Memory Care in North Carolina

Table of Contents

Memory Care in North Carolina

Table of Contents

• The Cost of Memory Care in North Carolina
• North Carolina Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in North Carolina?
• More Ways To Pay for Memory Care in North Carolina
• Memory Care Laws and Regulations in North Carolina
• Free and Low-Cost Resources for Seniors in North Carolina
• North Carolina COVID-19 Rules for Memory Care Facilities

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When figuring out how to pay for memory care, you first need to understand how much it will cost for your loved one to move to a quality community. As costs continue to rise, it's vital to have the latest details when planning for elderly care costs. In order to shed light on the impact of inflation on senior living costs, MemoryCare.com has gathered cost information from its network of over 75,000 senior living communities. These prices are based on the cost of Memory Care in North Carolina and 36 other cities in North Carolina.

How Inflation Has Impacted the Cost of Memory Care in North Carolina

Rising costs caused by inflation can make it difficult for some seniors to afford long-term care. For those in North Carolina memory care communities, the average cost rose from $4,636 in 2022 to $5,905 in 2023, nearly triple the increase in the national average. Most states surrounding North Carolina saw much lower increases, including Georgia at 4.5%, South Carolina at 6% and Virginia at 7%. Only Tennessee felt a similar impact, with an increase of 21.5%. Based on projections for 2024, South Carolina may see the highest increase at 15.5%, while North Carolina should see a minimal impact of 1.5%.

Memory Care Costs in North Carolina's Top Cities

Despite being the most populous city in the state, Charlotte has a lower average memory care cost than other major cities at $6,224, but still higher than the state average. Raleigh's average of $5,259 is nearly $1,000 lower than Charlotte's and more than $600 less than the state average. Other populous cities like Greensboro are slightly above average at $6,855, while Asheville has one of the highest costs at $8,951.

The Cost of Other Types of Senior Living

Because inflation can impact the costs of services in any senior living community, aging adults must choose what makes financial sense while receiving the level of care they need. While independent living presents the lowest-cost option in North Carolina at $3,054, these communities are for self-supporting seniors. For those needing some daily assistance, assisted living increases to $4,828, while those needing dementia support can expect to pay the highest rate, averaging $5,905.

North Carolina Medicaid pays for the cost of memory care indirectly through the Personal Care Services program. While it doesn’t pay for memory care directly, the Medicaid waiver program can help lower the out-of-pocket costs for personal care expenses.

Personal Care Services Program (PCS)

The North Carolina PCP helps pay for personal care services for individuals who live in private residences, residential care facilities or group homes. The program covers services like meals, dressing, bathing, toileting and mobility.

• Who Is Eligible: Applicants must be 65 years of age or older, submit to an independent assessment and meet Medicaid income and asset limits and the functional eligibility standards.
• How To Apply: To apply for PCP, seniors should visit their primary care provider, who can perform an examination and fill out the assessment request form. This form should be submitted to the state’s designation assessment agency, Liberty Healthcare Corporation. Contact North Carolina Medicaid at (888) 245-0179 for more information.

Medicaid Eligibility for Seniors in North Carolina

In North Carolina, Medicaid is automatically awarded to those who receive Supplemental Security Income (SSI). No additional application is needed to ensure coverage. For full Medicaid, the maximum amount of income for a single applicant is 100% of the federal poverty level or $16,920 per year. In a two-person household, the total is $16,920 per applicant. Asset limits are no more than $2,000 for a single applicant or $3,000 for a couple.

2022 Medicaid Income Limits for Seniors in North Carolina

Additional Medicaid eligibility requirements:

• Must be 65 years of age or older
• Must require nursing home care
• Permanent resident of North Carolina
• Citizen of the United States or legal alien

How To Get Help Applying for Medicaid in North Carolina

To assist seniors applying for Medicaid within the state, several programs and services are provided statewide. The following organizations also help seniors locate additional benefits and can answer additional questions about financial assistance.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

Assisted living residences that provide memory care are regulated and licensed through the North Carolina Department of Health and Human Services, Division of Health Service Regulation. The NCDHHS distinguishes between ALRs based on the number of residents. ALRs with two to six residents are commonly referred to as family care homes, while those with seven or more residents are known as adult care homes.

ACHs may have specialized care units specifically designed to meet the unique needs of those with Alzheimer’s and other related dementia disorders. Facilities with memory care units must meet additional licensing requirements and prepare a disclosure statement that provides relevant information, including the unit’s:

• Admission and discharge requirements
• Staff-to-resident ratio
• Dementia-specific staff training
• Features that address the safety and comfort needs of the cognitively impaired
• Type and frequency of memory care programs and activities

The state Division of Health Care Regulation’s Adult Care Licensure Section is responsible for inspecting ALRs to ensure compliance with applicable regulations and protect residents’ health and safety. Inspections are conducted annually or biennially and to investigate and follow up on filed complaints.

Facility Scope of Care

ALRs in North Carolina provide residents with housing and a range of other services to meet their individual needs. A facility must offer at least one meal per day along with housekeeping and personal and health care services. Any such services that cannot be performed by the facility’s staff may be handled by an outside licensed home care or hospice agency if a written agreement is in place.

ACH facilities are also required to provide residents with:

• 24/7 staff monitoring and supervision
• Assistance with personal care on a scheduled and unscheduled basis
• Transportation services
• Social and recreational activities

Residents may request respite, hospice or additional health care services, and a facility may provide or arrange them through an outside care agency if a physician’s order is in place. SCUs designed for those with Alzheimer’s disease and other cognitive impairments should provide a higher degree of supervision and dementia-related care services.

Admissions Requirements

State-licensed ACHs in North Carolina may accept individuals with a wide scope of care needs. The following table provides an overview of the types of care needs and conditions that may allow or prevent a person’s admission to an ACH:

Residents Who May Be Admitted

Adults of any age diagnosed with Alzheimer’s or another dementia disorder and elderly persons aged 55 or older with:

• Chronic illnesses
• Mental health issues
• Physical disabilities
• Developmental disabilities
• Nursing care needs, including hospice care, based on DHHS approval
• Manageable behavioral issues
• Intellectual disabilities

Residents Who May NOT Be Admitted Those who:

• Meet the state’s eligibility standards for nursing home care
• Require treatment for mental illness or drug or alcohol abuse
• Require continual nursing care under medical supervision
• Need lodging only, without supervision and personal assistance
• Pose a direct threat to the safety or health of other residents
• Are dependent on a ventilator
• Have health, medical or functional care needs that cannot be met in an AHC setting

Care Plan Requirements

North Carolina ACH facilities must develop an assessment-based care plan for each resident. An initial assessment by a trained staff member or RN is required in the first 72 hours following admission, and a functional assessment must be carried out within the first 30 days of residency. These assessments provide baseline measurements of a resident’s cognitive status, psychosocial well-being and ability to perform activities of daily living. Using the results, facilities must develop a detailed, personalized care plan within 30 days of a resident’s admission. Reassessments must be conducted at least annually or within 10 days of any significant change in an individual’s condition.

Before those diagnosed with dementia are admitted to a facility’s memory care SCU, they must be evaluated to verify that the placement is appropriate. Facility staff must develop a written profile for each resident within 30 days of their admission and update it quarterly. The profile should include assessments of a person’s level of ADL skills, behavioral patterns, self-help capabilities, physical abilities/disabilities and degree of cognitive impairment.

Medication Management Requirements

Residents living in an ACH may self-administer medications if they are competent and physically capable of doing so and have a physician’s order. Designated facility staff may assist residents with self-administration or administer medications after completing a 15-hour state-approved course and passing a written exam. A registered nurse must validate the competency of each staff member who oversees residents’ self-administration or administers medications.

Facility Requirements

Memory care SCUs in ACHs may offer private or shared rooms, and occupancy is limited to two residents per bedroom in facilities licensed after 2004. The SCU must provide a minimum of one toilet and sink for every five residents and one tub and shower for every 10 residents.

Memory care SCUs should provide residents with direct access to a secure outdoor area where mechanical noise is minimized. Locks on the unit’s exit doors must meet the state building code for special locking devices. Alternatively, exits may be equipped with a secure monitoring system.

Staffing Requirements

ACHs must have an administrator or supervisor-in-charge, who is responsible for the facility’s operation and residents’ physical, mental and emotional needs, and must employ an activities director. General staffing requirements and staff-to-resident ratios are determined by a facility’s size and the shift.

Memory care SCUs must have:

• One staff member for every eight residents on first and second shifts
• One staff member for every 10 residents on third shifts
• A care coordinator on-site eight hours per day, Monday through Friday

Administrators must complete a 120-hour administrator-in-training program, pass a written exam and complete 30 hours of relevant continuing education every two years. The training required for SCU staff includes six hours of orientation during the first week of employment, 20 hours of dementia-related training within the first six months and 12 hours per year of continuing education.

Medicaid Policy

North Carolina Medicaid does not directly pay the costs residents incur when living in an ACH or family care home. However, the state Medicaid plan does offer the (PCS) program, which provides up to 130 hours per month of personal care assistance with activities of daily living. This program can help lower eligible enrollees’ out-of-pocket care expenses but does not cover the cost of room and board.

Reporting Abuse

Anyone who has concerns about the care or services received in a licensed ACH and wishes to file a complaint may call the North Carolina DHHS Complaint Intake and Health Care Personnel Investigations Section hotline at 800-624-3004. Alternatively, a complaint form may be printed out and faxed to 919-715-7724 or mailed to 2711 Mail Service Center, Raleigh, NC 27699-2711.

In North Carolina, there is an abundance of resources designed to assist seniors throughout their retirement. MemoryCare.com has compiled information on a range of local organizations, programs, and agencies, categorizing them based on the care services they offer for easy browsing. Area Agency on Aging

The Area Agency on Aging in North Carolina is a crucial asset for retired individuals, providing advice on financial assistance, home-based care, and planning for extended care. It also connects seniors and their caregivers with local resources.

Cash Assistance Programs

Financial assistance initiatives exist in North Carolina to help seniors with low income sustain their home living. These initiatives provide tax reductions, discounts on crucial services, and aid for home temperature regulation costs.

Financial Assistance for Senior Care and Senior Living

Elderly individuals in North Carolina, living independently or in elderly care homes, can avail of numerous local financial support opportunities. These aid options help reduce in-home or long-term care costs and connect them to valuable community resources.

Food Assistance Programs

In North Carolina, numerous community programs focus on enhancing the health of seniors via proper diet. These initiatives provide meal delivery, shared meals, and food bank services, guaranteeing that older citizens can obtain reasonably priced, healthy food.

Free Used Medical Equipment

In North Carolina, several organizations are tackling the high cost of new medical devices. They collect lightly used equipment such as wheelchairs, ramps, and walkers, distributing them to local elderly and those requiring assistance.

Health Insurance & Prescription Drug Coverage for Seniors

Elderly residents of North Carolina with certain income brackets have access to local aid for prescription medication expenses. They might also be eligible for health coverage and other programs providing complimentary or reduced-cost healthcare services.

Home Repair and Modifications

In North Carolina, a variety of programs exist to support seniors and those with disabilities in funding home improvements and repairs. These initiatives, providing grants or loans, feature different eligibility criteria tailored for retired individuals.

Legal Resources

In North Carolina, there are several organizations offering cost-effective or free legal aid to senior citizens. They provide advice on issues such as estate planning, living wills, and power of attorney. Some also champion the rights of the elderly in long-term care establishments.

Senior Centers

In North Carolina, elderly individuals find a community hub in senior centers, offering a range of recreational pursuits, events, and essential resources. These centers also provide health programs, dietary advice, and support for issues related to senior living.

Social Security Offices

In the city of North Carolina, Social Security offices are crucial resources for the elderly and those with disabilities. They provide advice on retirement perks, disability benefits, and additional security income.

Tax Assistance

In North Carolina, a variety of tax assistance options exist for seniors and people with disabilities. These encompass possible medical cost exemptions, property tax cuts, and other tax alleviation measures.

Utility & Energy Bill Assistance

In North Carolina, there are establishments ready to assist seniors with limited income facing challenges with home upkeep expenses, such as energy and utility bills. Emergency financial support might be available for individuals threatened with utility disconnection due to outstanding payments.

Veteran's Services

In North Carolina, retired military personnel can find essential support through local veteran services. These organizations help veterans access their deserved benefits and offer advice on a variety of issues.

Note: The following information was compiled and most recently updated on 2/13/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.