In New York, assisted living residences fall under the formal category of adult-care facilities (ACFs), which provide housing, meals, supervision, personal care assistance, such as assistance with activities of daily living (ADLs) like bathing, dressing, and mobility (getting up from a chair/bed, walking, etc.), social activities, case management, and / or housekeeping for adults who are cognitively or functionally impaired. New York offers three types of adult-care facilities: adult homes, enriched housing programs, and assisted living residences. Of these adult-care facilities, adult homes provide the least intensive care, and assisted living residences provide the most intensive care.
In addition to traditional assisted living residences, New York has Special Needs Assisted Living Residences (SNALR), also referred to as Alzheimer’s care, dementia care, or memory care. These residences are designed and staffed specifically for persons with Alzheimer’s and other dementias. These types of homes in New York differ from traditional assisted living in several ways. These include increased security and supervision, additional staff training, recreational activities specific for persons with dementia, and of course, cost. A point of distinction should be made that memory care homes are not nursing homes. Generally SNALRs are less expensive and offer a better quality of life to their residents than do nursing homes.
In NY, assisted living residences, including memory care, accommodate a minimum of 5 residents, all of which must be unrelated to the assisted living provider. In order to be advertised as a SNALR, the residence requires both licensing as an assisted living facility and a certificate indicating it is a Special Needs Assisted Living Residence. SNALR’S may be units in traditional assisted living residences or may be standalone residences.
Due to the added level of security and supervision of Special Needs Assisted Living Residences in New York, memory care generally costs several hundred dollars more per month than does traditional assisted living. Statewide, as of 2019, the average cost of memory care is $4,983 / month, but based on the geographic location in which one resides, the average low may be as little as $1,313 / month and the average high may be as great as $13,253 / month. The most affordable areas of the state are Utica, where the average monthly cost of memory care is $3,097, and Glens Falls, with an average cost of $3,068 / month. The most expensive average cost per month can be found in the following areas of the state: Watertown ($6,500), Elmira ($6,737), and outer New York City ($6,980). However, even within the same geographic region, the average monthly cost can fluctuate greatly. For instance, in Binghamton, the average cost of memory care is $6,218, but can be found as low as $4,412 / month and as high as $15,773 / month.
All assisted living residences in New York must have an administrator who is a minimum of 21 years old that oversees it. If the administrator does not have a nursing home administrator license from the state of New York, he/she is required to take continuing education courses (60 hours every 2 years). In addition, each residence must have a case manager, as well as aides that provide residents assistance with personal care (bathing, personal hygiene, getting dressed/undressed, toiletry, etc.).
Special Needs Assisted Living Residences for persons with dementia must be physically constructed for the safety and wellbeing of those with such neurological disorders. For instance, while memory care units may not be fully locked, all doors leading to outside must have delayed egress systems, preventing the doors from opening immediately. The windows must have window stops, which keep the windows locked, and residences must also have enclosed outdoor areas to prevent wandering. In addition, activities specifically geared towards persons with dementia are required, as well as supervision around the clock.
Staff at assisted living residences must attend an orientation and undergo training, both initially and ongoing. Employees working with persons with Alzheimer’s disease and related dementias in special needs assisted living (memory care) must undergo training specific to this population. This includes common behaviors associated with dementia, emotional, cognitive, and functional changes that occur with the progression of the disease, and how to best assist persons with dementia. The number of hours of training that is required is not specified.
In New York, there are no set requirements as far as number of staffing that an assisted living residence must have on duty at any given time. In fact, it is very ambiguous, as the state specifies that there must be sufficient staff to meet the needs of the residents. However, it is left up to each residence to determine the number of staff that is needed to meet the residents’ needs. For dementia units, there is a bit more specification. A case manager, as well as an activities director, must be on duty at least 30 minutes each week per resident. For employees that work directly with the staff, 1 employee per 6-8 residents is recommended during the day and one employee per 12-15 residents at night. However, these figures can be adjusted based on an administrator showing that the needs of the residents can be met with a different staffing pattern.
In NY, in order to be admitted to an adult-care facility, including a Special Needs Assisted Living Residence, a potential resident must not require constant medical care, must not be confined to bed, and must not have impairments (physical, cognitive, or mental) that jeopardize the safety of oneself or others. In addition to the above, potential residents must take part in a comprehensive assessment covering a wide variety of topics, such as medical, behavioral, and mental health history. Needs will be considered and a personalized care plan created for each resident. At a minimum, reevaluation of each resident must take place on a bi-annual basis.
This should go without saying, but residents of Special Needs Assisted Living Residences must have Alzheimer’s disease or some form of dementia.
In most cases, a family will spend several weeks deciding which assisted living residence best meets the needs of his/her loved one. They then will spend several more weeks relocating their loved one and getting him/her settled in. Please note: Many assisted living residences have waiting lists, and therefore, admission is not always immediate.
While the cost of Special Needs Assisted Living (memory care) can be quite expensive, financial assistance is available for low-income persons in New York who need it.
Medicaid is a jointly funded federal and state health care program, and in New York (like all states), it pays for nursing home care for financially needy persons. NY offers its Medicaid recipients a Community First Choice State Plan Option, also referred to as CFCO. This option allows Medicaid recipients to receive long-term care services through the NY state Medicaid plan, which is an entitlement, meaning anyone who meets the eligibility requirements can receive services. While CFCO is not relevant to persons residing in assisted living / memory care residences, it is beneficial for persons who can continue to live at home alone or are awaiting placement in memory care or a nursing home.
Managed Long Term Care (MLTC) Program
The Managed Long Term Care Program offers three different managed care plans: The MLTC Medicaid Plan (only Medicaid services), Medicaid Advantage Plus (Medicare and Medicaid services), and the Program for All-Inclusive Care for the Elderly (Medicare and Medicaid services). These programs streamline long-term care needs for persons, including those with dementia, who require nursing home level of care, but wish to remain living in the community. A variety of care services and supports are available, including personal care assistance for those residing in assisted living residences. To be clear, the cost of room and board in assisted living is not covered, only care services.
NY’s Assisted Living Program (ALP)
The Assisted Living Program is for NY state residents 21 years of age and older who require the level of care that is provided in a nursing home. Personal care assistance, skilled nursing, housecleaning, and physical & occupational therapy are some of the benefits that are available via this program. Room and board may also be covered, although the funding comes from a non-Medicaid source. While the majority of ALP participants are on Medicaid, one does not have to be on Medicaid for program enrollment.
While not limited to New York, the VA offers an Aid & Attendance (A&A) pension for veterans and surviving spouses who receive either the basic VA pension or the basic survivor’s VA pension. Persons must be a minimum of 65 years old or disabled and require assistance with completing activities of daily living, such as mobility, transferring, eating, and bathing. The monthly cash assistance received from these pensions can be used as the recipient wishes, which means it can go towards the cost of Alzheimer’s care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing one’s countable income when determining one’s pension benefit amount. In 2019, veterans can receive as much as $26,765 / year, and surviving spouses can receive as much as $14,529 / year. Learn more here.
There are also State Veterans homes, which are residential care facilities that provide long-term care for Veterans. Nursing home care, assisted living, as well as memory care may be provided. Payment is made directly from the VA to the facility.
The Special Needs Assisted Living Voucher Demonstration Program is specific to the state of New York and offers financial assistance in the form of a voucher to help fund the cost of memory care for person’s with Alzheimer’s disease and other related dementias. Through this NY Department of Health program, 200 assisted living vouchers are available for persons who can no longer afford to privately pay for special needs assisted living, and as a result, would have to be moved to a Medicaid-funded nursing home. The average monthly cost of memory care is considered for the region. That said, vouchers may pay as much as 75% of the average cost.