North Carolina is a good retirement destination for many seniors, as three of its cities were ranked in the top 25 best places to retire in 2020 by Forbes. The state has 10.4 million inhabitants, 16.7% of whom are seniors aged 65 and older.

Recent data has found that 26.5% of the state’s seniors live alone, 35.8% have a disability, and 15% have difficulty with independent living. Approximately 84% also had at least one chronic illness, and 55% had two or more chronic conditions. In 2019, about 170,000 seniors aged 65 and older lived with Alzheimer’s disease.

There are 427 nursing homes in North Carolina, with 36,148 residents. Nursing home facilities provide constant, round-the-clock skilled nursing care, including personal care, rehabilitation and medication administration. In North Carolina, the average monthly cost is $7,300 for a semiprivate room in a nursing home facility and $8,060 for a private room, according to Genworth’s Cost of Care Survey 2020

This comprehensive guide covers everything related to nursing home care in North Carolina, such as average costs, financial options, the Medicaid program, free and low-cost resources and nursing facility rules and regulations.

The Cost of Nursing Home Care in North Carolina

According to Genworth’s Cost of Care Survey 2020, North Carolina has an average cost of $7,300 per month for a semiprivate room in a nursing home facility. This number is significantly less than the national average price for nursing home care, which is $7,756 per month. Nursing home care costs vary across North Carolina’s neighboring states. South Carolina’s average nursing home costs are only $2 less than North Carolina’s. Virginia’s nursing home prices are almost $400 more, while Tennessee is over $200 less expensive than North Carolina’s nursing home care costs.

$7300

North Carolina

$7756

The United States

$7298

South Carolina

$7665

Virginia

$7072

Tennessee

Average nursing home prices in North Carolina’s three largest cities of Charlotte, Greensboro and Raleigh range from $7,148 to $7,817 per month. Raleigh has the least expensive nursing home cost out of the three, at $7,148 per month. Greensboro has a cost of $7,695, and Charlotte’s nursing home cost is the most expensive of the three, at $7,817. Rocky Mount, located in eastern North Carolina, has the least costly nursing home option statewide, at $6,083 per month. Meanwhile, the small city of Goldsboro has an average cost of $8,752, the most expensive option in the state.

$6083

Rocky Mount

$6722

Fayetteville

$7148

Raleigh

$7270

Durham

$7695

Greensboro

$7817

Charlotte

$8000

Asheville

$8752

Goldsboro

Nursing home facilities are the priciest care option in North Carolina. A semiprivate room in a nursing home is over $6,000 more expensive than an adult day care, which has the least costly care option, at $1,278 per month. Assisted living and home care have comparable prices, at $3,800 and $3,813, respectively. Home health care has the second most expensive cost, at over $4,000 per month, but still over $3,000 less than nursing home costs.

$1278

Adult Day Care

$3800

Assisted Living

$3813

Home Care

$4004

Home Health Care

$7300

Nursing Home

Does Medicaid Cover Nursing Home Care in North Carolina?

North Carolina Medicaid covers some of the costs of a nursing home for low-income individuals who can show that a physician deems a nursing home level of care medically necessary. As of 2021, 2,101,394 individuals were enrolled in Medicaid throughout the state. In long-term care, Medicaid pays for services including speech and occupational therapy, prescription medications, physician services and personal care, including meals, transportation and grooming.

There are 422 nursing homes in North Carolina with over 36,000 residents. These facilities provide constant hospital-level care. For additional help paying for long-term care, seniors may qualify for the North Carolina Innovations Waiver. This federally approved Home and Community-Based Services Waiver (HCBS) helps meet the needs of seniors and those with disabilities who need assistance but prefer to age in place as long as possible.

Medicaid Eligibility in North Carolina

Seniors in North Carolina who receive SSI automatically qualify for Medicaid. Those who don’t receive SSI must meet the modified adjusted gross income level, which is based on the federal poverty level. For North Carolina, that percentage is 41% of $12,880 for a household of one with an asset limit of $2,000, and it’s $17,420 for a household of two with an asset limit of $3,000. Under the Spousal Impoverishment Act, the asset limit for a non-applicant is $137,400. Seniors with spouses who plan to live independently may keep more income and assets to prevent them from becoming poverty stricken.

2022 Medicaid Income Limits for Seniors in North Carolina

Annual Income Limits

Asset Limits

Single Applicant

Must be less than the amount Medicaid pays for nursing home care

(estimated $71,304 - $95,460/year)

$2,000

Two-Person Household

(One One Person Applying)

Must be less than the amount Medicaid pays for nursing home care

(estimated $71,304 - $95,460/year)

$2,000 for applicant

$137,400 for non-applicant

Two-Person Household

(Both People Applying)

Must be less than the amount Medicaid pays for nursing home care

(estimated $71,304 - $95,460/year)

$3,000

Additional eligibility requirements include:

  • Resident of North Carolina
  • U.S. citizen, permanent resident or legal alien
  • In need of health care or insurance assistance
  • Senior aged 65 or older; or
  • Disabled

How to Apply for Medicaid in North Carolina

Individuals in North Carolina may apply for Medicaid online through ePASS or over the phone by calling the Medicaid Department at (800) 662-7030. Hearing-impaired applicants may dial (TTY) (877) 452-2514. To apply in person, individuals may visit their local Division of Health Benefits office or download the appropriate forms and mail them to North Carolina Medicaid, 2501 Mail Service Center, Raleigh, NC 27699-2501.

Information You Will Need:

  • Current bank statements for the past 60 months
  • Current income statements for the past 60 months
  • List of assets, including real estate and vehicles
  • Government-issued ID
  • Copies of insurance
  • Social Security number
  • Birth certificate

Additional Medicaid Support & Resources in North Carolina

North Carolina has several organizations that can assist with applying for Medicaid. These services are available for free to help seniors, their loved ones and caregivers navigate the different financial options for paying for nursing homes.

Resource

Contact

Service

(800) 662-7030

Benefits.gov is a federal website that provides information on available government benefit programs. The site includes a definition of Medicaid, eligibility qualifications and contact information.

(866) 219-5262

Legal Aid of North Carolina offers a free Medicaid Managed Care Clinic that provides information on state Medicaid, including what it covers, the different parts and how to apply. Legal Aid also offers information on what to do in the event of Medicaid fraud for payment of long-term care and who to call for complaints.

(919) 855-3400

NC Aging and Adult Services provides insurance counseling for seniors throughout the state. Each county is served by a local office with trained counselors who offer unbiased information on the different public and private insurance options.

Does Medicare Cover Nursing Home Care in North Carolina?

Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.

Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.

What Does Medicare Cover?

Medicare covers a number of specific services, including:

  • Meals
  • A semiprivate room
  • Medications
  • Skilled nursing
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Audiologist care
  • Medical supplies
  • Medical social services
  • Nutritional counseling
  • Ambulance transportation

What Isn’t Covered by Medicare?

Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.

For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.

Medicare Support and Resources in North Carolina

Several agencies help answer general questions regarding Medicare programs and services. The following list of resources include trained counselors who can provide information and advice on qualifying and applying for Medicare.

Resource

Contact

Service

(855) 408-1212

SHIIP provides one-on-one insurance counseling and assistance with Medicare. Help is available for anyone making coverage changes during open enrollment, those worried about out-of-pocket costs associated with Medicare and those who are unsure about Medicare’s eligibility and what it covers. Information on supplemental insurance is also offered.

(800) 794-6559

Benefits CheckUp, a free service operated by the National Council on Aging, provides a free list of health care options for seniors. A helpline is available for those with questions regarding Medicare eligibility.

(800) 633-4227

The Medicare.gov website provides information about Medicare, including costs and eligibility and additional information on health and drug plans. Seniors may create an account to check the status of their application or make changes to their coverage.

Other Financial Assistance Options for Nursing Home Care in North Carolina

While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.

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 skilled nursing care.

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 nursing care. 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 skilled nursing care. 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 skilled nursing care will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in North Carolina

Seniors in long-term care in North Carolina have access to a selection of programs and services that address individual needs and help improve the overall quality of life for seniors. Many of these programs can also delay admittance into a nursing home by enabling seniors to age in place. 

Resource

Contact

Service

(800) 662-7030

The state long-term care ombudsman serves as an advocate for seniors in nursing homes and other long-term care facilities. The ombudsman accepts complaints from residents regarding quality of care and elder rights and works towards solutions. The ombudsman also visits nursing homes

(800) 662-7030

A service offered by the Department of Health and Human Services, these aides help seniors ages 60 and older with activities of daily living, including bathing, dressing, meals, shopping and cleaning. The service is free or low-cost depending on income.

(800) 662-7030

Administered by the local Area Agency on Aging, Family Caregiver Support provides assistance to caregivers including information on support groups, respite care and supplemental services. Caregivers must provide care to a senior who's 60 or older, is disabled or has Alzheimer’s or a related illness.

(800) 662-7030

Adult Placement Services helps seniors and those with disabilities locate appropriate living and health care arrangements to suit their individual needs and preferences. The service is available to those who are unable to live alone, those in residential care facilities who are looking to relocate and those who need help finding a nursing home.

(800) 698-2411

The VA Community Care Program is available to men and women who have served in the military and need help from providers outside the standard of care provided by the VA. This service is available when the VA can’t provide the appropriate level of care.

(800) 662-7030

The State-County Special Assistance program provides resources to seniors who prefer to receive care in their own homes. Factors that determine whether a senior can remain at home include the functional status, family availability and access to agencies that provide care.

COVID-19 Rules for Nursing Homes in North Carolina

The following information is based on research done on several government websites, including covid19.ncdhhs.gov. These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/13/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for North Carolina Communities

Are loved ones allowed to visit to provide emotional support?

Yes

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Yes

Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?

Yes

Are visitors checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for North Carolina Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for North Carolina Communities

Are staff members and contractors being screened for elevated temperatures?

Yes

Are staff members and contractors being tested for Coronavirus?

Yes (Conditions Apply)

Are staff members and contractors being asked questions about health, travel, and potential virus contact?

Yes

Are staff members required to regularly screen residents for coronavirus symptoms?

Yes

Are residents relied on to screen themselves and self-report potential coronavirus symptoms?

No

Are staff members required to take residents’ temperatures?

Yes

Are residents being tested for coronavirus?

Yes (Conditions Apply)

Nursing Home Laws and Regulations in North Carolina

NURSING HOME LAWS AND REGULATIONS IN NORTH CAROLINA
Licensing Requirements
All nursing facilities must be certified by the Division of Health Service Regulation. The facility must only have one license, and the license remains in effect for up to 12 months. The facility's license can be renewed at the end of each calendar year.
Staffing Requirements
Nursing home facilities must have a designated physician serving as the medical director and a registered nurse serving as the director of nursing. Each facility must have sufficient nursing staff to provide quality care for each patient. All professional staff must be licensed, registered or certified according to state laws. 
Staff Training Requirements
Facilities must provide staff orientation on policies and procedures at the time of employment. Nursing facilities must also train all staff regularly and provide training for all employees in emergency procedures.
Admission Restrictions
A physician must be the one to admit residents. If a patient needs health or rehabilitative care beyond what the facility is licensed or capable of providing, they cannot be admitted to the nursing home. 
Care Planning Requirements
Within 14 days of a resident's admission, a facility must perform a comprehensive assessment. The facility must also create a comprehensive care plan within seven days of the patient completing the evaluation. The facility must review each resident's comprehensive assessment and care plan every 90 days. 
Dietary and Nutrition Services Requirements
Nursing facilities must provide residents with a diet that meets their daily nutritional needs. At least three meals must be served to the residents daily, and the facility must ensure the residents are meeting their nutritional status, such as protein levels. The facility must have a director of food service responsible for the dietetic service and its personnel.
Specialized Rehabilitative Services
Nursing facilities must provide rehabilitative services, such as physical, speech and occupational therapies, as part of the daily allowance reimbursed to the facility. 
Medication and Pharmaceutical Services
A pharmacist must supervise pharmaceutical services, and they must ensure the acquiring and administering of all drugs are accurate. Facilities must also make sure medications are administered per regulations and recommendations.
Activities Requirements
Nursing facilities must provide an ongoing activities program per each resident's comprehensive assessment. The activities must promote the physical, psychosocial and mental well-being of every resident. The facility must also assign an activities director to oversee the recreational services.
Infection Control
The facility must create and maintain an infection control program to prevent the spread of diseases and infection. The facility's responsibility includes choosing the appropriate infection prevention procedures, such as isolation, for individual residents and investigating any infection incidents. The facility must also ensure residents are screened and tested for any infectious disease upon admission, and staff must be screened within seven days of the hire date. Tuberculosis screening for staff and residents must be done annually.
Medicaid Coverage
Medicaid pays a portion of the nursing home costs for qualified North Carolina individuals, but seniors have to use some of their income toward nursing home costs. Eligible applicants must be 65 years and older and meet both the income and nursing level of care requirements. 

Nursing Homes Facilities in North Carolina (97)