Though fairly large in area, North Dakota is the fourth least populous state in the country. Despite its small population size, the state has plenty to offer the approximately 113,000 residents who are age 65 and over, such as low income tax rates and below average healthcare costs. Read on for more information about assisted living in the Peace Garden State.
Paying For Assisted Living in North Dakota
The Cost of Assisted Living in North Dakota
The monthly median cost of assisted living in North Dakota is $3,315, which is considerably less expensive than the national average of $4,000. According to Genworth’s 2018 Cost of Care Survey, assisted living in North Dakota is also less expensive than the median in all of its neighboring states.
Residents of North Dakota can expect to pay a bit more than those in rural areas of the state for assisted living. Both Bismarck and Fargo cost $3,550, while the rest of the state is only $3,200. Grand Forks is the cheapest in the state at $3,025 a month.
Assisted living in North Dakota is less expensive than most types of long-term care, the exceptions being independent living and adult day care. However, neither of those options offer the same level of care that one would find in an ALF. Assisted living is less expensive than comparable care options, and is significantly less expensive than nursing care.
Financial Assistance for Assisted Living in North Dakota
Basic Care Assistance Program
The Basic Care Assistance Program (BCAP) is a state-funded program that helps seniors who need services in a basic care facility pay for their care. The amount of assistance one receives varies based on their income. The program pays the facility directly to cover the recipient’s health and medical costs.
Who Is Eligible?
To qualify for BCAP, applicants must also qualify for Medicaid. Applicants will undergo a functional assessment with a social worker to determine if they qualify for a basic care facility level of care.
How to Apply
Medicaid Waiver for Home and Community Based Services
North Dakota’s Medicaid Waiver for Home and Community Based Services, commonly referred to as the HCBS waiver, intends to help seniors access their preferred method of care, rather than being placed in a nursing home. The waiver covers many senior services, including residential care in a basic care facility for seniors who meet the eligibility requirements. The payment amount varies – some recipients will have their services covered in full by the waiver program, while others will still need to pay for a portion of the services.
Who Is Eligible?
To qualify for the HCBS waiver, seniors must already be a Medicaid recipient (and thus meet Medicaid income and eligibility requirements), require a nursing facility level of care, and be at least 65 years of age. Eligible seniors must also currently live in their own home or apartment and be capable of directing their own care.
How to Apply
Interested seniors can get more information about program scope, eligibility, and the application process by contacting their County Social Service Office. There may be a waiting list for the waiver program.
More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:
- Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.
- Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov
- Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.
- Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.
Free Assisted Living Resources in North Dakota
Long-Term Care Ombudsman Program
North Dakota maintains a Long-Term Care Ombudsman program. The ombudsman is an advocate to protect the interest of residents in long-term care facilities and help ensure they get the care that they need. Some duties of the ombudsman include:
- Investigate and work to resolve conflicts involving residents of long-term care facilities
- Provide information and answer questions about available services
- Promote community education about long-term care and related issues
- Identify problem areas in facilities, and recommend and implement change
To report a concern to the ombudsman or to ask any questions, contact the North Dakota Aging & Disability Resource LINK online or call 1-855-GO2LINK (1-855-462-5465).
Area Agencies on Aging and Senior Service Providers
Area Agencies on Aging (AAA) is a network of hundreds of nonprofit organizations across America that provide federally funded services to adults over 60 in their local areas.
In North Dakota, the Department of Human Services Division of Aging Services carries out all of the same functions as an AAA. The division offers comprehensive information on various kinds of programs and community supports for seniors.
Additionally, some areas throughout the state are served by branches of the North Dakota Senior Service Providers (NDSSP). The NDSSP provides seniors with useful services and advocates for their needs.
|Area Agency on Aging||Address||Phone Number|
N.D. Department of Human Services
315 N 20th St
P.O. Box 213
620 4th Ave S
404 Frontage Road
502 10th Ave SE
301 NW 15th St
21 1st Ave SE
139 2nd Ave SE
2801 32nd Ave S
Williston Council for the Aging(Region 1)
The Department of Veterans Affairs assists veterans and their families in areas such as medical care financing and long-term senior care. In North Dakota, there are four Vet Centers where veterans and their families can go to access services like counseling and substance abuse assessment, and to find out more about other VA programs that may benefit them.
|Vet Office||Address||Phone Number|
619 Riverwood Drive
3310 Fiechtner Drive, South
3001 32nd Ave
3300 South Broadway
Social Security Offices
North Dakota residents can contact or visit a Social Security office to get a better understanding of the available social security benefits. Some Social Security benefits may be able to go towards paying for assisted living expenses.
|Social Security Office||Address||Phone Number|
657 2nd Ave N
Minot Metro Center
Nutrition and Meal Services
There is no statewide senior nutrition program in North Dakota, but many regional NDSSP offices have comparable programs in place. Most of the existing programs focus on providing seniors with free, nutritious meals, often delivered to their place of residence.
To find out about nutrition and meal services in your area, visit the NDSSP website to find your local program or call the Aging and Disability Resource LINK at 1-855-GO2LINK (1-855-462-5465).
Service Payments for the Elderly and Disabled (SPED) Program
The Service Payments for the Elderly and Disabled Program (SPED) provides seniors with services that help them remain in their home and communities rather than being placed in a residential facility. Some of the services provided include homemaker services, ADL assistance, environmental modifications, and case management.
To find out more about eligibility and available services, contact your County Social Services office.
Regional NDSSP offices often provide transportation services for senior residents. Transportation can be arranged for seniors to access medical appointments, shopping, friends and families, and tend to their other needs.
The specifics of each program vary between different regions, so visit the NDSSP website or call the Aging and Disability Resource LINK at 1-855-GO2LINK (1-855-462-5465) to find out more about what transportation services are available in your area.
Legal Assistance Service Program
The Legal Assistance Service Program provides seniors with free legal representation for civil cases, and advice from licensed attorneys. For more information, visit the Legal Assist website.
Assisted Living Laws and Regulations in North Dakota
Assisted Living Definition
There are two types of non-nursing care residential facilities for seniors in North Dakota: assisted living facilities and basic care facilities.
- A basic care facility is a facility that provides five or more residents with room and board, health and personal care services, and social programs. Basic care facilities in North Dakota are actually more in line with typical assisted living facilities. Monthly costs are all inclusive for room, board, and services.
- An assisted living facility in North Dakota is a building with at least five living units housing five or more adults. The facilities must offer support services to help residents remain as independent as possible. These ALFs just charge residents rent, and then residents can choose to pay for the services that they want or need.
Assisted Living Care Plans
Residents of basic care facilities must be assessed within 14 days of moving into the facility and at least once per quarter thereafter. Assessment areas include functional and psychosocial abilities, nutrition and health status, personal care needs, social interests and activities, and self-preservation. The assessment is used in conjunction with resident input to develop a care plan.
Because residents of assisted living facilities choose what services they would like to access, there is no care planning for residents of these facilities. However, ALFs must keep a record of individual services provided to each resident.
Assisted Living Admission Requirements
In order to be admitted to a basic care facility, residents must be capable of self-preservation and must not have a condition that requires around-the-clock, on-site availability of nursing or medical care.
Beyond those requirements, it is up to each basic care facility to develop their own admission requirements. Assisted living facilities have no state-mandated admission requirements.
Assisted Living Scope of Care
Basic care facilities provide personal care services including assistance with activities of daily living (ADLs) like bathing and dressing, housekeeping and laundry services, and medication assistance. They also provide social and recreational activities and can arrange transportation for residents. Nursing services must be available to residents if needed.
Assisted living facilities must provide support services to residents as needed, including assistance with ADLs. Some facilities may also provide health services. In ALFs in North Dakota, residents choose which services they would like to use. So, one could hypothetically live completely independently in an assisted living facility, while other residents could receive ADL assistance and some medical care.
Assisted Living Medicaid Policy
Residents of basic care facilities can use Medicaid to help fund their care, including the HCBS waiver. However, these programs cannot be used to help cover the cost of an assisted living facility.
Assisted Living Facility Requirements
Resident rooms in basic care facilities may be single-occupancy or multiple-occupancy. There must be at least one toilet and sink for every four residents and one shower or bath for every fifteen residents.
Apartment style units are also not required in assisted living facilities. In ALFs, resident units must include a sleeping area, a lockable entry door, and a private bathroom including a shower. Units may be single or double occupancy.
Medication Management Regulations
In both basic care facilities and assisted living facilities, all staff, including unlicensed staff, can assist with medication. Assistance includes tasks like retrieving the medication for a resident or getting them water to take pills.
Staff licensed by the state Department of Health as a Medical Assistant level 1, 2, or 3, may administer medication when supervised by a registered nurse. But, only staff members with a Medical Assistant level 3 certification may administer medication by injection.
Additionally, basic care facilities must have a health professional or pharmacist review each resident’s medication plan at least once per year.
Basic care facilities must employ an administrator to handle managerial tasks and a licensed nurse to oversee medical care, including medication administration. Other staff members can provide personal care services to residents.
Assisted living facilities must employ a manager and direct care staff. If the facility provides medication assistance, they must also employ a registered nurse to administer medication or supervise medication assistants.
There are no state requirements for staff ratios in either facility. But, both facilities are required to have staff awake and available to assist residents 24 hours a day.
Staff Training Requirements
All employees of both basic care facilities and assisted living facilities must receive training in the following areas:
- Fire and accident prevention and safety
- Handling residents’ mental and physical health needs, including behavioral problems
- Infection prevention and control
- Residents’ rights
Additionally, staff responsible for social activities must attend at least two activity-related programs per year, and administrators/managers must attend at least 12 hours of continuing education courses per year.
Background Checks for Assisted Living
Basic care facilities must check state registries and licensure boards for any cases of inappropriate conduct, disciplinary actions, or termination prior to hiring any staff members.
There are no background check requirements for employees of assisted living facilities, but individual facilities may have their own processes for screening employees.
Requirements for Reporting Abuse
Reports of elder abuse or neglect in any type of residential facility should be reported to Vulnerable Adult Protective Services as soon as possible. Reports can be filed either online or using a paper form.
Any concerns about facilities violating state regulations or otherwise endangering residents should be reported to the Department of Health Division of Life Safety and Code and Construction. The division focuses on ensuring a safe environment for adults living in any institutional setting.