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Nursing Homes in North Carolina
North Carolina is a good retirement destination for many seniors, as three of its cities were ranked in the top 25 best places to retire in 2020 by Forbes. The state has 10.4 million inhabitants, 16.7% of whom are seniors aged 65 and older.
Recent data has found that 26.5% of the state’s seniors live alone, 35.8% have a disability, and 15% have difficulty with independent living. Approximately 84% also had at least one chronic illness, and 55% had two or more chronic conditions. In 2019, about 170,000 seniors aged 65 and older lived with Alzheimer’s disease.
There are 427 nursing homes in North Carolina, with 36,148 residents. Nursing home facilities provide constant, round-the-clock skilled nursing care, including personal care, rehabilitation and medication administration. In North Carolina, the average monthly cost is $7,300 for a semiprivate room in a nursing home facility and $8,060 for a private room, according to Genworth’s Cost of Care Survey 2020.
This comprehensive guide covers everything related to nursing home care in North Carolina, such as average costs, financial options, the Medicaid program, free and low-cost resources and nursing facility rules and regulations.
The Cost of Nursing Home Care in North Carolina
According to Genworth’s Cost of Care Survey 2020, North Carolina has an average cost of $7,300 per month for a semiprivate room in a nursing home facility. This number is significantly less than the national average price for nursing home care, which is $7,756 per month. Nursing home care costs vary across North Carolina’s neighboring states. South Carolina’s average nursing home costs are only $2 less than North Carolina’s. Virginia’s nursing home prices are almost $400 more, while Tennessee is over $200 less expensive than North Carolina’s nursing home care costs.
Average nursing home prices in North Carolina’s three largest cities of Charlotte, Greensboro and Raleigh range from $7,148 to $7,817 per month. Raleigh has the least expensive nursing home cost out of the three, at $7,148 per month. Greensboro has a cost of $7,695, and Charlotte’s nursing home cost is the most expensive of the three, at $7,817. Rocky Mount, located in eastern North Carolina, has the least costly nursing home option statewide, at $6,083 per month. Meanwhile, the small city of Goldsboro has an average cost of $8,752, the most expensive option in the state.
Rocky Mount
$6083
Fayetteville
$6722
Raleigh
$7148
Durham
$7270
Greensboro
$7695
Charlotte
$7817
Asheville
$8000
Goldsboro
$8752
Nursing home facilities are the priciest care option in North Carolina. A semiprivate room in a nursing home is over $6,000 more expensive than an adult day care, which has the least costly care option, at $1,278 per month. Assisted living and home care have comparable prices, at $3,800 and $3,813, respectively. Home health care has the second most expensive cost, at over $4,000 per month, but still over $3,000 less than nursing home costs.
Adult Day Care
$1278
Assisted Living
$3800
Home Care
$3813
Home Health Care
$4004
Nursing Home
$7300
Does Medicaid Cover Nursing Home Care in North Carolina?
North Carolina Medicaid covers some of the costs of a nursing home for low-income individuals who can show that a physician deems a nursing home level of care medically necessary. As of 2021, 2,101,394 individuals were enrolled in Medicaid throughout the state. In long-term care, Medicaid pays for services including speech and occupational therapy, prescription medications, physician services and personal care, including meals, transportation and grooming.
There are 422 nursing homes in North Carolina with over 36,000 residents. These facilities provide constant hospital-level care. For additional help paying for long-term care, seniors may qualify for the North Carolina Innovations Waiver. This federally approved Home and Community-Based Services Waiver (HCBS) helps meet the needs of seniors and those with disabilities who need assistance but prefer to age in place as long as possible.
Medicaid Eligibility in North Carolina
Seniors in North Carolina who receive SSI automatically qualify for Medicaid. Those who don’t receive SSI must have an income that’s less than what Medicaid will pay for the nursing facility, estimated at $6,381 to $9,087 monthly. Individuals can also have $2,000 in assets, and $3,000 for married couples who are both applying. Under the Spousal Impoverishment Act, the asset limit for a non-applicant is $148,620. Seniors with spouses who plan to live independently may keep more income and assets to prevent them from becoming poverty stricken.
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 | Must be less than the amount Medicaid pays for nursing home care (est. $6,381 to $9,087/mo) | $2,000 | |
| Two Person | 1 | Less than the amount Medicaid pays toward the facility. | $2,000 | $148,620 |
| Two Person | 2 | Must be less than the amount Medicaid pays for nursing home care (est. $6,381 to $9,087/mo) | $3,000 |
*Income must be less than the amount Medicaid pays for nursing home care. Estimated cost is $6,381 – $9,087/mo. Except for a $30/mo. personal needs allowance, Medicare premiums and possibly a spousal income allowance for a non-applicant spouse, all of a recipient's monthly income must be put toward the cost of nursing home care.
Additional eligibility requirements include:
- Resident of North Carolina
- U.S. citizen, permanent resident or legal alien
- In need of health care or insurance assistance
- Senior aged 65 or older; or
- Disabled
How to Apply for Medicaid in North Carolina
Individuals in North Carolina may apply for Medicaid online through ePASS or over the phone by calling the Medicaid Department at (800) 662-7030. Hearing-impaired applicants may dial (TTY) (877) 452-2514. To apply in person, individuals may visit their local Division of Health Benefits office or download the appropriate forms and mail them to North Carolina Medicaid, 2501 Mail Service Center, Raleigh, NC 27699-2501.
Information You Will Need:
- Current bank statements for the past 60 months
- Current income statements for the past 60 months
- List of assets, including real estate and vehicles
- Government-issued ID
- Copies of insurance
- Social Security number
- Birth certificate
Additional Medicaid Support & Resources in North Carolina
North Carolina has several organizations that can assist with applying for Medicaid. These services are available for free to help seniors, their loved ones and caregivers navigate the different financial options for paying for nursing homes.
| Program | Contact | Service |
|---|---|---|
| Benefits.gov | (800) 662-7030 | Benefits.gov is a federal website that provides information on available government benefit programs. The site includes a definition of Medicaid, eligibility qualifications and contact information. |
| Legal Aid of North Carolina | (866) 219-5262 | Legal Aid of North Carolina offers a free Medicaid Managed Care Clinic that provides information on state Medicaid, including what it covers, the different parts and how to apply. Legal Aid also offers information on what to do in the event of Medicaid fraud for payment of long-term care and who to call for complaints. |
| North Carolina Aging and Adult Services | (919) 855-3400 | NC Aging and Adult Services provides insurance counseling for seniors throughout the state. Each county is served by a local office with trained counselors who offer unbiased information on the different public and private insurance options. |
Does Medicare Cover Nursing Home Care in North Carolina?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn’t Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support and Resources in North Carolina
Several agencies help answer general questions regarding Medicare programs and services. The following list of resources include trained counselors who can provide information and advice on qualifying and applying for Medicare.
| Program | Contact | Service |
|---|---|---|
| North Carolina Seniors’ Health Insurance Information Program (SHIIP) | (855) 408-1212 | SHIIP provides one-on-one insurance counseling and assistance with Medicare. Help is available for anyone making coverage changes during open enrollment, those worried about out-of-pocket costs associated with Medicare and those who are unsure about Medicare’s eligibility and what it covers. Information on supplemental insurance is also offered. |
| Benefits CheckUp | (800) 794-6559 | Benefits CheckUp, a free service operated by the National Council on Aging, provides a free list of health care options for seniors. A helpline is available for those with questions regarding Medicare eligibility. |
| Medicare.gov | (800) 633-4227 | The Medicare.gov website provides information about Medicare, including costs and eligibility and additional information on health and drug plans. Seniors may create an account to check the status of their application or make changes to their coverage. |
Other Financial Assistance Options for Nursing Home Care in North Carolina
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| 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 skilled nursing care. |
| 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 nursing care. 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 skilled nursing care. 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 skilled nursing care 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. |
Nursing Home Laws and Regulations in North Carolina
| Topic | Rule |
|---|---|
| Licensing Requirements | All nursing facilities must be certified by the Division of Health Service Regulation. The facility must only have one license, and the license remains in effect for up to 12 months. The facility's license can be renewed at the end of each calendar year. |
| Staffing Requirements | Nursing home facilities must have a designated physician serving as the medical director and a registered nurse serving as the director of nursing. Each facility must have sufficient nursing staff to provide quality care for each patient. All professional staff must be licensed, registered or certified according to state laws. |
| Staff Training Requirements | Facilities must provide staff orientation on policies and procedures at the time of employment. Nursing facilities must also train all staff regularly and provide training for all employees in emergency procedures. |
| Admission Restrictions | A physician must be the one to admit residents. If a patient needs health or rehabilitative care beyond what the facility is licensed or capable of providing, they cannot be admitted to the nursing home. |
| Care Planning Requirements | Within 14 days of a resident's admission, a facility must perform a comprehensive assessment. The facility must also create a comprehensive care plan within seven days of the patient completing the evaluation. The facility must review each resident's comprehensive assessment and care plan every 90 days. |
| Dietary and Nutrition Services Requirements | Nursing facilities must provide residents with a diet that meets their daily nutritional needs. At least three meals must be served to the residents daily, and the facility must ensure the residents are meeting their nutritional status, such as protein levels. The facility must have a director of food service responsible for the dietetic service and its personnel. |
| Specialized Rehabilitative Services | Nursing facilities must provide rehabilitative services, such as physical, speech and occupational therapies, as part of the daily allowance reimbursed to the facility. |
| Medication and Pharmaceutical Services | A pharmacist must supervise pharmaceutical services, and they must ensure the acquiring and administering of all drugs are accurate. Facilities must also make sure medications are administered per regulations and recommendations. |
| Activities Requirements | Nursing facilities must provide an ongoing activities program per each resident's comprehensive assessment. The activities must promote the physical, psychosocial and mental well-being of every resident. The facility must also assign an activities director to oversee the recreational services. |
| Infection Control | The facility must create and maintain an infection control program to prevent the spread of diseases and infection. The facility's responsibility includes choosing the appropriate infection prevention procedures, such as isolation, for individual residents and investigating any infection incidents. The facility must also ensure residents are screened and tested for any infectious disease upon admission, and staff must be screened within seven days of the hire date. Tuberculosis screening for staff and residents must be done annually. |
| Medicaid Coverage | Medicaid pays a portion of the nursing home costs for qualified North Carolina individuals, but seniors have to use some of their income toward nursing home costs. Eligible applicants must be 65 years and older and meet both the income and nursing level of care requirements. |
Facilities in North Carolina
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