New York has a higher cost of living than many other states, especially in New York City. Yet, New York is still a popular retirement destination due to its many outdoor attractions and convenient access to world-class restaurants and entertainment venues. This guide explains the care options available to New Yorkers, how assisted living is regulated in the state, and how those needing long-term care can cover their costs. It also includes resources to help seniors improve their mental health and get help with various legal matters.

Assisted Living Facility (ALF) Definitions

The New York Department of Health licenses three types of adult care facilities, each offering different levels of personal care and supervision to five or more adults with functional or cognitive impairments. All three types are considered to be adult homes, all of which provide residential care, meals, housekeeping, and personal care to their residents. These settings can accommodate from five to 200 residents in one building. Some licensed before 1984 are permitted to house more.

Enriched housing programs provide long-term residential care primarily for adults 65 or older in private residential units. These facilities are required to provide one home meal a day in a group setting.

Assisted living residences provide or arrange 24-hour on-site monitoring, food services, case management, and personal or home care services for five or more adults.

Enhanced assisted living allows for residents to age in place who choose to remain in the residence but need assistance with transferring and walking, are dependent on medical equipment or personnel, or have incontinence issues.

The Department of Social Services licenses adult foster care facilities. These family-type homes provide long-term residential care, room, board, housekeeping, supervision, and/or personal care to four or fewer adults.

Resident Agreements and Disclosures

In admission agreements, adult homes and enriched housing programs must include a list of all services they are required by law to provide, a list of additional services, the basic payment rate, and all financial and payment policies.

Assisted living residences resident agreements must include the facility’s certification, the period of the agreement, the basic services provided, additional services available for a fee, a fee schedule, payment and refund policies, information about how to terminate the agreement, complaint resolution procedures, and admission and discharge criteria.

The ALR must also disclose to prospective residents the type of license the facility has been granted, including any special needs or enhanced assisted living certificates they have, policies regarding the use of third-party providers, information regarding any available public funding, and contact information for ombudsman services as well as the licensing department.

Assisted Living Admission and Retention

Assisted living residences, adult homes, and enriched housing programs are not allowed to admit or retain anyone who

• Needs continual medical or nursing care and supervision.
• Suffers from a serious and persistent mental disability that warrants placement in an acute care or treatment facility.
• Requires health or mental health services that the facility is unable to provide.
• Behaves in a manner that hinders the well-being or care of other residents.
• Does not comply with prescribed treatment programs.
• Regularly needs assistance to walk or to climb or descend stairs.
• Has urinary or bowel incontinence or personal care needs that the staff is unable to fulfill.
• Has a communicable disease.

Assisted Living Services and Service Planning

Adult homes and enriched housing programs provide personal care, supervision, activities, case management, and assistance with medications for their residents. Additional nursing and therapeutic services must be provided for ALPs serving Medicaid clients.

These facilities must determine if their program can support applicants’ and residents’ physical and social needs. The basis for this determination includes a medical evaluation by a physician, physician assistant, or nurse practitioner; an interview with the applicant and program staff; a mental health evaluation by a psychiatrist or physician; and a functional assessment by the program coordinator, case manager, or consulting RN. The functional assessment determines the residents’ sensory impairments, limitations with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), behavioral characteristics, personality characteristics, and daily habits. Residents are assessed annually as well as when there is a change in their condition.

Assisted living residences offer case management, coordination of health care services by outside agencies, personal care, and medication services. Facilities that are certified to provide enhanced services must provide and arrange for nursing services, monitoring and supervision, nursing care and treatments, and medication administration and management.

These facilities must provide an individualized service plan for all residents. This plan is implemented by the resident, their representative and/or a home care agency, in consultation with the resident’s physician. The service plan addresses the needs of the resident, including their medical, nutritional, rehabilitation, functional, and cognitive needs. The plan must be reviewed every six months and when the condition of the resident changes.

Assisted Living Food and Dietary Provisions

Each facility has different requirements for residents’ food and diet needs. An adult home must provide three meals a day and an evening snack. These must meet the recommended allowances of the National Academy’s Food and Nutrition Board. Enriched housing programs must serve a minimum of one hot meal at mid-day or in the evening that meets one-third of the same recommendations. Assisted living residences must follow one of the two provisions above, depending on their license type.

Assisted Living Staffing Requirements

Adult homes must employ an administrator responsible for overseeing the daily operations of the facility, a case manager to evaluate resident needs, personal services staff to provide resident care services, and an activities director. At least one staff member must be on duty at all times.

A minimum of 3.75 hours of personal services staff time is required per week per resident. The administrator must be on site 40 hours a week for facilities with 25 or more beds, or 20 hours a week for facilities with fewer than 25 beds. Facilities with 50 or more beds must have both a case manager and an activities director for 0.5 hours per week for each additional bed up to a total of 40 hours a week.

Enriched housing programs must employ a program coordinator who is responsible for operating and maintaining the program, a case manager to evaluate the needs of the residents, and personal care staff to assist the residents.

The following staff ratios are required: Personal care staff must have 6 hours per week per resident, the program coordinator must be available 1.5 hours per week for the first 16 residents and 1 hour per week for each additional resident until being “full-time,” and a case manager must be on duty for 0.5 hours per week per resident.

Assisted living residences must employ an administrator who is responsible for daily operations and compliance; a case manager who assists residents with housing issues, providing information about local services and activities, contacting urgent and emergency responders; and resident aides to provide personal care. If the facility is certified to provide enhanced assisted living, it must employ licensed practical nurses (LPNs), registered nurses, and home health aides.

There are no minimum staff ratios for ALRs. Resident aides must be present 24 hours a day and in numbers to meet the needs of the residents. Case managers must be available 20 hours a week for facilities with up to 24 residents, 40 hours for facilities with 45 or more residents, and 20 hours plus 1 hour per week per bed between 25 and 44 residents, up to 40 hours.

ALRs certified to provide enhanced assisted living must also provide sufficient nursing staff to meet the health care needs of the residents.

Assisted Living Staff Training Requirements

Adult homes and enriched housing programs must provide orientation and in-service training regarding the characteristics and needs of the residents they are serving, residents’ rights, program rules, staff duties and responsibilities, their specific job responsibilities, and emergency procedures. Adult homes must also train their staff to identify and report reportable incidents.

Assisted living residence employees must receive orientation on the facility’s policies and procedures, the residents’ characteristics, emergency evacuation, and disaster plans. Administrators who do not have a nursing home license must complete 60 hours of continuing education every two years. Resident aides must receive 40 hours of initial training and 12 hours of annual in-service education on topics related to their position.

Assisted Living Housing Requirements

Adult homes must provide single- or double-occupancy bedrooms, have at least one toilet and one sink for every six residents, and one bathtub or shower stall for every ten residents. Enriched housing programs must provide single-occupancy units unless they are shared by residents’ agreement, including a full bathroom, living and dining space, a sleeping area, and equipment for storing and preparing food. Assisted living residences may be single- or double occupancy, depending on the license of the facility.

What Is Included With Assisted Living Care In New York?

There are several requirements that each assisted living community must provide for their residents. The facility must offer both general observations and health supervision to assist in identifying each resident’s health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.

Health Care Services

In New York, facilities must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services. Many have health care specialists and on-site services, with 59% of communities offering dental care. In addition, 46% of ALFs have hospice services.

Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In New York, 80% of communities conduct depression screenings, and 63% offer mental health counseling. Social work programs are also found in 58% of facilities. Social workers can provide counseling, conduct assessments, and help ensure residents have access to all the resources they need.

State Mental Health Resources

New Yorkers also have access to a variety of mental health resources. The Office of Mental Health has a search tool to help people find geriatric mental health services in the state. New York City seniors can call 311 for referrals to local service providers specializing in treating mental health disorders in the aging population. The New York Foundation for Senior Citizens also operates a 24-hour crisis hotline specifically for older adults.

Medication Provisions

All three types of facilities may provide assistance with the self-administration of medications. The assistance includes prompting, identifying the medication, bringing the medication to the resident, opening containers, positioning the resident, disposing of used supplies, and storing the medication.  The only personnel authorized to provide assistance are licensed nurses or medical technician.

Activities of Daily Living (ADLs) Assistance Services

A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores. 

Residents in New York’s assisted living facilities often receive help with their ADLs. In New York, 10% of residents need help with eating. Other commonly used services include bed transfer (12%), toileting (24%), and walking (53%). Caregivers in ALFs help 42% of residents dress and 68% of residents bathe.

Cost Of Assisted Living Care In New York

The average cost of assisted living care in New York is $4,580. This is $80 higher than the monthly national average of $4,500. The cost of living in New York is more than the national average by 48.2%, with health care costs more than the national average by 2.5% and housing costs more than the national average by 130.1%.

The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,775 in the Rochester area to a high of $8,415 per month in the Watertown area of New York.

How Costs Compare In Nearby States

Although New York borders five other states, only Pennsylvania has a lower average monthly cost for assisted living. Pennsylvania’s average monthly cost is $4,100. Connecticut and Vermont’s average monthly costs average $5,129 and $5,250, respectively. Massachusetts and New Jersey’s average monthly costs are almost two thousand dollars more per month than New York, at $6,500 and $6,495, respectively.

How to Pay for Assisted Living

New York Assisted Living Oversight

The New York State Department of Health provides oversight of the assisted living communities operating within the state. This includes conducting inspections and following up to ensure that ALF operators comply with their instructions for addressing violations of state regulations. This agency also operates the Adult Care Facility Centralized Complaint Intake Program, which accepts complaints regarding the care provided at assisted living communities.

Legal Resources

The term “elder law” is often associated with estate planning, trusts, and help obtaining benefits through Medicare or Medicaid. The field has also grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.

Several resources are available to older adults who need help with legal matters in New York. Some of these resources are limited to the residents of a specific county, such as the Legal Services Program for the Elderly operated by the Dutchess County Office for the Aging. The Center for Elder Law & Justice operates a free legal advice helpline staffed with experienced attorneys. Legal assistance is available to people aged 55 and over. Legal Services NYC operates a legal hotline for people who need help getting public benefits. For those in other areas of New York, LawHelpNY.org offers educational materials on legal issues and a directory of legal professionals practicing within the state.