North Carolina Faces Long-Term Care Crisis Amid Caregiver Shortages and Rising Costs
North Carolina's sunny shores and charming towns are attracting not just tourists but a growing wave of retirees. This demographic shift, however, presents a looming challenge: a long-term care crisis fueled by a rapidly aging population. On the horizon, a silver tsunami.
According to the North Carolina Office of State Budget and Management, the number of residents aged 65 and over is projected to nearly double in the next two decades. This trend mirrors the national picture, with the US Census Bureau predicting that the number of adults 65 and older will reach a staggering 80 million by 2040.
Projected Population Change of Older Adults in North Carolina, 2021 - 2041
North Carolina's "graying" is particularly pronounced. In 2020, one in six residents was 65 or older, but by 2028, that number is expected to balloon to one in five. This aging translates to a significant portion of the population potentially requiring assistance with daily activities in the near future, placing a strain on families and social services.
North Carolina Gov. Roy Cooper says there is a shortage of caregivers for a growing aging population.
We know that there is a critical shortage right now to look after seniors and to make sure they receive the direct care that they need.
Financial Burden of Aging in North Carolina
Long-term care services, which include everything from assistance with bathing and dressing to medication management, can be financially crippling for many American families. Traditional health insurance and Medicare don't cover these costs, as these programs only pay for short-term skilled care, leaving many families scrambling.
While Medicaid, the government program for low-income individuals, can help, its eligibility requirements are strict, often leaving families on the hook for substantial expenses or for adult children to alter their lives to become caregivers.
Long-Term Care Insurance Paying Record Amounts in North Carolina
Long-term care Insurance has been paying millions in tax-free benefits to pay for quality care services in North Carolina and nationwide. AHIP's Long-Term Care Insurance Coverage report reveals a significant payout: North Carolina insurers paid a staggering $397,035,000 in LTC Insurance benefits in the last reporting year alone (2021).
Even more striking, the total payout since the inception of LTC Insurance in the state amounts to a whopping $3,968,735,000. These figures underscore the critical role Long-Term Care Insurance plays in helping families manage long-term care's physical, emotional, and financial burden.
The national picture paints a clear picture of surging demand. The American Association for Long-Term Care Insurance (AALTCI) reports that in 2023, top insurance companies paid out more than $14.1 billion in LTC Insurance benefits across the country.
A Workforce on the Brink: The Caregiver Shortage Looms Large
The looming long-term care crisis in North Carolina extends beyond just financial burdens. It also poses a significant challenge to the state's healthcare workforce. As the aging population swells, the demand for qualified caregivers and nurses to provide essential services will skyrocket.
The North Carolina Department of Health and Human Services (NCDHHS) paints a grim picture. Their reports indicate a critical shortage of caregivers across the state, with projections estimating over 186,000 job openings for direct care workers between 2018 and 2028. This shortage isn't limited to in-home care either. Hospitals and nursing facilities also face a growing strain on their nursing staff.
North Carolina is experiencing this crisis acutely. An estimated shortage of 12,500 nurses is projected by 2033, highlighting the urgent need for effective solutions.
One way to navigate the nursing shortage is to retain experienced nurses and other caregivers. Many registered nurses (RNs) pursue RN to BSN in North Carolina to advance their education and take on higher-level positions. These programs allow RNs to obtain a Bachelor of Science in Nursing (BSN), equipping them with the skills needed for leadership roles and better healthcare service management. The flexibility of online RN-to-BSN programs makes it easier for working nurses to continue their education without disrupting their careers.
Online programs also allow CNAs to pursue RD degrees as well.
The lack of qualified caregivers and nurses has real consequences for seniors in need. When the workforce is stretched thin, longer wait times for home care services, limited availability of nursing home beds, and even potential neglect can occur, impacting the quality of life for seniors but also places additional stress on families struggling to navigate the long-term care system.
Long-Term Care Costs Increasing
The growing demand for long-term care services, coupled with caregiver shortages, is driving up costs, significantly impacting North Carolina families and their retirement savings.
An LTC NEWS survey of long-term care costs in North Carolina highlights how these expenses are expected to rise in the coming decades.
The LTC NEWS Cost of Long-Term Care Calculator for North Carolina shows that the state medium average of in-home care (based on a 44-hour week) is $4,168 a month. In 2044, the same amount of home care is expected to run $7,101 per month.
Base assisted living costs average $4,043 statewide. However, surcharges can add $1,800 or more per month. In twenty years, that base cost is expected to average $6,888 a month before surcharges.
Nursing home costs are very high, averaging $8,578 for a private room today and $14,615 monthly in twenty years.
However, in certain areas within North Carolina, higher labor costs and other economic pressures increase the cost of long-term care services well above the state average.
Compare these monthly 2024 median statewide average home care costs to these areas in North Carolina:
| City | Cost |
| Asheville | $5,158 |
| Burlington | $5,003 |
| Charlotte | $4,912 |
| Durham | $5,341 |
| Greensboro | $4,327 |
| Wilmington | $4,413 |
Proactive Planning is Key
Experts recommend considering LTC Insurance options early, ideally in your 40s or 50s, when premiums are lower, and health is typically better. Qualified Long-Term Care Insurance specialists can be valuable resources for navigating the various options and securing the best fit for individual needs.
Keep in mind that insurance premiums and underwriting rules can vary significantly between companies that offer long-term care solutions. Also, not every policy meets federal guidelines - What Are Long-Term Care Insurance Regulations, and How Do They Protect Policyholders?
The Road Ahead
As North Carolina's population ages, as does the rest of the nation, the need for long-term care solutions will only intensify. Embracing the fact that your health, body, and mind will change as you age and being prepared for the consequences that long-term care will have on your family and finances will ease the stress and loved ones and protect your future retirement income and assets from these rising costs.
With no plan, that places the full responsibility on your family and your finances.
Supporting Family Caregivers
Informal caregivers, often family members, are crucial in supporting seniors at home. When your loved ones haven't planned for long-term care, you may need to find caregivers or facilities and pay for them out of their income and assets.
Finding quality long-term care services can be challenging, but the LTC NEWS Caregiver Directory simplifies the process. You can locate caregivers, senior communities, and long-term care facilities with just a few clicks.
However, if your loved one's financial resources are limited, you or a sibling may have to take on the role of caregiver.
The North Carolina Division of Aging and Adult Services Family Caregiver Support Program offers information and counseling, helping caregivers navigate the complexities of caregiving.
The Area Agencies on Aging across the state provide training workshops on topics like medication management and personal care. You can find your local Area Agency on Aging through the North Carolina Department of Health and Human Services website.
Family caregivers need to protect themselves from physical and emotional stress. Paying for respite care is an option for those on a limited budget to allow "time off" for family caregivers.
Adult Day Care Centers are an outstanding option for respite care - Adult Day Care Centers (ADCCs.)
The "Silver Tsunami" in North Carolina is placing many challenges on family members and their savings. For your parents, it might be too late to plan depending on their age and health; however, preparing for your future retirement should happen now.