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

Financial Assistance for Nursing Home Care in North Carolina

Most people do not pay for skilled nursing care entirely out-of-pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in North Carolina.

North Carolina’s Medicaid Program

As of July 2020, 1,874,977 North Carolina residents were enrolled in the state’s Medicaid and CHIP programs. North Carolina Medicaid helps pay for nursing home costs for eligible seniors when it’s medically necessary. In addition to meeting the state’s income requirements, seniors must also meet the nursing facility level of care criteria determined by the Department of Health and Human Services. For example, individuals are eligible if they require 24-hour monitoring and a minimum of eight hours of care daily by a skilled nurse, rehabilitative services or have cognitive disabilities.

Individuals on Medicaid must still use some of their income to help pay for the cost of care, and Medicaid pays the rest. Applicants’ local Department of Social Services office determines financial eligibility. If an individual is covered under Medicare Part A, Medicaid doesn’t pay for the first 20 days of care. Currently, North Carolina has 427 nursing homes, with over 40,000 beds.

Medicaid Eligibility in North Carolina

For North Carolina seniors to be eligible for Medicaid, they must be aged 65 or older, a U.S. citizen or have proof of immigration status, a North Carolina resident and have a Social Security number. They must also need a nursing facility level of care and have an income less than what Medicaid pays for nursing home care. If applicants are already receiving Supplemental Security Income, they’re automatically eligible for Medicaid. 

Seniors can apply for Medicaid in person at their local Department of Social Services office, call their local DSS or apply online through ePASS

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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: 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in North Carolina

Free and low-cost resources are available in North Carolina for seniors and their loved ones. These programs can help with nursing home costs, provide in-home and respite care that can help delay the need for nursing home care and deliver care for older loved ones while waiting to move into a nursing home.

ResourceContactService
In-Home Aides(800) 662-7030In-Home Aides can help seniors who have functional, physical or mental impairments with daily tasks such as bathing, dressing, feeding and ambulation. Some individuals may need home management help, which includes assistance with cooking, shopping and cleaning. The program aims to provide care for elderly residents in their homes to help delay or prevent institutional placement. Eligible applicants must be North Carolina residents, aged 60 years or older, unable to perform activities of daily living and live in a residence maintained by the applicant. Some individuals may have to pay a portion of the program’s cost. To apply, applicants can contact their county’s local Department of Social Services office.
Family Caregiver Support(800) 662-7030The Family Caregiver Support program provides grants to support caregivers. Some of the services include informing caregivers about available services, individual counseling and support groups, respite care for caregivers and supplemental services. Counties may differ in the types of services they offer, and the program can work jointly with other state and community-based services.Individuals interested in this program must be caregivers providing care for a senior aged 60 and older or a person with Alzheimer’s or related disorders. They can get in touch with their local Area Agency on Aging.
Adult Placement Services(800) 662-7030Adult Placement Services can help seniors or disabled adults find living and health care arrangements suited for their needs. The program is available for individuals whose well-being, health and safety can no longer be supported at home. Individuals receive assistance to complete medical evaluations and move to new locations. They may also get counseling to help adjust. The program also helps individuals who may need to relocate because of changes in their level of care. For more information, contact the local social services department
VA Community Care Program(800) 698-2411Veterans Affairs provides care to veterans through community providers when the department cannot provide the care veterans need. The care is offered on behalf of and paid for by VA. The community care provider must meet certain conditions, eligibility requirements and be authorized by VA before veterans can receive care.Services include general community care, home or respite care and state veterans homes. North Carolina has four state veterans homes that provide skilled nursing care.
State-County Special Assistance, In-Home(800) 662-7030The State-County Special Assistance Program provides a cash supplement to low-income seniors at risk of admission to a residential facility. Case managers conduct assessments to determine if seniors can live at home. Factors include the senior’s functional status, their friends and family’s availability to provide care and access to agencies providing care and services. Interested families can contact their local social services department

Nursing Home Laws and Regulations in North Carolina

Licensing RequirementsAll 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 RequirementsNursing 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 RequirementsFacilities 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 RestrictionsA 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 RequirementsWithin 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 RequirementsNursing 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 ServicesNursing 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 ServicesA 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 RequirementsNursing 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 ControlThe 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 CoverageMedicaid 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 (96)