Nursing homes and assisted living in North Carolina

If an older person in your family now needs help bathing, dressing, or taking their medicines, here we explain how senior care works in North Carolina, how Medicaid can help, and who you can call.

What care settings are called here

In North Carolina, care homes are licensed by the Division of Health Service Regulation (DHSR), part of the Department of Health and Human Services (NCDHHS). Its Adult Care Licensure Section is in charge of assisted living. These are the names you will hear:

• Adult care home: an assisted living residence with 7 or more beds. It offers housing, meals, supervision, and personal care. Some have a Special Care Unit (SCU), a special unit for people with Alzheimer's or another type of dementia (often called memory care).
• Family care home: a smaller home with 2 to 6 beds and the feel of a family home. It is similar to what other states call a board and care home.
• Nursing home: a care home with nursing care 24 hours a day.
• Adult day care / adult day health: adult day centers.

How Medicaid helps in North Carolina

NC Medicaid pays for care in a nursing home for people who qualify. For the other options, there are several programs:

• State/County Special Assistance (SA): a cash benefit, paid by the state and the counties, that helps people with low incomes (65 or older, or with a disability) pay for rent and meals in an adult care home or family care home that accepts this program. People who get Special Assistance automatically qualify for Medicaid. You apply at your county's Department of Social Services (DSS).
• Personal Care Services (PCS): Medicaid can pay for the personal care (bathing, dressing) the person gets, either at home or in a licensed residence. It requires an assessment and prior approval.
• CAP/DA (Community Alternatives Program for Disabled Adults): the main Medicaid waiver for adults who need a nursing home level of care but want to keep living at home. It has a limited number of slots in each county, so there may be a waitlist.

Where to apply for Medicaid: online at ePASS (where Medicaid is listed as "Medical Assistance"), or in person or by phone with your county DSS (list of offices). The NC Medicaid Contact Center can help you find your office: 1-888-245-0179.

How much care costs in North Carolina

According to the CareScout Cost of Care Survey 2025 (data collected from July to November 2025, published in March 2026), the median costs in North Carolina are:

• In-home caregiver (non-medical): $30 an hour.
• Adult day center: $85 a day.
• Assisted living: $6,496 a month (private one-bedroom unit).
• Nursing home, semi-private room: $9,733 a month.
• Nursing home, private room: $10,798 a month.

These are statewide medians. Ask each place for its price list in writing.

Who to call

• Long-Term Care Ombudsman Program: the state has 16 regional ombudsman offices, each one based in an Area Agency on Aging. They guide and advocate for residents of nursing homes and assisted living. Find the one for your county on the program's page.
• NCDHHS Customer Service Center: 1-800-662-7030.
• Division of Aging and Adult Services: 919-855-3400.
• Eldercare Locator (national): 1-800-677-1116.

Tips for your family

• Look at the state's star ratings. North Carolina has a Star Rated Certificate program for adult care homes and family care homes, based on DHSR inspections. You can look it up on the DHSR page. It's a practical help for comparing places, along with your own visit.
• Visit and talk with people. The state recommends touring the place and talking with residents and families, because months can go by between inspections.
• Ask if they accept Special Assistance. If your loved one has a low income, this question can save you a lot of time when choosing.
• Ask about language and about Spanish-speaking staff on each shift.
• On hogaresparamayores.com you can see licensed places in North Carolina and compare them at your own pace.

This page is for general information only and is not medical or legal advice. Medicaid rules change, so always check with your county DSS or a professional.