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Nursing Homes in North Carolina

Located in the country's southeastern region, North Carolina offers natural beauty, affordability and some of the best healthcare facilities in the nation. It has about 10.5 million residents and a large senior community that accounts for nearly 17% of the population. Several types of public transit are available in the state, making it easy to visit loved ones in nursing homes, and the cost of living is below the national median, which may leave more money in the budget for care services. The state is served by world-class hospitals, such as Duke University Hospital, which is nationally ranked in nearly a dozen adult specialties, and University of North Carolina Hospitals, which is nationally ranked or high-performing in four adult specialties.

North Carolina is also home to over 400 nursing homes, which provide care for those who are transitioning out of inpatient hospital care but aren’t ready to return to their home environment. These facilities provide short- and long-term care for those who need around-the-clock supervision and monitoring and extensive help with daily living activities. This guide provides an overview of the cost of this level of care in North Carolina, information on licensing regulations, financial assistance options and contact information for local agencies that serve seniors and families. 


SeniorAdvice's Guide to Nursing Home Care in North Carolina



The SeniorScore is a tool that seniors and families use to assess how comfortable a geographic region is for older adults. It's based on a range of factors that impact seniors’ quality of life, including affordability, safety, access to healthcare and age-friendly social and recreational amenities. North Carolina’s SeniorScore is consistent with the national average at 72, indicating that it has numerous benefits for its older population.

North Carolina offers a wide range of benefits for its senior population. Nearly one in three state residents are aged 55 and over, supporting funding for senior programs and services. The state is served by a large network of doctors, specialists and hospitals who accept payment from Medicare, promoting access to healthcare services for seniors, and it has an average number of hospitals. For those who are discharged from the hospital but still need skilled nursing services, there’s a high number of senior living facilities and home health care providers. The state also has a range of social and recreational amenities, including over 550 golf courses and numerous municipal parks, and nearly 3,700 churches provide support systems and volunteer-based services for seniors. The state’s cost of living is fairly consistent with the national average, property taxes are low and senior care, including nursing home care, is relatively affordable. The climate is comfortable and residents see about 50 inches of annual rainfall.

North Carolina has a few drawbacks for older adults. Property and violent crime occur at a higher rate in the state than in the nation as a whole. State income tax and sales tax rates tend to be high, although seniors aren’t taxed at the state level on Social Security benefits and household incomes tend to be lower than the national average.



Top Nursing Care in North Carolina




 
 

The Cost of Nursing Home Care in North Carolina



The Genworth 2020 Cost of Care Survey, which provides nationwide senior care cost data, discloses that seniors in North Carolina pay approximately $7,300 per month for semiprivate accommodations in nursing homes. This is several hundred dollars lower than the national median of $7,756. Other southeastern states are comparatively affordable, including South Carolina, where fees are roughly the same at $7,298, and Tennessee, where seniors pay $7,072 on average. Georgia is the cheapest bordering state for nursing home care at $6,722 per month, and Virginia is the most expensive at $7,665.

  • North Carolina: $7,300 
  • United States: $7,756 
  • Virginia: $7,665
  • Tennessee: $7,072 
  • Georgia: $6,722 
  • South Carolina: $7,298 

The Cost of Nursing Home Care in North Carolina’s Top Cities 

Nursing home care costs vary considerably throughout North Carolina, with fees ranging from $6,342 per month in Greenville to $8,752 in Goldsboro. In Jacksonville, monthly care costs are equal to the state median at $7,300, and in Burlington, fees are a little higher at $7,604. Seniors in the Charlotte area pay approximately $7,817 for this level of care, and in Asheville, facilities charge $8,000 per month on average. 

  • Greenville: $6,342 
  • Jacksonville: $7,300 
  • Burlington: $7,604
  • Charlotte Area: $7,817 
  • Asheville: $8,000
  • Goldsboro: $8,752 

Senior Care Cost Comparison in North Carolina 

North Carolina seniors have several care options available after hospitalization. Memory care, which costs $4,750 per month in the state, may be an appropriate option for those with dementia. For seniors who only need short-term or intermittent skilled nursing services, assisted living is more affordable at $3,800 per month. Home care, which includes personal care services and housekeeping, costs $3,813 per month, and home health care, which also includes skilled nursing services, may be an affordable alternative to nursing home care at $4,004. Adult day care is the cheapest senior care option at $1,278, and nursing home care is the priciest at $7,300.

  • Memory Care: $4,750 
  • Assisted Living: $3,800 
  • In-Home Care: $3,813 
  • Home Health Care: $4,004 
  • Adult Day Care: $1,278 
  • Nursing Home Care: $7,300 

Financial Assistance for Nursing Home Care in North Carolina



As you can see above, Nursing Home Care is often the most expensive senior care option – sometimes even 2-3 times the cost of other types of senior living. The primary reason for this is the 24/7 skilled nursing and other medical services that are provided. Thankfully, most people aren't forced to pay for skilled nursing care entirely out-of-pocket. Rather, many qualify for financial assistance programs to help cover the cost of nursing care.

Medicaid is the most comprehensive financial assistance program – but, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in North Carolina.



Medicaid in North Carolina


There are approximately 423 nursing homes in North Carolina, proving seniors with a range of amenities, services and price points. Even with this level of competition, nursing home care is expensive. For income-qualifying seniors in North Carolina, Medicaid can help cover some healthcare and senior care costs. Statewide, there are nearly 2 million people enrolled in NC Medicaid and CHIP, which covers healthcare services for children. NC Medicaid covers nursing home services, along with doctor and hospital bills, Medicare premiums, personal care services and durable medical equipment.

Medicaid Eligibility in North Carolina

NC Medicaid is the statewide health insurance program for low-income individuals. This program is an entitlement, meaning that everyone who qualifies is guaranteed to receive services. For seniors seeking personal care services in the community, NC Medicaid has waivers that cover assisted living and home-based care costs. To be eligible for this program, applicants have to meet a range of personal and financial requirements. 

  • Applicants must be citizens or legal residents of the United States, and they must be permanent residents of North Carolina. 
  • Those living in nursing homes typically don’t have to pay a deductible to be eligible for Medicaid. However, they must pay all of their income, except a $30 personal needs allowance, and the cost of medical expenses not covered by Medicaid or any other health insurance. Medicaid covers the rest of their care costs. 
  • Medicaid applicants who live in nursing homes don’t have set income limits, but their income must be less than what Medicaid pays for nursing home care. Depending on the facility, this generally ranges between $5,470-$7,775 per month. 
  • Single applicants can have up to $2,000 in countable assets. Assets that don’t count toward this limit include personal belongings, household furnishings, irrevocable burial trusts, one vehicle and their primary home 
  • Non-applicant spouses are entitled to an asset allowance and are permitted to retain half of the couple’s joint assets up to $130,380. The minimum asset allowance is $26,076, meaning that the spouse can keep up to 100% of the joint assets up to this amount.

To apply for Medicaid, seniors can submit an online application through ePASS. Alternatively, seniors can apply in person at their local Department of Social Services office or print off a paper application and submit it to the office in person or through the mail. For over-the-phone assistance, seniors can call the NC Medicaid Contact Center at (888) 245-0179. 



Additional Financial Assistance Options


  • Medicare: For the first 20 days in a skilled nursing facility, Medicare will cover the entire cost of care, and a portion of the costs up until day 100. After 100 days, Medicare won't cover any of the costs. Importantly, seniors must also have a "qualifying hospital stay" that lasts 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: Aid and Attendance may be available to veterans who receive a VA pension. This benefit is a monthly cash allowance that veterans receive in addition to their standard pension amount. It is intended for veterans in need of long-term care services and may be used to pay for skilled nursing care.
  • Reverse Mortgages: For those who own a home, reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. It's often a good fit for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Keep in mind that reverse mortgage loans do need to be repaid (with interest), typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: For seniors who already have long-term care insurance, the cost of skilled nursing care may be covered. Most policies cover at least a portion of the costs, but it depends on the specific policy terms. It's important to note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a long-term care insurance policy.

North Carolina Nursing Home Care Rules and Regulations



Nursing homes in North Carolina are regulated by the NC Department of Health and Human Services. Along with enforcing a comprehensive set of rules for nursing homes, the department oversees disability determination services, administers NC Medicaid and operates public health initiatives, such as vaccination clinics and low-cost primary care services. Keep reading for more information on the regulations that nursing homes in North Carolina must follow. 

Scope of Care 

Nursing homes provide necessary care and services included in each patient’s medical orders. Facilities employ administrators, registered nurses, nurses aides and pharmacists who provide around-the-clock monitoring and care. The scope of services depends on the patient’s needs and may include help with personal and oral hygiene, daily grooming, toileting, eating and bathing.

Care Planning 

Within 48 hours of the new patient’s admission, nursing homes must create short-term care plans that outline current medical findings and diagnoses. Initial care plans must address the individual’s needs, functional limitations, skin conditions, mood and behavior and food and medication regimen. A comprehensive care plan must be completed with seven days of the patient’s initial assessment. Care plans must be updated at least every 90 days. 

Pharmacy Services 

Nursing homes must provide pharmaceutical services under the supervision of a pharmacist. They are required to obtain all medications, vitamins and supplements prescribed or ordered by the patient’s doctor. To ensure that each patient’s drug regimen is appropriate, pharmaceutical care assessments must be conducted at least every 31 days. Facilities aren’t allowed to stock prescription drugs for general use, except as permitted by the North Carolina Board of Pharmacy.

Staff Screening 

The NC Division of Health Service Regulation operates the Automated Background Check Management System, which screens staff members hired at nursing homes in the state. 

Staff Training 

Nursing homes are required to provide an orientation that covers policies and procedures for all new staff members. Facilities are to provide ongoing training for staff members relevant to their job duties and training for those responsible for providing CPR regarding where resources are located and how to protect themselves while administering the procedure. 

Medicaid Coverage 

Nursing home services are covered under NC Medicaid for seniors who meet the program’s income and asset guidelines. To have services covered, the facility must receive a written confirmation that the individual was referred for services by the appropriate entities. 

Reporting Abuse 

Nursing homes are required to follow up on all reports of abuse or neglect and ensure that a report of the investigation is submitted to the Division of Health Service Regulation within five business days. The report must include details, such as the time and place of an incident, the senior’s name and room number, details of the allegation and any injuries, the results of the investigation and corrective actions taken by the facility. 


Free Nursing Home Resources in North Carolina



North Carolina Health Care Facilities Association

The North Carolina Health Care Facilities Association is a statewide nonprofit organization that provides support for nursing home staff, helping them provide a high quality of care for residents. It monitors quality developments in long-term care facilities and maintains an up-to-date database of skilled nursing facilities in the state.

Legal Aid of North Carolina

Legal Aid of North Carolina provides free legal services to seniors in the state. Through this nonprofit organization, seniors can get help with obtaining public benefits that help cover nursing home care, including Medicaid, Medicare and Social Security benefits. The organization also advocates on behalf of seniors in skilled nursing facilities and helps resolve issues related to quality of care, admission and discharge procedures and care planning.

Friends of Residents in Long-Term Care

Friends of Residents in Long-Term Care is an independent nonprofit organization that promotes the quality of care for those in nursing home facilities. It serves as an independent resource for information regarding long-term care options and residents’ rights, helps families navigate long-term care services and offers educational seminars for seniors, families and care providers. It also operates a long-term care consumer hotline, which seniors can reach at (919) 782-1530.



North Carolina Agencies


North Carolina Department of Health and Human Services 

Address: 2001 Mail Service Center, Raleigh, NC 27699 
Phone Number: (800) 662-7030 
Website: https://www.ncdhhs.gov

The North Carolina Department of Health and Human Services provides a range of services for North Carolina residents who are children, seniors or have disabilities. Through this department, seniors obtain information on the state’s Medicaid program, which can help them cover nursing home expenses. The department also promotes independence and quality of life for seniors through the Aging and Adult Services division, and it enforces regulations in licensed nursing home facilities in the state.

Seniors’ Health Insurance Information Program 

Address: 325 N. Salisbury Street, Raleigh, NC 27603 
Phone Number: (855) 408-1212 
Website: https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip

Seniors’ Health Insurance Information Program provides free volunteer-based health insurance options counseling for seniors. Through this program, trained volunteers answer seniors’ questions regarding Medicare and Medicaid benefits and long-term care insurance, which can help them determine out-of-pocket costs for nursing home care. Volunteers can also help seniors resolve medical billing errors and dispute denied health insurance claims.

Long Term Care Ombudsman 

Address: 2001 Mail Service Center, Raleigh, NC 27699 
Phone Number: (919) 855-3426 
Website: https://www.ncdhhs.gov/providers/provider-info/health-care/long-term-care-ombudsman-program

The state’s Long Term Care Ombudsman Program advocates on behalf of seniors in nursing homes. It helps residents exercise their rights and resolve issues that arise between families and facilities. The ombudsman can also help seniors and families understand long-term care options, choose a nursing home and determine the degree to which Medicare and Medicaid cover nursing home care. 



Area Agencies on Aging in North Carolina


There are 16 Area Agencies on Aging in North Carolina, each with a designated service area. These agencies provide a broad range of services to state residents aged 60 and over, including home-delivered and congregate meals, transportation, personal care and information and referrals for local programs and services, which may help seniors avoid, delay or shorten the duration of nursing home care. The agencies also administer the statewide SHIIP for seniors, researching information on health insurance and looking for options for covering nursing home care. To find their local AAA, seniors can refer to the NC Area Agencies on Aging Location List on this page.



Veteran Affairs Office in North Carolina


The North Carolina Department of Military and Veterans Affairs serves veterans in the state through advocacy, outreach and benefits counseling. Its team of professionals helps qualifying veterans obtain necessary documentation and apply for benefits, such as the Aid and Attendance or Housebound Benefit, pension programs and disability compensation. The department helps veterans arrange supportive services that promote independence, including transportation and home-delivered meals. It also screens veterans for VA healthcare eligibility and veterans’ home placement, which can reduce skilled nursing costs. To find their local VA office, veterans can refer to this page. 



Social Security Offices in North Carolina


There are 37 Social Security offices throughout North Carolina. At these locations, seniors can obtain Social Security retirement benefits, disability insurance programs and Supplemental Security Income, which can help them cover nursing home care. Seniors can also receive one-on-one help with checking the status of their application for benefits, request a replacement Social Security card and print a benefit verification letter. To find their nearest office, seniors can follow this link. 

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