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Assisted Living in North Carolina
North Carolina is an excellent location for assisted living. The state is home to more than 1.76 million senior citizens who enjoy a pleasant Southern climate and scenic surroundings that extend from the coastal plains to the Blue Ridge Mountains.
Although North Carolina ranks 39th in the nation for its senior-friendly amenities, according to the 2024 Senior Living Report, it received more favorable ratings for community involvement, health care and affordability. The cost of living is about 9% lower than the national average, and housing and transportation are particularly budget-friendly. Assisting living is also more affordable than the national average. You can expect to pay about $4,010 per month, depending on your location and the type of facility.
In this guide, you’ll find more information about long-term care prices, financial assistance programs and assisted living regulations. We’ve also provided a number of resources related to Medicaid and healthy aging.
The Cost of Assisted Living in North Carolina
When trying to decide how to pay for assisted living, one of the first questions that comes up is "How much does it cost?" With the impact of inflation, it's more important than ever to have up-to-date information when making a financial plan for senior living. To help shed light on real senior living prices, Caring.com has compiled proprietary cost data from its network of over 75,000 senior living providers to offer insight into the average cost of assisted living in North Carolina and its 49 cities.
The Cost of Assisted Living in North Carolina's Top Cities
In North Carolina, care costs vary significantly. Statewide, the average is $4,828, yet Durham exceeds this at $5,490. Charlotte, Greensboro, and Winston-Salem, however, fall below the average at $4,650, $4,521, and $4,826 respectively. Given these differences, ranging from $2 to $662, cross-city and state cost comparisons are crucial.
North Carolina
$4,828
Charlotte
$4,650
Greensboro
$4,521
Durham
$5,490
Winston-Salem
$4,826
Inflation's Impact on the Cost of Assisted Living in North Carolina
In North Carolina, inflation increased the cost of assisted living by a startling 18.1% between 2022 and 2023, from $4,088 to $4,828. This increase outpaced the national average for assisted living costs, which rose 9.6% from $4,070 to $4,459.
Virginia's prices declined slightly by 0.8% to $4,604, while Georgia's rates rose marginally by 6% to 3,952. Conversely, South Carolina's inflation increased dramatically by 17.4% to $4,161, while Tennessee's care costs rose even higher by 24.2%, averaging $4,201. Because some percentage hikes can be striking, checking real-time figures for planning is vital.
| Location | 2022 Cost (Historical) | 2023 Cost (Current) | 2024 Cost (Estimated) |
|---|---|---|---|
| North Carolina | $4,088 | $4,828 | $4,803 |
| U.S. Average | $4,070 | $4,459 | $4,802 |
| Virginia | $4,641 | $4,604 | $5,013 |
| Tennessee | $3,383 | $4,201 | $4,543 |
| Georgia | $3,730 | $3,952 | $3,895 |
| South Carolina | $3,545 | $4,161 | $4,526 |
The Costs of Other Types of Senior Living
It is just as essential to compare the cost of care types across North Carolina as it is to compare expenses across cities in states. Assisted living in North Carolina is higher than independent living at $4,828 compared to $3,054 because it has more benefits. Likewise, memory care is higher at $5,905 since it frequently comes with more expert medical support. Other features that add to care costs include the types of amenities and services a facility offers.
Assisted Living
$4,828
Memory Care
$5,905
Independent Living
$3,054
Does Medicaid Cover Assisted Living in North Carolina?
Yes, North Carolina covers assisted living directly through its Medicaid State Plan. Personal Care Services (PCS) are part of the state’s Long-Term Services and Supports program. You must be financially eligible for Medicaid for the Aged, Blind and Disabled, and you must meet additional medical criteria as determined by a personal needs assessment.
Specifically, you must have a medical condition, physical disability or cognitive impairment that results in unmet personal care needs. You may qualify if you need:
- Limited help with three or more activities of daily living
- Extensive assistance with at least one of two ADLs
- Complete assistance with one of two ADLs
What Assisted Living Services Are Covered by Medicaid in North Carolina?
If you’re eligible, PCS covers a variety of personal care services provided at home or in a residential setting, including a group home or adult care home, commonly known as an assisted living facility. Personal Care Services are designed to help with a variety of daily activities, including the following:
- Eating
- Bathing
- Dressing
- Grooming
- Toileting
- Mobility
Many states only pay for assisted living through Medicaid waivers, which means that eligible individuals are placed on a waiting list. While North Carolina’s PCS program has strict financial requirements, all qualifying applicants are eligible for benefits once approved. There may be restrictions regarding how many hours of monthly care you can receive based on your individual requirements.
Other Long-Term Care Benefits
State-County Special Assistance
Individuals who receive Social Security Disability Insurance or Supplemental Security Income are automatically entitled to Medicaid. Additionally, North Carolina offers State-County Special Assistance to help individuals who are aged, blind or disabled and need help paying for the cost of room and board provided by an assisted living facility or adult care home.
The state and county government may provide an extra stipend of $554 per month to individuals in assisted living or up to $887 for those in memory care. When federal benefits are added, beneficiaries may receive $1,228 or $1,561, respectively. You can apply by contacting your local DSS office.
Program of All-Inclusive Care for the Elderly
PACE is another option for seniors aged 55 or older who require a nursing level of care. There are multiple payment options for individuals who qualify for Medicaid, Medicare or are private-pay. With PACE, all medical and long-term care services are provided by a single organization, but the program pays for any services that you need. However, there are geographic restrictions. You must reside in a participating ZIP code. The state has 11 regional PACE programs. You can see if these services are available in your area by visiting the National PACE Association.
Assisted Living Waiver Programs in North Carolina
North Carolina’s Community Alternatives Program for Disabled Adults (CAP/DA) waiver covers a variety of services typically offered in assisted living. It’s designed to keep residents out of nursing homes and in community-based settings. It may cover short-term respite care in an assisted living facility or nursing home, as well as some of the following services.
- Adult day health care
- Bill pay assistance
- Case management
- Emergency response systems
- Home health aids
- Household services
- Meals and meal prep
- Medical equipment
- Transitional care
You can learn more by calling (919) 855-4340 or reaching out to a designated case management agency in your county. A directory of providers is available online.
How To Know If You’re Eligible for Medicaid in North Carolina
Medicaid is a health insurance program available to individuals who have limited income and resources. To qualify for Regular Medicaid or Medicaid for the Aged, Blind and Disabled in North Carolina, you must have no more than $1,074 in monthly income if applying individually or $1,452 if applying as a couple. Assets are capped at $2,000 or $3,000. If only you or your spouse requires long-term care, the non-applicant can keep up to $137,400. A home, vehicle and other possessions are also exempt. Income limits are higher for individuals who live in a nursing home and spend most of their income on care.
2022 Basic Medicaid Income Limits for Seniors in North Carolina
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | $14,580 | $2,000 | |
| Two Person | 1 | $14,580** | $2,000 | $148,620 |
| Two Person | 2 | $19,728 | $3,000 |
*Depending on the facility setting, a recipient may not be able to keep income up to this level.
**Income limit is for applicant only.
How to Apply for Medicaid in North Carolina
You can apply for Medicaid Long Term Services and Supports online at North Carolina ePass. This system also screens you for related benefits, such as food stamps and utility bills assistance. If you’d rather apply in person, contact the Division of Social Services office in your county to sit down with a caseworker. You can find a complete directory of DSS locations online. You can also request a paper application that can be completed and mailed to your local DSS office.
Information You Will Need
To qualify for Medicaid, you must provide documentation supporting your eligibility. These records may include:
- A government-issued ID
- Proof of U.S. citizenship or immigration
- Proof of in-state residency
- A Social Security card
- Health and life insurance information
- Proof of income and assets
- Benefits award letters
- Disability information, if applicable
How to Get Help Applying for Medicaid
If you have questions about Medicaid or need help accessing your benefits or appealing a decision, the following agencies can help. Assistance may also be available through local nonprofit groups.
| Program | Contact | Services provided |
|---|---|---|
| NC Medicaid Contact Center | (888) 245-0179 | North Carolina's Medicaid Contact Center is available to help beneficiaries and health care providers with questions related to health insurance benefits. The helpline is open Monday through Friday during business hours. |
| NC Medicaid Ombudsman | (877) 201-3750 | North Carolina's Medicaid Ombudsman can answer questions about the transition to managed care, which began in July 2021. If you're having trouble accessing your benefits, staff members can provide referrals to legal aid partners and other agencies. |
| Medicaid Fraud, Waste and Program Abuse Tip Line | (877) 362-8471 | If you have concerns about Medicaid fraud or have been billed for services that were never provided, call the state's Medicaid Tip Line for information or to make a report. |
| Department of Health and Human Services | (800) 662-7030 | The DHHS Customer Service Center can help you find information about health care, financial assistance and other safety net programs provided by the state or county. |
Does Medicare Cover Assisted Living in North Carolina?
The short answer is that no, Medicare does not cover the cost of assisted living in North Carolina. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in North Carolina.
Paying for Assisted Living Facilities in North Carolina
This program covers room and board costs in licensed assisted living residences, as well as adult foster care and group homes. Seniors who are eligible for this program are also eligible for Medicaid, which may also help pay for their care and medical needs.
To be eligible, applicants must:
- Be at least 65 years of age unless they are designated as disabled by Social Security, in which case they must be at least 18
- Be U.S. citizens
- Be residents of North Carolina for at least 90 days prior to applying
- Have monthly income not exceeding $1,255
- Have less than $2,000 in assets, excluding their home, vehicle, and personal belongings
Eligible seniors are those who have a medically documented need for the level of care provided by assisted living but do not need nursing home care. They must also choose an assisted living community that is authorized to receive payments from this program.
To learn more about eligibility requirements, call the Department of Social Services.
Other Financial Assistance Options for Assisted Living in North Carolina
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
| Name | How To Apply | How It Works |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in North Carolina
There are many resources in North Carolina that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Area Agencies on Aging | There are 16 Area Agencies on Aging (AAA) in North Carolina. Their primary responsibilities typically fall within five categories: program and resource development, advocacy, information brokerage, planning and funds administration quality assurance. Contact information for each AAA location, along with the names of the respective counties they serve, is available on the NC Department of Health and Human Services website. |
Cash Assistance Programs
Cash assistance programs in North Carolina provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Financial Assistance for Senior Care and Senior Living
Whether living in their own home or in a senior living community, North Carolina seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Money Follows the Person | 855-761-9030 | Although it's not one of North Carolina's Medicaid waivers, the Money Follows the Person program is typically used in conjunction with waiver services. It enables those who are living in institutional facilities to move back home or into a community setting to receive supportive services via waiver programs. Participants receive priority access to home- and community-based services, as well as extra funding, to enable a successful transition. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help North Carolina seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Congregate Nutrition Sites | Nutrition sites provide hot meals to seniors in a communal setting. Generally served at lunchtime, meals contain one-third of an adult's daily recommended nutrition. Congregate dining often takes place within senior centers, where older adults can also join an array of enrichment and social activities. | |
| North Carolina Meals on Wheels | North Carolina Meals on Wheels provides seniors across the state with nutritious meals, friendly visits and safety checks. This food assistance program is open to older adults ages 60+. Those mobile enough can enjoy healthy meals in a congregate setting at their local senior center, while those with qualifying mobility issues may receive home delivery. Meals are provided on a sliding-scale basis, ranging from no price to full cost depending on personal circumstances. | |
| North Carolina Seniors Farmers' Market Nutrition Program (SFMNP) | 800-662-7030 | The North Carolina Seniors Farmers' Market Nutrition Program (SFMNP) is open to older adults residing in one of the 45 counties in which the program is active. They must also fall within the current year's specified low income level. Coupons are issued to eligible participants to use at local farmer's markets for buying fruits and vegetables. The coupons are not valid on additional items at farmer's markets, such as jams, honey or baked goods. |
Free Used Medical Equipment
Due to the high cost of purchasing new medical equipment, several organizations in North Carolina collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Assistive Technology Program | The North Carolina Assistive Technology Program operates statewide, with centers in Raleigh, Charlotte, Greensboro, Greenville, Sanford, Wilmington, Sylva, Morganton and Winston-Salem. Individuals can borrow diverse equipment for testing purposes, with loans typically available for a few months. |
Health Insurance & Prescription Drug Coverage for Seniors
North Carolina seniors who meet certain income criteria can apply to local resources to help them pay for prescription drugs. Eligible residents can also receive assistance through health insurance and other programs to access free or discounted medical services.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Drug Card | The free North Carolina Drug Card is the statewide prescription assistance program. Available to all residents of North Carolina, it provides significant discounts on the cost of prescription medications at participating outlets. |
Home Repair and Modifications
Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in North Carolina have different eligibility criteria and often assist retirees by providing grants or loans.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Section 504 Home Repair Program | Administered by the U.S. Department of Agriculture, the Section 504 Home Repair Program gives grants and loans to low-income homeowners. Older adults who live in certain areas may be eligible for a grant of up to $10,000 to make their property safe. | |
| North Carolina Weatherization Assistance Program | The Weatherization Assistance Program is available to low-income households across North Carolina, with a priority given to seniors and other vulnerable individuals. Free services include educating people about energy efficiency and home safety, evaluating homes and performing tests, repairing and replacing inefficient heating and air systems, insulating properties and fitting smoke and carbon monoxide detectors. |
Legal Resources
Many organizations offer free or low-cost legal services to North Carolina seniors. Older adults can access advice on issues such as estate planning, living wills and power of attorney. Some firms also act as long-term care ombudsmen, advocating for the rights of seniors in senior living communities.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Long Term Care Ombudsman | 828-485-4213 | The North Carolina Long Term Care Ombudsman program provides advocates that help protect the rights of seniors who reside in nursing homes, assisted living facilities and similar shared communities. Long-term care ombudsmen investigate complaints about quality of care, resolve conflicts regarding services or benefits and help educate seniors and their loved ones about their rights. Each North Carolina county has a dedicated Community Advisory Council that works alongside LTC ombudsmen to ensure that local adult care homes are appropriately run. |
| North Carolina Senior Law Project | 877-579-7562 | The Senior Law Project provides free legal assistance to seniors aged 60 and older. Seniors can call the toll-free line for help with wills and powers of attorney, public benefits, consumer issues, housing issues and concerns related to elder abuse or neglect. |
Senior Centers
Senior centers in North Carolina bring together residents through recreational activities and events. Many also offer advice and support on senior issues, run wellness and nutrition programs, and connect older adults with other resources in the local area.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Division of Aging and Adult Services | 919-855-3400 | The Division of Aging and Adult Services provides a network of community-based senior programs and benefit opportunities across the state. Seniors can access information about health insurance, housing, senior rights protections, the ombudsman program and other support services. |
Social Security Offices
Social Security offices in North Carolina help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several North Carolina resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Homestead Exclusion Program | 877-252-3052 | Through the North Carolina Homestead Exclusion Program, seniors aged 65 years and older who meet income eligibility requirements can apply for property tax exemptions by excluding a portion of the appraised value of their permanent residence. Income includes Social Security benefits, retirement income, interests, dividends and proceeds from insurance. Honorably discharged disabled veterans or their unmarried surviving spouses are also qualified for the homestead exclusion program. New applicants may complete the necessary form and submit it to the local tax office. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. North Carolina retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina Low Income Energy Assistance Program (LIEAP) | 800-662-7030 | The federally funded Low Income Energy Assistance Program (LIEAP) provides one-time payments to eligible households to help pay for their heating services. |
Veteran's Services
North Carolina retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| North Carolina VA Benefits and Health Care | The North Carolina VA Benefits and Health Care's Regional Office is in Winston-Salem, and nine Vet Centers throughout the state further support former members of the U.S. Armed Forces. Senior veterans can receive care at four VA Medical Centers in Durham, Asheville, Salisbury and Fayetteville. Seven outpatient clinics offer specialized services such as dialysis and rehabilitation, and individuals may also visit 20 community outpatient clinics. The North Carolina VA operates four veteran cemeteries in Raleigh, Salisbury, New Bern and Wilmington. |
Assisted Living Laws and Regulations in North Carolina
Assisted living facilities in North Carolina must comply with licensing requirements enforced by the Division of Health Service Regulation, Adult Care Licensure Section. These regulations apply to resident care, staffing and training, among other areas.
| Topic | Rule |
|---|---|
| Assisted Living Service Plan Requirements | North Carolina requires adult care homes, also called assisted living facilities, to assess new residents within 72 hours of admission. A comprehensive needs assessment and plan of care must be completed within 30 days. The plan of care must be reassessed annually or within 10 days following a significant change in health. Individuals who require placement in a special care unit must be assessed before admission. |
| Assisted Living Admission Requirements | Assisted living facilities are prohibited from admitting residents who require full-time skilled nursing or medical monitoring. Temporary exceptions can be made with a physician's approval. Individuals who pose a threat to others, have a mental health condition or require treatment for substance misuse are not eligible for admission. |
| Assisted Living Scope of Care | Assisted living facilities must provide 24-hour staffing to meet residents' scheduled and unscheduled needs. Facilities must also provide recreational activities, transportation and environmental services. Skilled nursing may be provided in-house or through a third-party home health provider on a case-by-case basis. Facilities must also provide three daily meals and three snacks, including special diets and feeding assistance if needed. |
| Assisted Living Medicaid Policy | North Carolina's Community Alternatives Program for Disabled Adults is a Medicaid waiver that can pay for meals, personal care and many services provided in an adult care home. Medicaid's State-County Special Assistance benefit can provide a monthly stipend for room and board. |
| Assisted Living Facility Requirements | Apartment-style accommodations or suites may be provided but are not required. In most cases, bedrooms can be shared by no more than two residents. Residents may share a bedroom with up to 4 individuals depending upon the date the ACH was licensed. Bathrooms can be shared by up to five residents, and at least one bathtub or shower must be provided for every 10 residents |
| Medication Management Regulations | Assisted living residents may self-administer medications if they're able. Otherwise, assistance can be provided by a qualified medication aide who has completed a state-approved competency evaluation. After passing the exam, aides must complete six hours of continuing education annually. Residents' medication records must be reviewed quarterly by a pharmacist, RN or prescriber. Additional training is required for diabetes care. |
| Staffing Requirements | NC has specific staffing ratios based on the size and type of facility. ACHs with 20-30 residents need 16 hours of personal care aide (PCA) time on the first and second shifts, and 8 hours on the third shift. A community with 131-140 residents must have 96 PCA hours. ACHs need one administrator on site 24/7. A licensed health care professional must be there to assess residents' medical needs. At least one staff member trained in CPR must be on site at all times. |
| Staff Training Requirements | Direct-care workers in North Carolina must complete a state-approved training program and competency evaluation. Most programs include 80 hours of training, including 34 hours of clinical work experience. Additional training may be required for dementia and extra services, such as diabetes care. Facility administrators and supervisors must complete 30 hours of continuing education every two years and at least 12 hours of continuing education annually. |
| Background Checks for Assisted Living | Direct-care workers must pass a comprehensive background check before employment. Individuals who have a history of abuse or theft as determined by the North Carolina Health Care Personnel Registry are prohibited from working in assisted living facilities. Facility administrators must also pass a background check. |
| Requirements for Reporting Abuse | North Carolina requires health care facilities to report instances of suspected abuse or neglect within 24 hours. Facilities must also post information to inform residents about their rights and ways to report concerns. Complaints can be made to the intake center by calling (800) 624-3004. Reports can also be mailed or faxed. For additional help you can call a toll-free CARE-LINE within North Carolina at 1-800-662-7030. |
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