Assisted Living Financial Considerations


All N.C. Residents entering an adult care home must have a basic health assessment within the first few days of admission. This N.C. regulatory assessment form is not used to set rates for reimbursement. However, some facilities set their “rate” of reimbursement on their own company assessment. There is NO STANDARDIZED formula for rate setting in North Carolina or for the forms used by facilities to determine private pay rates. Before signing a contract, consumers should clearly understand:

  • What aspects of resident care are being assessed and who is doing the assessment? What are their credentials? Does the consumer have an opportunity to participate or challenge the results?
  • Will the assessment create a change in how service is delivered?
  • What staff person(s) are responsible for the service?
  • What duration and frequency will the service be provided?
  • What staff person will be supervising the services?

Since there is no rate setting standard in North Carolina, the costs of adult care homes can vary from $1,800 – $5,500 a month. Many facilities charge a basic fee for a complete package of room, board, and services. Others have a base fee and then charge from a “menu” of cost associated with each specific service. There may be other fees associated with a stay at the assisted living:

  • Entry or application fee
  • Fees associated to admission to the secure unit designed specifically for persons with Alzheimer’s Disease or other types of dementia.
  • Room holds when a resident is away for an extended period to the hospital or other health care setting.
  • Private room fees
  • Medication administration or packaging fee
  • Leave of absence fees for packaging medication
  • A pre-determined time to be a private pay resident
  • An additional payment to supplement the cost for private rooms or rooms in a special care unit when a person receives State/County Special Assistance
  • Care fees associated with special needs such as isolation, difficult behavior, extra housekeeping if the resident is incontinent of has other health care needs.
  • Activity fees
  • Special dietary needs may require extra fees for food or preparation

Remember, that ALL charges for services should be specifically outlined in the contract/resident agreement and agreed to by both the resident and the facility. Many companies will negotiate special rates, discounts and other benefits to moving into their community. Be sure that these are also detailed in the agreement including the special rate, the end date of the “special” and if other promises are made about deals for the future, that these are also well documented and agreed upon by both parties. This might include having a room when the person changes their pay status from private pay to SCSA. Some long-term care insurance policies will pay for assisted living care. Verify this coverage before the move-in date so there is no surprise at the first month billing. The lease agreement or admission contract is also called the RESIDENT AGREEMENT. This important document indicates costs and responsibilities of the resident and/or their representatives to ensure payments to the facility in exchange for services. These are not regulated or standardized either.

Consumers should:

  • Request a copy of the contract prior to admission to review the language and prepare questions.
  • Keep a copy of the signed contract on hand.
  • Facilities are obligated to make sure that residents and their representatives understand their rights, the language of the contract, the programs available to cover services and the limits of these programs.
  • has legal authority to handle the resident’s financial affairs.
  • If a resident has been declared legally incompetent, a guardian or Power of Attorney may have to sign all of the necessary papers for admittance. BEWARE mediation clauses that may ask you to waive your right to contact an attorney.