Memory Care in New York

Table of Contents

Memory Care in New York

Table of Contents

• The Cost of Memory Care in New York
• New York Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in New York?
• More Ways To Pay for Memory Care in New York
• Memory Care Laws and Regulations in New York
• Free and Low-Cost Resources for Seniors in New York
• New York COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

In order to calculate the cost of memory care, we added 25% to the cost of assisted living as reported in the 2021 Genworth Cost of Care Survey. 

In New York, the average cost of memory care is $5,725 per month, which is similar to the national median of $5,625. Seniors in New York pay on average less than those in the nearby states of New Jersey ($8,119), Connecticut ($6,411) and Vermont ($6,563). However, those residing in Pennsylvania pay slightly less, with an average of $5,125 per month. 

The average cost of memory care differs vastly across the state of New York. The most affordable option is Rochester at $4,719 per month, while seniors in Watertown pay almost $6,000 more each month for care. Those seniors living in New York City pay $7,188, and their counterparts in the state capital of Albany pay $6,586 on a monthly basis.  

Seniors in New York who are eligible for Medicaid may be eligible for assistance in paying for memory care services through the two waiver programs offered by the state. Both of these programs assist seniors who require a nursing home level of care to continue to live in a community setting, such as an assisted living facility. Low-income residents who meet certain criteria may be eligible for these waiver programs and Medicaid.

Managed Long Term Care (MLTC) Program Waiver

The MLTC is a program that helps seniors with chronic conditions such as memory loss receive the care they require without having to move to a nursing home. The program doesn't cover the costs of room and board in an adult care facility, but it does cover a number of services. These services may include assisted living personal care, care management, occupational therapy, physical therapy and nutritional counseling. Three different plans are offered, and medical services are provided through Medicare, Medicaid or both, depending on the needs and eligibility of the senior.

• Who Is Eligible: Seniors must be 65 years or older, require nursing home level care, undergo a medical evaluation, be U.S. citizens or legal residents and meet the Medicaid income guidelines for New York.
• How To Apply: Seniors can apply by contacting their local Social Services Department Office.

Assisted Living Program

The Assisted Living Program enables New Yorkers who require nursing home level care to receive care services in the less restrictive environment of an assisted living facility. The program is funded partially by Medicaid and partially by the state and private donations. It only assists a limited number of people, and there's a long waiting list. Services covered by the program include room and board, skilled nursing care, personal care, case management and medical supplies. Physical, speech and occupational therapy services are also covered.

• Who Is Eligible: Seniors must meet the financial and residency guidelines to be eligible for Medicaid in New York to apply for the ALP. They can't be bedridden or require full-time nursing care, must be medically eligible for nursing home care and can't pose a danger to themselves or others.
• How To Apply: The program assists a limited number of seniors; however, a waiting list is available for those who qualify for the program. Applications can be made through a Social Services Department Office or the Area Agency on Aging for the county where the senior lives.

Medicaid Eligibility for Seniors in New York

Medicaid in New York helps low-income seniors receive the health care and assistance they need. Eligibility for Medicaid is based on a number of factors, including residency, health and income. Single applicants can't receive income that exceeds $934 per month, and married couples must have an income of less than $1,367 per month. Asset limits are set at $16,800 for single applicants and $24,600 for married couples who are both applying.

2022 Medicaid Income Limits for Seniors in New York

Additional requirements for Medicaid eligibility in New York include:

• Applicant must reside in New York
• Applicant must be a U.S. citizen, legal alien or permanent resident
• Applicant must be 65 or older or have a qualifying disability

When applying for Medicaid, seniors must submit the following documents:

• Medical bills for the last three months
• Proof of current income
• Proof of current address
• Bank statements for the past 60 months
• Proof of U.S. citizenship or immigration status 
• Health insurance policy or Medicare card

How To Get Help Applying for Medicaid in New York

New York has a number of programs available to assist people in applying for Medicaid.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, seniors looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if you already have long-term care needs. More information about the intricacies of long-term care insurance can be found at LongTermCare.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loan will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

In New York, the State Department of Health regulates and licenses adult care facilities to provide care for five or more residents, including those who suffer from cognitive impairment. Facilities licensed as adult homes, enriched housing programs and assisted living residences offer advancing levels of care.

ACFs certified as assisted living residences provide the highest level of care, and may be certified as special needs ALRs that serve those diagnosed with Alzheimer's disease and other forms of dementia. The DOH requires operators of SNALRs to demonstrate how the care needs of residents will be met, and stipulates specific staffing and training criteria for these facilities.

To ensure that facilities stay in compliance with state regulations, the DOH conducts inspections of licensed ACFs every 18 months and in response to filed complaints.

Facility Scope of Care

The DOH mandates that adult care facility operators in New York ensure that each resident receives considerate, respectful care that aligns with their needs in a non-restrictive, homelike atmosphere that promotes autonomy and independence. The scope of care differs depending on the type of facility:

• AHs and EHPs must provide 24-hour supervision, meals, personal care, social and recreational activities, housekeeping services and assistance with medications.
• ALRs and SNALRs are required to provide the same basic services as AHs and EHPs as well as coordinate health care services, monitor each resident's condition and offer medication administration and management.

Admissions Requirements

Adult care facilities in New York may accept individuals who are no longer able to live independently due to age or various physical and mental limitations or conditions. However, ACFs are not licensed to provide full-time nursing or medical care. The chart that follows provides a general guide on who may be admitted to an ACF:

Residents Who May Be Admitted

Adults and seniors who have:

• Age-related physical or cognitive impairment
• Managed mental or physical disabilities
• Stable medical conditions

Residents Who May NOT Be Admitted

Those who:

• Are dependent on medical equipment
• Have chronic bowel or urinary incontinence
• Require 24-hour nursing or medical care
• Are chronically chairfast or bedridden
• Are physically, cognitively or mentally impaired and pose a threat to their own or others' safety
• Have a communicable disease

Care Plan Requirements

All adult care facilities licensed by the state of New York must develop an individualized service plan for each resident on move-in, based on assessments of the person's physical, cognitive and mental status. These assessments should include:

• A pre-admission functional assessment that covers activities of daily living, personal and behavioral characteristics, sensory impairments and daily habits
• An interview with the administrator and resident
• A mental health evaluation if the resident has a history of mental disabilities
• A medical assessment by a physician, physician's assistant or nurse practitioner that lists the person's medical history, current condition, known allergies and medication regimen. The assessment should describe the individual's ability to self-administer medication and provide recommendations for diet and exercise.

The ISP should be developed with the participation of the resident or their representative and the facility's administrator, in consultation with the individual's primary care provider. The plan must address the person's medical, cognitive, functional, nutritional, rehabilitative and other needs.

Functional, medical and mental health assessments should be performed and the service plan updated whenever a change occurs in a resident's care needs. Reassessments must be performed every six months for ALR residents and every 12 months for residents of AHs and EHPs, at minimum.

Medication Management Requirements

All types of ACFs may assist residents with self-administration of medications, which may include storing, identifying and opening medication bottles and prompting residents. In ALRs and SNALRs, only trained staff and licensed nurses may administer medication to residents.

Facility Requirements

There are specific requirements for different types of adult care facilities in New York:

• AHs may offer single- or double-occupancy bedrooms and must provide a minimum of one toilet and sink for every six residents and one bathtub or shower per every 10 residents.
• EHPs must offer single-occupancy units, which may only be shared by agreement. Each unit should include living and sleeping areas, equipment for preparing and storing food, dining space and a full bathroom.
• ALRs may offer single- or double-occupancy resident rooms with private bathrooms.
• SNALFs licensed for dementia care must be self-contained units that meet enhanced fire safety guidelines and feature delayed-egress systems on exterior doors, window stops and enclosed outdoor courtyards to ensure residents' safety and well-being.

Staffing Requirements

Adult care facilities must employ an administrator who oversees daily operations, a case manager who evaluates residents' needs, an activities director who organizes and implements social and recreational programming and personal care staff who provide direct care to residents.

ALRs and SNALRs must also employ RNs, licensed practical nurses and home health aides. There are no minimum staff-to-resident ratios required for ALR facilities that provide specialized memory care. However, these facilities must have sufficient nursing and home health aide staff on duty 24/7 to meet each resident's care needs based on medical assessments by the resident's physician or service plan.

The DOH requires that all employees of an ACF receive orientation training on the facility's procedures and policies, resident characteristics, emergency evacuation protocols and its disaster plan. Staff who provide direct dementia care must receive training on the needs and characteristics of memory-impaired individuals, including behavioral symptoms, emotional/mental changes and methods of meeting residents' needs.

Administrators who do not have a current New York nursing home administrator license are required to complete 60 hours of continuing education over a two-year period. Direct care staff must have 40 hours of initial training and 12 hours of relevant in-service education annually.

Medicaid Policy

New York Medicaid's MLTC program provides eligible individuals who apply with financial assistance to cover some costs associated with residential memory care, but it does not pay for room and board. Another Medicaid program, the ALP, does pay the housing and meal costs for qualified residents of licensed ACFs and pays for numerous other care-related services. However, the ALP is a waiver program rather than an entitlement, and the program is limited to 4,200 concurrent participants.

Reporting Abuse

Complaints and concerns about conditions or the mistreatment of residents in New York ACFs are handled through the Adult Care Facility Centralized Complaint Intake program. To file a confidential complaint, concerned parties may call the program's hotline at 866-893-6772 between 8:30 a.m. and 4:45 p.m. Monday through Friday, excluding holidays, or leave a detailed voicemail message after hours.

A number of resources are available to seniors and their caregivers in New York. These resources can provide support, information or access to services that make the journey through memory loss a bit easier for everyone involved.

Note: The following information was compiled and most recently updated on 2/13/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.