North Carolina Assisted Living


North Carolina Assisted living: How to pay for, Licensing and Questions to ask…

North Carolina is a beautiful place full of majestic scenery, a cheerful climate and is home to 1.75 million senior citizens 65 and older. The landscape is full of mountain ranges and a long sandy coastline, which make an inviting environment to call home. As people age and reach retirement years and beyond, some aging adults may require care at some point. North Carolina has rated high for the state’s health care affordability and is a sought out destination for seniors and ideal place for retirees and our aging adult population to join an assisted living community. Assisted living communities are a specific level of care in a community setting. Most importantly, community living allows your loved one the benefit of security and peace of mind. In these communities and facilities, your loved one may experience increased socialization, classes for health and fitness, and quality nutrition plans.

There are a variety of care and housing options available in North Carolina for aging adults.

Common terms that differentiate levels and types of senior living: 

  • Continuing Care Retirement Communities (CCRCs)- typically include independent living, assisted living, residential care and skilled nursing services all on one campus.  
  • Independent Living Communities – provide residents a setting without the burden of home ownership. Residents commonly live in fully equipped private apartments or cottages from a studio to large two-bedroom units.  
  • Care Home or Adult Family Care Home- are private residences in a home-like setting that provide care services to a smaller more limited number of residents (typically 5-12 residents, depending on each state’s regulations). 
  • Assisted Living- provides housing and supportive care in a community setting, but the residents do not require 24-hour nursing care. 
  • Memory Care- a care setting for residents with memory loss or confusion. The community typically has a “secured” entry for residents that may wander. This care can be provided in different care settings depending on the state licensing requirements. 
  • Skilled Nursing is state licensed to provide a safe, therapeutic environment for people who require rehabilitative care 24 hours a day.

Assisted Living in North Carolina

Assisted living communities are NOT nursing homes.

The most common universal term is assisted living. Some other common terms include: care home, residential care, convalescent home, rest home, or retirement home. The lay person sometimes groups all senior housing into the term of “nursing home.” Similarly to a nursing home, plans in assisted living are put in place for residents, which outlines the provided care for each aging adult, all specific to their requirements and preferences.

What services may you find in assisted living?

Service Plans

Written copy of of rules and facility policies must be handed to residents prior to moving in. Included is: written resident’s bill of rights, policy regarding grievances, contact for local ombudsman.

Typical services

Assisted living communities and facilities in North Carolina must provide at east one meal a day. There may be light housekeeping services and activities programs to promote socialization and transportation arrangements. Nursing services may be provided as required and specific to each individual. There must be 24/7 staffing on hand.  Above all, residents move into these communities to receive assistance with activities of daily living (ADLs):

  • Dressing
  • Bathing
  • Medication assistance and reminders
  • Eating 
  • Toileting and incontinence management
  • Transferring

Some assisted living communities may offer additional activities and amenities

  • Clubs
  • Game nights
  • Classes 
  • Parties and other social events
  • Planned outings

Laws and Regulations

North Carolina ensures all assisted living communities comply with licensing requirements enforced by the Division of Health Service Regulation, Adult Care Licensure. All regulations apply to resident care, staffing and training, among other areas.

Housing in assisted living

  • There is a two resident limit in a room. Private units are required to be 100 square feet, not including space taken by bathrooms, kitchen and closets.
  • A minimum requirement of 1 toilet and sink for each 5 residents. A minimum requirement of 1 bathtub or shower for every 10 residents.
  • Smoke detectors.

The fee schedule is regular monthly rent. There may be additional charges for amenities and any specific services.


There must be an administrator or in-charge supervisor on premises at all times. Administrators must have 120 hours of completed of training, Associates degree or 2 years of coursework at higher education institution. Other staff must complete evaluations in the specific tasks they perform in the community or facility. These requirements are set by the Department of Health and Human Services.


Reportable abuses may include psychological and or sexual abuse, physical or financial. All staff in North Carolina are assigned as a mandatory reporter and can face criminal charges if they neglect to inform abuse.

Expected Monthly Costs of Assisted Living Communities in North Carolina

Paying for assisted living depends on several factors. The average base cost of assisted living in the United States is $4,550 per month. The average cost per month in North Carolina is $4,050. Some nearby states like South Carolina and Georgia are cheaper, whereas if you move north up the east coast the cost of assisted living increases.

  • National average: $4,550
  • North Carolina: $4,050
  • Virginia: $5,300
  • South Carolina: $3,650
  • Georgia: $3,575

Within North Carolina, the costs will vary. Fayetteville is on the very low end at $3,000 per month. Raleigh is much more expensive, costing $5,400 per month. Other cities in the state fluctuate in the middle.

  • North Carolina state average: $4,050
  • Raliegh: $5,400
  • Wilimington: $5,300
  • Fayetteville: $3,000
  • Charlotte: $4,450
  • Winston-Salem: $5,000

What Financial Assistance is available in North Carolina?

North Carolina, Special Assistance

This program is a supplemental social security program created to help low income seniors who live in or plan to reside in a licensed long-term care facility, if eligible. The funds to support the program are funded half and half by the state and the counties of care. The Special Assistance program helps with rent and meals as well as small cash allowances.

How to pay for assisted living

You want to consider your payment options for assisted living, memory care, and care homes. For these services, Medicare is NOT an option for payment.

The most common payment for these services would be out of pocket Private Pay and assessing a combination of retirement funds, personal savings, and pension payments.

Medicaid can also be an option, be sure to see if you or a loved one qualifies.

Long-Term Care insurance is also a possible option in cases of chronic conditions, be sure to see if you or a loved one qualifies.

For our Veterans and spouses of veterans, be sure to assess Veteran Aid and your eligibility for these benefits.

Medicare – NO:

  • Medicare does NOT pay for Assisted Living.
  • People 65 years and older and individuals with end stage renal disease are eligible for Medicare benefits, no matter their income.
  • Coverage is meant for people in need of short-term care.

Private pay – YES:

  • Many families pay for assisted living with private funds.
  • Private pay can be a combination of retirement funds, personal savings, and pension payments.
  • Family members may contribute funds to pay for assisted living or other senior housing and care.

Medicaid – MAYBE:

  • Medicaid provides health coverage to millions of Americans. Eligible participants include: low-income adults, elderly adults and people with disabilities.
  • Medicaid is administered by state, according to federal requirements. The program is funded jointly by each state and the federal government.
  • Every state has their own individual Medicaid assistance program.
  • National guidelines are in place do decipher how states must spend Medicaid money, but with allowances toward the guidelines.
  • The state determines what levels of care will be covered by Medicaid, who is eligible, and how much the state will reimburse the care community.
  • If you are unsure whether you qualify for Medicaid, you should apply. You may be eligible depending on your household income, family size, age, disability and other factors.

Long-term Care Insurance – MAYBE:

Long term care insurance is a great way to pay for assisted living, and planning ahead is important when considering how to pay for senior housing and care. Nearly 75% of people over the age of 65 will require long-term care and services at some point. Buying into long-term care insurance when a person is in their 50s and 60s is the most common time to do so.

  • Long-term care insurance helps cover the costs of chronic medical conditions.
  • Individuals and couples with the ability to pay into long-term care insurance have the advantage of a head start in allocating funds for senior care.

Veteran Aid and Assistance – MAYBE:

This benefit is available to some military veterans and surviving spouses who live in an assisted living community and those who have in-home care.

  • There are specific guidelines, but a veteran may qualify for as much as $2,050 each month.
  • A veteran with a sick spouse may be eligible for $1,600 per month.
  • If a veteran has passed, their surviving spouse can qualify for $1,300 per month.

It is important to take your time when exploring payment and coverage options

Questions to Ask

Finding an assisted living community can be overwhelming. Here are some tips on things to be observant of:

  • Make sure the facility is clean and well maintained. You can tell a lot about the operation by noting what is clean and maintained. Are doorknobs loose or damaged? Do you see any frayed carpet or trip hazards?
  • Visit during lunch hour to observe what the residents are eating. Ask questions about the nutrition program. Is there diversity in meals, healthy fruits and vegetables served at all meals, drink options?
  • Speak to residents and/or family members to learn their perspective.
  • Ask about staff and resident engagement. Get a feel for how staff interact with residents.
  • Ask about the life enrichment programs. Activities are crucial when it comes to quality of life and play a key role in care for older adults.
  • And finally (along with a plethora of more things to consider), get to know the leadership in the building. If you feel good around the Executive Director, Head Nurse, Lead Activities Director and even the Chef or Janitor, it is a good sign you can trust them with the care of your loved one.

Eldercare Locator is a nationwide service that connects older Americans and their caregivers with trustworthy local support resources. Connect with services such as meals, home care or transportation, or a caregiver education or respite from caregiving responsibilities. The Eldercare Locator is a public service of the Administration on Aging (AoA), an agency of the U.S. Administration for Community Living.

Medicare provides a search feature to find & compare providers near you, most senior housing and care providers are included on Find & compare plans in your area. Determine if you qualify for premium savings

Medicaid offers information on how to apply for Medicaid, eligibility criteria, links to local state offices, and additional resources.

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research. Whether you are living with Alzheimer’s or caring for someone with the disease, information and resources are available. 

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Written by The Care Availability Team
Experts in the senior care & retirement living industries

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