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Census 2025 estimates · CMS September 2026 · CDC 2020

Senior housing development in North Carolina

North Carolina had 910,753 residents aged 75 and older in July 2025, +29.0% since April 2020 (US +23.4%), and 210,994 aged 85 and older (+16.0%). Its 419 certified nursing homes hold 43,850 beds, 207.8 for every 1,000 people 85 and older, fewer than the US ratio of 222.6. Certificate of need for nursing home beds: yes; for assisted living: yes (adult care homes).

Age 75+ (2025)
910,753
Growth since 2020
+29.0%
Nursing beds per 1,000 aged 85+
207.8
Assisted living beds per 1,000 aged 75+
37.2

Demand: the older population

Age groupApril 2020July 2025ChangeUS change
75 and older705,931910,753+29.0%+23.4%
85 and older181,829210,994+16.0%+11.3%

Nationally, the Census Bureau's 2023 projections have the 75+ population growing 21% from 2025 to 2030 and the 85+ population 59% from 2025 to 2035. The bureau publishes those projections for the US only, not by state.

Supply: licensed beds

SettingBedsPer 1,000 aged 75+Per 1,000 aged 85+Source
Nursing homes (Medicare or Medicaid certified)43,85048.1207.8CMS, September 2026
Residential care / assisted living33,90037.2160.7CDC survey, 2020

US: 222.6 nursing beds and 170.1 assisted living beds per 1,000 aged 85+. Assisted living beds are CDC's 2020 survey estimate, its latest with state detail, set against 2025 population, so the ratio understates any supply added since.

Certificate of need

Nursing home beds
Yes
Assisted living
Yes (adult care homes)
Notes
Lists "Adult care homes", NC's main licensed assisted living category

From NCSL's certificate of need table (updated April 29, 2025, covering January 2025) with later changes checked on state sites on October 24, 2026. "Not listed" means NCSL does not name assisted living, not that it is exempt. Confirm with the state health planning agency before relying on it. HUD requires a state CON for nursing home beds where the state has one (Handbook 4232.1, 2.5.EE).

Counties

The 25 counties with the most residents aged 75+, with certified nursing home beds per 1,000 aged 85+.

CountyAge 75+Since 2020Share of populationAge 85+Nursing homesBeds per 1,000 aged 85+
Wake County76,989+45.3%6.1%18,32621118.6
Mecklenburg County67,871+36.0%5.5%15,96429186.9
Guilford County44,383+25.3%7.9%11,08820206
Forsyth County33,267+23.6%8.3%8,31214177.7
Buncombe County28,911+31.3%10.4%6,59519287.9
Brunswick County25,594+61.6%14.7%4,3575129.4
New Hanover County23,590+34.6%9.6%5,52411176.9
Durham County23,533+40.9%6.8%5,40913261
Cumberland County20,083+21.5%5.9%4,76910215.8
Gaston County18,930+23.2%7.7%4,72810197.5
Union County17,173+39.2%6.4%3,7457186.1
Henderson County17,101+25.1%14%4,0639224.5
Iredell County16,346+30.4%7.7%3,7505134.9
Davidson County16,276+24.9%9%3,8979227.9
Cabarrus County15,838+31.5%6.3%3,6147186.8
Alamance County15,545+21.6%8.3%3,9637221
Johnston County15,392+41.2%6%3,0245203.4
Catawba County15,336+23.6%9%3,5326210.1
Randolph County13,682+23.4%9.2%3,0276237.9
Moore County13,556+18.9%12.3%3,4477204.5
Rowan County13,193+19.7%8.5%3,1119271.3
Pitt County12,427+33.9%6.8%2,9196187.1
Orange County11,780+45.4%7.7%2,685381.2
Chatham County11,510+38.2%13.5%2,8073109
Craven County11,276+29.0%10.7%2,6315175.2

Fastest growth in the 75+ population

  1. Brunswick County: +61.6% (25,594)
  2. Orange County: +45.4% (11,780)
  3. Wake County: +45.3% (76,989)
  4. Currituck County: +43.9% (2,472)
  5. Lincoln County: +43.0% (8,929)
  6. Franklin County: +41.8% (6,148)
  7. Johnston County: +41.2% (15,392)
  8. Durham County: +40.9% (23,533)
  9. Dare County: +40.1% (4,390)
  10. Union County: +39.2% (17,173)

Counties with at least 2,000 residents aged 75+.

Fewest nursing beds per 1,000 aged 85+

  1. Orange County: 81.2 (218 beds, 2,685 aged 85+)
  2. Chatham County: 109 (306 beds, 2,807 aged 85+)
  3. Wake County: 118.6 (2,174 beds, 18,326 aged 85+)
  4. Brunswick County: 129.4 (564 beds, 4,357 aged 85+)
  5. Iredell County: 134.9 (506 beds, 3,750 aged 85+)
  6. Carteret County: 160.6 (302 beds, 1,880 aged 85+)
  7. Onslow County: 162.4 (359 beds, 2,210 aged 85+)
  8. Nash County: 165.9 (318 beds, 1,917 aged 85+)
  9. Lincoln County: 171.8 (300 beds, 1,746 aged 85+)
  10. Pender County: 174.3 (210 beds, 1,205 aged 85+)

Counties with at least 1,000 residents aged 85+.

HUD Section 232 construction in North Carolina

Since fiscal 2001 HUD has insured 63 new construction or substantial rehabilitation loans on care facilities in North Carolina (24 assisted living, 26 nursing homes), $303.2 million of original principal, 4 of them since fiscal 2016.

  • FY2022: The Foley Center at Chestnut Ridge, Blowing Rock, nursing home, $10.5 million
  • FY2017: Spring Arbor of Greenville, GREENVILLE, assisted living, $2.5 million
  • FY2017: Spring Arbor of Wilmington, Wilmington, assisted living, $2.6 million
  • FY2016: Spring Arbor of Cary, Cary, assisted living, $17.6 million

Planning a building in North Carolina? Model the budget, lease-up and a HUD 232 construction loan.

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Sources: Census Bureau Vintage 2025 county population estimates; CMS Nursing Home Provider Information (September 2026); CDC/NCHS National Post-acute and Long-term Care Study (2020); HUD Office of Healthcare Programs endorsement database (data run 07/08/2026); NCSL. Absorption is operated by Janover Capital LLC and is not affiliated with any of them. Methodology.