I. Paying for Memory Care in New York

The Cost of Memory Care in New York

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 New York, the average price of assisted living is $4,630 per month. This is almost $600 above the U.S. median cost of $4,051 and over $700 higher than the $3,913 average rate paid in Pennsylvania. The cost in New Jersey is significantly higher at $6,400 per month, and the average price in Connecticut is moderately more expensive at $4,880. When an increase of 25% above the statewide assisted living rate is factored in, residents of New York can expect to pay an average of $5,800 per month for residential memory care.

The price paid for assisted living in New York differs based on the facility chosen and its location within the state. Seniors in the New York City area face the highest average rate at $6,950, and those in Syracuse pay just $4,033 per month. Prices in other major cities throughout the state fall in between. For example, rates average $4,748 in Rochester, $4,525 in Albany and $4,443 in Buffalo. These prices are for assisted living, as well, so memory care may cost an additional $1,000 to $2,000 per month.

   

New York Medicaid Programs for Memory Care

Managed Long-Term Care Program

New York Medicaid offers the Managed Long-Term Care program to help eligible individuals with chronic illnesses remain in an adult care facility as an alternative to nursing home placement. The program includes three plans, all of which provide medical services through either Medicaid or Medicare. The MLTC program provides additional services for participants including care management, medical social services, dental care, nutritional counseling and assisted living personal care. Physical, occupational, rehabilitative and speech therapies are also covered, as well as personal emergency response systems, vision and hearing services, prosthetics and orthotics.

  • Who Is Eligible: The MLTC program is open to seniors aged 65 and older who meet the financial eligibility guidelines for New York Medicaid and are assessed as needing the level of care normally provided in a nursing facility.
  • How to Apply: Interested seniors can apply for the MLTC program by visiting their nearest county Social Services Department office.

Assisted Living Program

The Assisted Living waiver program is designed to allow New York residents who qualify for nursing home placement receive care in a less restrictive assisted living setting. The program covers a wide range of services including:

  • Case management by an RN
  • Supervision
  • Personal care
  • Housekeeping and laundry
  • Physical, speech and occupational therapies
  • Medical equipment and supplies
  • Intermittent nursing care
  • Personal emergency response systems

The ALP also covers the cost of room and board in state-licensed ACFs, including those that provide specialized memory care. Enrollment in the program is capped at 4,200 participants statewide, so applicants may be placed on a waiting list depending on availability.

  • Who Is Eligible: Applicants must demonstrate a need for nursing-home-level care and be at risk of admission to a nursing facility. They also need to meet the residency and financial guidelines to qualify for NY Medicaid. Those who require continuous nursing care, are bedridden or pose a danger to others are not eligible for the ALP.
  • How to Apply: Those who wish to apply for the ALP should contact the Department of Social Services office or Area Agency on Aging serving the county where they live.

Non-Medicaid Financial Assistance Programs for Memory Care in New York

State Supplement Program

New York provides financial assistance to eligible aged, blind and disabled residents through the SSP. This state-funded benefit is paid monthly and may be put toward the cost of residential memory care services. The amount of SSP assistance a person receives depends on a number of factors including their income, county of residence and housing situation.

  • Who Is Eligible: New York SSP assistance is available to state residents who are U.S. citizens or qualified aliens and are aged 65 and older, disabled or blind. Applicants must also meet the income and asset guidelines of the federal Supplemental Security Income program to qualify.
  • How to Apply: To apply for the SSP program, individuals must file an application for SSI benefits with the Social Security Administration. Interested New York residents may call 800-772-1213 to learn more or schedule an appointment at the closest SSA office.

Medicare Advantage Plans

New York residents enrolled in Original Medicare have the option of signing up for one of several Medicare Advantage plans. Commonly known as Part C coverage, MA plans are offered through approved private insurance companies as an alternative to Original Medicare Parts A and B coverage. Additionally, these plans may offer Part D drug coverage and a number of extra benefits such as vision, dental and hearing care, transportation to medical appointments, health and wellness programs and personal care services.

Medicare recently updated its definition of an enrollee’s home to include an adult care facility, allowing for the reimbursement of some related costs through an MA plan.

  • Who Is Eligible: U.S. citizens and legal aliens with five years’ residency aged 65 and older who are enrolled in Original Medicare may switch their coverage to an MA plan. There are no financial limitations or restrictions for pre-existing conditions, including Alzheimer’s disease and related disorders, but enrollees are responsible for paying Medicare Part B premiums as well as any applicable MA plan premiums.
  • How to Apply: Interested individuals can use Medicare’s online plan finder tool to compare and choose between MA plans offered in their area of New York and then contact Medicare at 800-633-4227 or the plan’s provider to apply.

More Ways to Pay for Memory Care

In addition to the programs mentioned above, those 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 one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.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 loans 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.
  • Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

II. Memory Care Laws and Regulations in New York

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 AdmittedAdults and seniors who have:

  • Age-related physical or cognitive impairment
  • Managed mental or physical disabilities
  • Stable medical conditions
Residents Who May NOT Be AdmittedThose 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.

III. Free Memory Care Resources in New York

ResourceContactDescription
Alzheimer’s Disease Regional Caregiver Support InitiativeSearch the NYS list for a support initiative program in your areaTen regional organizations partner with local community agencies across the state of New York to provide a wide range of supportive services for caregivers of those with Alzheimer’s. The available services include family and care consultations, education and training, support groups, wellness programs, technology-based services and respite care financial assistance.
Alzheimer’s Association New York State Coalition518-867-4999The New York State Coalition of the Alzheimer’s Association represents seven organization chapters located across the state. The coalition supports research endeavors within New York and nationwide and provides dementia patients and their caregivers with access to educational resources and support services.
Centers of Excellence for Alzheimer’s DiseaseFor information and referrals, contact the nearest CEADCEADs are a statewide network of 10 medical facilities and teaching hospitals with expertise in the diagnosis and treatment of Alzheimer’s disease and related dementias. The centers make screening tools available, enhance knowledge in the healthcare workforce, provide support to dementia patients and their caregivers and offer access to the most up-to-date research and clinical trials.