In New York regulations, assisted living homes fall under the formal category of adult-care facilities (ACFs), which provide the following for adults who are cognitively or functionally impaired:
– 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
– 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 ACFs, adult homes provide the least intensive care, and assisted living residences provide the most intensive care.
For people with Alzheimer’s disease or related dementia, , New York has Special Needs Assisted Living Residences (SNALR), also referred to as memory care. These residences are designed and staffed specifically for persons with dementia. These types of homes in New York differ from traditional assisted living in several ways, including increased security and supervision, additional staff training, recreational activities specific for persons with dementia, and, of course, cost (see below). 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 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 an SNALR, the residence requires both licensing as an assisted living facility and a certificate indicating it is a Special Needs Assisted Living Residence. SNALRs may be units in traditional assisted living residences or may be standalone residences.
Assisted living in New York is regulated by the state’s Department of Health. There are almost 400 memory care homes in New York. There are also 30 board and care homes, which offer the same services as assisted living, sometimes including memory care. Board and care homes are smaller, more like a house, with fewer than 12 residents. For free help finding memory care to meet your family’s needs and budget, click here. https://www.dementiacarecentral.com/memory-care-form/
Memory care homes, or Special Needs Assisted Living Residences as they are referred to in New York regulations, cost on average $5,668 per month statewide, or about $68,016 annually. However, there are great cost differences throughout the state. It is worth noting as well that memory care costs significantly more each month than regular assisted living. One should expect to pay $1,000 – $1,500 more for the higher security and higher level of care provided in memory care homes when compared to traditional assisted living.
The most expensive areas of New York for memory care are, of course, the New York City area, as well as Ithaca and Watertown. In these areas, costs are approximately 25% higher than the statewide average. NYC memory care costs about $7,067 per month and $84,804 annually. Less expensive memory care can be found around Albany, Buffalo, Rochester, Syracuse and Utica. Families can expect to pay around $5,500 each month. New York cities and their memory care costs:
For New Yorkers who live near the state’s border, it might be possible to find more affordable memory care in one of New York’s neighbors. An example is Pennsylvania, whose overall memory care costs are lower than New York’s, at about $4,336 per month. The town of Scranton, within an hour’s drive of Binghamton and other southern NY cities, costs roughly $2,900 per month for memory care. To the east, Vermont ($6,278 per month), Massachusetts ($7,174) and Connecticut ($7,426) each average overall higher memory care costs than New York, but it still may be possible to find more affordable options there because rates vary widely.
|New York Memory Care / Assisted Living Costs (updated Feb. 2021)|
|Region / City||Monthly Cost||Annual Cost|
|New York City||$7,067||$84,804|
In NY, someone with these issues cannot be admitted to an adult-care facility, including memory care (Special Needs Assisted Living Residence):
– requires constant medical care
– Is confined to bed
– has impairments (physical, cognitive, or mental) that jeopardize the safety of oneself or others
Potential residents must take part in a comprehensive assessment covering a wide variety of topics, such as medical, behavioral, and mental health history. The information is used to create a personalized care plan that guides care for each resident. At a minimum, reevaluation of each resident must take place on a bi-annual basis. Assessments are usually performed by a medical professional who works for the residence. The cost of assessing might be included in the base rate, or it may be part of a one-time “community fee” that covers move-in costs including the assessment as well as deep cleaning and painting a new resident’s room. Community fees typically cost between $1,500 and $2,500.
This should go without saying, but residents of Special Needs Assisted Living Residences must have Alzheimer’s or a related disease like vascular, frontotemporal, and Lewy body dementia. An official diagnosis of Alzheimer’s or related disease is not necessarily required, however, because dementias are difficult to diagnose, with symptoms that change and vary even among people with the same disease. Whether a home is suitable for someone should be determined by the assessment.
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. Assisted living residences may have waiting lists, so admission is not always immediate. Even if it were possible to move into assisted living on short notice, it’s not a good idea because of the steps involved in finding a good home.
Memory care, or “Special Needs Assisted Living Residences for persons with dementia,” must be physically constructed for the safety and wellbeing of residents. For instance, while memory care units may not be fully locked, all doors leading outside must have delayed egress systems, preventing them from opening immediately. The windows must have window stops to keep them locked. Residences must also have enclosed outdoor areas to prevent wandering while allowing for time in the open air.
There are no minimum square footage requirements for living units (apartments) in memory care homes, but a room should typically be about 100 square feet for a single person and 150 square feet for two people. No more than two people are allowed to live in one unit. Regulations also do not specify how many bathrooms a residence must have, but most states require that every living unit in memory care have its own toilet, sink, and shower.
All assisted living residences in New York must be overseen by an administrator who is at least 21 years old. If the administrator does not have a nursing home administrator license from the state of New York, they are 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.).
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 training hours required is not specified.
In New York assisted living, there must be sufficient staff to meet the needs of the residents. However, it is left up to each residence to determine that number. For dementia units, however, there are defined staff-to-resident ratios. 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.
New York assisted living homes, including those with memory care, must give 30 days written notice before a resident has to move out. Anyone who is evicted can appeal. The process for appealing should be explained at admission, but one option is to contact New York’s Long Term Care Ombudsman in the Office for the Aging (click here) for advice and possibly an investigation.
Homes generally are allowed to evict when a resident’s personal or medical needs cannot be met there. If feeding tubes or ventilators become necessary, for example. But specific homes will have their own criteria, and it’s important to be clear on eviction rules before agreeing to move in. Can a resident be asked to leave for aggressive behavior? Is non-payment of bills after a certain amount of time enough to get a person evicted? You need to know these answers ahead of time, because unfair evictions are a big problem in assisted living.
If your loved one in memory care has received an eviction notice, and you need to know next steps, click here.
While the cost of Special Needs Assisted Living (memory care) can be quite expensive, averaging about $5,700 per month, 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 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. For more information, including how to apply, click here.
NY’s Assisted Living Program (ALP)
The Assisted Living Program is for adult NY state residents who require the level of care provided in a nursing home. Personal care assistance, skilled nursing, housecleaning, and physical and occupational therapy are some of the benefits 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. If you are on Medicaid, apply by finding your local Department of Social Services at this link. Keep in mind that only a limited number of residents (4,200) may receive this benefit.
Because of the frequency of medical conditions tied to service, including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), veterans are statistically more likely to develop dementia. Veterans around the country, including New York, should consider the VA’s Aid & Attendance (A&A) pension to help pay for care. A&A is also called the Enhanced Monthly Benefit and the Income Improvement Pension for veterans and surviving spouses who already 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 the pension benefit amount. In 2021, veterans can receive as much as $27,540 / year, and surviving spouses can receive as much as $14,928 / year. Learn more here.
There are also five State Veterans homes in New York, which are residential care facilities that provide long-term care for veterans. Nursing home care and assisted living are provided. Three of these homes offer dementia care: the New York State Veterans Home at Batavia (Western New York), the New York State Veterans Home at Oxford (Central NY, south of Syracuse), and the Long Island State Veterans Home (on the campus of Stony Brook University). There are also VA homes in New York City and Montrose (in the Lower Hudson Valley), which may be appropriate for veterans in the early and middle stages of dementia, who don’t necessarily need full-time dementia care. Payment for room and board and services at these homes is made directly from the VA to the facility. For more information, including applications and contacts, click here.
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 persons with Alzheimer’s disease and other related dementias. Through this NY Department of Health program, 200 assisted living vouchers were available for persons who could 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 was considered for the region. That said, vouchers paid as much as 75% of the average cost. Unfortunately, the Department of Health stopped accepting applications for this program in June 2020.
Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that might include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should the spouse move, the reverse mortgage would become due.
Elder care loans are for families to cover costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.