Why small homes matter
What North Carolina pays for a person to have a home.
These numbers are public. Almost nobody knows them. We think more people should.
Forty-six dollars a day
What $46 actually buys.
In 2026, North Carolina's Special Assistance program pays a maximum of $1,397 a month for an eligible resident's room and board in an adult care home. That works out to about forty-six dollars a day.
Forty-six dollars covers the room, the utilities, three meals and snacks, the laundry, and a house with staff in it around the clock.
A budget motel room costs more than that. It doesn't come with dinner.
(Hands-on personal care is paid separately, through Medicaid, by the hour, and only for the hours an assessor approves.)
A budget motel room costs more than that. It doesn't come with dinner.
What the alternatives cost
Where a person can live, and what it costs.
| Per month | Per day | |
|---|---|---|
| Small home, Special Assistance resident | $1,397 | ≈$46 |
| Assisted living, NC median, private pay | $6,496 | ≈$214 |
| Nursing home, semi-private, NC median | $9,733 | ≈$320 |
NC Special Assistance rate, 2026. Assisted living and nursing home figures are North Carolina medians.
A small home is the least expensive residential care North Carolina buys. A nursing home bed costs the public about seven times as much.
The rate didn't move for fourteen years
Still, from 2008 to 2022.
From 2008 to 2022, the Special Assistance rate did not increase once. Not through the financial crisis, not through a decade of rising food and labor costs. It only began moving in January 2022, when it was tied to the annual Social Security cost-of-living increase.
There's a cruel wrinkle in that. While the rate stood still, Social Security and SSI did give raises — which pushed people's incomes up against an eligibility ceiling that wasn't moving. People lost their assistance because their Social Security went up.
And the limit is a cliff, not a slope. One dollar over, and the payment is zero.
The state's own study says the rate is too low
$1,780, against $1,397 today.
In August 2024, a cost analysis prepared for the Department of Health and Human Services concluded the monthly rate should be $1,780.
The rate today is $1,397. That's a gap of nearly four hundred dollars per resident, per month, at every one of these homes in North Carolina.
Who's left doing this work
Every one of them is privately owned.
There are roughly 530 licensed family care homes in North Carolina and about 582 larger adult care homes. Every single one is privately owned and operated. The state licenses them and pays them. It does not run them.
There is no public system standing behind these houses. When one closes, the people who live there are simply moved — somewhere bigger, somewhere further from their family, or into a nursing home that costs the public several times more.
We think that's worth understanding before the next one closes.
Come and look
The best way to understand a house is to walk into one.
Any day, no appointment. Walk through the whole house, meet whoever is on shift, and ask us anything you want.