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Nursing Homes in North Dakota

Rich agricultural lands and a very low population density give North Dakota its countryside charm. Scenic rides along the Enchanted Highway make the state’s wide-open spaces more fascinating, in addition to the diverse crops produced largely by family farms. The Peace Garden State has nearly 800,000 residents, approximately 16% or about 120,000 of whom are seniors aged 65 and over. This older age group is expected to increase to 18% by 2025, and the North Dakota aging network recognizes a steady need for coordinated long-term services and supports for its senior population. In terms of health care, federally funded initiatives in integrating geriatrics into primary care help support older North Dakotans.

Despite North Dakota’s general affordability, its nursing home care costs are fairly steep, with an average monthly cost of $12,167. Nursing home care is usually the most expensive long-term care option because it provides 24-hour skilled care and other professional clinical services. There are at least 79 nursing homes in the state, and all of them have Medicaid-certified beds to accommodate low-income residents. This guide offers helpful insight on North Dakota’s long-term care costs and its financial assistance programs, as well as the state’s nursing home regulations and free resources.


SeniorAdvice's Guide to Nursing Home Care in North Dakota



A SeniorScore uses over 100 data points from government and private sources and is broken down into four categories that highlight a location’s pros and cons when it comes to aging. Although North Dakota’s overall SeniorScore of 68 is four points below the national average, several positive factors favor retirement in the state.

North Dakota received its highest score of 68 in the Finances category due to a low overall cost of living and low tax rates. Although 401(k) and IRA withdrawals are fully taxable, Social Security benefits and pensions have tax deductions, and the maximum income tax rate is only 2.9%. Despite the General Quality of Life score of 61 due to frigid winters, North Dakota is among the best states in terms of urban air and drinking water quality, as well as infrastructure, and it has a very short commute time of approximately 17 minutes.

The state received a score of 58 in the Recreation & Leisure category. The Roughrider State is abundant in natural attractions, but its rugged, rural nature and low population density may limit access for some seniors. However, North Dakota's short commute time makes up for the distance of community facilities and city amenities. The Theodore Roosevelt National Park, the International Peace Garden and select agritourism spots have wheelchair-accessible trails. North Dakota received its lowest score of 56 in the Health & Safety category due to the state’s average number of senior care providers, hospitals and Medicare-enrolled physicians.



Top Nursing Care in North Dakota




 
 

The Cost of Nursing Home Care in North Dakota



With an average monthly cost of $12,167, North Dakota is the Midwest’s most expensive state for nursing home care. Costs in the state are over $4,400 more than the national average of $7,756, according to Genworth Financial’s 2020 Cost of Care Survey. South Dakota is the cheapest bordering state at $7,011, saving older North Dakotans over $5,500 per month. Northwest states Montana and Wyoming are also significantly more affordable at $7,665 and $8,258, respectively. Minnesota is considered expensive at $11,026, but it's still cheaper than North Dakota by about $1,100.

  • North Dakota: $12,167
  • United States: $7,756
  • Montana: $7,665
  • South Dakota: $7,011
  • Minnesota: $11,026
  • Wyoming: $8,258

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

Nursing home care costs in North Dakota’s three major cities are below the state average. Grand Forks costs $11,365 per month, while Fargo and state capital Bismarck have average costs of less than $11,000. These cities are less expensive than St. Cloud, Minnesota, which costs $12,767 per month. Rapid City, South Dakota, is considerably more affordable at $7,452.

  • Fargo: $10,946
  • Bismarck: $10,646
  • Grand Forks: $11,365
  • St. Cloud, MN: $12,767
  • Rapid City, SD: $7,452

Senior Care Cost Comparison in North Dakota

North Dakota’s steep pricing for nursing home care at $12,167 is more than twice the cost of any other senior care option in the state. Home health care costs $5,529 per month and includes intermittent skilled nursing care. Home care, which provides personal care and assistance with daily living activities, costs less at $5,335. Assisted living at $4,096 and memory care at $5,120 are cost-effective, with homelike accommodations included. Adult day care costs an estimated $2,245 per month.

  • Memory Care: $5,120
  • Assisted Living: $4,096
  • In-Home Care: $5,335
  • Home Health Care: $5,529
  • Adult Day Care: $2,245
  • Nursing Home Care: $12,167

Financial Assistance for Nursing Home Care in North Dakota



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 Dakota.



Medicaid in North Dakota


North Dakota Medicaid covers medical services, including nursing facility care, for eligible low-income residents. The state’s Medicaid expansion in 2013 saw a net increase in Medicaid and CHIP enrollees of approximately 51% in 2020. Nursing facility services covered by Medicaid include room and board, nursing care, therapies and general medical supplies. As of 2021, approximately 52% of over 5,600 licensed beds in the state’s 79 nursing homes are Medicaid-certified.

Medicaid Eligibility in North Dakota

ND Medicaid’s coverage for nursing home care is subject to eligibility requirements and benefit guidelines, which include the following:

  • Effective April 2021, the income limit for Medicaid in the medically needy category (aged, blind and disabled) is $891 for single applicants and $1,205 for those in two-person households. For every dependent in the applicant’s household, there’s an addition to the income limit of $314. Applicants earning above the income limit may qualify for partial Medicaid coverage through a client share (recipient liability).
  • The maximum amount for countable assets is $2,000 for single applicants and $6,000 for couples. Homes, personal vehicles and other similar property are not counted.
  • Medicaid-eligible nursing home residents are allowed to retain personal needs allowances of $65 per month in addition to allowances for health insurance premium payments and low-income dependents.
  • Community spouses are entitled to keep up to $2,550 of gross monthly income, and each of their household's additional dependents may retain up to $718.
  • As of 2021, community spouses may retain countable assets worth up to $130,380 but no less than $26,076.
  • Recipients must be North Dakota residents aged 65 and older with U.S. citizenship or permanent residency status.
  • An applicant must require a nursing facility level of care, as determined through a Pre-Admission Screening and Resident Review.

The NDDHS Application for Assistance page lets residents check their eligibility and submit online applications for Medicaid and other Human Services assistance programs. Applicants aged 65 and older may also opt to complete the Health Care Application for the Elderly and Disabled form for submission to their respective local DHS offices.



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 Dakota Nursing Home Care Rules and Regulations



The North Dakota Department of Health’s Division of Health Facilities is responsible for the licensing and regulation of skilled nursing facilities in the state. It also facilitates the registration of certified nursing assistants and the investigation of reported abuse allegations in long-term care facilities. The following table shows an overview of the North Dakota Century Code’s dedicated licensure rules for nursing facilities.

Scope of Care

Nursing home residents shall receive the necessary medical care and nursing services to help attain or maintain their highest level of functioning. Dietary services must include prescribed therapeutic diets. Social services and an ongoing program of activities shall be provided to support the residents’ physical, mental and psychosocial well-being. Direct or outsourced specialized rehabilitative services shall at least include physical, speech and occupational therapies, and health services for mental illness and mental retardation. Diagnostic services must be arranged as needed by residents. Adult day care services may be offered, subject to the service program’s advance approval by the NDDoH as a condition for licensure.

Care Planning

A resident’s comprehensive care plan shall be developed in coordination with the client (or legal representative) and attending staff. A care plan must be individualized and consistent with the resident’s needs and medical care plan, and it shall contain measurable resident-centered goals and plans of action. The initial care plan shall be implemented upon admission and revised accordingly within seven days after completion of the resident’s initial comprehensive and succeeding periodic assessments (at least quarterly).

Pharmacy Services

A licensed pharmacist shall develop policies and procedures for a nursing facility’s provision of pharmaceutical services, which must be approved by medical staff or the medical director. A resident’s monthly pharmacist medication review shall include the reporting of any discrepancies to the facility’s nurse executive or the resident’s licensed health care practitioner. 

Medication administration must be done by authorized staff and based on written orders by licensed health care practitioners. Telephone and verbal orders may only be carried out by qualified licensed personnel who must immediately put them in writing with date and signature, followed by the ordering practitioner’s countersign or initials.

Staff Screening

Prior to employing an individual, a nursing facility shall check the appropriate state registry or licensing board for the applicant’s current registry or licensure status and history of disciplinary actions. The NDDoH currently maintains the North Dakota CNA abuse list.

Staff Training

There shall be educational programs for orienting new employees and ensuring the competence of all staff in terms of quality care. An annual educational program shall include the following topics:

  • Safety and emergency procedures
  • Infection prevention and control
  • Resident rights
  • Advanced directives
  • Caring for confused or emotionally disturbed residents

Paid feeding assistants must be certified nurse aides or have successfully completed a department-approved paid feeding assistant training program of at least eight hours. This program must be instructed by an experienced, licensed health care professional.

Medicaid Coverage

North Dakota’s Medicaid program covers nursing facility care for individuals who are medically and financially eligible. Recipients may retain portions of their income as monthly personal needs allowances, health care insurance premium payments and other allowable expenses.

Reporting Abuse

All nursing home personnel are mandated reporters when it comes to abuse of vulnerable adults. Incidents of suspected resident abuse, neglect and exploitation must be immediately reported to Vulnerable Adults Protective Services online, via email or by calling the central intake line at (855) 462-5465.


Free Nursing Home Resources in North Dakota



North Dakota Senior Services Providers

NDSSP, a statewide association of nonprofit agencies, provides contracted senior services that are funded through the Older Americans Act. These member agencies deliver home and community-based services with the help of volunteers throughout the state, across all 53 counties and four Native American Reservations. They consist of commissions and councils on aging, senior centers and major service providers in rural communities. The extent of OAA and state-funded services may vary per agency. The NDSSP website has links to these member agencies listed by region that older North Dakotans and their families can approach for more information on what supportive programs may be available to them.

Legal Services of North Dakota

LSND is a nonprofit organization that provides free legal assistance to eligible low-income individuals and the elderly in North Dakota. Services include legal advice and representation on civil law matters, such as government benefits, long-term care, medical directives and other elder law topics. Seniors 60 and older may submit an online application form, visit one of LSND’s offices or call (866) 621-9886 during office hours to request legal aid.



North Dakota Agencies


NDDHS Aging Services Division

Address: 1237 W. Divide Avenue, Suite 6, Bismarck ND 58501
Phone Number: (855) 462-5465
Website: www.nd.gov/dhs/services/adultsaging/ 

The Aging Services Division of the Department of Human Services administers programs for 60+ seniors and adults with disabilities. Its aim is to enhance their ability to maintain independence and to support those with greater long-term care needs. The free options counseling service includes home visits for needs assessments for referrals to community services as possible alternative options to institutional care. Also, the local contact agency service offers free referrals to nursing home residents who are transitioning back to community living. The division also facilitates the Long-Term Care Ombudsman Program for receiving, investigating and resolving complaints by or on behalf of nursing home residents. Other administered programs include the Vulnerable Adult Protective Services, free senior legal assistance and the guardianship establishment program.

Aging and Disability Resource LINK

Address: 1237 W. Divide Avenue, Suite 6, Bismarck ND 58501
Phone Number: (855) 462-5465
Website: carechoice.nd.assistguide.net/

ADRL is the free information and assistance program of the NDDHS Aging Services Division. It connects seniors, disabled adults and family caregivers to available local, statewide and nationwide services that can enhance their quality of life. Aside from its toll-free hotline and the ADRL website’s online directory of service providers, there’s a web intake assessment form that's reviewed by information specialists. A printable form is also available for submission via email at [email protected].

State Health Insurance Counseling

Address: 600 E. Boulevard Avenue, Bismarck, ND 58505-0320
Phone Number: (701) 328-2440
Website: www.insurance.nd.gov/shic-medicare

The SHIC program of the North Dakota Insurance Department provides free, confidential counseling on Medicare and private health insurance to help beneficiaries make informed choices on health care coverage. Around 80 trained SHIC counselors statewide can assist clients with navigating options for Medicare plans and other long-term care insurance, understanding their medical bills, statements and other related paperwork, and filing appeals on denied benefits.



Area Agencies on Aging in North Dakota


North Dakota’s eight Regional Human Service Centers have dedicated units that function as Area Agencies on Aging, working with the DHS Aging Services Division in implementing State Plan on Aging programs. These agencies contract with local providers for the delivery of state-funded services and those in accordance with the Older Americans Act. These long-term services can support people eligible for a skilled nursing level of care through home and community-based waivers that can help delay institutionalization.



Veteran Affairs Office in North Dakota


The North Dakota Department of Veterans Affairs has county Veterans Service Officers and tribal VSOs who provide free, expert assistance in filing claims for state and federal benefits, including compensation, pensions, health care coverage and long-term supports. These VSOs coordinate with National Service Officers on VA claims and with other county, state and federal government units on other forms of assistance available to veterans and their dependents. For eligible vets and spouses who require a nursing home level of care, the North Dakota Veterans Home has a homelike skilled care unit and is a licensed Medicaid/Medicare provider.



Social Security Offices in North Dakota


SSI recipients in North Dakota may also qualify for Medicaid, subject to the state’s eligibility rules, which are different from SSA’s guidelines. While there are no state supplementation payments given to North Dakotan SSI recipients, the State Long-Term Care Subsidy Program provides additional cash assistance to long-term care facility residents who are qualified for both SSI and Medicaid. Applications for SSI/SSDI, Medicare and other Social Security benefits may be made online or through local SSA field offices.

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