Dementia Care in North Dakota: A Caregiver's Guide (2026)

About 14,000 North Dakotans 65 and older were living with Alzheimer's in 2020, and 19,000 family caregivers carry the work of caring for people living with dementia in the state.1

Dementia caregiving is its own kind of hard: the long arc, the behavioral changes, the safety worries, the grief that starts before any loss. This guide maps the North Dakota-specific help available in 2026, from the free 24/7 helpline to Medicaid respite to the programs that can pay you for the care you already provide.

You do not have to do this alone, and you do not have to fund all of it from your savings.

In This Guide

• Where to Start
• North Dakota Dementia Caregiving, by the Numbers
• North Dakota's Dementia Support Infrastructure
• Who Pays for Dementia Care in North Dakota
• Respite Care for Dementia Caregivers in North Dakota
• Safety, Behavior, and Planning
• Frequently Asked Questions
• Learn More

Where to Start

When a diagnosis lands, or when caregiving starts to outpace what you can manage alone, two contacts are the place to start in North Dakota:

• The Alzheimer's Association 24/7 Helpline: 1-800-272-3900. A live person answers around the clock, 365 days a year, with information, local resources, crisis assistance and emotional support, in more than 200 languages. The service is free and open to caregivers, families and the public, and conversations are confidential, with one limit: Helpline Care Consultants are mandated reporters, so if abuse or neglect is reported to them, they are required by law to report it to state authorities.2
• The ND Aging & Disability Resource-LINK: 1-855-GO2LINK (1-855-462-5465), 711 for TTY. It is how families reach the North Dakota Family Caregiver Support Program, which offers a trained caregiver coordinator to help assess your needs, counseling, support groups and training, and respite for caregivers who provide 24-hour care.2

North Dakota Dementia Caregiving, by the Numbers

About 14,000 North Dakotans age 65 and older were living with Alzheimer's disease in 2020, and about 19,000 family caregivers provide an estimated 26 million hours of unpaid care.1

If the work feels overwhelming, that is not a personal failing. It is the reality of a condition that can demand a great deal, for a long time.

North Dakota's Dementia Support Infrastructure

North Dakota's own caregiver front door is the North Dakota Family Caregiver Support Program, run by ND Health and Human Services Adult and Aging Services and federally funded under the Older Americans Act.2

It offers help to four groups. The one that matters most here: individuals caring for a person with Alzheimer's or another type of dementia, regardless of age. The program also serves people caring for an adult age 60 or older, and relative caregivers age 55 or older who are caring for grandchildren or other young relatives age 18 or younger, or caring for an adult child age 19 to 59 who has a disability.2

Its services include information about local community services and supports, a trained caregiver coordinator, counseling, support groups and training, respite care offering a short break to caregivers who provide 24-hour care, and supplemental services toward the cost of incontinence supplies and assistive devices such as a shower bench or safety rails. Services are provided at no cost to qualifying people and are federally funded, and caregivers have the opportunity to contribute toward the cost. Reach the program through the ND Aging & Disability Resource-LINK at 1-855-GO2LINK (1-855-462-5465), 711 for TTY, by email at carechoice@nd.gov, or by applying online.2

Who Pays for Dementia Care in North Dakota

North Dakota Medicaid (HCBS Waiver)

For North Dakotans who qualify, the Medicaid Home and Community Based Services (HCBS) waiver covers respite care alongside adult day care, adult foster care, adult residential care, extended personal care, family personal care, homemaker, chore, home delivered meals, emergency response, supervision and other services. North Dakota Health and Human Services describes the waiver as designed for members ages 65 and older, or 18 to 64 with a disability such as brain injury or dementia, and defines respite as relief for the primary caregiver of a person who is ill or disabled. The current waiver took effect Jan. 1, 2026.3

Two further conditions decide whether a family actually gets it. First, this is Medicaid: the waiver serves eligible Medicaid members, and ND HHS says waivers give eligible people options if their needs can be met in their homes and if home and community services are cost neutral compared to institutional services. Second, medicaid.gov describes the waiver as serving people who meet a nursing facility level of care.3

On the financial side, North Dakota Medicaid may review assets for the last five years when it decides long-term care eligibility, to make sure they were not transferred or given to others. Adults who are not severely impaired in daily activities may instead fit North Dakota's Basic Care Assistance Program, which helps people who qualify for Medicaid pay a portion of their care cost in a licensed basic care facility.3

Here is how to move from "we might qualify" to enrolled:

Getting Paid to Care for a Loved One With Dementia

Some North Dakota dementia caregivers can be paid through the HCBS waiver's family personal care service. It lets a waiver member choose their spouse, or a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or adult nephew, as their paid provider. Payment is made only to a legal spouse or family member who lives in the same home, and the relative must be enrolled as a Qualified Service Provider (QSP). Family personal care pays for help with daily activities such as bathing, dressing, toileting, transferring and eating, but not for housework, laundry, meal preparation, shopping or transportation.3 Our North Dakota Family Personal Care guide explains enrollment in more detail.

For veterans' families, VA's caregiver program is another route (below). The pathways and the pay are covered in the North Dakota paid family caregiver guide.

VA Benefits (for Veterans)

If the person you care for is a veteran, the VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to the approved Primary Family Caregiver, which VA called a nontaxable benefit when it proposed the current rules in 2020, and a spouse can serve in that role. Approval alone does not start the money: VA states that you must be enrolled in direct deposit using the VA customer engagement portal to get your monthly stipend.4

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:4

• A VA disability rating, individual or combined, of 70 percent or higher.4
• Discharge from the U.S. military, or a date of medical discharge.4
• A need for at least six months of continuous, in-person personal care services.4
• Enrollment in VA health care.4

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:4

• Participating in the program is in the veteran's best interest.4
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.4
• The veteran receives care at home, or will do so if VA designates a family caregiver.4
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.4

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.4

Separately, VA Aid and Attendance (A&A) adds a monthly amount to a VA pension for qualified veterans and survivors: someone who gets that pension may be eligible if they meet at least one of VA's listed requirements, such as needing another person to help with daily activities like bathing, feeding, and dressing, or being a patient in a nursing home because of the loss of mental or physical abilities related to a disability.4 The Veterans Pension requires wartime service, among other conditions.5

For help understanding these benefits, call the VA Caregiver Support Line at 1-855-260-3274, staffed Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time. It is not a crisis line: anyone in crisis or having thoughts of suicide can reach the Veterans Crisis Line any hour of any day by calling 988 and pressing 1, or texting 838255.6

Medicare

Medicare covers specific dementia-related services. If signs of cognitive impairment show up at a routine or yearly Wellness visit, Medicare Part B covers a separate visit to assess cognitive function and write a care plan, which may help diagnose dementia; after the Part B deductible, the patient pays 20% of the Medicare-approved amount. Medicare also covers certain home health services when a person is homebound and needs part-time or intermittent skilled services, and hospice when a hospice doctor and the person's regular doctor certify a life expectancy of 6 months or less and the person chooses comfort care instead of care to cure the illness. It does not pay for long-term custodial care, meaning ongoing non-medical help with bathing, dressing and using the bathroom, when that is the only care a person needs.7

The Guiding an Improved Dementia Experience (GUIDE) Model, a voluntary, nationwide CMS Innovation Center model, provides care navigation, a 24/7 support line, caregiver training and education, respite services, and connections to community resources, but only through a participating provider and only for patients aligned to one. To be aligned, a patient must have dementia confirmed by a participant's clinician, be enrolled in both Medicare Parts A and B with Medicare as the primary payer, not be in Medicare Advantage or another Medicare health plan (including Special Needs Plans and PACE), not be in the Medicare hospice benefit, and not be a long-term nursing home resident (a stay of 101 days or more). Beginning in performance year 2026, the patient must also live in a private residence or in a residential care community that CMS has approved as a partner organization of that provider, and a patient living in a memory care unit cannot be aligned.7

GUIDE respite is narrower still. Only aligned patients with moderate or severe dementia whose primary caregiver is a relative or an unpaid nonrelative are eligible for it, and aligned patients living in assisted living or another residential care community are not. For the performance year that began July 1, 2026, CMS pays the participating provider up to $2,625 a year per eligible patient for respite; the money goes to the provider, not the family, and unused funds do not carry over. Not every provider takes part, so ask your loved one's doctor whether they are enrolled in GUIDE.7

Respite Care for Dementia Caregivers in North Dakota

Respite is what makes the long haul survivable. The North Dakota Family Caregiver Support Program offers respite care as a short break for caregivers who provide 24-hour care, at no cost to qualifying people, though caregivers have the opportunity to contribute toward the cost. For the full picture, see Respite Care in North Dakota.2

The Medicaid HCBS waiver also covers respite care and adult day care for eligible members who meet a nursing facility level of care.3

Safety, Behavior, and Planning

Dementia often brings its own safety and planning questions: wandering, driving, sundowning, and legal and financial planning such as a durable power of attorney and advance directives, ideally while your loved one can still take part in the decisions. The Alzheimer's Association 24/7 Helpline (1-800-272-3900) can offer information, local resources, crisis assistance and emotional support when these come up.2

Learn More

Find personalized help caring for a loved one with dementia in North Dakota at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.