North Dakota Assisted Living
Due to its harsh winters, North Dakota can be overlooked as a retirement destination. But, the state's low taxes and cost of living, especially in the health care field, make it an attractive option for older adults. North Dakota also waives payments on Social Security income, giving people a welcome boost to their monthly budgets.
Families of older adults can also benefit from North Dakota's tax credits, which help compensate individuals paying for medical care and companionship services for older relatives. This guide provides more information about North Dakota assisted living communities, including the associated costs and regulations.
The typical resident population in North Dakota's assisted living communities is 69% female. Overall, 83% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 53% ages 85 and older.
The Department of Human Services oversees the licensing and fuels for assisted living facilities (ALFs), and the Department of Health established rules for basic care facilities. An ALF is a facility of at least five living units that provides individualized support services for five or more adults.
A basic care facility provides room and board and health, social and personal care to five or more residents to maintain a high level of function.
Agreements between assisted living facilities and their residents must include the rates for rent and the services provided to the resident, payment, refund, rate change policies, criteria for discharge and continued residence, and the inspection policies of living units.
AFLs develop their own admission and retention criteria.
Residents of basic care facilities must be capable of self-preservation and may not have a condition that requires continuous 24-hour on-site availability of nursing or medical care. Facilities can develop their own criteria for admission and retention of residents.
ALFs must provide or coordinate support services for residents, including assistance with activities of daily living (ADLs). Facilities may provide health services to individuals to prevent disease and promote, maintain, or restore health or minimize the effects of illness. Residents pay for services, not a service package.
ALFs must evaluate applicants to ensure they meet the facility's admission requirements. The facility must keep a record of services provided to each resident.
Basic care facilities provide personal care services, including assistance with ADLs and instrumental activities of daily living (IADLs). Services also include observation and documentation of changes in physical, mental, and emotional function; arrangements for health care when necessary; arrangements of transfer and transportation; housekeeping and laundry; medication services and social and recreation activities.
Residents must be assessed within 14 days of move-in and then quarterly thereafter. The assessment reviews the health, psychosocial, functional, nutritional, and activity status, personal care needs, the capacity for self-preservation, and social interests and activities. A care plan is developed based on this assessment.
Residents of both categories can contract with outside home health agencies.
ALFs are not required to provide meals.
Basic care facilities must serve three meals and snacks daily. If the facility accepts residents that require a therapeutic or other prescribed diets, the meals must be planned and reviewed by a professional dietitian.
ALFs must have a manager and direct care staff. If the facility has opted to offer medication administration, an RN must be available to administer medications or train and supervise certified medication assistants. There are no minimum staff ratios. Staff must be available 24 hours a day and must be able to provide resident care.
Basic care facilities must employ an administrator that is in charge of the facility. A licensed nurse must be employed or contracted to provide nursing services and supervise any medication assistants. Staff is required to provide personal care and other services to the residents. There are no minimum staff ratio requirements, but staff must be awake and available 24 hours daily.
Apartment-style units are not required in ALFs. A resident unit must include a sleeping area, an entry door that can be locked, a private bath with a toilet, a sink, and a bathtub/shower. Units can be single occupancy or double occupancy.
Resident rooms in basic care facilities may be single or multiple occupancies (three or more). At least one toilet and sink is required for every four residents, and one bathtub/shower is required for every 15 residents.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
In North Dakota, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 68% of communities providing skilled nursing. Many have health care specialists and on-site services, with 50% of communities offering dental care. In addition, 37% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In North Dakota, 89% of communities conduct depression screenings, and 45% offer mental health counseling. Social work programs are also found in 46% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In North Dakota, 26% have Alzheimer's disease or another form of dementia. In addition, 50% have high blood pressure, 28% have heart disease, 36% have depression, and 20% have diabetes.
The Department of Mental Health & Substance Abuse Services operates the Older Adult Program, which provides essential mental health services to North Dakota residents aged 50 and older. Available services include screenings, referrals to community resources, and supportive care.
Some North Dakota cities and counties also have their own programs, such as the mental health services offered by the Knoxville-Knox County Community Action Committee. Participants have access to crisis services, geriatric assessments, and other services to help them improve their mental health. North Dakota 2-1-1 offers referrals to local mental health resources for older adults in other areas of the state.
Both categories of facilities must meet state requirements for medication administration. Unlicensed staff may provide assistance with medications and must be Level 1, 2, or 3 when supervised by a registered nurse. Level 3 medication assistants may administer medications by injection.
In addition to the above, basic care facilities must have a health professional or consulting pharmacist review each resident's medication regimen, at a minimum, annually.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in North Dakota’s assisted living facilities often receive help with their ADLs. In North Dakota, 5% of residents need help eating. Other commonly used services include bed transfer (10%), toileting (15%), and walking (36%). Caregivers in ALFs help 29% of residents dress, and 50% need help bathing.
The average cost of assisted living care in North Dakota is $3,391. This cost is $1,109 lower than the monthly national average of $4,500 per month. The cost of living in North Dakota is less than the national average by 1.8%, with health care costs more than the national average by 13.3% and housing costs less than the national average by 4.6%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $2,200 in the Grand Forks area to a high of $3,840 per month in the Fargo area of North Dakota.
If you live close to one of North Dakota’s borders, you may find assisted living in a neighboring state is an affordable option. South Dakota has a lower average monthly cost for assisted living at $3,350 per month, while Montana and Minnesota have a higher average cost of $4,450 and $4,508.
How to Pay for Assisted Living
Licensing and oversight for North Dakota assisted living communities are jointly maintained by the Department of Health and the Department of Human Services. For detailed information about individual communities or their rights as an ALF resident, people can contact the state ombudsman program and speak with trained volunteers.
Assisted living communities must be licensed by the North Dakota Department of Human Services and the Department of Health. To be considered for licensing, each community must have a minimum of five residential units and maintain certain safety protocols, such as having smoke detectors, emergency lighting, and emergency plans.
Assisted living facilities are also expected to provide individualized services to residents, including health services aimed at reducing illnesses and promoting residents' overall wellness. Although background checks aren't required for personnel at assisted living facilities, staff members must be available 24/7 and complete training on important eldercare topics. Continued education and training are expected for all staff members, including managers.
The term "elder law" is often associated with estate planning, trusts, and help to obtain benefits through Medicare or Medicaid. The field has also grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues. The attorney general publishes a list of common scams targeting older individuals and ways to avoid becoming a victim of fraud.
Many resources are available from groups such as the State Bar Association of North Dakota and Legal Services of North Dakota to help prevent abuse and offer guidance and aid in times of need. Nonprofit groups also exist to provide guardians to vulnerable adults without in-state family and friends to speak for them.
Families of older adults can also benefit from North Dakota's tax credits, which help compensate individuals paying for medical care and companionship services for older relatives. This guide provides more information about North Dakota assisted living communities, including the associated costs and regulations.
The typical resident population in North Dakota's assisted living communities is 69% female. Overall, 83% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 53% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Department of Human Services oversees the licensing and fuels for assisted living facilities (ALFs), and the Department of Health established rules for basic care facilities. An ALF is a facility of at least five living units that provides individualized support services for five or more adults.
A basic care facility provides room and board and health, social and personal care to five or more residents to maintain a high level of function.
Resident Agreements and Disclosures
Agreements between assisted living facilities and their residents must include the rates for rent and the services provided to the resident, payment, refund, rate change policies, criteria for discharge and continued residence, and the inspection policies of living units.
Assisted Living Admission and Retention
AFLs develop their own admission and retention criteria.
Residents of basic care facilities must be capable of self-preservation and may not have a condition that requires continuous 24-hour on-site availability of nursing or medical care. Facilities can develop their own criteria for admission and retention of residents.
Assisted Living Services and Service Planning
ALFs must provide or coordinate support services for residents, including assistance with activities of daily living (ADLs). Facilities may provide health services to individuals to prevent disease and promote, maintain, or restore health or minimize the effects of illness. Residents pay for services, not a service package.
ALFs must evaluate applicants to ensure they meet the facility's admission requirements. The facility must keep a record of services provided to each resident.
Basic care facilities provide personal care services, including assistance with ADLs and instrumental activities of daily living (IADLs). Services also include observation and documentation of changes in physical, mental, and emotional function; arrangements for health care when necessary; arrangements of transfer and transportation; housekeeping and laundry; medication services and social and recreation activities.
Residents must be assessed within 14 days of move-in and then quarterly thereafter. The assessment reviews the health, psychosocial, functional, nutritional, and activity status, personal care needs, the capacity for self-preservation, and social interests and activities. A care plan is developed based on this assessment.
Residents of both categories can contract with outside home health agencies.
Assisted Living Food and Dietary Provisions
ALFs are not required to provide meals.
Basic care facilities must serve three meals and snacks daily. If the facility accepts residents that require a therapeutic or other prescribed diets, the meals must be planned and reviewed by a professional dietitian.
Assisted Living Staffing Requirements
ALFs must have a manager and direct care staff. If the facility has opted to offer medication administration, an RN must be available to administer medications or train and supervise certified medication assistants. There are no minimum staff ratios. Staff must be available 24 hours a day and must be able to provide resident care.
Basic care facilities must employ an administrator that is in charge of the facility. A licensed nurse must be employed or contracted to provide nursing services and supervise any medication assistants. Staff is required to provide personal care and other services to the residents. There are no minimum staff ratio requirements, but staff must be awake and available 24 hours daily.
Assisted Living Housing Requirements
Apartment-style units are not required in ALFs. A resident unit must include a sleeping area, an entry door that can be locked, a private bath with a toilet, a sink, and a bathtub/shower. Units can be single occupancy or double occupancy.
Resident rooms in basic care facilities may be single or multiple occupancies (three or more). At least one toilet and sink is required for every four residents, and one bathtub/shower is required for every 15 residents.
What Is Included With Assisted Living Care In North Dakota?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In North Dakota, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 68% of communities providing skilled nursing. Many have health care specialists and on-site services, with 50% of communities offering dental care. In addition, 37% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In North Dakota, 89% of communities conduct depression screenings, and 45% offer mental health counseling. Social work programs are also found in 46% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In North Dakota, 26% have Alzheimer's disease or another form of dementia. In addition, 50% have high blood pressure, 28% have heart disease, 36% have depression, and 20% have diabetes.
State Mental Health Resources
The Department of Mental Health & Substance Abuse Services operates the Older Adult Program, which provides essential mental health services to North Dakota residents aged 50 and older. Available services include screenings, referrals to community resources, and supportive care.
Some North Dakota cities and counties also have their own programs, such as the mental health services offered by the Knoxville-Knox County Community Action Committee. Participants have access to crisis services, geriatric assessments, and other services to help them improve their mental health. North Dakota 2-1-1 offers referrals to local mental health resources for older adults in other areas of the state.
Medication Provisions
Both categories of facilities must meet state requirements for medication administration. Unlicensed staff may provide assistance with medications and must be Level 1, 2, or 3 when supervised by a registered nurse. Level 3 medication assistants may administer medications by injection.
In addition to the above, basic care facilities must have a health professional or consulting pharmacist review each resident's medication regimen, at a minimum, annually.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in North Dakota’s assisted living facilities often receive help with their ADLs. In North Dakota, 5% of residents need help eating. Other commonly used services include bed transfer (10%), toileting (15%), and walking (36%). Caregivers in ALFs help 29% of residents dress, and 50% need help bathing.
Cost Of Assisted Living Care In North Dakota
The average cost of assisted living care in North Dakota is $3,391. This cost is $1,109 lower than the monthly national average of $4,500 per month. The cost of living in North Dakota is less than the national average by 1.8%, with health care costs more than the national average by 13.3% and housing costs less than the national average by 4.6%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $2,200 in the Grand Forks area to a high of $3,840 per month in the Fargo area of North Dakota.
How Costs Compare In Nearby States
If you live close to one of North Dakota’s borders, you may find assisted living in a neighboring state is an affordable option. South Dakota has a lower average monthly cost for assisted living at $3,350 per month, while Montana and Minnesota have a higher average cost of $4,450 and $4,508.
How to Pay for Assisted Living
North Dakota Assisted Living Oversight
Licensing and oversight for North Dakota assisted living communities are jointly maintained by the Department of Health and the Department of Human Services. For detailed information about individual communities or their rights as an ALF resident, people can contact the state ombudsman program and speak with trained volunteers.
Quality and Safety of Assisted Living Facilities in North Dakota
Assisted living communities must be licensed by the North Dakota Department of Human Services and the Department of Health. To be considered for licensing, each community must have a minimum of five residential units and maintain certain safety protocols, such as having smoke detectors, emergency lighting, and emergency plans.
Assisted living facilities are also expected to provide individualized services to residents, including health services aimed at reducing illnesses and promoting residents' overall wellness. Although background checks aren't required for personnel at assisted living facilities, staff members must be available 24/7 and complete training on important eldercare topics. Continued education and training are expected for all staff members, including managers.
Legal Resources
The term "elder law" is often associated with estate planning, trusts, and help to obtain benefits through Medicare or Medicaid. The field has also grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues. The attorney general publishes a list of common scams targeting older individuals and ways to avoid becoming a victim of fraud.
Many resources are available from groups such as the State Bar Association of North Dakota and Legal Services of North Dakota to help prevent abuse and offer guidance and aid in times of need. Nonprofit groups also exist to provide guardians to vulnerable adults without in-state family and friends to speak for them.
