Who Qualifies for Assisted Living in North Carolina? Eligibility and Options

Who Qualifies for Assisted Living in North Carolina

Living independently becomes more challenging as we age. At some point, seniors may need extra help with daily activities like bathing, dressing, and household chores.

That’s where assisted living communities come in. They provide personal care services so older adults can retain independence while getting their needed support.

In North Carolina, dozens of assisted living options cater to different budgets and care needs. Before transitioning, families must understand the eligibility requirements, costs of assisted living, and the different types of communities available across our state.

Planning and reviewing finances now can help cover expenses down the road — whether you intend to pay privately, use long-term care insurance, or apply for Medicaid.

Basic Eligibility Requirements for Assisted Living Facilities in North Carolina

Assisted care facilities in our state primarily serve older adults and disabled individuals who require help with everyday tasks. Known as adult care homes, these healthcare facilities must have a license from the state showing they meet specific standards for staffing, safety procedures, and cleanliness.

To qualify for assisted living here, residents should meet a few broad requirements:

  • Need help with activities like bathing, dressing, medication management, or household tasks.
  • Be able to evacuate the building independently during an emergency.

Within this framework, North Carolina recognizes three main licensing categories:

  • Family Care Homes: Accommodate 2-3 residents in a private house. The owner lives on site.
  • Adult Care Homes: Serve between 3 and 6 residents and offer more of a home-like environment.
  • Multi-Unit Assisted Housing with Services: Larger communities with seven or more residents. Many provide dementia or nursing home care.

Financial Considerations for Assisted Living Communities

Paying for senior living depends greatly on your financial situation. North Carolina families can explore the following options to cover costs.

Private Pay

Many residents pay privately through pensions, Social Security, retirement savings, and other income streams. Adult care homes typically charge a monthly rate, covering housing, meals, activities, medication management, and some level of personal care. Rates often range from $3,000-$5,500 monthly. Memory care units cost more.

Long-Term Care Insurance

If you purchased a policy years ago, check if it covers assisted living services. These insurance policies help pay for skilled, intermediate, or custodial care in a licensed facility daily.

Medicaid Coverage

Medicaid does cover certain assisted living and home care costs in North Carolina through programs like Community Alternatives Program for Disabled Adults (CAP/DA) and Special Assistance. Beneficiaries must meet financial and functional requirements. Medicaid only pays room and board fees, not personal care services.

VA Pension Benefit

Veterans and their spouses may claim the VA Aid and Attendance benefit to help with assisted living if they need assistance with two or more daily activities. Monthly amounts depend on medical costs minus your household income.

Additional Assistance Programs

Some services assist low-income seniors with a portion of assisted living fees if they meet eligibility rules. Check if you qualify for the Special Assistance Program for Adult Care Home resident program or other support in North Carolina.

Understanding Assisted Living Care Needs and Levels of Care

Adult care homes offer socialization, leisure activities, and assistance to those who aren’t entirely independent. Services vary based on licensing categories and staff. Consider current needs and future declines in health or cognition when choosing assisted living for yourself or a loved one during estate planning activities.

Personal Care Services Offered

At a basic level, adult care homes help residents remain safe and comfortable through:

  • Meal planning and preparation.
  • Bathing and grooming.
  • Dressing and laundry.
  • Medication administration.
  • Some health monitoring.

Facilities can arrange additional home health services as required. Some larger communities provide extra care with daily living or have special dementia units when round-the-clock supervision becomes necessary.

Assessing Current and Future Needs

Relocating to an assisted living residence is highly personal. The first step involves honest conversations between seniors, medical providers, and family about the help they’ll need for daily functioning and medical issues. Consider if health will decline further in the coming years, requiring more significant support.

If Parkinson’s disease or arthritis now makes cooking or dressing hard, for example, how might that progress over time? Addressing mobility limitations and fall risk also make selecting a suitable facility easier. You want care in a setting that can adapt as needs change.

Understanding Levels of Care in Special Units

Enhanced personal care and dedicated staff specially trained in behavioral issues are hallmarks of a Special Care Unit, usually focused on Alzheimer’s or other dementia. Structured routine with activities and sensory cues attuned to resident’s abilities.

Specially trained staff to handle emotional outbursts, wandering, and other challenges. A secured environment designed for resident safety.

Many larger Continuing Care Retirement Communities (CCRCs) offer specialized memory care. Some even have skilled nursing on-site, which may become essential.

Additional Care In North Carolina

Most assisted living residents see outside doctors and therapists to manage complex conditions. Visiting nurses or aides may also provide medical or supportive services in the home setting through Medicare-approved home health agencies.

Hospice care can additionally help those with a life-limiting illness. With assisted living, folks ultimately retain the right to make healthcare decisions and manage care teams.

NC Estate Planning and Wealth Management Considerations

Affording assisted living without sacrificing your savings requires diligent budgeting and cost comparisons.

Crunching the Numbers on Assisted Living Costs

North Carolina estate planning attorneys in 2023 add $65,000 to the number of activities of daily living (ADLs) you need times five to find a reasonable projection for future assisted living expenses.

For example, if you require help with bathing, dressing, and medication reminders (3 – ADLs), that’s roughly $80,000 yearly or ($65,000 + $15,000). Costs rise further for memory care ADLs.

You should also compare pricing tiers for different service levels at multiple locations. Account for likely healthcare costs, too.

Paying Privately vs. Spending Down for Medicaid

Some families with moderate savings pay privately for assisted living as long as possible before selling assets to meet Medicaid thresholds. This consideration maintains control over community choice rather than going to only Medicaid-approved locations later.

An estate planning attorney in North Carolina can advise you on allowable gifting and transfers to protect personal funds for a healthy spouse still residing at home while obtaining coverage for assisted living care.

Power of Attorney and Living Wills

Granting financial power of attorney helps trusted advocates manage bills and transactions when aging residents experience cognitive decline. A living will may similarly convey wishes for medical interventions and end-of-life care to guide difficult decisions for family and doctors.

Planning Early is Key

Consider assisted living options long before an urgent health episode forces quick decisions about appropriate care. Touring communities together and comparing financial assistance packages helps families make good choices. Veterans should investigate what benefits apply and if service years improve priority access to some locations.

Consulting Estate Planning Attorneys About Assisted Living Options

North Carolina estate planning attorneys understand the options and regulations around assisted living and Medicaid. They assist families with contracts, asset protection strategies, and more. Guidance during the transition helps ensure aging loved ones receive the most appropriate care.

Further, Johnson Legal has an experienced registered nurse on staff who served as Director of Nursing at several elder care facilities. Joelle Johnson has 15 years of elder housing experience and is available for consultations.

With a better understanding of requirements, costs, and resources now available, North Carolina families can thoughtfully plan for assisted living needs. Seeking input from medical teams, financial advisors, and experienced attorneys ensures aging adults have the support to maximize independence and quality of life.

Contact Johnson Legal today to start planning.

Author Bio

Shane T. Johnson is the CEO and Managing Partner of Johnson Legal, an estate planning and business law firm in Wilmington, NC. With years of experience in estate and business law, he has zealously represented clients in various legal matters, including small business formation and purchasing, estate planning, probate, domestic violence, and other legal cases.

Shane received his Juris Doctor from the University of Wyoming and is a member of the North Carolina Bar Association. He has received numerous accolades for her work, including being named among the Best Probate Lawyers in Wilmington by

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