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What Assisted Living Costs in North Dakota

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Four dots and a remainder. North Dakota's assisted living costs are published across just five regions, and the single residual line carries the Bakken counties, the Turtle Mountains, and every small town between them. Fargo and Grand Forks, meanwhile, are names North Dakota lends to Minnesota's table as well. Here is what the 2024 figures measure, and why a five-line state changes how a quote should be read.

Last updated: July 2026

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North Dakota is surveyed in five regions

The 2024 Cost of Care Survey reports five North Dakota regions and no statewide figure: Bismarck; Fargo; Grand Forks; Minot; and ND Rest of State 1. Four named markets and one remainder. For comparison, the same survey cuts Michigan into sixteen lines and New York into fourteen 1 — the instrument has not gone easy on North Dakota, it has simply found less to name.

The reason is structural. Costs are published in 431 regions built on 383 federal Metropolitan Statistical Areas, whose boundaries the U.S. Office of Management and Budget sets, with some counties outside the MSA regions included as well 1. Metro delineations follow population, and North Dakota has four places with enough of it to be delineated separately.

Four North Dakota markets are named in the 2024 cost data. Everything else in the state — every county, every small town — shares one line 1.

What that does to a reader is worth being blunt about. In a sixteen-line state, most families find a heading that plausibly describes their market. In North Dakota, unless the search is for Bismarck, Fargo, Grand Forks, or Minot, the answer is a residual — and a residual is a different kind of number, answering a broader question than the one being asked.

So the five-line table is not a defect in the data. It is an accurate reflection of a state with four metros and a great deal of distance between them. It just means the usual advice — find your region and read that line — resolves, for most of North Dakota, to a line that is not really a region at all.

Fargo and Grand Forks belong to Minnesota's table too

Two of North Dakota's four named lines are not exclusively North Dakota's. Fargo appears on North Dakota's region list and, word for word, on Minnesota's 1. Grand Forks does the same 1. One region, filed under both states, because each metro crosses the Red River and the survey files a region under every state whose territory sits inside it.

The methodology says so directly: after OMB refined its delineations in July 2023, the regions reflected in all 2024 data "can often include counties from other nearby states" 1.

A family in Moorhead and a family in Fargo are reading the same median. The river is a state line, not a market boundary, and the data sides with the market.

What makes North Dakota unusual is the direction of the traffic. Every one of its five headings names a North Dakota place — Bismarck, Fargo, Grand Forks, Minot, and the state's own residual 1. Nothing on North Dakota's table is named for a city in Montana, South Dakota, or Minnesota. Plenty of states import a heading from a neighbour; North Dakota imports none and exports two.

That asymmetry has a practical payoff. A North Dakotan never has to hunt for their number under an unfamiliar out-of-state city name — a genuine source of confusion elsewhere. Every heading on the list is a place they have heard of, and the only thing to remember is that two of them are shared. Someone weighing assisted living cost in South Dakota against a North Dakota figure is comparing two independent tables; someone weighing Fargo against a Minnesota Fargo figure is reading one line twice.

ND Rest of State holds the Bakken, and everything else

Look at what is missing from the list of named regions, because in North Dakota the absences are the story. Williston has no line. Neither does Dickinson, or Jamestown, Devils Lake, Wahpeton, Valley City, or Rugby 1. The entire western oil patch, the Turtle Mountains, the Missouri Coteau, the Red River Valley outside Fargo and Grand Forks — all of it resolves to ND Rest of State.

ND Rest of State is not a market. It is a subtraction — whatever the four metro lines did not claim — and it spans several hundred miles and several unrelated economies.

The Bakken counties deserve particular caution here. Western North Dakota went through a labour and housing shock that the rest of the state did not, and a median blended across the whole residual cannot distinguish a Williston market from a Rugby one. The survey is not hiding this; it simply has no line on which to say it.

What follows is not that the number is useless. It is that its job is smaller than a family wants it to be. It can say whether a quote is roughly ordinary for non-metro North Dakota. It cannot say what a particular town charges, and no statewide or residual figure can.

The state and regional medians live in the survey's interactive cost-of-care lookup; the published summary report carries the national medians, the methodology, and these region definitions 1. For anywhere outside the four named metros, though, the lookup will hand back the residual — which is the honest answer, and also the reason four phone calls will outperform it.

What the $5,900 national median actually measures

In 2024 the national midpoint for an assisted living community was $5,900 a month, up ten percent from $5,350 the year before 1. Annualised, that is $70,800 2. North Dakota's regions are not obliged to land anywhere near a national midpoint, but it is the right anchor to reason from, because — unlike almost every figure circulating online — its method is published beside it.

Surveyors polled 17 percent of licensed assisted living communities, completing 4,610 interviews between July and December 2024, and recorded the monthly private-pay rate for a one-bedroom unit 1. That phrase carries three limits worth stating separately:

  • It is private money. The figure is what a household spends from its own funds. Programme reimbursement is something else entirely, and the survey does not gather it.
  • It is a one-bedroom apartment. Sharing prices beneath the line; a larger unit prices above.
  • The band was averaged flat. Rates came in "as they ranged from basic care to more substantial care," and a quoted range was reduced to the mean of its two ends 1.

The published median is the midpoint of a basic-to-substantial-care band 1. Someone needing substantial help starts above it, before a single add-on appears.

One methodological choice widens the spread further, and it lands hard in a rural state. Because licensing standards vary so much between states, both small group homes and large multi-service communities qualified as assisted living for this study, and they share the same median 1. In much of North Dakota the realistic options skew small; the median they are being compared against does not.

The survey attributed 2024's ten percent rise for assisted living chiefly to inflation. Labour cost was the leading driver for home care instead 1.

Why five regions changes how a North Dakota quote should be read

A caveat buried in the methodology matters more here than almost anywhere: the survey reports results only for the regions where data collection actually succeeded 1. Nationally it reached 17 percent of licensed communities 1. In a state carved into five lines rather than sixteen, any given line rests on whatever completed interviews existed inside it — and a thin sample makes a median a rough centre of gravity rather than a going rate.

That is not a reason to distrust the figure. It is a reason to give it the weight it can carry and no more.

In North Dakota, treat the published median as a sanity check on quotes you have already collected — not as the starting point you negotiate away from.

Distance compounds it. In a dense state, a family unhappy with a quote can drive twenty minutes to a different market. In much of North Dakota, the next community may be sixty or a hundred miles on, which means the practical choice set is small enough to enumerate by hand — and enumerating it by hand is genuinely better than any median.

This also changes what a care-level increase means. Elsewhere, needing more help raises a bill. Here, if the nearest setting cannot take on the additional need, it can mean a move to a different town — away from the church, the neighbours, and the people who visit. That is a cost the survey has no column for, and it is worth putting on the table early, while there is still time to choose rather than react.

Across the border the arithmetic is the same instrument on different ground: assisted living cost in Minnesota and assisted living cost in Maryland are measured by this identical survey 1, so the medians compare cleanly even where nothing else does.

The base rate, the care level, and the fee due at signing

No median is a bill. Assisted living is generally sold as rent plus a care level, and the level comes from an assessment the community performs before move-in and repeats whenever needs change. Because the survey's figure already sits mid-band between basic and substantial care 1, a resident assessed high begins above the median, not at it.

Then there is the money due before the first night. Roughly 58 percent of assisted living communities charge a one-time, non-refundable fee 1 — typically payable at signing, and typically absent from every monthly number in circulation.

About 58% of communities charge a one-time, non-refundable fee that no monthly quote includes 1.

The sign on the building is a weak guide to what is inside, and the survey puts numbers on that too: there are more than 70 different names or designations for facilities licensed as some form of assisted care community, and generally fewer than 40 percent use "assisted living" as part of their formal name or licensure designation 1. A place that calls itself something else entirely may be exactly what a family is looking for.

A short list of questions makes the structure visible, and every one is fair to ask on a tour:

  • What level would today's assessment assign, and what does that level charge monthly?
  • Which events force a reassessment, and how much warning precedes a level moving?
  • Does the one-time fee ever come back — on a death, or a move inside the first month?
  • What did the base rate rise by in each of the last three years?
  • What is billed apart from the rent: medication management, incontinence care, transport, a second occupant?

And one more that belongs specifically to a state this size, and that a family somewhere denser could afford to leave unasked: at what point would you no longer be able to care for them here? The answer sets how many moves this decision really contains.

Answers in writing describe a price. The same answers spoken on a tour describe an opening bid.

Medicare's limit, Medicaid's waiver, and the PACE question in a rural state

Start with the boundary almost every family runs into. Medicare does not pay for long-term custodial care — help with bathing, dressing, eating, and getting around — in assisted living, in a nursing home, or at home, when that help is the only care needed. Medigap does not fill it either 3. This is what the benefit is, nationally. It is not a North Dakota gap or a fault in anyone's plan.

Medicaid can reach assisted living, and it does so obliquely. A Section 1915(c) waiver allows a state to deliver long-term services and supports in the home or community instead of an institution, aimed at people who would otherwise require an institutional level of care 4. What is covered, and who qualifies, varies by state 4.

Even where a waiver covers assisted living services, room and board generally falls outside it. The rent stays with the family — the fact that most often breaks a plan built on a waiver alone.

One more programme is worth knowing by name, particularly where distance is the binding constraint. PACE — the Program of All-Inclusive Care for the Elderly — is a Medicare and Medicaid programme for people 55 and older who need a nursing-home level of care but can live safely in the community, coordinating their care to help them avoid nursing-home placement 5. It provides everything Medicare and Medicaid cover plus whatever the interdisciplinary care team judges necessary, and enrollees who have Medicaid generally pay no monthly premium and no cost-sharing for PACE-approved care 6. PACE is built around a centre, which makes whether one operates within reach a real question rather than a formality — and it is a question for the state's aging agency, not for this page.

The live thresholds, the current programme names, and any waiting-list position belong with North Dakota's own Medicaid and aging agencies rather than on a page like this one, where they would go stale and mislead. Put two questions to them plainly: does the state's waiver reach assisted living services at all, and how is the room-and-board half treated for someone who qualifies. The cost survey speaks to neither, by design — private-pay rates are its whole subject, and public reimbursement is not 1.

Common questions

The survey behind most published figures reports five North Dakota regions rather than one statewide number. Bismarck, Fargo, Grand Forks, and Minot are named separately, and everything else shares a residual line. A statewide average would blend four metros with several hundred miles of very different country.

In ND Rest of State. Williston has no named line of its own, and neither does Dickinson, Jamestown, or Devils Lake. The residual covers the whole oil patch alongside farm counties with quite different economies, so it reads as a rough centre of gravity rather than a going rate for any particular town.

Because it is one region belonging to both states. Survey regions follow federal metro areas, which cross state lines, and each is filed under every state whose territory sits inside it. The Fargo and Grand Forks metros both span the Red River, so both appear on North Dakota's list and Minnesota's.

Usually not. It is a base rate for a one-bedroom unit, and the survey averages the high and low of a community's basic-to-substantial-care range. A care level set by assessment sits on top, roughly 58 percent of communities charge a one-time non-refundable fee at signing, and things like medication management or transport are often billed separately.

No. Medicare does not cover long-term custodial care — help with bathing, dressing, eating, and moving around — in assisted living, a nursing home, or at home when that assistance is the only care needed, and Medigap does not fill the gap. The limit is national rather than specific to North Dakota.

PACE serves people 55 and older who need a nursing-home level of care but can live safely in the community, providing what Medicare and Medicaid cover plus what the care team deems necessary; enrollees with Medicaid generally pay no premium and no cost-sharing for approved care. It is organised around a centre, so whether one operates within reach is worth asking the state's aging agency.

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When the cost question has turned into a care question

  • —A fall with a head strike or a suspected fracture, or a second fall inside a month — recurring falls usually mean the supervision being paid for no longer fits the need
  • —Confusion, agitation, or new incontinence coming on over hours or days rather than gradually, which more often signals an infection or a medication problem than dementia advancing
  • —Going outside alone and being unable to find the way back — a particular hazard in a state where winter exposure turns dangerous quickly
  • —Weight coming off without anyone trying, or meals and medications repeatedly missed even though the care plan covers them

A fall with a head strike, a suspected fracture, or any head injury in someone taking a blood thinner needs emergency assessment — call 911 or go to the emergency department rather than waiting for the next scheduled reassessment. Where the nearest hospital is an hour away, that call is more urgent, not less.

This page explains how assisted living costs are measured and what the public data does and does not show. It is general information rather than medical, legal, or financial advice, and it does not assess any individual's care needs or eligibility for any programme. Costs, Medicaid rules, and state programmes change. Care and payment decisions are worth working through with a clinician, and with North Dakota's own Medicaid and aging agencies for anything touching eligibility.

References

  1. 1.CareScout (Genworth) (2024). Cost of Care Survey 2024. CareScout / Genworth. link ✓The 2024 national median monthly assisted living cost of $5,900, up 10% from $5,350 in 2023, with inflation identified as the leading driver for assisted living and labour cost the leading driver for home care; the methodology (4,610 completed assisted living surveys from 17% of licensed communities; monthly private-pay rate for a one-bedroom unit; rates collected as they ranged from basic to substantial care with the high-low average used; approximately 58% of communities charging a one-time non-refundable fee; collection July-December 2024; both small group homes and large multi-service communities qualifying as assisted living; more than 70 names or designations in use and generally fewer than 40% using 'assisted living' in their formal name or licensure designation); and the region structure (431 regions based on 383 federal MSAs defined by OMB, some counties outside the MSA regions also included, the July 2023 OMB redelineation reflected in all 2024 data, regions often including counties from other nearby states, results reported only where data collection was successful) together with the specific North Dakota, Minnesota, Michigan and New York region definitions listed in the report.
  2. 2.Genworth Financial / CareScout (2025). Genworth and CareScout Release Cost of Care Survey Results for 2024. Genworth Financial Investor Relations. link ✓The 2024 national median annual assisted living cost of $70,800, a 10% year-over-year increase.
  3. 3.Centers for Medicare & Medicaid Services (2026). Long-term care coverage. Medicare.gov (U.S. Centers for Medicare & Medicaid Services). link ✓That Medicare and most health insurance, including Medigap, do not pay for long-term custodial care — help with activities of daily living — in assisted living, a nursing home, or the community when that is the only care needed.
  4. 4.Centers for Medicare & Medicaid Services (2025). Home & Community-Based Services 1915(c). Medicaid.gov (U.S. Centers for Medicare & Medicaid Services). linkThat Section 1915(c) waivers let states provide long-term services and supports in the home or community instead of an institution, targeted to people who would otherwise require an institutional level of care, and that what is covered and who qualifies vary by state.
  5. 5.Centers for Medicare & Medicaid Services (2026). PACE (Programs of All-Inclusive Care for the Elderly). Medicare.gov (U.S. Centers for Medicare & Medicaid Services). link ✓That PACE is a Medicare and Medicaid programme for people 55 and older who need a nursing-home level of care but can live safely in the community, providing coordinated care to help them avoid nursing-home placement.
  6. 6.Centers for Medicare & Medicaid Services (2025). Programs of All-Inclusive Care for the Elderly Benefits. Medicaid.gov (U.S. Centers for Medicare & Medicaid Services). linkThat PACE provides all Medicare- and Medicaid-covered services plus anything the interdisciplinary care team deems necessary, and that enrollees with Medicaid generally pay no monthly premium and no cost-sharing for PACE-approved care.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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