I. Paying for Memory Care 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.

Assisted living costs average $4,000 per month in North Carolina, according to the 2019 Genworth Cost of Care Survey. This cost is slightly below the U.S. national median of $4,051. The average price is much higher in neighboring Virginia, at $4,800, but somewhat lower in other surrounding states, including South Carolina ($3,500) and Tennessee ($3,900). Adding 25% to the price of assisted living provides an estimated cost of $5,000 per month for memory care in North Carolina.

The cost of assisted living is also influenced by the facility and its location within North Carolina. For example, the major centers of Durham and Raleigh have two of the highest average costs statewide at $5,563 and $5,325, respectively. In the coastal city of Wilmington, assisted living is in the same cost bracket, at $5,408 per month. The cost is significantly lower in Charlotte, at $4,583, and dramatically so in Greensboro, where the average is just $3,649 per month. Keep in mind that memory care services are often $1,000 to $2,000 more per month than standard assisted living.

   

North Carolina Medicaid Programs for Memory Care

Personal Care Services Program

North Carolina Medicaid offers a Personal Care Services program to assist eligible individuals living in state-licensed adult care homes. The program’s goal is to provide personal care services to help disabled, frail and cognitively-impaired Medicaid recipients maintain their quality of life in a setting with the fewest restrictions possible. A personalized service plan is developed for each enrollee that can include up to 130 hours per month of assistance with activities of daily living, such as bathing, toileting, dressing, eating and mobility.

  • Who Is Eligible: Applicants for the PCS program must meet the personal, income and asset requirements to be eligible for North Carolina Medicaid coverage. Once enrolled in Medicare, an independent assessment is performed to determine if an applicant meets the functional eligibility standards to qualify for the PCS program.
  • How to Apply: Individuals should visit their primary care provider who can complete and send in an assessment request form to the state’s designated assessment agency, Liberty Healthcare Corporation. To learn more about the application process, interested individuals can call North Carolina Medicaid at 888-245-0179.

Non-Medicaid Financial Assistance Programs for Memory Care in North Carolina

Special Assistance Special Care Unit Program

Low-income seniors diagnosed with Alzheimer’s disease or a related dementia may receive financial assistance to cover the cost of residential memory care through the Special Assistance Special Care Unit program. This state- and county-funded program provides a monthly benefit to help eligible individuals pay for room and board in a licensed ACH. Administered by the North Carolina Department of Health and Human Services, SA/SCU is the state’s Supplemental Security Income program.

  • Who Is Eligible: Financial assistance through the SA/SCU program is available to U.S. citizens or legal aliens who are North Carolina residents and aged 65 or older or disabled according to Social Security Administration criteria. Additionally, applicants must be diagnosed with Alzheimer’s or a related form of dementia and have a medically verified need for the level of care provided in an ACH special care unit. Individuals also need to have a monthly income equal to or less than the program’s current income limit, and no more than $2,000 in countable assets.
  • How to Apply: Those who wish to apply for the S/A SCU program should visit the Department of Social Services office in the county where they reside to complete and file an application.

Medicare Advantage Plans

North Carolina residents who are enrolled in Original Medicare may switch to one of several Medicare Advantage plans offered through Medicare-approved private insurance providers. Also known as Part C coverage, these plans provide the services covered under Medicare Parts A and B, and most offer Part D prescription drug coverage along with various optional benefits such as vision, hearing and dental care, medical appointment transportation, and wellness services.

Recently, the Medicare program expanded its definition of an enrollee’s place of residence to include adult care homes that provide memory care. This change may allow residents of these facilities to be reimbursed for covered expenses, such as personal care assistance, through some MA plans.

  • Who Is Eligible: Enrollees in Original Medicare Parts A and B are eligible to switch to their choice of MA plans during specific enrollment periods each year, without regard to income or preexisting health conditions. Participants in MA plans must still pay their monthly Medicare Part B premiums along with any premiums charged for their Part C coverage.
  • How to Apply: Those interested in changing over can compare MA plans available in their locale with the Medicare plan finder tool. To learn about the application process and specific enrollment periods when they can apply, seniors can call Medicare at 800-633-4227 or the provider of the plan they prefer.

More Ways to Pay for Memory Care

In addition to the 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.
  • Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

II. 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 AdmittedAdults 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 AdmittedThose 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.

III. Free Memory Care Resources in North Carolina

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.
Duke Family Caregiver Resource Center919-660-7510Duke University’s Family Support Program offers a number of resources for families and caregivers of those with cognitive impairments. These include a semiannual research newsletter and help by telephone with coping strategies and care decisions and locating support groups, education programs, memory care providers and service agencies.
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.