Memory Care Facility Licensing in North Dakota: Requirements Families Should Verify

How North Dakota Regulates Memory Care

North Dakota does not issue a separate memory care license. Specialized dementia care is regulated as an optional designation within the state's existing facility licenses. For basic care facilities, the relevant rule is N.D. Admin. Code § 33-03-24.1-24. This means "memory care" in North Dakota is not a distinct facility type — it's an authorization layered on top of an existing facility license.

A facility that wants to market or operate specialized Alzheimer's, dementia, or memory care services must apply to the Health Response and Licensure Unit within North Dakota Health and Human Services. The unit reviews the facility's staffing plan, physical safety features, and training programs before granting authorization.

The critical consumer protection built into this system: assisted living facilities licensed under N.D.C.C. Chapter 50-32 are legally prohibited from advertising or claiming to provide memory care unless they also hold an approved basic care license. Any facility marketing "memory care" or "Alzheimer's care" that only holds an assisted living license is making a claim it cannot legally back up.

Staff Training Mandates

The training requirements for facilities authorized to provide memory care are specific and measurable:

Initial training: All nursing and personal care staff must complete at least 8 hours of dementia-specific education within three months of hire. This training must cover the progression of dementing illnesses, behavioral management techniques, communication strategies, and personal care approaches tailored to cognitive impairment.

Competency evaluation: Staff are legally prohibited from working independently with memory care residents until they have completed a verified competency evaluation. This is not a formality — the evaluation must demonstrate the staff member can safely manage the specific behavioral and safety challenges of dementia care.

Continuing education: A minimum of 4 hours of annual dementia-focused continuing education is required for all staff working in approved memory care units.

Medication administration: In basic care facilities, staff registered on the North Dakota Nurse Aide Registry who have completed state-approved training may administer oral, topical, inhalant, vaginal, or rectal medications under RN supervision. However, they are prohibited from administering "as needed" (PRN) controlled prescription medications — those require licensed nurse intervention.

Physical Safety Standards

Facilities authorized for memory care must meet physical plant requirements designed around the specific risks of cognitive impairment:

• Secured exits to prevent elopement and wandering
• Environmental design that minimizes confusion (consistent wayfinding cues, reduced glare, appropriate lighting for residents with altered visual processing)
• Emergency systems that account for residents who cannot self-evacuate
• Outdoor spaces that allow supervised access without exit risk

The "capable of self-preservation" standard is the regulatory threshold that determines whether a resident can remain in a basic care facility. If a resident can no longer move to safety during an emergency — fire evacuation, severe weather — the facility is legally required to transition them to a higher level of care. This standard is assessed through ongoing functional evaluations.

What to Verify Before Choosing a Facility

Families evaluating memory care facilities in North Dakota should request the following directly from the facility or the Health Response and Licensure Unit:

1. License type and memory care authorization: Confirm the facility holds a basic care license with approved memory care designation — not just an assisted living license
2. Most recent inspection report: Review any deficiency citations, especially those related to staffing, medication management, or resident safety
3. Staff training records: Ask for documentation of the 8-hour initial dementia training and annual continuing education for current staff
4. Staff-to-resident ratio: There is no state-mandated minimum ratio for memory care, so this varies by facility. Ask specifically about overnight staffing — basic care requires 24-hour awake staff, but the number of staff members present varies
5. Discharge criteria: Ask under what circumstances the facility would initiate an involuntary transfer or discharge, and confirm they provide the legally required 30 days written notice

The Chemical Restraint Rule

North Dakota prohibits the use of psychopharmacologic drugs for discipline, staff convenience, or as a substitute for active behavioral intervention. A chemical restraint may only be administered when ordered in writing by a physician, nurse practitioner, or physician's assistant to treat a documented medical symptom or ensure immediate physical safety. In emergencies, a restraint may be applied only until a written order is promptly obtained.

If you suspect a facility is using medication to manage behavior without proper documentation, contact the State Long-Term Care Ombudsman. Families have the right to review their parent's medication administration records at any time.

The North Dakota Dementia & Memory Care Guide includes a facility evaluation scorecard structured around these licensing and safety requirements — designed to turn a facility tour into a systematic verification process rather than a marketing presentation.

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