Home to just over 760,000 people, North Dakota is the fourth least populated state in the country. Nearly 16% of residents are aged 65 and over, creating an increasing need for senior care options. To provide services for seniors who wish to age in place and support for their caregivers, the state’s Human Services Department, Adults and Aging Services administers several programs to promote independence and safety. The department also regulates in-home care providers to ensure consistently high-quality care. On average, seniors in North Dakota pay $5,148 per month for in-home care, which is about 18% higher than the national average.

Keep reading to learn more about the cost of in-home care in North Dakota and its major cities, as well as the financial assistance options that are available to seniors. This guide also provides an overview of the free programs that are available to seniors, the laws and regulations that govern in-home agencies and seniors’ most frequently asked questions regarding this type of care.

The Cost of In-Home Care in North Dakota

In-Home Care Costs in Nearby States

The Genworth 2019 Cost of Care Survey reports that seniors in North Dakota pay $5,148 per month on average for non-medical in-home care, compared to the national average of $4,290. While this state is pricier than most for this type of care, it’s among the more affordable options in the region. Of its nearby states, only Montana is cheaper at $4,576 per month. In South Dakota and Wyoming, seniors pay $5,339 per month, and in Minnesota, in-home care costs $5,529 monthly.

$5148

North Dakota

$4290

United States Average

$4576

Montana

$5339

South Dakota

$5529

Minnesota

$5339

Wyoming

Cost of Other Types of Care in North Dakota

In-home care is among the most expensive types of senior care in the state. It’s surpassed in cost only by home health care, which offers personal care services along with skilled nursing services, and nursing home care, which provides skilled nursing in a hospital-like setting. These care options cost $5,331 and $11,875 per month, respectively. Assisted living, which provides assistance with daily living activities in a community-based setting, is cheaper at $3,405 monthly. Adult day care offers supervised daytime services in a community setting and is the most affordable option at $2,059.

$5148

In-Home Care

$5331

Home Health Care

$2059

Adult Day Care

$3405

Assisted Living Facility

$11875

Nursing Home Care

The Cost of In-Home Care in North Dakota’s Top Cities

Comparing Costs Across North Dakota

Across the state, the cost of in-home care varies widely depending on how many in-home care agencies are operating in a given region and local living costs. In the capital city of Bismarck, seniors enjoy highly affordable in-home care that is lower than state and national averages at $2,669 monthly. In Fargo, monthly fees are on par with the statewide average, and in Grand Forks, costs exceed the statewide average at $5,331. Across state lines, seniors pay nearly $800 less per month for care in Billings, MT and about $1,500 more for care in Rapid City, SD.

$2669

Bismarck

$5331

Grand Forks

$5148

Fargo

$4376

Billings, MT

$6673

Rapid City, SD

Financial Assistance for In-Home Care in North Dakota

Medicaid State Plan – Personal Care Services

In-home care may be covered for some North Dakota seniors through the Medicaid State Plan’s Personal Care Services program. Like the regular Medicaid program, MSP-PC is an entitlement, meaning that all seniors who meet eligibility guidelines are guaranteed to receive services. This program covers assistance with daily living activities, food preparation, shopping for essentials and homemaker services. Beneficiaries are enrolled in one of three levels, depending on their care needs as determined by a case manager, with coverage ranging between 120 hours to 300 hours per month. Seniors are permitted to choose who they receive services from, and in some cases, friends, family members and neighbors may be Qualified Service Providers. Services may be paid in full by Medicaid, or beneficiaries may have to pay part of the cost in the form of a monthly deductible.

Who Is Eligible?
To be eligible for MSP-PC, seniors must be on Medicaid and have care needs that are expected to last at least 30 days.

How to Apply
To apply for MSP-PC, individuals should contact their local Department of Human Services or call the main office at 701-328-231.

Home and Community Based Services Waiver

The Home and Community Based Services waiver is offered jointly by the Center for Medicare and Medicaid Services and the state’s Medicaid Agency. It provides in-home services to allow seniors who need nursing home level care to avoid or postpone nursing home placement. Some of its covered services include at least four hours daily of adult day care, chore services, home modifications, non-medical transportation, respite care and homemaker services.

Who Is Eligible?
To be eligible for the Home and Community-Based Services waiver, seniors must be enrolled in Medicaid and require nursing home level care. They must be at least 65 years old or disabled by Social Security Disability criteria, and they must live in their own home and be capable of directing their own care.

How to Apply
To apply for this waiver, individuals should contact their local Human Services Office.

Service Payments for the Elderly and Disabled Program

The SPED program covers services for seniors or those with physical disabilities who would otherwise have difficulty living independently in their own home. It has more generous income limits than Medicaid, which may make it a good option for those whose income exceeds Medicaid’s limits but who still need help affording in-home care. This state-funded program assigns participants a case manager that assesses their needs and helps them plan their care, including provider selections and care monitoring. Some services provided under this program include home modifications, chore service, homemaker service, personal care and respite care. The program also reimburses family caregivers who reside with program participants and meet the relationship requirements outlined in the state’s law.

Who Is Eligible?
To be eligible for this program, applicants can have an annual income of up to $50,000, and they must be unable to afford services. They must need some measure of assistance with at least four activities of daily living such as bathing or eating, or they must need help with at least five instrumental activities of daily living such as driving or managing money. Additionally, they must not be receiving services under Medicaid or any of its waiver programs.

How to Apply
To apply for services, seniors should contact their local Human Services Office.

More Ways to Pay for In-Home Care

While the above programs help many people finance in-home care, they will not cover all costs for everyone. There are other ways to pay for in-home care, including out-of-pocket arrangements with siblings, annuities, reverse mortgages, private insurance, and more. Read Caring.com’s Guide to In-Home Care Costs to learn more about these alternative payment options.

Free and Low-Cost In-Home Care Resources in North Dakota

North Dakota offers several programs and resources to reduce homeownership costs for seniors and provide meal deliveries, care management and options counseling.

ContactServices Provided
Office of the State Tax Commissioner

Taxinfo@nd.gov

The Office of the State Tax Commissioner offers property tax credits to eligible individuals that may reduce the financial burden associated with maintaining home ownership. The homestead property tax credit is available to low-income seniors aged 65 and over. The disabled veterans property tax credit is provided to veterans of the U.S. armed forces who have a disability of 50% or greater.
Low Income Home Energy Assistance Program

701-328-2332LIHEAP provides assistance with home heating costs for low-income homeowners and renters, partially paying the cost of natural gas, coal, fuel oil, wood, electricity and propane. It also covers weatherization services, chimney cleaning and emergency assistance. Those aged 60 and over don’t need to provide documentation of a medical need for assistance.
North Dakota Senior Services Providers

wandm@restel.net

North Dakota Senior Services Providers is comprised of 30 nonprofit organizations across the state that provide services to seniors. These organizations exist in each of the state’s 53 counties and four Native American reservations. Some services that these organizations provide include meal deliveries, transportation and health screenings.
State Health Insurance Counseling program

701-328-2440The state’s SHIC program provides free, unbiased Medicare counseling for seniors. Counselors are trained in all aspects of senior health insurance, including Original Medicare, Medicare Advantage plans and prescription drug coverage. They help sort and reconcile medical bills, understand paperwork received after a hospital stay or doctor’s office visit and review options for paying for long-term care.
Lifespan Respite Care Grant Service

855-462-5465The Lifespan Respite Care Grant Service provides assistance for adults who have an urgent need for respite care in the event of circumstances such as a caregiver illness or death, abuse/neglect prevention or substance use disorder. Eligibility criteria applies.
Prescription Connection

888-575-6611The state’s Prescription Connection program helps residents obtain needed prescriptions that would otherwise be unaffordable.
Vulnerable Adult Protective Services

855-462-5465

The Vulnerable Adult Protective Services fields and investigate claims of senior abuse, neglect or exploitation.

In-Home Care Laws and Regulations in North Dakota

In-home care in North Dakota is officially referred to as supportive services, and they are provided by home health aides. This type of care is governed by the North Dakota Department of Human Services. The department has extensive laws and regulations in place to ensure high-quality care and safety for seniors.

Scope of CareIn North Dakota, personal care services provide assistance to those who need help with activities of daily living and instrumental activities of daily living, enabling the individual to continue living at home. Caregivers are permitted to perform tasks such as bathing, dressing and undressing, feeding mobility, meal preparation, housework, and laundry shopping, medication assistance, and money management. Provided services may not include skilled services that must be performed by someone with professional training.
Care Plan RequirementsCare plans should be established and signed by the home care agency and reviewed every 62 days by a registered nurse. They must include all relevant diagnoses, short-term and long-term care goals, the types and frequency of services to be provided, permitted activities, necessary safety measures and sociopsychological needs of the patient.
Medication Management RequirementsPersonal care assistants may provide medication reminders for patients.
Staff Screening RequirementsPrior to hiring a home health aide, the agency must check registries and licensure boards for inappropriate conduct, disciplinary actions and termination from previous positions. A competency evaluation must be documented at least every two years.
Staff Training RequirementsUpon employment, home health aides must complete a 75-hour training program, at least 16 hours of which are in a classroom setting and 16 hours under supervised practical training. Some topics that must be covered include communication skills, patient rights and safe techniques for personal hygiene and grooming. On an annual basis the agency must provide training that covers topics such as prevention and control of infections and safety procedures. Home health aides must also receive 12 hours of in-service education every 12-month period.
Medicaid CoverageIn-home care is covered by the Personal Care Services program, which is a part of the Medicaid State Plan. Medicaid also covers this type of care under a Home and Community-Based Services waiver program.
Reporting AbuseAbuse and neglect should be reported to the state’s Vulnerable Adult Protective Services department by calling 855-462-5465. Reports may also be filed online.

Frequently Asked Questions

How much does in-home care cost in North Dakota?

In North Dakota, in-home care costs $5,148 per month, which is about 18% higher than the national average of $4,290. Across the state’s major cities, monthly costs range from $2,669 to $5,331.

Are there programs to cover home modifications in North Dakota?

Limited home modifications are covered under the state’s Home and Community Based Services waiver program to enhance the resident’s safety and independence. Modifications for eligible seniors may also be paid for by the SPED program.

Are there transportation assistance programs in North Dakota?

Medicaid-eligible seniors in North Dakota may receive non-medical transportation services through the state’s Home and Community Based Services waiver. The state’s Human Services Department also maintains a database of local organizations that provide services such as transportation for seniors.

What is the difference between in-home care and home health care?

In-home care includes personal care services that the senior would be able to complete if a physical impairment wasn’t preventing them from doing so. Home health care generally includes personal care services along with skilled nursing care.

What types of services does a home care aide provide?

Home care aides provide assistance with daily living activities such as toileting, grooming and bathing, as well as instrumental activities of daily living such as errands, money management and homemaker services. These services are provided to support the highest degree of independence and self-reliance possible.

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