Page Reviewed / Updated - Feb. 2014
The goal of this webpage is to help North Carolina residents understand long term care costs in the state including assisted living, in-home, Alzheimer's and adult day care. It is also to make them aware of the financial assistance programs that help pay for care and options that can reduce the cost of care, prescription drugs and home medical equipment.
The cost of assisted living in North Carolina is approximately 85% of the national average. In 2013, North Carolinians paid on average $2,900 / month for assisted living care. However, there is a great deal of variance in this cost both within the same geographic area and within the North Carolina on the whole. In Asheville, for example, the monthly cost of assisted living ranges from approximately $1,900 to $4,200. For an individual with Alzheimer's, due to the increased need for supervision, the monthly cost goes up by approximately $1,000.
The towns and cities where the lowest cost care can be found are Burlington, Greenville, Goldsboro and Jacksonville. In these areas, residents pay as little as $2,000 / month. In the most expensive areas, assisted living costs $500 - $800 per month over the state average. This include Raleigh, Chapel Hill, Winston Salem and Wilmington.
The more expensive areas for home care do not always align with those for assisted living. This is the case in NC. Statewide the average hourly rate for non-medical, personal care provided in the home in 2013 is $17. Wilmington, which has higher than average assisted living costs, has lower than average home care costs. Other locations with below average hourly rates are Fayetteville, Greenville and Greensboro where is the hourly rates all average close to $16. Asheville and Durham have higher than average rates closer to $18 or $19 / hr.
The cost of adult day care in NC is also well below the national average. In most parts of the state, families should expect to pay $50 / day or less. The notable exceptions to this rule are Chapel Hill, Durham and Charlotte where the average cost can be $10 per day higher.
The State of North Carolina has several programs, independent of their Medicaid program, which provide assistance in caring for the elderly. Although these programs may or may not provide direct financial assistance, they each can help to offset a family's overall care cost burden.
The first program is called Project C.A.R.E. (Caregiver Alternatives to Running on Empty). In this program, primary caregivers of individual's with Alzheimer's or other dementias are provided with respite care services to help them avoid caregiver burnout. The dollar value of the respite care changes from year to year. In recent years, it has fluctuated between $1,000 - $2,500 worth of assistance. More information is available here.
The Adult Care Home Assistance program offers financial help to low income North Carolina citizens who reside in adult care homes. It is unclear from the state's official description whether "adult care homes" include assisted living residences. The level of financial assistance can increase depending on the program participant's diagnosis. Those with Alzheimer's or dementia may receive a greater level of aid than others with less severe needs. Click here to learn more.
Before reading about Medicaid based assistance, it is helpful to have an understanding of what Medicaid is and some of the associated terminology. Initially Medicaid for elderly and disabled individuals only paid for the care of qualified individuals in nursing homes. After some time, it became apparent that it could be less costly to help these same individuals by providing certain services at home and in their communities. In addition to cost savings, these "home and community based services" were preferred by the persons receiving them. Home and Community Based Services (HCBS) are also called Waivers.
The predominant North Carolina Medicaid Waiver relevant to the elderly is called the Community Alternatives Program for Disabled Adults or CAP/DA. Under CAP/DA, participants can receive personal care, homemaker services, meals and various other supports in their homes. Learn more about CAP/DA eligibility and benefits.
A second North Carolina Medicaid option is the Special Assistance In-Home Program for Adults (SA/IH). Most Medicaid programs are about paying for care, the SA/IH Program is not. Instead this program provides a cash grant to participants with the objective of helping them to cover the cost of food and / or shelter, clothing and other basic necessities. Learn more. A third option is Special Assistance / Adult Care Home which covers room and board costs in adult foster care and at licensed assisted living residences.
In addition to these three options which help Medicaid eligible individuals remain living at home or in adult care homes, NC Medicaid will of course cover the cost of nursing home care should it be medically necessary.
In addition to the state specific options that help pay for care, there are many non-profit and federal options. Use our Resource Locator Tool to find other programs that help pay for or reduce the cost of care. There are also programs that help veterans with assisted living and there are eldercare loans available in North Carolina.
As shown in the Assisted Living Costs and Home Care Costs sections above, in North Carolina there is a great deal of variety in the cost of care depending on one's location throughout the state. To assist families find the most affordable, high-quality care in their preferred geographic areas, we work with several organizations who assist families at no charge. Click here to find the most affordable care that meets your family's needs.