I. Paying for Memory Care in North Dakota

The Cost of Memory Care in North Dakota

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.

According to Genworth Financial’s 2019 Cost of Care Survey, the average monthly cost of assisted living in the state of North Dakota and the city of Bismarck is $3,405. Located along the eastern border of the state near Minnesota, Grand Forks has an average monthly cost of only $1,950. Seniors in Fargo, which is situated a little further south along the border, incur an average cost of $3,984 per month. All of these rates are significantly lower than the national average of $4,015 per month.

Estimating a 25% average increase in costs for memory care, on average, North Dakota and Bismarck residents may pay approximately $4,256 per month for memory care. This also translates to residential memory care costs of approximately $2,438 per month in Grand Forks and approximately $4,908 per month in Fargo.

   

North Dakota Medicaid Programs for Memory Care

Medicaid Waiver for Home and Based Services

Also known as the Aged and Disabled Waiver, North Dakota’s Medicaid Waiver for Home and Community Based Services was developed to help aging adults and people with disabilities stay out of nursing homes and remain in a community setting, such as an assisted living or memory care facility. Services include residential care services, such as personal care, facilitated recreational and social programming and the availability of a 24-hour staff. While participants must be able to direct their own care to qualify, those enrolled in the waiver program can receive assistance with activities of daily living and memory care in a group facility, such as an assisted living or basic care facility.

Who is Eligible: North Dakota residents must qualify for and be enrolled in Medicaid to be eligible for the waiver. Eligible individuals can earn no more than $883 in monthly income and have no more than $3,000 in countable assets (not including personal belongings and an individual’s home and vehicle). Applicants must also be at least 65 years old or disabled and require a nursing home level of care. Individuals must live in their personal residence and be capable of directing their own care at the time of applying.

How to Apply: Those interested in applying can complete an online application through the N.D. Department of Human Services or contact their local county Human Service Zone for assistance in completing the application.

Basic Care Assistance Program

North Dakota’s Basic Care Assistance Program (BCAP) provides funding to seniors, disabled and blind individuals, including those in need of memory care, to help cover the cost of room and board in a licensed basic care facility. Any income received by the participant will generally go toward the cost of care, but individuals may keep $60 per month to help pay for personal expenses. The program sends payments directly to the basic care facility, is available to qualified Medicaid-eligible residents and is administered by the N.D. Department of Human Services.

Who is Eligible: To qualify, North Dakota residents should be eligible for Medicaid and meet the requirements of a functional assessment. These requirements include not being able to cook meals, take medication independently or complete household tasks. They also may not be so impaired that they are unable to perform activities of daily living, such as eating, dressing and toileting.

How to Apply: Interested individuals may apply by completing an online application at the N.D. Department of Human Services website or by contacting their local human service zone office.

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

Medicare Advantage

North Dakota residents may be eligible to enroll in a Medicare Advantage plan to help cover the cost of memory care through a private insurance company. Participants in these plans receive benefits included with original Medicare plans Part A and Part B, which cover certain hospital and outpatient services, as well as additional coverage for benefits and services not otherwise available through Medicare. The state’s Medicare Advantage program provides seniors with a choice of several different types of plans, one of which is called a Special Needs Plan (SNP). SNPs are insurance plans dedicated to certain populations, such as those with dementia, diabetes or another type of condition. Depending on the plans available in the individual’s area, an SNP plan that helps cover the cost of memory care services may be available. Additionally, SNPs are required to include prescription drug coverage.

Who is Eligible: For North Dakota residents to qualify for Medicare Advantage, they must be within three months of their 65th birthday or older, enrolled in Medicare Parts A and B, pay a monthly premium for the Medicare Advantage plan and live in their selected plan’s service area. There are special enrollment periods that are available each year, depending on the applicant’s Medicare standing and other factors. Those with end-stage renal disease may not enroll.

How to Apply: Interested individuals can contact their local county Human Service Zone office for assistance with enrolling in a plan, learning more about their options and accessing helpful resources in the state. Seniors can also call the Department of Human Services at 800-472-2622, the State Health Insurance Counseling Program (SHIC) at 701-328-2440 or email [email protected] for more information.

More Ways to Pay for Memory Care

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.
  • 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 Dakota

Memory Care Regulation

Facilities that are licensed to provide memory care in North Dakota include assisted living facilities and basic care facilities. Assisted living facilities are overseen by the Department of Health and the Department of Human Services, and basic care facilities follow rules designated by the Department of Health.

North Dakota’s assisted living facilities have fewer regulations than basic care facilities. Additionally, basic care facilities must provide residents with meals, while ALFs are not required to do so. Neither type of facility has specific regulations related to providing memory care, although certain basic care facilities are specifically permitted to provide care for those with dementia.

Facility Scope of Care

Assisted living facilities provide individualized care to five or more residents in a building with five or more living units. Residents may receive assistance with activities of daily living (ADLs) and independent activities of daily living (IADLs), and they are only required to pay for the services they receive based on request or need. Home health agencies may contract with residents to provide additional services.

Basic care facilities have living quarters for five or more residents who receive meals, personal care, social support and health care. Services include assistance with ADLs and IADLS, medical care arrangements, transportation, assistive devices and living unit maintenance. Third-party home health and hospice agencies may contract with the facility for nursing and end of life care.

Admission Requirements

Residents Who May Be AdmittedOlder adults and people with:

  • Alzheimer’s or other forms of dementia
  • A need for assistance with ADLs or IADLs
  • Physical impairments
  • Cognitive Impairments
  • Traumatic Brain Injuries
  • Needs that can be met by the facility’s available services
Residents Who May NOT Be AdmittedThose who:

  • Pose an immediate or potentially high risk of danger to other residents
  • Require frequent medical or nursing care
  • Are incapable of self-preservation (Basic Care Facility)
  • Are unable to comply with National Fire Protection Association (NFPA) 101 Life Safety Code requirements (Basic Care Facility)

Care Plan Requirements

Applicants at assisted living facilities must be evaluated to ensure they qualify for admission according to the facility’s requirements. For every admitted resident, facilities must maintain ongoing records of specific services provided.

Basic care facilities must assess residents in areas of need relating to personal care, nutrition, health, socializing and more. Assessments must be completed within the first two weeks of a resident’s move-in date and then at least once per quarter. The facility should formulate a care plan resulting from resident consultations and the assessments.

Medication Management Requirements

Unlicensed staff in assisted living and basic care facilities may only administer drugs that are controlled and prescribed on an as-needed basis if they are specifically trained to do so and a registered nurse monitors the administration. Other medications may be administered by unlicensed staff.

In assisted living and in basic care facilities, unlicensed staff members may administer medication, except for controlled prescription drugs taken on an as-needed basis. Personnel acting in this capacity must have specific training and be monitored by a registered nurse.

Facility Requirements

While most basic care facilities have semiprivate units, which must provide each resident with at least 80 square feet, private units must be at least 100 square feet. The facility may have shared bathrooms. Up to 15 residents may share a bathtub or shower, and up to four residents may share a toilet.

In an assisted living facility, each unit must include a lockable entry door, a private full bathroom and a sleeping area. A maximum of two people may occupy one bedroom.

Staffing Requirements

Basic care facilities specifically licensed to provide memory care must require staff to undergo specialized training. This includes:

  • At least eight hours of related, specified training in the first three months of employment
  • At least four hours of additional training annually
  • An annual competency evaluation

There are no specific staffing ratios that assisted living or basic care facilities are required to maintain, but each must have staff available 24 hours per day. All staff in both types of facilities must complete training in residents’ rights, infection control, residents’ mental and physical health needs, fire and safety procedures and behavioral problems and prevention.

Medicaid Policy

Basic care facilities that serve residents with dementia or a brain injury can have services covered by a home and community-based Medicaid waiver. Personal care services are also covered by state-funded Medicaid in licensed basic care facilities.

Reporting Abuse

Assisted living facilities must provide a written notice to residents explaining how they can file complaints against the facility. Residents of both types of facilities may file complaints by emailing [email protected], completing an online form at the Department of Human Services’ Long-Term Care Ombudsman Program website or by calling 701-328-4617 or 855-462-5465 and selecting option 3.

III. Free Memory Care and Alzheimer's Resources in North Dakota

ResourceContactDescription
Kairos Alive! Dancing Heart Program

 

612-926-5454The Kairos Alive! Dancing Heart Program brings dance and music to people with Alzheimer’s and other forms of dementia who reside in basic care and assisted living facilities. In 90-minute sessions, individuals receiving memory care can share stories that come to life through stimulating and interactive performance art.
Alzheimer’s Association Minnesota-North Dakota Chapter

 

800-272-3900The Minnesota-North Dakota Chapter of the Alzheimer’s Association helps individuals with dementia-related illnesses and their families through training, support groups and resources, such as an online community and care consultations.
North Dakota Family Caregiver Support Program

 

855-462-5465The North Dakota Family Caregiver Support Program (FCSP) helps caregivers of individuals with dementia or Alzheimer’s disease through respite, care coordination, counseling and information. Trained coordinators can help caregivers understand the needs of people with dementia and access appropriate support services.
Dementia Care Services Program

 

701-258-4933North Dakota’s Dementia Care Services Program (DCSP) aims to empower caregivers with knowledge and training about caring for individuals with dementia throughout its multiple stages. DCSP services are administered through a partnership between the Alzheimer’s Association and the North Dakota Department of Human Services (DHS). The program also works with the Vulnerable Adult Protective Services Program and the FCSP to educate law enforcement agencies, medical professionals and the public on dementia’s symptoms and treatment options.