This webpage will help North Carolina residents understand assisted living, home care, and adult day care costs throughout various geographic regions of the state. It also explores the payment options and financial assistance programs available to assist in caring for the elderly, be that in residential care or for aging in place at home.
The programs outlined here are comprehensive of what is available in North Carolina, but is not comprehensive of what is available at a national level. In order to search for assistance nationwide, and to find the best program to fit your needs, make sure to use our Resource Locator Tool.
North Carolina Eldercare Costs for 2024
Assisted Living / Memory Care
According to Genworth’s Cost of Care Survey, the average cost of assisted living in North Carolina in 2024 is $5,769 a month. However, there is a great deal of variance in this cost within North Carolina as a whole. The towns and cities with the lowest average cost of care can be found in Fayetteville, Charlotte, and Durham. In these areas, residents generally pay between $2,750 and $4,863 a month. In the areas of Burlington, Wilmington, Goldsboro, and Greensboro, the cost is significantly higher and is between $7,250 and $8,603 a month.
For an individual with Alzheimer’s, due to the increased need for supervision, the monthly cost is approximately 20% – 30% higher than the cost of traditional assisted living within a geographic region.
Home Care
In North Carolin, per Genworth’s Cost of Care Survey, the statewide average hourly rate for non-medical personal care provided in the home in 2024 is $28. The lowest average hourly rates in the state can be found in New Bern, Rocky Mount, and Greenville, at $13 an hour. Durham, Asheville, and Charlotte have the highest cost of care at $32 – $33 an hour.
For persons who require minimal in-home medical care, home health care is also available. This type of care is provided by health care professionals and costs, on average, 20-30% more than traditional home care.
Adult Day Care
Genworth’s Cost of Care Survey indicates that the cost of adult day care in North Carolina in 2024 is $69 a day. The areas of Charlotte, Greensboro, and Raleigh have the most expensive care at $83 – $97. The areas with the most affordable adult day care can be found in the Durham, Hickory, Wilmington, and Rocky Mount, where the average daily cost is between $53 and $63.
North Carolina Medicaid Financial Assistance Programs
Medicaid Programs & Waivers for the Elderly
Before reading about Medicaid based assistance, it is helpful to have an understanding of what Medicaid is and some of the associated terminology. Initially, Medicaid for elderly and disabled individuals only paid for the care of qualified individuals in nursing homes. After some time, it became apparent that it could be less costly to help these same individuals by providing certain services at home and in their communities. In addition to cost savings, these “home and community based services” were preferred by the persons receiving them.
Home and Community Based Services (HCBS) are typically provided through Medicaid Waivers instead of regular Medicaid programs. While regular Medicaid is an entitlement, meaning anyone who is eligible to receive services is able to do so, Medicaid Waivers are not entitlement programs. This means the number of people who are able to receive services via waivers is limited. Currently, the state of North Carolina offers one waiver relevant to the elderly and one program through regular Medicaid.
The Community Alternatives Program for Disabled Adults is called CAP/DA for short. Under CAP/DA, participants can receive personal care, homemaker services, meals, and various other supports in their homes. Family members may be hired as personal caregivers.
The state Medicaid plan also offers a Personal Care Services Program. This program provides assistance with daily activities in an individual’s home or in residential care, including an adult foster care home. Since this is part of the regular Medicaid program, anyone who is eligible for services via this program is able to receive them.
In addition to the above options, which help Medicaid eligible individuals remain living at home or in adult care homes, North Carolina Medicaid will cover the cost of nursing home care, should it be medically necessary.
Medicaid Eligibility
Income & Asset Limits
In order to be eligible for Medicaid, there are both income and asset requirements. In 2024, an individual’s income cannot exceed $1,255 a month. Married applicants can have slightly more income, with the limit set at $1,703 a month. These figures are equivalent to 100% of the Federal Poverty Level (FPL). The asset limit for a single senior is $2,000, and the asset limit for a married couple is $3,000. These limits exclude an individual’s home, given the applicant, or their spouse, live in it. If the applicant is single and does not live in the home, he / she must intend to live in it and have a home equity interest no greater than $713,000. A single vehicle, household furnishings, personal items, and pre-paid funeral arrangements are also exempt.
Over the Limits?
Being over the income and / or asset limit(s) does not mean one cannot still qualify for Medicaid. For instance, those over the income limit who have high medical bills can qualify via a spend-down program. This is often referred to as the medically needy pathway. In simple terms, once one has spent their “excess” income (the income over the limit) on medical bills, they are Medicaid eligible for the remainder of the spend-down period. For those over the asset limit, the above program will not offer assistance. However, one is still able to “spend down” their assets. For example, one can pay off debt or make home reparations / modifications. It is very important one does not gift assets or sell them under fair market value. This is in violation of Medicaid’s look-back rule and can result in a period of ineligibility.
Qualifying for Medicaid can be complicated, particularly if one is over the income and / or asset limitation(s). Professional assistance is available to help families whose finances exceed these limits. Read more.
North Carolina Non-Medicaid Assistance Programs
The State of North Carolina has several programs, independent of their Medicaid program, that provide assistance in caring for the elderly. Some of these programs provide direct financial assistance, while others can help to offset a family’s overall care cost burden.
The first program is called Project C.A.R.E. (Caregiver Alternatives to Running on Empty). In this program, unpaid primary caregivers of individuals with Alzheimer’s or other dementias are provided respite care services to help them avoid caregiver burnout. While respite care is very limited, other services are available and include dementia information and training for caregivers.
A second option is the Special Assistance In-Home Program for Adults (SA/IH). This program is intended for those who require a level of care consistent to that of an adult care home, but they prefer to remain living in their homes. It provides a monthly cash grant to participants with the objective of helping them cover the cost of food and / or shelter, clothing, and other basic necessities.
Another option is the Special Assistance Adult Care Home Program. This program covers room and board costs in adult foster care, group homes, and licensed assisted living residences. Those who are eligible for this program are automatically eligible for Medicaid.
The Special Assistance In-Home Program provides financial assistance for room and board for special care units within an adult care home. These units, which are often referred to as memory units, provide care for those with Alzheimer’s disease and related dementias, such as Parkinson’s Disease. Those who are eligible for this program are automatically eligible for Medicaid.
A final option is the In-Home Aide Services program, which helps with personal care, meal preparation, respite care, errands, and home management. On average, individuals enrolled in this program receive 5 to 20 hours per week of assistance.
PACE Programs in North Carolina
The Program of All-Inclusive Care for the Elderly (PACE) is a joint initiative between Medicare and Medicaid to help seniors get the care and services they need in the community rather than transitioning to a nursing home for care. Because Medicaid differs in each state, PACE eligibility varies between states.
PACE programs in North Carolina provide various services, including primary care, dentistry, meals, home care, specialty medical services, preventive care, and transportation. Each participant receives a comprehensive care plan and the support of multiple staff members. To be eligible for PACE in North Carolina, participants must be:
- At least 55 or older
- A resident of the PACE organization’s service area
- Eligible to receive nursing home care in the state
- Able to live safely in a community setting at the time of enrollment
How To Get Started With PACE in North Carolina
For further information about what PACE offers, who’s eligible and how to sign up, visit North Carolina’s Medicaid website or contact the below PACE providers based on place of residence.
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PACE Provider
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Contact
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Areas Served
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Piedmont Health SeniorCare
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(919) 942-8741
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Alamance, Caswell, Chatham, Lee and Orange counties. They also serve those living in Durham County with ZIP code 27278.
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Senior TLC
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(704) 874-0600
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Gaston, Cleveland, and Lincoln counties
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PACE Triad
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(336) 550-4040
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Guilford or Rockingham Counties
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LIFE St. Joseph of the Pines (Trinity)
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(910) 429-7220
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Select zip codes of Cumberland, Harnett, Bladen, Robeson, Sampson, and Moore Counties
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CarePartners PACE
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(828) 213-8442
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Buncombe or Henderson Counties
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PACE Southern Piedmont
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(704) 887-3840
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Cabarrus, Mecklenburg, and Union Counties
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Carolina SeniorCare
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(336) 746-3500
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Davidson, Davie, Iredell, and Rowan Counties
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Senior CommUnity Care of NC
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(919) 425-3000
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Select zip codes of Wake, Durham, and Granville Counties
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PACE@Home
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(828) 468-3980
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Select zip codes of Alexander, Burke, Caldwell, Catawba, and Lincoln Counties
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Elderhaus PACE
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(910) 343-8209
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New Hanover County and parts of Brunswick County
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Other Financial Options for Care
In addition to the state specific options that help pay for care, there are many non-profit and federal options available. Use our Resource Locator Tool to find other programs that help pay for or reduce the cost of care. There are also programs that help veterans with assisted living and there are eldercare loans available in North Carolina.
Finding Affordable Care in North Carolina
As shown in the Assisted Living Costs and Home Care Costs sections above, North Carolina has a great deal of variance in the cost of care depending on one’s location within the state. To assist families in finding the most affordable, high-quality care in their preferred geographic areas, we work with several organizations that assist families at no charge. Click here to find the most affordable care that meets your family’s needs.
Eldercare Financial Assistance Locator
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Top Cities for Senior Care in North Carolina
For more information about the costs and resources available in North Carolina cities, click on the links below.
Top Cities for Memory Care
Top Cities for Assisted Living
