Page Reviewed / Updated - January 27, 2021
This webpage will help North Carolina residents understand assisted living, home care, and adult day care costs throughout various geographic regions of 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
According to Genworth’s 2020 Cost of Care Survey, the cost of assisted living in North Carolina is approximately 90% of the national average, which is $4,300 / month. In 2021, North Carolinians pay on average $3,800 / month. However, there is a great deal of variance in this cost within North Carolina as a whole. The towns and cities where the lowest average cost of care can be found are Burlington, Asheville, and Jacksonville. In these areas, residents generally pay between $2,675 and $2,850 / month. The areas of New Bern, Fayetteville, and Goldsboro, also have average monthly costs under the statewide average at $3,400 - $3,673. In the areas of Winston, Greensboro, Charlotte, and Raleigh, the cost is significantly higher and is between $4,500 and $4,800 / month. The most expensive area of the state is Wilmington at an average of $5,877 / month.
For an individual with Alzheimer's, due to the increased need for supervision, the monthly cost goes up by approximately $950 / month. On average, the cost is approximately 20% - 30% higher than is the cost of traditional assisted living within a geographic region.
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, per the 2020 Genworth Cost of Care Survey, the average hourly rate for non-medical, personal care provided in the home in 2021 is $20.00. Wilmington, which has much higher than average assisted living costs, has average home care costs just over the statewide average, with the hourly average at $20.50. The lowest average hourly rates in the state can be found in Rocky Mount, Goldsboro, Fayetteville, and Greenville ($18.00 - $19.00 / hr.). One location, Charlotte, has an average hourly rate on par with the statewide average. Durham and Asheville have higher than average rates closer to $23.00 - $24.00 / hr.
For persons who require minimal in-home medical care, home health care is also available. This type of care is provided by health care professionals and costs, on average, $21.00 / hr. across the state. The areas of Asheville and Durham have average hourly costs higher than the statewide average at $24.50 - $25.00.
Genworth’s 2020 Cost of Care Survey indicates that the cost of adult day care in NC in 2021 is also well below the national average, which is $74 / day. In fact, the state average is approximately 20% less costly at $59 / day. The areas of Hickory, Greensboro, and Durham have average hourly rates that are near the statewide average, ranging from $55 - $62. The areas where the highest cost for adult day care are found are Winston, Burlington, and Raleigh, averaging $67 - $68 / day. The most affordable adult day care can be found in the areas of Rocky Mount, Fayetteville, and Jacksonville, where the average daily cost is between $33 and $42.
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. While regular Medicaid is an entitlement, meaning anyone who is eligible to receive services is able to do so, Medicaid Waivers are not entitlement programs. This means the number of people who are able to receive services via waivers is limited. Currently the state of North Carolina offers one waiver relevant to the elderly.
The Community Alternatives Program for Disabled Adults is called CAP/DA, for short. 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.
The state Medicaid plan also offers a Personal Care Services Program. This Abbreviated PCS, assistance with daily activities in an individual’s home or in residential care, including an adult foster care home is offered. Since this is part of the regular Medicaid program, anyone who is eligible for services via this program is able to receive them.
In addition to the above options, which helps Medicaid eligible individuals remain living at home or in adult care homes, NC Medicaid will cover the cost of nursing home care, should it be medically necessary.
In order to be eligible for Medicaid, there are both income and asset requirements. Criterion for Medicaid Waivers may differ from the state Medicaid plan. However, as a general rule of thumb, as of April 2020 – March 2021, an individual’s income cannot exceed $1,063 / month. Married applicants can have slightly more income, with the limit set at $1,437 / month. These figures are equivalent to 100% of the Federal Poverty Level (FPL). The asset limit for a single senior is $2,000, and the asset limit for a married couple is $3,000. These limits exclude an individual’s home, given the applicant, or their spouse, live in it. If the applicant is single and does not live in the home, he / she must intend to live in it and have a home equity interest no greater than $603,000. A single vehicle, household furnishings, personal items, and pre-paid funeral arrangements are also exempt.
Being over the income and / or asset limit(s) does not mean one cannot still qualify for Medicaid. For instance, those over the income limit who have high medical bills can qualify via a Spend-Down program. This is often referred to as the medically needy pathway. In simple terms, once one has spent their “excess” income (the income over the limit) on medical bills, they are Medicaid eligible for the remainder of the spend-down period. For those over the asset limit, the above program will not offer assistance. However, one is still able to “spend down” their assets. For example, one can pay off debt or make home reparations / modifications. It is very important one does not gift assets or sell them under fair market value. This is in violation of Medicaid’s look-back rule and can result in a period of ineligibility.
Qualifying for Medicaid can be complicated, particularly if one is over the income and / or asset limitation(s). Professional assistance is available to help families whose 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. Some of these programs provide direct financial assistance, while others 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, unpaid primary caregivers of individuals with Alzheimer's or other dementias are provided with respite care services to help them avoid caregiver burnout. While respite care is very limited, other services are available and include dementia information and training for caregivers. More information is available here.
A second option is the Special Assistance In-Home Program for Adults (SA/IH). This program is intended for those who require a level of care consistent to that of an adult care home, but they prefer to remain living in their homes. This program provides a monthly 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.
Another option is the Special Assistance (SA) Program (For Adult Care Home Residents). This program, which was previously called the Special Assistance Adult Care Home (SA/ACH) program, covers room and board costs in adult foster care, group homes, and licensed assisted living residences. Those who are eligible for this program are automatically eligible for Medicaid. Read more.
The Special Assistance Adult Care Home Special Care Unit Program (SA/SCU) provides financial assistance for room and board for special care units within an adult care home. These units, which are often referred to as memory units, provide care for those with Alzheimer’s disease and related dementias, such as Parkinson’s Disease. Those who are eligible for this program are automatically eligible for Medicaid.
A final option is the In-Home Aide Services program, which helps with personal care, meal preparation, respite 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 variance in the cost of care depending on one's location within 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.
For more information about the costs and resources available in North Carolina cities, click on the links below.