care costs are considerably higher at $4,767. In Tennessee, clients pay $4,576 for services, and in South Carolina, agencies charge $4,433. Only Georgia has more economically priced care, with rates averaging $4,290 per month.

In-home care costs vary throughout North Carolina, but rates in all cities are at or below the national median. Of the surveyed cities in the state, Raleigh is the costliest place to obtain care, with fees coming in at $4,957 per month. In Charlotte, care costs are considerably lower but still exceed the state median at $4,668, and in Wilmington, rates average $4,576. Seniors in Rocky Mount pay comparatively low monthly fees of $4,290, and seniors in Jacksonville pay $4,195. In Hickory, care is affordable at $4,099. Goldsboro has the lowest surveyed rates in the state of $3,813.  

Seniors pay $4,385 for in-home care as well as home health care, which is similar but also includes skilled nursing services, making home-based care the second-most expensive long-term care option in North Carolina. Only nursing home care is costlier at $7,483 per month. Older adults may save money by moving into an assisted living facility, which provides personal care services along with housing, meals and recreational activities. For those who want to remain in their homes while obtaining affordable care, adult day care may be a viable option at $1,197 per month.

Does Medicaid Cover Home Care in North Carolina?

While North Carolina is a generally affordable state for in-home care, for some seniors, monthly expenses exceed what they can pay for with their retirement income. Fortunately, NC Medicaid provides coverage for in-home care for income-qualifying individuals in the state. It pays for services directly under its Personal Care Services program, which pays for an approved number of hours per month of attendant care. Because this program is part of regular Medicaid, it doesn’t have enrollment caps and those who qualify are guaranteed services.  

The Personal Care Services program features services provided by in-home aides who provide non-medical care to help you age in place. Services include: 

• Bathing/showering  
• Dressing 
• Toileting 
• Mobility  
• Eating 
• Housekeeping 
• Grocery shopping 
• Meal preparation 
• Laundry 
• Medication reminders 
• Companionship  

To be eligible for services, you have to undergo an independent assessment that’s conducted by or on behalf of NC Medicaid. You must need partial help with at least three activities of daily living (ADLs) or partial help with one ADL and extensive or full help with a second ADL.  

NC Medicaid also covers in-home care through the Community Alternative Program for Disabled Adults program. This program provides home-based care as an alternative to nursing home care for those who need assistance due to age or disability.  

Home Care Waiver Programs in North Carolina 

Community Alternative Program for Disabled Adults 

The CAP/DA waiver program provides additional in-home services beyond the scope of the regular Medicaid program and is for those aged 18 and over with disabilities that qualify them for nursing home level care. Program participants may have the option to self-direct their care, meaning they choose who provides the services in their care plans. In some cases, family and friends are eligible for hire. Some services this program covers include: 

• Adult day care 
• In-home aide services 
• Personal assistance  
• Case management 
• Money management 
• Respite care 
• Pest control 
• Chore services 
• Basic housekeeping and laundry services 
• Transportation for errands 
• Home-delivered meals 
• Home and vehicle modifications 

To qualify for services, applicants must be at least 18 years old and they must need an institutional level of care. They must also meet Medicaid’s eligibility requirements and need at least one service the waiver pays for. While regular Medicaid is an entitlement, CAP/DA has enrollment caps, and eligible applicants may be placed on a wait list until slots are available. Each county has an allotted number of waiver slots, so even if the program is at capacity in one county, other counties may have open slots.  

To apply for CAP/DA, you must fax a referral request to North Carolina Medicaid at (919) 715-0052.  

How to Know If You’re Eligible for Medicaid in North Carolina 

The primary purpose of NC Medicaid is to provide comprehensive health insurance for low-income individuals. As such, the program has strict income and asset limits. If you are single, you may have an annual income of up to $13,596. All types of earned and unearned income count towards this limit, including veterans’ and public benefits, stock dividends, pensions, withdrawals from retirement accounts and wages. You may have up to $2,000 in countable assets, which include savings accounts, investments and rental or vacation properties you own. Your primary residence, vehicle and personal belongings are exempt. If you’re married, the respective income and asset limits are $18,312 and $3,000.  

2022 Medicaid Income Limits for Seniors in North Carolina  

*Per year 

Along with meeting financial criteria, Medicaid applicants must meet additional requirements, including: 

• They must be permanent North Carolina residents.
• They must be legal U.S. citizens or residents.
• They must need the coverage Medicaid provides.

How to Apply for Medicaid in North Carolina 

You can apply for Medicaid online through ePASS or HealthCare.gov. Alternately, you can fill out a paper application and submit it to your nearest Division of Social Services office in person, by fax, through email or through the postal service. You can also contact the DSS to check on the status of your application.   

What Information You Will Need 

To expedite the approval process, you should ensure that you have supporting documents on hand before submitting your Medicaid application. Some documents that you should have include: 

• Driver’s license or state-issued ID card 
• Policy numbers for primary health insurance, including TRICARE or Medicare 
• Birth certificate 
• Social Security card 
• Proof of income 
• Proof of assets 

How to Get Help Applying for Medicaid 

If you need help applying for Medicaid or understanding your benefits, several agencies and programs can assist you in navigating the system and making important decisions regarding your health insurance coverage. The following resources are open to all North Carolina residents and include specialists, legal advisors and informational services.  

Does Medicare Cover In-Home Care in North Carolina?

In general, Medicare does not cover the cost of non-medical home care. That being said, there are situations in which Medicare provides some coverage for medical home care, referred to as “Home Healthcare.” There are several eligibility restrictions for coverage, including that individuals must be homebound and have a referral from their doctor specifically for home healthcare services.

Below is an overview of some of the skilled medical professionals whose in-home services are typically covered by Medicare – for more in-depth information, refer to our Guide to Home Healthcare.

• Physical Therapists: Physical therapy is used to help patients recover from injuries (broken bones, knee injuries, etc.), treat ongoing conditions such as arthritis, and assist in recovery from surgeries and procedures such as a knee or hip replacement.
• Visiting Nurses: Licensed nurses can provide a number of medical services for those who don’t need to stay in the hospital, but do need regular medical services such as wound care, changing feeding tubes, etc.
• Occupational Therapists: Occupational therapists help seniors regain or maintain the ability to accomplish normal, daily tasks, such as bathing, dressing, eating, and other daily activities.
• Speech Therapists: Speech therapists help seniors who are struggling to adequately communicate due to a stroke, dementia, or any other cause regain the ability to functionally communicate using a variety of means. Additionally, speech therapists help to keep seniors independent by modifying diets, teaching special techniques to swallow safely, and retraining associated muscles.

As mentioned above, in-home care is distinctly different from home healthcare. But, there can be some overlap in services between the two types of care. So, while Medicare doesn’t cover non-medical in-home care, there are in-home care services that may be covered in special circumstances when they’re provided in conjunction with home healthcare (such as an occupational therapist helping with eating or dressing)

Other Financial Assistance Options for In-Home Care in North Carolina

While the above programs help many people finance in-home care, they will not cover all costs for everyone. There are other ways to pay for in-home care, including out-of-pocket arrangements with siblings, annuities, reverse mortgages, private insurance and more. Read Caring.com’s Guide to In-Home Care Costs to learn more about these alternative payment options.

Free and Low-Cost Resources for Seniors in North Carolina

The following table highlights resources in North Carolina that can help you obtain the services you need to age in place.

COVID-19 Rules for In-Home Care Providers in North Carolina

Unless they have an exemption, home health care aides in North Carolina must be fully vaccinated against COVID-19 before working directly with seniors. This rule is current as of April 2022, but as new information on the virus is available or variants are introduced to the population, guidelines may continue to evolve. The local Area Agency on Aging or health department may have the latest guidelines that home health care agencies are required to follow.  

Currently, there are no vaccine mandates for in-home aides. However, agencies may have their own safety guidelines that exceed state and federal regulations. If you have questions or concerns about the precautions your home care agency takes against COVID, it may be a good idea to contact the agency directly.  

In-Home Care Laws and Regulations in North Carolina

The North Carolina Division of Health Service Regulation regulates home care providers throughout the state. This agency is also responsible for the licensing of home care agencies. The table below gives a basic overview of the rules and regulations that home care agencies in North Carolina must follow.

Frequently Asked Questions

How to Find an In-Home Care Provider in North Carolina

Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. When you hire an in-home care aide you’re placing a lot of trust in the hands of the person by inviting them into your home, so you’ll want to be diligent in your search. At Caring.com, we’re here to help – we’ve created a helpful checklist below that can help guide you through the process of both determining your needs and finding a home care agency that will provide the best care possible.

Find Home Care Agencies Near You

To find quality home care providers near you, simply input the zip code or city where you would like to start your search. We have an extensive directory of home care agencies all across the nation that includes in-depth information about each provider and hundreds of thousands of reviews from seniors and their loved ones.

Directory of Home Care Services in Raleigh, NC

Marywins Home Care Services LLC

2609 Atlantic Avenue Raleigh. Suite 101B, Raleigh, NC, 27604

1 review

I gave 4 stars to Marywins home caregivers for their professionalism in caregiving. Our family are very much satisfied with the treatment and care they are providing to my mother. Their professional … (read more)

I gave 4 stars to Marywins home caregivers for their professionalism in caregiving. Our family are very much satisfied with the treatment and care they are providing to my mother. Their professional caregiving experience is highly commendable. First the caregivers are very punctual to the job, very responsive to their duties, and display very friendly relationship between them and our mother. Thank you staffs and management of Marywins home care. (read less)

I gave 4 stars to Marywins home caregivers for their professionalism in caregiving. Our family are very much satisfied with the treatment and care they are providing to my mother. Their professional … (read more)

I gave 4 stars to Marywins home caregivers for their professionalism in caregiving. Our family are very much satisfied with the treatment and care they are providing to my mother. Their professional caregiving experience is highly commendable. First the caregivers are very punctual to the job, very responsive to their duties, and display very friendly relationship between them and our mother. Thank you staffs and management of Marywins home care. (read less)

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Visiting Angels – Raleigh, NC

5003 Falls of Neuse Rd, Raleigh, NC, 27609

8 reviews

Do not hire this agency. Their initial in person consult seems fine and promises of superb care and communication are emphasized. We needed an aide for a few hours a day for simple tasks for a patie … (read more)

Do not hire this agency. Their initial in person consult seems fine and promises of superb care and communication are emphasized. We needed an aide for a few hours a day for simple tasks for a patient with a motor neuron disease, aged 65 and specifically requested someone close in age and interests. We were assured there was no problem. Instead, a young 28 yo woman was sent who complained her wages were too low and she was waiting for a remote job to open so she could work from home. Not exactly what a patient wants to hear who is dealing with their own issues. This company is all about making money and has no regard for patient needs. (read less)

Do not hire this agency. Their initial in person consult seems fine and promises of superb care and communication are emphasized. We needed an aide for a few hours a day for simple tasks for a patie … (read more)

Do not hire this agency. Their initial in person consult seems fine and promises of superb care and communication are emphasized. We needed an aide for a few hours a day for simple tasks for a patient with a motor neuron disease, aged 65 and specifically requested someone close in age and interests. We were assured there was no problem. Instead, a young 28 yo woman was sent who complained her wages were too low and she was waiting for a remote job to open so she could work from home. Not exactly what a patient wants to hear who is dealing with their own issues. This company is all about making money and has no regard for patient needs. (read less)

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Comfort Keepers Home Care of Cary, NC

1616 Evans Road, Cary, NC, 27519

2 reviews

Several years ago, we hired Comfort Keepers Cary to care for my parents. The reviews weren’t good at that time, but we liked the folks who came to visit and the nurse staff seemed competent, so we sig … (read more)

Several years ago, we hired Comfort Keepers Cary to care for my parents. The reviews weren’t good at that time, but we liked the folks who came to visit and the nurse staff seemed competent, so we signed with them. Admittedly, care was good for a while. Over the last two years, though, the service has been inconsistent and honestly a bit scary. I first hand, witnessed a caregiver raise her voice to my parents and then to me. When I questioned my mom about her erratic behavior, mom told me that this was "normal" for her. This same caregiver even persuaded my dad to loan her over $1200 which has not ever been repaid (and when my parents questioned the company management about it, they didn’t seem to care). The final straw occurred this year, the day after Easter, when a caregiver employed by them left mid-day/mid-shift without notice to the company (or my parents). He told my parents he was going to his car and then never returned. They found a note on the table about 30 minutes later saying he had left. They were unable to send a replacement caregiver that day or evening, so my parents were left alone (not just that day, but the following day as well) during which time my mother fell, hit her head on a piece of furniture and suffered a serious head injury. The next day (two days after after the caregiver abandoned my parents and his shift), the owner and head nurse came to see my mother and father to outline a new plan of care for them which would cost them in excess of $1700 additional weekly out of pocket. This conversation, mind you, was happening while my mother was laying in bed with a concussion and in extreme pain from her fall only a day and a half before. Once the nurse and owner left our home, my mother returned to the hospital where she stayed for several days. She is now in a rehab facility recovering from an unnecessary head injury, to which Comfort Keepers has barely acknowledged. They would say (and may even reply here as some sort of defense, that my mother was verbally abusive to their staff).I would tell you that their response to my mother calling them to express frustration and her pain from her hospital bed was a cowardly email sent to me after hours, giving me four days to find a new agency. My disabled father is home and out $1200. My mother is in the rehab. Comfort Keepers abandoned us. That’s pretty much all you need to know if you are seeking care for your family members. At one time, this company might have been good. Now, I believe they are in trouble. Buyer beware. (read less)

Several years ago, we hired Comfort Keepers Cary to care for my parents. The reviews weren’t good at that time, but we liked the folks who came to visit and the nurse staff seemed competent, so we sig … (read more)

Several years ago, we hired Comfort Keepers Cary to care for my parents. The reviews weren’t good at that time, but we liked the folks who came to visit and the nurse staff seemed competent, so we signed with them. Admittedly, care was good for a while. Over the last two years, though, the service has been inconsistent and honestly a bit scary. I first hand, witnessed a caregiver raise her voice to my parents and then to me. When I questioned my mom about her erratic behavior, mom told me that this was "normal" for her. This same caregiver even persuaded my dad to loan her over $1200 which has not ever been repaid (and when my parents questioned the company management about it, they didn’t seem to care). The final straw occurred this year, the day after Easter, when a caregiver employed by them left mid-day/mid-shift without notice to the company (or my parents). He told my parents he was going to his car and then never returned. They found a note on the table about 30 minutes later saying he had left. They were unable to send a replacement caregiver that day or evening, so my parents were left alone (not just that day, but the following day as well) during which time my mother fell, hit her head on a piece of furniture and suffered a serious head injury. The next day (two days after after the caregiver abandoned my parents and his shift), the owner and head nurse came to see my mother and father to outline a new plan of care for them which would cost them in excess of $1700 additional weekly out of pocket. This conversation, mind you, was happening while my mother was laying in bed with a concussion and in extreme pain from her fall only a day and a half before. Once the nurse and owner left our home, my mother returned to the hospital where she stayed for several days. She is now in a rehab facility recovering from an unnecessary head injury, to which Comfort Keepers has barely acknowledged. They would say (and may even reply here as some sort of defense, that my mother was verbally abusive to their staff).I would tell you that their response to my mother calling them to express frustration and her pain from her hospital bed was a cowardly email sent to me after hours, giving me four days to find a new agency. My disabled father is home and out $1200. My mother is in the rehab. Comfort Keepers abandoned us. That’s pretty much all you need to know if you are seeking care for your family members. At one time, this company might have been good. Now, I believe they are in trouble. Buyer beware. (read less)

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Interim HealthCare of Raleigh, NC

6310 Chapel Hill Rd., Suite 280, Raleigh, NC, 27607

3 reviews

In our experience, the CNA staff is very kind but the management is absolutely horrible. They demand more and more money but do not follow through with services already agreed to. When we told them w … (read more)

In our experience, the CNA staff is very kind but the management is absolutely horrible. They demand more and more money but do not follow through with services already agreed to. When we told them we could not afford what they were demanding they dropped services with 2 1/2 business days notice. Caring for loved ones during end of life is already emotional and stressful. This company only made this situation worse. (read less)

In our experience, the CNA staff is very kind but the management is absolutely horrible. They demand more and more money but do not follow through with services already agreed to. When we told them w … (read more)

In our experience, the CNA staff is very kind but the management is absolutely horrible. They demand more and more money but do not follow through with services already agreed to. When we told them we could not afford what they were demanding they dropped services with 2 1/2 business days notice. Caring for loved ones during end of life is already emotional and stressful. This company only made this situation worse. (read less)

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Homechoice Healthcare

4000 Blue Ridge Rd Suite 120, Raleigh, NC, 27612

4 reviews

They send us poor people. They are not responsive to our problems. I spend 3-4 hours per day trying to manage their people. After giving them nearly $40K in business over the past 8 months, they c … (read more)

They send us poor people. They are not responsive to our problems. I spend 3-4 hours per day trying to manage their people. After giving them nearly $40K in business over the past 8 months, they cannot be bothered to send us people who can read the English language. (read less)

They send us poor people. They are not responsive to our problems. I spend 3-4 hours per day trying to manage their people. After giving them nearly $40K in business over the past 8 months, they c … (read more)

They send us poor people. They are not responsive to our problems. I spend 3-4 hours per day trying to manage their people. After giving them nearly $40K in business over the past 8 months, they cannot be bothered to send us people who can read the English language. (read less)

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Maxim Healthcare Raleigh, NC

8521 Six Forks Rd. , Suite 350, Raleigh, NC, 27615

2 reviews

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Absolute Care Staffing Health Agency, Inc

111 Windel Dr, Suite 221, Raleigh, NC, 27609

0 reviews

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Care One Nursing Services, Inc

319 Chapanoke Road #104, Raleigh, NC, 27603

0 reviews

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Health Keeperz Inc. – Pembroke

209 W 3rd Street, PO Box 1030, Pembroke, NC, 28372

0 reviews

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Comfort Keepers of Raleigh

8480 Honeycutt Rd, Suite 200, Raleigh, NC, 27615

0 reviews

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Senior Helpers (CLOSED)

5007 Southpark Drive Suite 200-H, Durham, NC, 27713

0 reviews

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ComForCare Home Care – Raleigh

3820 Merton Dr., Suite 203, Raleigh, NC, 27609

0 reviews

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Griswold Home Care South Raleigh

5448 Apex Peakway, Suite 343, Apex, NC, 27502

0 reviews

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BAYADA Adult Nursing

5505 Creedmoor Rd, Raleigh, NC, 27612

0 reviews

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1 On One Home Care

117 Heather Drive, Garner, NC, 27529

0 reviews

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Continued Care

1140 Kildaire Farm Road , Suite 107, Cary, NC, 27511

0 reviews

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Assurance Health Services

5530 Munford Road Suite 105, Raleigh, NC, 27612

0 reviews

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ResCare HomeCare Raleigh, North Carolina

343 East Six Forks Road, Suite 170, Raleigh, NC, 27609

0 reviews

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Gericare & Health Svc

3790 Guess Rd # 201, Durham, NC, 27705

0 reviews

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1st Response Home Care LLC

106 fountain brook circle suite b2, Cary, NC, 27511

0 reviews

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