Page Reviewed / Updated - Jul. 2016
This webpage will help North Carolina residents understand assisted living, home care, and adult day care costs throughout the state. It also explores the payment options and financial assistance programs available to assist in caring for the elderly, be that in residential care or for aging in place at home.
The programs outlined here are comprehensive of what is available in North Carolina, but is not comprehensive of what is available at a national level. In order to search for assistance nationwide, and to find the best program to fit your needs, make sure to use our Resource Locator Tool.
Cost of Care Calculator
The cost of assisted living in North Carolina is approximately 85% of the national average, which is $3,600 / month. In 2016, North Carolinians pay on average $3,000 / month. However, there is a great deal of variance in this cost, both within the same geographic area and within North Carolina as a whole. In Raleigh, for example, the monthly cost of assisted living ranges from approximately $1,500 to $7,100. 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 of care can be found are Burlington, Asheville, Fayetteville, Goldsboro, Greenville and Raleigh. In these areas, residents pay as little as $2,500 / month. In the most expensive areas of the state, assisted living costs around $4,100 - $4,300 per month. These areas are Winston and Wilmington.
The more expensive areas for home care do not always align with those that are most expensive for assisted living. This is the case in NC. Statewide the average hourly rate for non-medical, personal care provided in the home in 2016 is $18. 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, Rocky Mount, New Bern, and Goldsboro, where the hourly rate is close to $16. Asheville, Raleigh, and Durham have higher than average rates closer to $19 - $20 / hr.
The cost of adult day care in NC is also well below the national average, which is approximately $68 / day. In most parts of the state, families should expect to pay $51 / day or less. Exceptions to this rule are Durham and Charlotte, where the average cost can be $10 per day higher. Wilmington is also a notable exception, and is the area where the highest cost for day care is found, and can average $90 / day.
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 typically provided through Medicaid Waivers instead of regular Medicaid programs. Currently the state of North Carolina offers three waivers.
1) 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. Family members may be hired as personal caregivers. Learn more about CAP/DA eligibility and benefits.
2) A second North Carolina Medicaid option is the Special Assistance In-Home Program for Adults (SA/IH). While 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.
3) A third option is the Special Assistance / Adult Care Home (SA/ACH) program, 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. The state Medicaid plan also offers a Personal Care Services Program, which offers assistance with daily activities in an individual’s home or in residential care.
In order to be eligible for Medicaid, there are both income and asset requirements. Eligibility requirements for Medicaid Waivers may differ from the state Medicaid plan. However, as a general rule of thumb, as of 2016, an individual’s income cannot exceed $990 / month. Married applicant’s can have slightly more income, with the limit being $1,335 / month. The asset limit is $2,000, though this excludes an individual’s home, given they live in it and it is valued under $552,000. A single vehicle is also exempt. Professional assistance is available to help families who finances exceed these limits. Read more.
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 individuals 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.
A third option is the In-Home Aide Services program, which helps with personal care, errands, and home management. On average, individuals enrolled in this program receive 5 to 20 hours per week of assistance. Read more.
In addition to the state specific options that help pay for care, there are many non-profit and federal options available. 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, North Carolina has a great deal of variety in the cost of care depending on one's location throughout the state. To assist families in finding the most affordable, high-quality care in their preferred geographic areas, we work with several organizations that assist families at no charge. Click here to find the most affordable care that meets your family's needs.