Stretching across the Great Plains, the midwestern state of North Dakota is home to more than 760,000 people, around 16%, or 120,000, of whom are seniors aged 65 and older. North Dakota offers a variety of features that support happy and healthy retirement living, including a plethora of outdoor recreational opportunities, low crime rates and access to 47 hospitals, including Sanford Medical Center Bismarck, CHI St. Alexius Health Bismarck and Sanford Medical Center Fargo, which was named the best hospital in North Dakota by U.S. News.

Nursing homes are one option for seniors who require long-term care. In these facilities, seniors receive 24-hour care and supervision from trained nursing professionals. According to Genworth Financial’s 2020 Cost of Care Survey, seniors can expect to pay an average of $12,167 per month for a semiprivate room in a nursing home, while a private room costs $12,764.

This guide provides an overview of nursing home costs in North Dakota compared to nearby states and the nation as a whole. It also includes information about financial assistance and the laws and regulations that nursing homes in North Dakota must abide by, as well as a list of resources available to seniors and their caregivers.

The Cost of Nursing Home Care in North Dakota

Nursing home care in North Dakota is considered very expensive compared to other U.S. states. According to Genworth Financial’s 2020 Cost of Care Survey, seniors can expect to pay an average of $12,167 per month for a semiprivate room in a nursing home, which is significantly higher than the national average of $7,756. North Dakota is one of the costliest states in the region. Even Minnesota, which costs an average of $11,026 per month is still over $1,000 cheaper than North Dakota. Wyoming and Montana are significantly more affordable, with average monthly costs of $8,258 and $7,665, respectively. Just below North Dakota, South Dakota is the least expensive option at $7,011.

$12167

North Dakota

$7756

The United States

$7665

Montana

$8258

Wyoming

$7011

South Dakota

$11026

Minnesota

Nursing home costs can vary greatly from city to city based on a variety of factors, such as population, location, cost of living and access to health care. The state’s highest nursing home rates are in Grand Forks, where seniors can expect to pay an average of $11,365 per month. To the south in Fargo, costs are slightly lower at an average of $10,942. The state’s least expensive nursing home care is found in the capital city of Bismark, where seniors can expect to pay around $10,646 per month.

$10646

Bismarck

$11365

Grand Forks

$10942

Fargo

Seniors in North Dakota have additional options for long-term care, depending on the level of care and attention they require. These include in-home care, home health care, adult day care and assisted living care. For seniors who only require basic daytime care services, adult day care is an affordable option at an average cost of $2,245 per month. Seniors who wish to remain in their own homes have the option of homemaker services for $5,335 per month. Those who require light medical care may benefit from home health care, which costs an average of $5,529 monthly. Seniors who need comprehensive full-time care but are not yet ready for a nursing home may opt for an assisted living facility, which costs an average of $4,096 per month.

$5335

In-Home Care

$5529

Home Health Care

$2245

Adult Day Care

$4096

Assisted Living Facility

$12167

Nursing Home Care

Financial Assistance for Nursing Home Care in North Dakota

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 Dakota.

North Dakota’s Medicaid Program

In North Dakota, participation in Medicaid and CHIP has risen by over 46%, with 102,459 individuals currently enrolled. Medicaid currently provides long-term support programs to around 2,800 eligible seniors across the state who require the services offered at licensed nursing care facilities. In North Dakota, over 50% of beds in assisted living residences are licensed for supplementary Medicaid funding. 

North Dakota’s Medicaid program covers the cost of long-term care for seniors residing in nursing facilities. The amount covered may vary, as costs are determined by the level of care required by an individual resident. Nursing facilities in North Dakota operate under a case-mix system that includes 48 classifications, organized into seven major clinical groups. These groups are further divided based on a residents’ Activities of Daily Living (ADL) score, which ranges from zero, meaning a resident is independent, to sixteen, meaning a resident is fully dependent on assistance with daily tasks. Upon arrival at a nursing home, residents undergo an evaluation by an interdisciplinary team to identify their needs. The results are then sent to the North Dakota Department of Human Services and a classification is assigned.

Medicaid Eligibility in North Dakota

To be eligible for Medicaid-funded nursing home care, seniors must be a resident of North Dakota and a U.S. citizen who is in need of health care assistance and expresses a need for financial aid. Single seniors aged 65 and older may have up to $3,000 in countable assets and are permitted to keep $65 of their monthly income to cover personal needs, as well as any funds required to cover health insurance premiums.

To apply for Medicaid benefits, seniors can visit their county social services office to fill out a Health Care Application for the Elderly and Disabled form, which can either be returned in-person or submitted by mail. Seniors can also complete an online Application for Assistance.

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 Dakota

There are a number of services for seniors in North Dakota available at little to no cost, including resources to help cover the costs associated with nursing home care, as well as those that can help seniors to remain living independently at home before having to transition to a nursing facility. Here’s a list of some of the resources available to seniors in North Dakota.

ResourceContactService
The Aging and Disability Resource-Link (ADRL) of North Dakota(855) 462-5465The Aging and Disability Resource-Link (ADRL) of North Dakota helps connect seniors with services and resources to help them improve their quality of life. Trained professionals are able to offer advice and information about some of the local programs available, including advice about Medicaid and health insurance, assistance with transitioning to long-term care settings and caregiver support programs.
Community Action Partnership of North Dakota(701) 232-2452The Community Action Partnership of North Dakota is a nonprofit agency that provides a variety of programs and services to support low-income individuals. These include hunger prevention programs, weatherization assistance and supportive programs for veterans, such as outreach, case management and financial assistance.
North Dakota Department of Veterans Affairs(701) 239-7165The North Dakota Department of Veterans Affairs helps veterans living in North Dakota access the federal and state benefits they’re entitled to. These may include pension benefits, assistance with medical care costs and financial assistance to help cover the cost of care in nursing facilities.
Lutheran Social Services of North Dakota(701) 235-7341Lutheran Social Services of North Dakota offers a number of senior-focused programs to support aging members of the community. These include a senior companion program, a volunteer companion program, care coordination, family support services and a retired senior volunteer program.
Service Payments for the Elderly and Disabled (SPED) ProgramInterested applicants should contact their local County Social Services officeNorth Dakota’s SPED Program provides seniors with services that can help them continue to live independently at home. These services may include supervised adult family foster care, case management, chore services, home modifications, homemaker services, emergency response systems and caregiver respite.
Older Americans Act Services (OAA)(855) 462-5465For seniors who wish to remain living at home rather than at a nursing facility, the Older Americans Act offers a range of supportive services. These may include home-delivered and congregate meals, personal care services, shopping assistance, transportation, family caregiver support and companion services.
North Dakota Senior Service ProvidersSeniors can contact the organization via email at wandm@restel.netNorth Dakota Senior Service Providers is a nonprofit organization made up of 30 agencies across the state that provide a variety of seniors services through contacts with the North Dakota Department of Human Services’ Aging Services Division. Some of these services include outreach, referral services, transportation, home-delivered meals, legal assistance and companionship.

Nursing Home Laws and Regulations in North Dakota

Licensing RequirementsIn North Dakota, skilled nursing facilities must pass an inspection and investigation to obtain a license from the state Health Department’s Division of Health Facilities. Licenses must be renewed on an annual basis. The department must be given 30 days notice for any changes made to a facility’s ownership, bed capacity or name.
Staffing RequirementsAll medical care in nursing homes is conducted under the supervision of the facility’s medical director, who is responsible for coordinating care services.The facility must employ a director of nursing to oversee all nursing services. It is also required that a nursing home have a sufficient number of nursing staff on duty. This includes at least one registered nurse and one licensed nurse on duty for eight hours a day, seven days a week.
Staff Training RequirementsTo hold the position of medical director at a nursing facility, an individual must be a licensed physician. Similarly, a facility’s director of nursing must be a registered nurse who is licensed to practice in the state of North Dakota.New employees are required to go through an orientation program. All current staff must complete an annual educational program that covers safety and emergency procedures, the prevention and control of infections, resident rights, advanced directives and how to provide care for residents with behavioral issues.
Admission RestrictionsNursing homes may refuse to admit residents whose needs cannot be adequately met by the accommodations and care services provided by the facility. In order to be admitted, residents must be referred under the order of a licensed health care practitioner and undergo a physical examination within 48 hours of admission.
Care Planning RequirementsNursing homes are required to develop a comprehensive care plan for each resident that’s individualized to meet their needs and assist them in maintaining the highest level of functioning possible. Care plans must identify a resident’s difficulties and strengths, outline measurable, behavior-oriented goals and include a plan of action. Plans are to be revisited on a quarterly basis.
Dietary and Nutritional Services RequirementsNursing homes must provide their residents with at least three daily meals, served at regular times. Menus must be nutritious and meet the food and nutrition board’s recommended dietary allowances. Facilities must make efforts to adjust menus to address resident requests or special dietary needs whenever possible.
Specialized Rehabilitative ServicesIn North Dakota, communities are required to provide specialized rehabilitative services that, at a minimum, include physical therapy, speech and language therapy, occupational therapy and behavioral health services for seniors with mental illnesses or impairments. These services may be provided directly by on-site staff members or by outside professionals.
Medication and Pharmaceutical ServicesNursing homes in North Dakota are required to provide pharmaceutical services for their residents. Any medication administered to a resident must be ordered in writing by a licensed health care professional, and a licensed pharmacist is to review each resident’s medications on a monthly basis.
Activities Requirements Nursing facilities must provide ongoing activity programs that support residents’ physical, mental and psychosocial well-being. Activities should be meaningful, stimulating and therapeutic and designed around residents’ interests and needs.
Infection Control Requirements Nursing facilities are expected to have programs in place to protect residents’ health that follow the standards set by the Centers for Disease Control and Prevention. This includes procedures, such as proper facility maintenance, disinfection of surfaces, staff hygiene measures and isolation protocols.
Medicaid CoverageNorth Dakota’s Medicaid program covers the cost of services for individuals who require nursing home care. Medicaid also offers waiver programs to cover certain services for seniors with similar care needs who have chosen to remain living independently at home.