Memory Care in North Carolina | MemoryCare.com

Memory Care in North Carolina

According to the Alzheimer’s Association, approximately 4,500 people died from Alzheimer’s-related deaths in North Carolina in 2019, and approximately 180,000 individuals had been diagnosed with the disease. Statewide, this number is expected to increase by nearly 17% in five years, making dementia and other cognitive impairment a growing epidemic in the aging community.

Memory care facilities provide those living with Alzheimer’s and dementia with care that is tailored to their unique needs. Memory care can take place in its own facility, or as part of a designated wing of another residential care community. Staff members of memory care units or facilities undergo specialized training in caring for those with memory impairment, and the facilities often coordinate social activities and schedules specifically for the needs of those living with Alzheimer’s or dementia.

This guide will cover the cost of memory care in North Carolina, financial assistance options for paying for memory care, free memory care resources in the state and a directory of memory care facilities in North Carolina.

The Cost of Memory Care in North Carolina

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

To estimate the cost of memory care, we added 25% to the cost of assisted living as reported by the 2021 Genworth Cost of Care Survey. In North Carolina, the median state average is $5,013 a month, which is less than the national average of $5,625. South Carolina and Georgia residents pay less at $4,515 and $4,419 per month, while Tennessee and Virginia residents pay more at $5,131 and $6,563.

Memory care costs vary within the state, depending on the size and location of the city, the number of amenities and the additional types of care the community offers. New Bern has one of the lowest costs at $4,556, while Raleigh seniors pay one of the highest monthly costs at $6,735. Other costs vary within the state from $5,500 and $6,000 per month in Charlotte and Durham and $6,248 and $6,568 in Asheville and Wilmington.  

North Carolina Medicaid Programs for Memory Care

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

family sizeannual income limitsasset limits
Single Person$16,920$2,000
Two-Person Household (Single Applicant)$16,920$2,000
Two-Person Household (Dual Applicants)$33,840 ($16,920 per applicant)$3,000

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.

resourcecontactdescription
Medicaid.gov877-267-2323Medicaid.gov is the official website for Medicaid coverage across the nation. Seniors can apply for assistance and get answers to the most popular questions, including claims amounts, billing explanations and how to make changes to an account.
Benefits.gov800-662-7030Benefits.gov is a federal website committed to providing residents with information on state and national benefit programs. The site offers a questionnaire that matches seniors with benefits they may qualify for and gives detail about the application process and coverage amounts.
North Carolina Medicaid and Health Choice (CHIP)919-855 4800CHIP is a community outreach program that helps seniors and other individuals understand their options provided by Medicaid. The organization provides basic information on health insurance, doctor visits and other treatment services.

Can You Use Medicare To Pay for Memory Care in North Carolina?

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.

More Ways To Pay for Memory Care in North Carolina

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.
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Memory Care Laws and Regulations in North Carolina

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.

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Free and Low-Cost Resources for Seniors in North Carolina

Several North Carolina organizations provide valuable programs and services to seniors to help enrich their lives and create a better quality of life. The following is a list of resources that address a variety of needs of older adults in the community.

resourcecontactdescription
Dementia Alliance of North Carolina800-228-8738Dementia Alliance of North Carolina provides community education, resources, support services and referrals to aid those suffering from dementia and their families. The organization also raises funds for research into the prevention, treatment and cure of Alzheimer’s disease and related memory disorders and offers a 24-hour, toll-free helpline.
Project C.A.R.E.919-855-3462Project C.A.R.E is a state-funded support program that assists unpaid direct caregivers of persons with Alzheimer’s and related memory disorders. Caregivers can access counseling, care consultations, educational resources, respite care and referrals to social support networks.
Alzheimer’s Association800-272-3900The Alzheimer’s Association’s two North Carolina chapters provide a wealth of educational resources and support services for individuals living with dementia and their loved ones and support Alzheimer’s research efforts. Information about the local chapters can be accessed online or by calling the organization’s 24-hour helpline.
North Carolina Area Agencies on Aging800-662-7030The North Carolina Area Agencies on Aging was established by the Older Americans Act to address the needs of seniors in the state. It advocates for new and improved programs and provides home and community-based services to seniors in long-term care, including meals, companionship and transportation.
Dementia-Capable North Carolina919-855-3400Dementia-Capable North Carolina is a comprehensive state plan aimed at improving the quality of life for those with Alzheimer’s disease and other forms of dementia, raising awareness of memory disorders and enhancing support for families and caregivers.

North Carolina COVID-19 Rules for Memory Care Facilities

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.

questionanswer
Am I allowed to visit my loved one in person?Yes
Is my loved one required to quarantine after I visit him or her?No
Am I required to wear a mask if I visit my loved one in person?Yes
Are visitors screened for elevated temperatures?Yes
Are residents allowed to leave the facility at-will?Yes
Are residents of senior living facilities who leave required to quarantine when they get back?No (Conditions Apply)
Are staff members and contractors checked for elevated temperatures?Yes
Are staff members and contractors tested for COVID-19?Yes (Conditions Apply)
Do staff members have to regularly screen residents for COVID-19 symptoms?Yes
Do staff members have to regularly check residents for elevated temperatures?Yes
Do staff members have to regularly test residents for COVID-19?Yes (Conditions Apply)
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