North Dakota Assisted Living


North Dakota Assisted Living: How to pay for, Licensing and Questions to ask…

The residents of North Dakota enjoy the wide open spaces and the low crime rates. The state offers ample job opportunities in a wide variety of professions, and the cost of living is low and affordable. North Dakota ranks as one of the happiest states in the country, so people come and they stay. The state ranks 15th for most senior living. There are over 120,000 seniors aged 65 and older in the state, and the number is growing each passing year. The rising number of seniors will likely require care at some point. Most people think of nursing homes when it comes time for senior care. However, there are excellent options aside from a nursing home. North Dakota assisted living communities offer your loved one the benefit of security and peace of mind. These communities are a specific level of care in a community setting.

North Dakota has several states which provide excellent health care for seniors: Bismarck, Fargo, Minot, Grand Forks, Mandan, among many others.

Aside from assisted living, there are a variety of senior living and housing and care options which suit the requirements and desires of seniors.

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.

More about assisted living in North Dakota

The definition of assisted living in North Dakota is a building with at least five living units housing five residents or more. The facilities must offer support services to help residents remain as independent as possible. Residents are charged a monthly rent, and then can choose to pay for the services that they want or need.

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.”

What does Assisted Living in North Dakota offer?

Service plans

New residents must be assessed within two weeks of entry into a facility, and then once every quarter thereafter. These assessments are for the facility to know the scope of care required for the resident, to have documentation of the resident’s health status, dietary needs and restrictions, personal care needs and their interests.


Assisted living facilities typically offer help with activities of daily living:

  • bathing
  • dressing
  • medication management
  • mobility
  • grooming
  • meals

Laws and regulations


All assisted living facilities are licensed by The North Dakota Department of Human Services.


Rooms may be single or double occupancy. There must be one toilet and sink for every four residents, and one shower or bath for every fifteen residents.

In North Dakota, assisted living facilities are not required to provide apartments. However, units must have a sleeping area, lockable door, and a private bathroom with a shower.


All facilities must employ a manager and direct care staff. Any facility which provides medication assistance must have a registered nurse to administer medications.

There are no staff to resident ratio requirements, but staff must be available and awake 24 hour a day.


Any suspected abuse should be reported to the Vulnerable Adult Protective Services. To report concerns regarding any facility violations, contact the Department of Health Division of Life Safety and Code and Construction.

Expected monthly cost of assisted living in North Dakota

Residents of North Dakota have the advantage of very affordable assisted living. The average cost per month for assisted living in North Dakota is one of the last expensive in the country, costing $3,400 per month. The national average per month for assisted living is $4,500. South Dakota is also much lower than the national average ($3,375), and like North Dakota they are the least expensive in the region.

  • National average: $4,500
  • North Dakota: $3,400
  • South Dakota: $3,375
  • Minnesota: $4,525
  • Montana: $4,475
  • Wyoming: $4,200

The cost of assisted in North Dakota Varies city to city.

  • North Dakota state average for assisted living per month: $3,400
  • Grand Forks: $2,200
  • Bismarck: $3,725
  • Fargo ($3,850)

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.

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. 

North Dakota Department of Human Services Provides services that help vulnerable North Dakotans of all ages to maintain or enhance their quality of life.

The Long-term care Ombudsman Program advocates for residents in log-term care communities and facilities.

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

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