New York regulations say that assisted living homes are defined as assisting adults who are cognitively or functionally impaired with:
– personal care assistance, such as assistance with activities of daily living like bathing, dressing, and mobility (getting up from a chair/bed, walking, etc.)
– social activities
– case management
New York offers three types of adult-care facilities: adult homes, enriched housing programs, and assisted living residences. Out of these facilities, adult homes provide the least amount of 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, less formally referred to as memory care. These residences are designed and staffed specifically for patients with dementia. These types of homes in New York differ from traditional assisted living in several ways, by:
– having increased security and supervision
– requiring additional staff training
– having recreational activities specific for persons with dementia
-costing more (see below).
Memory care homes are not nursing homes. Generally, memory care is less expensive and offers a better quality of life to residents than nursing homes. In NY, assisted living residences, accommodate a minimum of 5 residents all of which must be unrelated to the assisted living provider. Residences are required to have a license as an assisted living facility and a certificate indicating it is a Special Needs Assisted Living Residence. These 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, 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.
Memory care homes cost on average $5,558 in NY. However, there are great cost differences throughout the state. Memory care costs significantly more each month than regular assisted living. You can 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 Albany. In these areas, costs are approximately 25% higher than the statewide average. Memory care in New York City costs about $6,957 monthly. Less expensive memory care can be found around Buffalo, Rochester, Syracuse and Utica.
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 neighboring states. An example is Pennsylvania, where it costs at about $4,969 per month. The town of Scranton (within an hour’s drive of Binghamton and other cities in the southern part of the state), costs $3,497 per month for memory care. To the east, Vermont averages at $6,368 monthly, Massachusetts costs $7,877 per month and Connecticut is $6,221. While each average overall might have higher memory care costs than New York, it still may be possible to find more affordable options because rates vary widely. Other cities in New York and their memory care costs are:
|New York Memory Care / Assisted Living Costs (updated June. 2022)|
|Region / City||Daily Cost||Monthly Cost|
|New York City||$229||$6,957|
In New York, someone cannot be admitted to an adult-care facility if they:
– Require constant medical care
– Are confined to bed
– Have impairments (physical, cognitive, or mental) that jeopardize the safety of themselves or others
Potential residents must take a comprehensive assessment covering a variety of topics, including medical, behavioral, and mental health history. The information is used to create a personalized care plan that guides care for each resident. Re-evaluation 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. Community fees typically cost between $1,500 and $2,500.
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 is not required because dementias are difficult to diagnose, with symptoms that change and vary even among people with the same disease.
In most cases, a family will spend several weeks deciding which assisted living residence best meets their needs. Normally, they will spend several more weeks relocating their loved one and getting them settled in. Assisted living residences may have waiting lists, so admission is not always immediate. Beginning the process early, because dementia worsens over time, lets you get as much input as possible from the person making the move before their decision-making skills become affected.
Memory care facilities must be physically constructed for the safety and wellbeing of residents. For example, 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 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 60 hours every 2 years of continuing education courses. In addition, each residence must have a case manager, as well as aides that provide residents assistance with personal care like bathing, personal hygiene and getting dressed.
Employees working with Alzheimer’s patients in memory care units must have dementia-appropriate training. This includes education in common behaviors associated with dementia. Emotional, cognitive, and functional changes that occur with the progression of the disease and this offers training in how to best assist people 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, 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, this 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. 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 can be a 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 can be expensive, averaging $5,558 per month. Financial assistance is available for low-income people who need it.
Medicaid is a jointly funded federal and state health care program. In New York, it pays for nursing home care for those who qualify. New York offers its Medicaid recipients a Community First Choice State Plan Option. This option allows Medicaid recipients to receive long-term care services through the state Medicaid plan, which is an entitlement, meaning anyone who meets the eligibility requirements can receive services. While Community First Choice State Plan Option is not relevant to residents in assisted living, it is beneficial for people who can continue to live at home or are awaiting placement in memory care.
Managed Long Term Care Program
The Managed Long Term Care Program offers three different managed care plans:
-The MLTC Medicaid Plan that provides only Medicaid services
-Medicaid Advantage Plus that provides Medicare and Medicaid services
-Program for All-Inclusive Care for the Elderly that provides Medicare and Medicaid services
These programs streamline long-term care needs for patients. This includes those with dementia, who require nursing-home-level care, but wish to remain living in the community. A variety of care services are available, including personal care assistance for those residing in assisted living residences. The cost of room and board in assisted living is not covered, only care services. For more information, including how to apply, click here click here.
NY’s Assisted Living Program
The Assisted Living Program is for adult New York state residents who require nursing home level care. Personal care assistance, skilled nursing, housecleaning, and physical and occupational therapy are some of the benefits available through this program. Room and board may also be covered, although the funding comes from a non-Medicaid source. While the majority of 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. This is a very limited program only giving 4,200 residents this benefit.
The Special Needs Assisted Living Voucher Demonstration Program is specific to the state of New York. It offers financial assistance in the form of a voucher to help fund the cost of memory care for people with Alzheimer’s disease and other related dementias. Through this New York 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. Vouchers can pay as much as 75% of the average cost. Because of this, the program is waitlisted only.
Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.
There are three types of VA Pensions available. The benefits change annually and are valid from December 2022 to December 2023. The benefits (and their maximum allowance) are as follows:
1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:
– Veterans without spouses or children up to $16,073
– Veterans with dependent spouses or children up to $21,001
– Surviving spouses without dependent children up to $10,756
2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:
– Veterans without spouses or children a maximum of $26,751
– Veterans with dependent spouses or children a maximum of $31,713
– Surviving spouses without dependent children a maximum of $17,191
3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:
– Veterans without spouses or children a maximum of $19,598
– Veterans with dependent spouses or children a maximum of $24,562
– Surviving spouses without dependent children a maximum of $13,145
There are 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 in Batavia, the New York State Veterans Home in Oxford, and the Long Island State Veterans Home. There are also VA homes in New York City and Montrose, which may be appropriate for veterans in the early and middle stages of dementia, who don’t necessarily need full-time dementia care. Neighboring states also have veterans’ homes, so a loved one might consider looking there for more options as there are no requirements that one must live in the state. More info.
1) Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.
2) Tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that can include assisted living costs.
3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.