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Assisted Living in North Dakota
There are already more than 121,000 seniors living in North Dakota, as of the latest U.S. Census estimates, and the state is doing its best to attract even more retirees. In 2021, North Dakota added another reason for seniors to consider it as their new home by removing the state tax on Social Security benefits, and the state capital, Bismarck, joined the AARP Age-Friendly Network in the same year.
North Dakota performs well overall in our 2024 Senior Living Report where it’s ranked No. 15 of the 50 states and in the top three for its senior living and community engagement metrics. Elderly residents who need the kind of help available in assisted living facilities also have a great incentive to do so in North Dakota, where the average cost of $3,391 per month is much lower than most states.
This guide provides more details about assisted living costs in North Dakota, including potential funding sources and helpful resources for seniors in the state.
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The Cost of Assisted Living in North Dakota
When trying to decide how to pay for assisted living, one of the first questions that comes up is "How much does it cost?" With the impact of inflation, it's more important than ever to have up-to-date information when making a financial plan for senior living. To help shed light on real senior living prices, Caring.com has compiled proprietary cost data from its network of over 75,000 senior living providers to offer insight into the average cost of assisted living in North Dakota and its 2 cities.
North Dakota is one of the most affordable states for assisted living, at an average cost of $3,391 per month according to the Genworth Financial 2021 Cost of Care Survey, which is roughly 25% below the norm for the United States. South Dakota’s assisted living facilities are priced similarly to their northern counterparts, with average savings of $41 per month. Minnesota and Montana have average costs just above and below the national average, at $4,508 and $4,450 per month, respectively. Seniors in Wyoming pay an average of $778 per month more than those in North Dakota.
The Cost of Assisted Living in North Dakota's Top Cities
There's less than a $50 difference between assisted living costs in two of North Dakota's top cities: Prices average $3,435 in Bismarck and $3,483 in Minot. Across the state's eastern border in Saint Cloud, MN, prices are around $136 higher. Meanwhile, over the southern border in Aberdeen, SD, average costs are a more affordable $2,795. These price differences highlight a reason to consider both in- and out-of-state assisted living providers.
North Dakota
$3,472
Bismarck
$3,435
Minot
$3,483
Aberdeen, SD
$2,795
Saint Cloud, MN
$3,608
Inflation's Impact on the Cost of Assisted Living in North Dakota
Inflation has impacted the price of assisted living care in North Dakota. From 2022 to 2023, monthly costs rose by 13.9%, from $3,047 to $3,472, and are projected to rise by another 5.2% to $3,653 in 2024. The U.S. average has increased by just 9.56%, reaching $4,459 in 2023.
Inflation caused even lower percentage price rises in neighboring Montana (4.35%) and Minnesota (0.77%). Wyoming, meanwhile, saw prices increase by almost 26.8% to $5,000. In South Dakota, prices actually deflated slightly to $4,443, but are set to increase by an estimated 6.5% in 2024.
| Location | 2022 Cost (Historical) | 2023 Cost (Current) | 2024 Cost (Estimated) |
|---|---|---|---|
| North Dakota | $3,047 | $3,472 | $3,653 |
| U.S. Average | $4,070 | $4,459 | $4,802 |
| South Dakota | $4,514 | $4,443 | $4,732 |
| Montana | $5,038 | $5,257 | $5,599 |
| Wyoming | $3,944 | $5,000 | $5,325 |
| Minnesota | $4,399 | $4,433 | $4,314 |
The Costs of Other Types of Senior Living
The price of senior living in North Dakota varies depending on the type of care. Assisted living costs $3,472, while memory care is around 70% more expensive, costing $5,899. Independent living is the most affordable at $2,873, nearly $600 per month less than assisted living. Factors influencing the price differences between these care types include amenities, specialized programming and the extent of assistance provided.
Assisted Living
$3,472
Memory Care
$5,899
Independent Living
$2,873
Does Medicaid Cover Assisted Living in North Dakota?
Yes, but only partial coverage for assisted living is available. In addition to being financially eligible for Medicaid in North Dakota, seniors must qualify for the Home and Community-Based Services Waiver. The HCBS Waiver provides coverage for an expanded set of services intended to help people avoid or delay the need for nursing home placement by providing care in their own home or other residential (non-medical) setting, such as an assisted living facility. It’s not an entitlement program, however, which means applicants for HCBS services may be placed on a waiting list until state funding is available.
What Assisted Living Services Are Covered by Medicaid in North Dakota
North Dakota Medicaid and the HCBS Waiver cover the following services when provided in assisted living facilities licensed by the state.
- Case management (assessments, planning, monitoring, etc.)
- Personal care
- Residential care services (therapeutic programming, recreation, etc.)
- Housekeeping, laundry and meal preparation
- Non-medical transportation
- Specialized equipment (mobility aids, etc.)
It’s important to note that while Medicaid and its HCBS Waiver cover some of the services received in assisted living facilities, it doesn’t cover the room and board portion of the monthly bill.
Assisted Living Waiver Programs in North Dakota
Medicaid Waiver for Home and Community-Based Services
As mentioned above, the Medicaid HCBS Waiver covers various assisted living services. Applicants must meet all eligibility rules for the standard North Dakota Medicaid plan as well as the following list of requirements specific to the HCBS Waiver.
- Assessed as requiring a nursing facility level of care
- Aged at least 65 or assessed with a disability (based on Social Security definition)
- Able to self-direct their own care
- Living at home or licensed residential care facility (includes assisted living)
Applications for Medicaid and the HCBS Waiver can be submitted online, by mail and at local offices. Help in the application process is available by contacting the appropriate Human Service Zone office or via resources listed below in this guide.
How To Know If You’re Eligible for Medicaid in North Dakota
The standard Medicaid state plan in North Dakota is intended to help vulnerable members of the community, including the elderly, children, pregnant women and people with certain other conditions. However, this guide focuses on seniors who wish to live in assisted living facilities and their Medicaid eligibility requirements in particular.
Depending on income, Medicaid recipients may receive full coverage or be responsible for a share of costs. Countable assets include bank balances, stocks, bonds and other liquid assets. Excluded assets include the applicant’s home, one vehicle, personal and household items.
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | $12,108 | $3,000 | |
| Two People | 1 | $12,108** | $3,000 | $148,620 |
| Two People | 2 | $16,368 | $6,000 |
*Depending on the facility setting, a recipient may not be able to keep income up to this level.
**Income limit is for applicant only.
The applicant must also be a resident of North Dakota and a U.S. citizen or lawfully admitted permanent resident.
How to Apply for Medicaid in North Dakota
The North Dakota Department of Human Services manages the application process for Medicaid and the HCBS Waiver, among other public assistance programs. Applications can be submitted online at the department website, which also provides application forms that can be printed and submitted by mail or in person via local Human Service Zone offices throughout the state.
Information You Will Need
The following is a list of information and documents to prepare before submitting an application. Anyone who is unsure how to obtain such items should contact the department directly or request help from the resources below.
- Proof of age and identity (birth certificate, driver’s license, passport, etc.)
- Proof of the value of assets owned
- Proof of income and expenses
- Proof of residence (rent receipts, utility bills, lease, etc.)
- Social Security number
Non-citizen applicants must also provide proof of lawful alien status.
How to Get Help Applying for Medicaid
Help in determining eligibility and applying for Medicaid and how to receive a level of care assessment for the HCBS Waiver is available via telephone or in person via the local offices linked below.
| Program NAME | Contact | Services AVAILABLE | Contact INFORMATION |
|---|---|---|---|
| Local Human Service Zone Offices | (701) 328-2310 | Each county in North Dakota is served by a Human Service Zone office. These offices are staffed by professionals who can help by answering, identifying what is needed and locating the required documents, questions and getting the application process started. | |
| Legal Services of North Dakota – Senior Helpline | Free legal assistance is available to seniors with a variety of legal issues, such as guardianships, medical bills, health care, SSI, Medicare and Medicaid. North Dakota residents who feel they've been wrongly denied any such services can ask for assistance here. | (866) 621-9886 | |
| American Council on Aging | ACOA is a free service that connects seniors with resources who can help them understand and fill out Medicare paperwork. Resources include public employees working at Aging and Disability Resource Centers, Geriatric Care Managers, Elder Law Attorneys or private Medicaid planning professionals. | Fill out contact form on website |
Does Medicare Cover Assisted Living in North Dakota?
The short answer is that no, Medicare does not cover the cost of assisted living in North Dakota. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in North Dakota.
Paying for Assisted Living Facilities in North Dakota
The HCBS program offers financial assistance to eligible residents at BCFs. The program does not apply to ALFs. Qualified seniors receive residential care in a facility with services that include meals, personal care, social, recreational and therapeutic programs and 24-hour on-site staff.
To be eligible, applicants must:
- Be at least 65 years of age
- Be enrolled in Medicaid
- Be screened at a nursing facility
- Be capable of directing self-care
- Be in a home or apartment setting (no dorms or group homes)
- Be able to have needs adequately met in a BCF environment
To learn more about eligibility requirements, contact your local county social services office.
Other Financial Assistance Options for Assisted Living in North Dakota
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
| Name | HOW TO APPLY | HOW IT WORKS |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in North Dakota
There are many resources in North Dakota that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Department of Health and Human Services | 855-462-5465 | North Dakota's Area Agencies on Aging operates programs under the umbrella of the North Dakota Health and Human Services. The program offers specialized assistance to seniors based on an assessment of individual needs. These include services that help seniors stay in their homes instead of moving into long-term care. Examples include funding for in-home services, family home care and adult foster care. Other forms of practical assistance are homemaker services, such as chores, shopping, meal preparation and money management. |
Cash Assistance Programs
Cash assistance programs in North Dakota provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Financial Assistance for Senior Care and Senior Living
Whether living in their own home or in a senior living community, North Dakota seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Medicaid Waiver for Home and Community Based Services | 855-462-5465 | The Medicaid Waiver for Home and Community Based Services is designed to help older adults and people with disabilities remain living in their homes with access to local community services. This waiver provides a wide range of services including personal care, transport, chore services and respite care. It can also pay for minor home modifications. Services can be provided at home, in adult daycare, adult foster care or memory care facilities. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help North Dakota seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Commodity Supplemental Food Program (CSFP) | The North Dakota Community Supplemental Food Program is a government program targeted at improving the health of seniors. CSFP food packages distributed to eligible older North Dakotans contain USDA-approved supplementary food items suitable for inclusion in a diet that addresses the nutritional needs of older adults. All low-income North Dakota residents aged 60 and over are invited to apply. Packages are available through nominated community action agencies with location details accessible online. | |
| North Dakota Meals on Wheels | North Dakota Meals on Wheels provides nutritious, well-balanced meals and support services for eligible seniors statewide. Seniors must be 60 years old or over to qualify, and the program focuses on those who aren't mobile enough to prepare or shop for food. Depending on circumstances, meals are served on a sliding-scale basis in a congregate setting, such as the local senior center, or they're delivered directly to the senior's front door with an accompanying safety check. | |
| North Dakota The Emergency Food Assistance Program (TEFAP) | The Emergency Food Assistance Program of North Dakota is a federal government program aimed at stemming food insecurity and nutritional deficiencies in older adults. North Dakota seniors aged 60 and over with limited financial means can access emergency food packages and attend free communal meals. TEFAP partners with local North Dakota agencies such as the Great Plains Food Bank in Fargo to distribute food to pantries statewide. Seniors can make inquiries through TEFAP or their local seniors' agency. |
Free Used Medical Equipment
Due to the high cost of purchasing new medical equipment, several organizations in North Dakota collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Healthcare Equipment Recycling Organization (HERO) | 701-212-1921 | Based in Fargo, this program provides donated durable medical equipment to people in need locally and worldwide. It also has a shopfront where anyone can purchase low-cost medical equipment and supplies. |
Home Repair and Modifications
Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in North Dakota have different eligibility criteria and often assist retirees by providing grants or loans.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Rehab Accessibility Project | 800-292-8621 | North Dakota Housing Finance Agency is in Bismarck, ND. The agency operates diverse programs to assist homeowners, renters and homeless people. Low-income individuals with a physical disability may qualify for financial assistance through the Rehab Accessibility Program. Grants for home renovations may cover fitting accessibility features, such as grab rails, ramps and wheelchair-accessible showers, as well as widening doorways and installing door levers. To qualify, households must earn less than 80% of the county's median income. |
Social Security Offices
Social Security offices in North Dakota help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several North Dakota resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Homestead Property Tax Credit | The Homestead Property Tax Credit reduces the taxable value of a person's home. The credit amount is variable, based on an individual's income. | |
| North Dakota Renter's Refund | 701-328-7088 | The Renter's Refund provides a partial refund for the rent of a person's place of residence or mobile home lot. The benefit provides a refund if 20% of your rent is more than 4% of your annual income. The overpayment is refunded, up to $400. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. North Dakota retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota Low Income Home Energy Assistance Program (LIHEAP) | 866-614-6005 | LIHEAP partially pays for home heating costs, including natural gas, electricity, coal or other fuel sources. It can also help with weatherization, furnace cleaning and repair, chimney cleaning and emergency assistance. |
Veteran's Services
North Dakota retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| North Dakota VA Benefits and Health Care | North Dakota VA Benefits and Health Care helps seniors access long-term care and various in- and out-patient medical services throughout the state. Eligible veterans can receive treatment and nursing home care at clinics and veteran's centers in North Dakota, as well as utilize financial benefits such as Aid and Attendance. Typically, individuals must serve 24 months of active duty to be eligible for these benefits; however, this is sometimes waived for people discharged due to disability or hardship. |
Assisted Living Laws and Regulations in North Dakota
The North Dakota Department of Human Services is responsible for licensing assisted living facilities and basic care facilities (BCF). Licenses are valid for 1 year and may be revoked for failure to comply with state regulations and other laws. These regulations are briefly described below
| Topic | Rule |
|---|---|
| Assisted Living Service Plan Requirements | The resident or legal representative must agree to and sign a written agreement detailing the cost of room and board as well as the required services, discharge criteria, and inspection policies. The agreement must be made within 2 weeks of admission and updated quarterly to reflect changes in resident requirements, cost and other policies. Prior to admission, a resident will be assessed on their health needs, functionality, and social interests. |
| Assisted Living Admission Requirements | Assisted living facilities are responsible for developing admission criteria based on what can be safely and reasonably accomplished by staff. Basic care facilities must ensure residents are capable of self-preservation, and that residents do not have conditions that require 24-hour skilled nursing care. |
| Scope of Care | ALFs in North Dakota must provide assistance with activities of daily living. Some ALFs might provide health services. BCFs must provide ADL assistance, transportation, monitoring, medication services, social enrichment, and nursing care. |
| Assisted Living Medicaid Policy | Assisted living facilities aren't required to accept payment for services via Medicaid. However, those living in BCFs may qualify for the HCBS waiver or BCAP program. North Dakota does permit family supplementation, which means that family members may assist with living expenses without affecting a senior's Medicaid eligibility. Not all facilities accept Medicaid as a form of payment. Contact your local communities to learn about their policies. |
| Assisted Living Facility Requirements | Facilities with more than two stories must maintain adequate fire escapes that are kept clear at all times. Residential units must be occupied by no more than four people, equipped with a sink and toilet, and at least one bathtub or shower per 15 residents. |
| Medication Management Regulations | Staff can assist residents in taking medications but must have appropriate certifications in order to administer medications. To administer medication, a staff member must be certified as a level I, II, or III medication assistant and operate under the supervision of a registered nurse.The facility must employ or contract with a health professional or pharmacist to provide an annual review of each resident's medication requirements. |
| Staffing Requirements | Personal care staff must be available at all times, but there is no minimum staff to resident ratio. ALFs must employ a manager and direct care staff, and the manager may be the licensee. For ALFs that administer medication, an RN must be available. BCFs must staff an administrator as well as a licensed nurse. Direct care staff are required to provide personal care and services as needed.BCFs must have at least one awake staff member on duty at all times. |
| Staff Training Requirements | Managers and administrators must have a minimum of 12 hours of in-service education per year. All staff must undergo yearly training on accident/emergency prevention and response, residents' rights and needs, infection control and management of residents' behavioral issues. |
| Background Checks for Assisted Living | State regulations don't require background checks for assisted living staff, but they must check all new employees against various registries and licensure boards to verify employment history, terminations, inappropriate conduct and disciplinary actions taken against them. |
| Requirements for Reporting Abuse | The North Dakota Department of Health contracts with the Long-Term Care Ombudsman Program for oversight of any complaints made by residents and people acting on their behalf, which are then forwarded to the relevant agency or other authority for investigation. Complaints can be raised directly with facility staff or submitted online, by mail, phone and fax. |
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