Assisted Living in North Carolina

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Families looking for assisted living in North Carolina (NC) have a wide array of communities to choose from, since estimated that there are more than 30,000 assisted living communities serving seniors across the U.S., and over 561 statewide. The state is also home to a rapidly growing number of senior citizens, with adults over 65 making up an estimated 15.9 percent of the population. A resident in an assisted living community in North Carolina will pay $3,250 per month on average.

Average Monthly Costs

States near North Carolina

$4,863.00 Virginia
$4,283.00 Tennessee
$4,035.00 North Carolina
$4,000.00 US
$3,387.00 Georgia
Genworth lists the average cost of a private, one bedroom unit in an assisted living community in North Carolina as $4,035. This places North Carolina on the higher end of the scale at about $0 over the national average, and about $0 lower than the median cost of assisted living in nearby states.

Compare Monthly Care Costs

When it comes to care options, assisted living is just one of several choices available to seniors. Some care options, like part-time in-home care or independent living, may cost less, while others like memory care or skilled nursing are likely to cost significantly more. Seniors can speak with their medical practitioners to receive guidance on what level of care will best suit their needs and abilities.

Nursing Home Care


In-Home Care


Assisted Living

Average Monthly Costs

Cities in North Carolina

$6,283.00 Raleigh
$5,851.00 Wilmington
$5,335.00 Greensboro, High Point
$5,135.00 Greenville
$4,907.00 Asheville
$4,605.00 Winston, Salem
$4,155.00 Charlotte, Concord, Gastonia
$3,920.00 New Bern
$3,606.00 Rest Of State
$3,606.00 Hickory, Lenoir, Morganton
$3,442.00 Durham, Chapel Hill
$3,414.00 Jacksonville
$3,387.00 Fayetteville
$3,059.00 Burlington
$3,005.00 Rocky Mount
$3,005.00 Goldsboro
When estimating the cost of assisted living, it's important to know that average prices can differ significantly between various parts of North Carolina. For example, assisted living rates in areas such as Wilmington are at least $1,800 more than the state average of $4,035, but in areas like Burlington, you're saving on average $1,000. The most affordable region in North Carolina for assisted living is Goldsboro at $3,005.

What You Should Know About Assisted Living in North Carolina

In North Carolina, assisted living residences are commonly called adult care homes (ACHs). Seniors and their loved ones seek out adult care homes in this state because communities are economically priced and meet a high standard of care for residents. While many states have no regulations regarding how many caregivers must be on site at a given time, North Carolina has strict regulations regarding resident/staff ratios to ensure that residents’ needs are met.

Financial Assistance for Assisted Living in North Carolina

North Carolina has subsidy programs that can assist low-income seniors in paying for assisted living.

Special Assistance Program (For Adult Care Home Residents)

This program covers room and board costs in licensed assisted living residences, as well as adult foster care and group homes. Seniors who are eligible for this program are also eligible for Medicaid, which may also help pay for their care and medical needs.

Who Is Eligible?

Applicants must be at least 65 years of age unless they are designated as disabled by Social Security, in which case they must be at least 18. They must be U.S. citizens and residents of North Carolina for at least 90 days prior to applying. Their monthly income cannot exceed $1,228, and they must have less than $2,000 in assets, excluding their home, vehicle, and personal belongings.

Eligible seniors are those who have a medically documented need for the level of care provided by assisted living but do not need nursing home care. They must also choose an assisted living community that is authorized to receive payments from this program.

How to Apply

Seniors who meet the eligibility requirements can apply by submitting an application in person to their county Department of Social Services.

Those needing memory care may be able to apply for additional support. For more information, see our North Carolina Memory Care page.

More Ways to Finance Assisted Living

While many families use their own funds or personal assets to pay for assisted living, there are plenty of additional options to cover these costs. Visit our 9 Ways to Pay for Assisted Living page for more information.

Free Assisted Living Resources in North Carolina

North Carolina has a variety of free resources that provide information and support for seniors.

North Carolina Area Agencies on Aging

Area Agencies on Aging focus on promoting the independence and dignity of seniors. This network provides a variety of services, including transportation, senior activities and support groups and prescription drug programs.

Southwestern Commission Area Agency on Aging

125 Bonnie Lane, Sylva, NC 28779
(828) 586-1962

Land-of-Sky Regional Council

339 New Leicester Highway, Suite 140, Asheville, NC 28806
(828) 251-6622

High Country Council of Governments

468 New Market Boulevard, Boone, NC 28607
(828) 265-5434

Western Piedmont Council of Governments

1880 Second Ave, NW, Hickory, NC 28601
(828) 322-9191

Isothermal Planning and Development Commission

111 West Court Street, Rutherfordton, NC 28139
(828) 287-2281

Centralina Council of Governments

525 North Tryon Street, Charlotte, NC 28202
(704) 372-2416

Piedmont Triad Regional Council

1398 Carrollton Crossing Drive, Kernersville, NC 27284
(336) 904-0300

Kerr Tar Regional COG

1724 Graham Avenue, Henderson, NC 27536
(252) 436-2040

Triangle J Council of Governments

4307 Emperor Blvd., Suite 110, Durham, NC 27703
(919) 558-2711

Mid-Carolina Council of Governments

130 Gillespie Street, Fayetteville, NC 28301
(910) 323-4191

Lumber River Council of Governments

30 CJ Walker Road, Pembroke, NC 28372
(910) 618-5533

Upper Coastal Plain Council of Governments

121 W. Nash Street, Wilson, NC 27894
(252) 234-5952

Cape Fear Council of Governments

1480 Harbour Drive, Wilington, NC 28401
(910) 395-4553

Albemarle Commission

512 South Church Street, Hertford, NC 27944
(252) 426-5753

Mid-East Commission

1385 John Small Avenue, Washington, NC 27889
(252) 946-8043

Eastern Carolina Council of Governments

233 Middle Street, New Bern, NC 28563
(252) 638-3185

Assisted Living Laws and Regulations in North Carolina

Assisted Living Service Plan Requirements

Assessments are required to assist in creating service plans which are individualized written programs that detail the care each resident needs. An initial assessment is performed within 72 hours of admission with a more detailed evaluation occurring within 30 days of the move-in date. Assessments are also repeated annually and in any instance where a significant change occurs in a resident’s health condition. Thanks to these assessments and in-depth care plans, ACHs are able to make sure they provide the necessary assistant each resident needs during their daily activities.

Assisted Living Admission Requirements

As is common in most states, residents looking to be admitted to an ACH should not require full-time skilled nursing care, ventilators, or intravenous therapy. Exceptions can be made on a short term basis with a physician’s cooperation. Mental illness, drug or alcohol abuse and communicable disease infections may also disqualify a senior from being admitted to an adult care home.

Assisted Living Scope of Care

Residents of ACHs receive 24-hour supervision along with assistance in transportation, housekeeping, personal care regimens and occasionally short-term periods of nursing care. Residents may also contract with other service agencies for personal and nursing care.

Assisted Living Medicaid Policy

The North Carolina Medicaid plan pays for personal care services received by eligible residents in an ACH. In addition, there is a state/county sponsored supplemental assistance program for low-income seniors and medically disabled residents.

Assisted Living Facility Requirements

Private rooms are not required and residents may share a bedroom with up to 4 individuals depending upon the date the ACH was licensed. There must be a toilet and a sink for every 5 residents and a tub or shower for every 10 individuals.

ACHs in North Carolina are required to provide three meals and three snacks each day. They must be able to serve modified or therapeutic diets when ordered by a physician, and there should be a registered dietitian on staff to review these meals. There must be enough staff available to provide individual feeding assistance as needed.

Medication Management Regulations

Before a staff member is responsible for administering or supervising the administration of medications, they’re required to undergo community-provided orientation. If an unlicensed staff member will be performing any task related to medication administration, then they must receive a competency validation by an RN.

Any staff members who administers or supervises the administration of medication must successfully complete the clinical skills validation portion of North Carolina’s competency evaluation. Residents are permitted to self-administer their medications as long as a physician deems them competent and physically able.

Residents’ medication orders and the ACH’s medication procedures are reviewed quarterly by a licensed pharmacist, prescriber, or RN. Special diabetic training must be provided to unlicensed staff before they are allowed to assist with insulin injections and blood glucose monitoring.

Staffing Requirements

North Carolina has relatively strict guidelines for staff ratios. Communities that have between 20 and 30 residents must have 16 hours of personal care aide (PCA) time on the first and second shifts and eight hours on the third shift. A community with 131 to 140 residents must have 96 PCA hours. The larger the community, the greater the number of PCA hours required.

Assisted living communities must have one administrator or acting administrator on site 24 hours a day to ensure that residents are never alone and duties are being performed. Communities must also have an activity director on staff.In communities with at least 31 beds, the first and second shifts must have at least one supervisor. Communities with at least 91 beds must have a supervisor on site for all shifts. The supervisor cannot simultaneously serve as the administrator, though they can be an acting administrator.Communities must have at least one staff member onsite at all times who has completed a course on choking management and cardiopulmonary resuscitation within the last 24 months.

Staff Training Requirements

North Carolina ensures that residents receive quality care thanks to a comprehensive competency evaluation program, which is established by the state. Administrators must complete 30 hours of continuing education every two years. Acting administrators must complete 12 hours of continuing education every year.

Staff members who provide personal care or supervise those that do must complete 80 hours of personal care training that includes 34 hours of classroom instruction and 34 hours of supervised practical experience.

This training also includes instruction for handling conditions like diabetes and the need for restraints, as well as an in-depth look at resident rights, personal care skills and interventions for residents with mental disabilities.

Background Checks for Assisted Living

Every employee of a licensed facility must undergo an extensive background check and have no instances of abuse or neglect listed on the North Carolina Health Care Personnel Registry. Administrators must also have a criminal background fingerprint check.

Requirements for Reporting Abuse

North Carolina law has provisions to protect seniors and disabled individuals from abuse and neglect. To report a possible abuse situation contact the local county office of the Department of Social Services. For additional help you can call a toll-free CARE-LINE within North Carolina at 1-800-662-7030.

Assisted Living Facilities in North Carolina



Top-Rated Caring Stars Winners in North Carolina’s Caring Stars award program recognizes the best assisted living facilities across the U.S. based on reviews from family caregivers and older adults. This award is meant to help older adults and their loved ones find the best assisted living or in-home care option in their area. The list below shows up to 10 listings that have won the most Caring Stars annual awards in their state, sorted by their current overall average rating. For a complete list of Caring Stars winners for each year, please visit our Caring Stars info center.


LiveWell at Birchwood Lake Estates

Chapel Hill, NC $$$

24 reviews


Brookdale South Charlotte

Charlotte, NC $$$

23 reviews


The Perryman House

Thomasville, NC $$$$

10 reviews


Deerfield Ridge Assisted Living

Boone, NC $$$

13 reviews

Carillon Assisted Living of Lincolnton

Lincolnton, NC Cost Levels

12 reviews


Heritage Place

Fayetteville, NC $$$$

9 reviews


Fox Hollow Senior Living Community

Pinehurst, NC Cost Levels

14 reviews


Morningside of Concord

Concord, NC Cost Levels

16 reviews


Warren Care Services

Burlington, NC $

19 reviews


Croatan Village

New Bern, NC $

9 reviews