Paying for Assisted Living & Home Care in North Dakota

This webpage was created to assist North Dakota residents in understanding the costs of senior care assistance. Below one will find the average cost of living in an assisted living facility, in-home medical and non-medical care, and adult day care services (sometimes called adult day health). Programs that provide assistance with the cost of care, as well as a variety of elderly care services, are also included on this page.

The list of programs found below includes all of the programs funded by the state of North Dakota. That being said, those seeking senior care assistance should not limit themselves to only these options. There are also national, local, and non-profit programs available. Based on one’s senior care needs, some programs better serve some individuals than others, and it’s important to find the program that best serves the circumstances. Our free Resource Locator Tool is invaluable at assisting one in this endeavor.

North Dakota Eldercare Costs for 2023

Assisted Living / Memory Care

In North Dakota, per Genworth’s 2020 Cost of Care Survey, the average monthly cost of assisted living is $4,096 (as of 2021) across the state. In the Greater Grand Forks area, assisted living can be found as much as 30% less than the statewide average at $2,600 / month. In Burleigh County (Bismarck), the average monthly cost is $3,470, which is still approximately 15% less than the statewide average. In Cass County (Fargo), the average cost swings the other way and is approximately 15% higher than the statewide average at $4,623 / month. 

Alzheimer’s patients, and those suffering from dementia, often need a higher level of care and security as the disease progresses. Assisted living facilities provide care specifically for this purpose in Alzheimer’s units (also called Memory units), which costs approximately 20% – 30% more per month than does traditional assisted living. In dollars, this additional monthly cost may be between $625 and $1,155 / month.

Home Care

For seniors who wish to remain living in their own homes, but require assistance with daily living activities, home care is a great option. As of 2021, per Genworth’s Cost of Care Survey 2020, the average hourly rate for in-home care across the state is $27.98. This is much higher than the nationwide average of $23.50 / hour. Bismarck has hourly costs on par with the statewide average at $28. The Greater Grand Forks area is even more costly than the statewide average at $29.29 / hour. However, the most affordable in-home care can be found in Fargo at approximately $27.00 / hour. 

While in-home care is non-medical in nature, home health care, which is provided by health care professionals, is also available at an hourly rate in North Dakota. The cost is, on average, $1.00 / hour more statewide.

Adult Day Care

In North Dakota, according to Genworth’s 2020 Cost of Care Survey, as of 2021, the average cost of adult daycare throughout the state is $104 / day, which is significantly higher than the nationwide average of $74 / day. Still, adult day care offers a much more affordable option than does in-home care, while also allowing an individual to be supervised during daytime hours. The most affordable adult day care can be found in the city of Fargo, with a daily average of just $48. Compared to the statewide average, Bismarck also offers affordable adult day care at $81 / day. Those in Grand Forks can expect a much higher daily rate of $189 / day.

North Dakota Medicaid Financial Assistance Programs

Medicaid Programs & Waivers for the Elderly

Medicaid is a federal and state funded health care program for low-income individuals, families, seniors, and those who are disabled. While the parameters for the program are federally set, each state implements the program as best serves their state within the set guidelines. The state Medicaid program in North Dakota will cover the cost of nursing home care for those who are elderly or disabled (as it does in every state).

The North Dakota state Medicaid program also offers a program, Personal Care Services (MSP-PC), which provides in-home assistance, preventing or delaying unnecessary nursing home placement. Supports may include assistance with bathing and grooming, food preparation and eating, shopping for essentials, housecleaning, and laundry. Aid may be provided in one’s home, the home of a friend or relative, an adult foster care home, or an assisted living facility. For more information and eligibility requirements, click here. 

North Dakota also offers a Home and Community Based Services (HCBS) Waiver. Unlike the state plan, which is open to all eligible applicants, the waiver program is limited to the number of slots that are available for individuals to receive services. This means, at times, there may be a waitlist. The Aged and Disabled Waiver provides services for seniors and / or disabled individuals in their homes, in adult foster care homes, and in assisted living facilities, including Alzheimer’s care units. Services and supports may include adult day care, non-medical transportation, home modifications, personal care, and specialized medical equipment.

Medicaid Eligibility

For a senior to be eligible for North Dakota Medicaid in 2023, functional ability is considered, and income and assets are restricted. Single elderly individuals are limited to $1,009 a month in income, while married applicants are allowed up to $1,364 a month. Being over the income limit does not automatically mean one is not able to qualify for Medicaid. North Dakota has a medically needy pathway. This allows applicants who exceed the income limit, but have high medical bills, to still qualify for Medicaid after “spending down” their “excess” income on medical expenses. This can be thought of as similar to a deductible, and once one has “spent down” their income to the income limit, they will be eligible for Medicaid services for the remainder of the “spend down” period. 

The limit for assets for single seniors is $3,000, and $6,000 for married couples. However, some assets are considered exempt, such as one’s home (if it is an individual’s primary residence and his / her equity interest is not valued at more than $688,000). Other exemptions include household furnishings, personal belongings, such as clothing, one motor vehicle if used by the Medicaid applicant, and burial plots. Having excess assets, like excess income, does not mean one cannot become eligible for Medicaid. For instance, one can “spend down” assets on home reparations and modifications or pay off debt. However, it is critical one does not give away assets or sell them inexpensively in order to meet the asset limit. Doing so is in violation of Medicaid’s look-back rule and can result in a period of Medicaid ineligibility.

Applying for Medicaid can be a complicated process and it should not be taken lightly. If one is over the eligibility limits for income and / or asset(s), or is married, it can be extremely beneficial to have a professional Medicaid planner assist in the application process.

North Dakota Non-Medicaid Assistance Programs

In North Dakota, there are also non-Medicaid, state funded programs available to assist in the cost of senior care. Currently, there are two such programs.

1) Service Payments for the Elderly and Disabled (SPED) and Expanded SPED, also referred to as Ex-SPED, provide a variety of supportive services for seniors and disabled individuals who wish to age while living at home. While services under SPED may require a minimal service fee, with services under Ex-SPED, there are no fees. Supports may include adult day care, adult foster care, personal care, homemaker services, and more. These programs allow for consumer direction, which means eligible applicants are able to hire the service provider of their choosing. This includes select relatives. To learn more, click here.

2) Through the Older Americans Act (OAA), elderly care services are provided to assist seniors in living at home, again reducing unnecessary nursing home placements. Services may include meals, transportation, companion care, assistance with Activities of Daily Living (ADLs), and essential household errands. To see eligibility requirements, click here. 

PACE Programs in North Dakota

The Program of All-Inclusive Care for the Elderly (PACE) is a joint initiative between Medicare and Medicaid to help seniors get the care and services they need in the community rather than transitioning to a nursing home for care. Because Medicaid differs in each state, PACE eligibility varies between states.

PACE services in North Dakota provide qualified individuals with full-spectrum health care services, including primary care, emergency care, dentistry, nutritional counseling, and in-home services designed to promote independence and a good quality of life among senior citizens. Eligibility requirements include the following:

• Age 55 or over
• Resident of service areas
• Require a nursing home level of care
• Eligible for Medicaid in North Dakota

How To Get Started With PACE in North Dakota

Contact the service provider listed below or visit North Dakota’s Medicaid page for more information on PACE, including who’s eligible and how to apply.

Other Financial Options for Care

In addition to the state specific programs that assist in covering the cost of elderly care in North Dakota, there are also federal and non-profit programs available. In order to find other programs that assist in paying for care or reduce your out-of-pocket cost, make sure to use our Resource Locator Tool.  This tool makes it easy to locate and consider all of your options and choose the program that best fits the circumstances. Eldercare loans and programs that aid veterans with assisted living are other available options.

Finding Affordable Care in North Dakota

As one can see, the cost of elderly care varies greatly across the geographic regions of North Dakota. With this extreme variance in cost, finding the most affordable rate for elderly care is a very important cost saving measure. Through partnerships with other organizations that maintain large databases of caregivers throughout North Dakota, one is able to find high quality care at the most affordable rate in one’s preferred geographic region. Click here to find the most affordable senior care.

Top Cities for Senior Care in North Dakota

For more information about the costs and resources available in North Dakota cities, click on the links below. 

• Fargo