Home Care in North Dakota

Home-based care is ideal for older adults who want to continue enjoying the comfort and privacy of their own home but have certain tasks that have become challenging. There are two levels of home-based care. In-home care provides basic services such as companionship, meal preparation, transportation and help with personal grooming. Licensed or certified health care workers administer home health care and provide services such as medication administration and medical monitoring. According to the 2021 Genworth Cost of Care Survey, both care types cost $5,689 per month in North Dakota.

North Dakota residents pay a moderate price of $5,689 for home-based care and home health care. This rate is a few hundred dollars higher than the respective national average of $4,957 and $5,148 per month.

While care costs are higher in North Dakota than in many other U.S. states, rates are consistent with those in surrounding states. In South Dakota, residents pay $5,911 per month for both care types. In Minnesota, fees are considerably higher, with seniors paying $6,673 for home care and $6,912 for home health care. Montana residents pay $5,339 for both care types, more than the national average but affordable relative to North Dakota.

North Dakota seniors pay $5,689 per month for home care and home health care, making it one of the more expensive care types in the state. Assisted living, which provides a comparable care level in a residential community setting, is considerably cheaper at $3,391 per month. If you want to live in your home but need a more budget-friendly option, consider adult day health care, which has a similar monthly price as assisted living at $3,383. Nursing homes charge rates roughly double that of home care, with seniors paying $11,978 for semiprivate accommodations.

Home care is relatively expensive in North Dakota. Fortunately, depending on income, seniors may have service payment options. Under the state’s Medicaid program, they may be eligible to get up to 300 hours of care per month. This program is an entitlement, meaning that it’s available to all qualifying Medicaid beneficiaries without enrollment caps.

Medicaid State Plan – Personal Care Services is made up of three levels. Level A pays for up to 120 hours of care per month, Level B pays for up to 240 hours and Level C pays for up to 300 hours. Regardless of the level you’re approved for, covered services include:

• Bathing
• Transferring
• Toileting
• Dressing
• Laundry
• Light housekeeping

To obtain services under any level, recipients must be on Medicaid and need care for at least 30 days. A case manager assesses the services received and the monthly number of eligible care hours. Depending on income, recipients may have to pay a deductible for their care.

If you need more care than the state plan provides, you may apply for services through the Home- and Community-Based Services Waiver. This waiver enables qualifying individuals to obtain care at home as an alternative to a nursing home. Unlike the state Medicaid plan, this waiver has an enrollment cap, and you may be placed on a waitlist if there aren’t any slots available.

Home- and Community-Based Services Waiver 

The Home- and Community-Based Services Waiver is open to those who need nursing home care but want to live in their own home or apartment. This waiver covers several services, including:

• Adult day care
• Case management
• Chore services
• Emergency response systems
• Home modifications
• In-home care
• Transportation for errands
• Durable medical equipment
• Respite care
• Transitional living services

To be eligible for services under this waiver, applicants must be at least 65 years old or disabled according to Social Security Disability criteria. They must be capable of living independently, and the waiver must pay for all needed services. Applicants must also live in their own home or apartment and meet Medicaid’s eligibility requirements, which we outline below.

To learn more about this waiver and apply for services, seniors can contact their nearest Human Service Zone Office.

To be eligible for Medicaid, an applicant’s income and assets must fall within strict limits. Single seniors may have up to $11,280 in annual income. This requirement includes all income sources, including wages, veterans pensions, stock dividends, retirement account withdrawals and public benefits. VA Aid and Attendance is the only income source that doesn’t count toward this limit. However, some expenses are deductible from countable income, such as health insurance premiums and taxes. Applicants may have up to $3,000 in countable assets. This includes bank accounts, investments, stocks and vacation properties. Primary residence, personal belongings and vehicle are not included. For married applicants, respective income and asset limits are $15,204 and $6,000.

Seniors can apply for Medicaid through the state’s online public benefits portal. They can access paper applications online or call their county human service zone office to request one by mail. Applicants can submit completed applications in person or by mail to the office. For help with filling out or following up on an application, seniors can call the Department of Human Services at (800) 472-2622.

What Information You Will Need 

Before applying for Medicaid, applicants need supporting documents to verify their service eligibility. These include:

• Driver’s license or state-issued ID
• Birth certificate
• Proof of income and assets
• Policy numbers for primary health insurance

How to Get Help Applying for Medicaid 

If you need assistance applying for Medicaid or understanding your benefits, there are several resources that can help. The following table features websites, hotlines and programs that can aid you in getting the most from your benefits and resolving issues that arise.

Medicare doesn’t pay for non-medical home care, but it can cover the cost of the medical version of home care, called “Home Healthcare” in some situations. In order to be eligible, you need to be homebound and have a referral from your doctor for the specific type of medical care that is needed. There are also other restrictions that apply.

Below is an overview of some of the services typically covered by Medicare for those who are eligible:

• Physical Therapy: Physical therapy is used to help patients recover from injuries (broken bones, knee injuries, etc.), and to treat ongoing conditions such as arthritis. Additionally, physical therapy is often provided in the home to help seniors recover from surgeries and procedures, such as a knee or hip replacement.
• Nursing Care: Licensed nurses can provide a number of medical services (such as wound care, changing feeding tubes, etc.) for those who need medical care, but don’t need to stay in a hospital full-time.
• Occupational Therapy: Occupational therapy is designed to help seniors regain or maintain the ability to accomplish normal, daily tasks, such as bathing, dressing, eating, etc., and providers can travel to your home if needed.
• Speech Therapy: Seniors can lose the ability to adequately communicate for many reasons, and speech therapists are there to help seniors regain the ability to communicate using a variety of means. Additionally, speech therapists help to keep seniors independent by modifying diets and teaching special techniques to swallow safely.

As mentioned above, home care is distinctly different from home healthcare, but there is some overlap – so while Medicare doesn’t cover non-medical home care, there are personal care services that may be covered in special circumstances – such as an occupational therapist helping with eating or dressing.

Read our guide to Medicare and Home Care Coverage for more information.

While the above programs can be a great way to make home care affordable for many people, they are not the right solution for everyone. Thankfully, there are other ways to make home care more affordable for you and your family. For more information about your other options, read our section on Other Ways to Pay for this guide.

North Dakota has numerous resources to help you get the care you need at home. Through the following agencies and programs, you can obtain case management, home-delivered meals, transportation and referrals for community-based services, which may help you reduce out-of-pocket care expenses and remain in your home safely and comfortably.

Rules and vaccination requirements for COVID-19 are constantly evolving in response to infection trends and new information. For the most recent guidelines, contact your local health department or Area Agency on Aging. As of April 2022, North Dakota requires home health care workers to be fully vaccinated against the virus unless they have exemption status.

At this time, there are no rules in place requiring home care workers to be vaccinated. However, agencies in your area may have mandates beyond what the state requires. If you’re concerned about your risk of exposure to COVID-19, or you want details regarding masking and sanitation practices, contact your home care agency.

In North Dakota, home care agencies aren’t regulated by the state if they only provide in-home care and companion services. The North Dakota Health Resources and Response, Division of Health Facilities governs agencies that provide skilled nursing services. This division has rules in place to ensure a consistently high standard of care for seniors.

Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. To help you overcome this challenge, we’ve created a helpful checklist below that can help guide you through the process of both determining your needs, and finding a home care agency that will be the best fit for you and your family.

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