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Nursing Homes in New York

More than just the home of America’s largest city, the State of New York features a diverse scenery that attracts urban and nature-loving retirees. The Empire State ranks high when it comes to the natural environment and health care. Upstate New York’s Niagara Falls and Adirondack Mountains are just a few of nature’s wonders that complement New York City’s countless cultural and entertainment landmarks, and the state has over a dozen nationally ranked hospitals. New York is just among AARP’s few state members, and approximately 17% or 3.3 million of New Yorkers are 65 and older. This large senior population has access to a wide range of long-term care options, including nursing home care.

New York State has at least 621 nursing homes that provide 24-hour skilled care to seniors who may need post-hospitalization, transitional or specialized medical support. This guide provides an overview of nursing home care costs, available financing programs, facility regulations and free resources related to long-term care.


SeniorAdvice's Guide to Nursing Home Care in New York



The Empire State’s overall SeniorScore of 69, which is three points below the national average. This final score is broken down into four general categories, substantiated by over 100 data points.

Health & Safety scores the highest at 70 for the state’s high number of health care facilities, senior care providers and Medicare-enrolled physicians. New York also has an above-average life expectancy of 80.4 years. According to U.S. News and World Report, New York is among the top-ranking states when it comes to public health. Recreation & Leisure has a SeniorScore of 64 for the adequate number of parks, churches and other recreational amenities. In addition, nursing homes in New York are required to offer an ongoing program of activities that are facilitated by qualified therapeutic recreation specialists.

New York’s General Quality of Life scores 57 for the generally cold climate, especially in upstate areas. As for Finances, which has the lowest SeniorScore at 54, the state’s above-average income levels and zero tax on Social Security income and public pensions compensate for the high cost of living. The cost of nursing home care is also very high, while other senior care options are only a few hundred dollars higher than the national averages.



Top Nursing Care in New York




 
 

The Cost of Nursing Home Care in New York



The Empire State’s nursing home care cost of $12,319 per month is far greater than the United States average of $7,756, based on the Genworth Cost of Care Survey 2020. Most of New York’s neighboring states are also relatively expensive, with Massachusetts costing about $300 more at $12,623. The least expensive options are Vermont and Pennsylvania with respective costs of $9,779 and $10,038, saving seniors roughly $2,300 to $2,500 per month. New Jersey at $11,254 is also less costly by nearly $1,100.

  • New York: $12,319
  • United States: $7,756
  • New Jersey: $11,254
  • Pennsylvania: $10,038
  • Massachusetts: $12,623
  • Vermont: $9,779

The Cost of Nursing Home Care in New York’s Top Cities

Nursing home care in New York City costs $11,771, and many other major cities in the state are more expensive. State capital Albany is steep at $12,973 per month, somewhat comparable to Syracuse's average of $12,890. Western region areas Buffalo and Rochester have respective nursing home care costs of $12,669 and $12,380. Binghamton is more affordable at $11,543. Utica in Central New York is the state’s most affordable option at $9,581 per month.

  • New York City: $11,771
  • Buffalo: $12,669
  • Rochester: $12,380
  • Syracuse: $12,890
  • Albany: $12,973
  • Utica: $9,581
  • Binghamton: $11,543

Senior Care Cost Comparison in New York

As New York’s most expensive senior care option, nursing home care at $12,319 costs approximately 150% more than noninstitutional care options, whereas assisted living, home care and home health care range from $4,800 to $4,957. It’s also twice as costly as memory care, which is $6,000 per month. Adult day care is the cheapest option at $1,945.

  • Memory Care: $6,000
  • Assisted Living: $4,800
  • In-Home Care: $4,814
  • Home Health Care: $4,957
  • Adult Day Care: $1,945
  • Nursing Home Care: $12,319

Financial Assistance for Nursing Home Care in New York



As you can see above, nursing home care is often the most expensive senior care option – sometimes even 2-3 times the cost of other types of senior living. The primary reason for this is the 24/7 skilled nursing and other medical services that are provided. Thankfully, most people aren't forced to pay for skilled nursing care entirely out-of-pocket. Rather, many qualify for financial assistance programs to help cover the cost of nursing care.

Medicaid is the most comprehensive financial assistance program – but, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in New York.



Medicaid in New York


Medicaid covers the cost of nursing home care for low-income older New Yorkers, and most recipients are enrolled in managed care plans as part of the state’s medical reforms. A managed care plan lets a Medicaid recipient choose a primary care practitioner (PCP) who’s responsible for coordinating all needed long-term care services and their respective payments. Seniors who are both eligible for Medicaid and Medicare, and who require more than 120 days of Medicaid long-term care services, must enroll in a managed care plan of their choice.

Since New York expanded its Medicaid coverage to low-income adults in 2013, enrollment has increased by over 16%. A large majority of New York’s 621 nursing homes accept Medicaid, covering over 60% of the state’s 90,000 nursing home residents. As of April 2021, nearly 7 million New Yorkers or more than 30% of the state's population are Medicaid recipients, and more than 5 million of them are enrolled in Medicaid managed care plans.

Medicaid Eligibility in New York

The following eligibility guidelines for Medicaid apply to seniors 65 and older with nursing facility level of care:

  • As of January 1, 2021, the income limit for individual applicants is $884 per month and $1,300 for couples. Applicants earning above these levels may qualify through the Medicaid Excess Income program.
  • Resource levels are capped at $15,900 for individuals and $23,400 for couples. Personal property such as homes and vehicles are excluded. Applicants for nursing home coverage are subject to a lookback period of 5 years on nonexempt asset transfers below fair market value.
  • Medicaid-funded nursing home residents are allowed to retain up to $50 for personal needs allowance.
  • As of November 2017, applicants 65 and older or turning 65 within 3 months and with incomes below 120% of the federal poverty level or below the applicable Medicaid program’s standard are required to apply for Medicare to be eligible for Medicaid.
  • Community spouses are permitted to keep some income as a minimum monthly maintenance needs allowance. Those earning above the MMMNA may be asked to contribute 25% of the excess income to the institutionalized spouse’s cost of care.
  • Applicants must be U.S. citizens or permanent residents.
  • Regardless of income eligibility, all applicants undergo clinical assessments through NYSDOH’s Patient Review Instrument (PRI) screening tool to qualify for nursing home placement.
  • Nursing home residents are exempted from Medicaid co-payments.

Applicants who meet these requirements may qualify for long-term care in nursing facilities or in noninstitutional settings covered by Medicaid waivers. Applicants 65 and older must apply for Medicaid through their local Department of Social Services offices. Applications for Medicare may be done online or through local SSA offices.



Additional Financial Assistance Options


  • Medicare: For the first 20 days in a skilled nursing facility, Medicare will cover the entire cost of care, and a portion of the costs up until day 100. After 100 days, Medicare won't cover any of the costs. Importantly, seniors must also have a "qualifying hospital stay" that lasts 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: Aid and Attendance may be available to veterans who receive a VA pension. This benefit is a monthly cash allowance that veterans receive in addition to their standard pension amount. It is intended for veterans in need of long-term care services and may be used to pay for skilled nursing care.
  • Reverse Mortgages: For those who own a home, reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. It's often a good fit for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Keep in mind that reverse mortgage loans do need to be repaid (with interest), typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: For seniors who already have long-term care insurance, the cost of skilled nursing care may be covered. Most policies cover at least a portion of the costs, but it depends on the specific policy terms. It's important to note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a long-term care insurance policy.

New York Nursing Home Care Rules and Regulations



Nursing homes in New York are also referred to as residential health care facilities (RHCF). They are regulated by the New York State Department of Health, which also issues licenses for nursing home administrators and manages the NYS Nurse Aide Registry. Nursing facilities are required to comply with the NYSDOH’s minimum standards as cited below. 

Scope of Care

Nursing homes provide lodging for 24 or more consecutive hours to individuals who need regular nursing services but do not require hospitalization. Nursing home residents shall receive treatments, medications, diets and other health services that support their physical, mental and psychosocial well-being, as provided in their individual care plans. Such services must be provided accordingly by registered professional nurses, licensed practical nurses, nurse aides and other qualified nursing personnel. Rehabilitative services may be offered in-house or through outside providers. Optional services may include specialized care for individuals with head injuries, traumatic brain injury, mental illness, neurodegenerative diseases, AIDS and ventilator dependency.

Care Planning

An individualized plan of care shall be developed by an interdisciplinary team, with the participation of the resident and the resident’s family or legal representative, within 7 days after a comprehensive assessment is completed. The initial assessment shall be done no later than 14 days after admission, and periodic assessments must be done at least once every 12 months and after a significant change in the resident’s condition. A review of assessments is required at least once every 3 months to ensure their accuracy and to check for necessary care plan revisions.

Pharmacy Services

Routine and emergency drugs and biologicals may be provided directly by nursing homes or through provider contracts. A registered pharmacist shall be employed or consulted to develop and implement policies and procedures on accurate drug acquisition, dispensing and administration. Drug regimen reviews must be conducted by a pharmacist at least monthly for each resident. All medications may only be administered based on written orders by legally authorized practitioners. Verbal orders must only be given to licensed nurses or registered pharmacists in urgent circumstances, and these must be immediately reduced to writing and countersigned by their prescribers within 48 hours.

Staff Screening

Nursing facilities shall verify that their potential nursing employees are listed in the New York State RHCF Nurse Aide Registry, or have applied and are not denied for state certification while listed in another state’s registry. They must not employ those with findings of resident abuse, neglect, mistreatment.

Staff Training

Nurse aide functions may only be performed by individuals who have successfully completed a state-approved RHCF nurse aide training program and those who graduated from approved nursing programs. Nurse aide trainees who are concurrently enrolled in a state-approved training program may only provide direct care to residents, as part of their in-service training in their employer facility and under the direct supervision of a registered nurse, if they complete at least 16 hours of classroom instructions within 120 days of employment.

Medicaid Coverage

New York Medicaid pays for nursing home care services provided to recipients who are medically and financially eligible. Its comprehensive application process includes a five-year lookback on uncompensated asset transfers. Medicaid recipients in nursing homes are also qualified for a monthly personal needs allowance.

Reporting Abuse

A nursing facility shall immediately report alleged incidents of resident abuse, neglect and mistreatment, as well as injuries of unknown source, to their administrators and to the Department of Health, in accordance with the NYSDOH’s nursing home incident reporting manual. Such incidents must also be documented and investigated by the facility.


Free Nursing Home Resources in New York



LeadingAge New York

Formerly called the New York Association of Homes and Services for the Aging (NYAHSA), LeadingAge NY is an organization of not-for-profit continuing care providers. Its consumer hub publishes an annual Consumer Guide to Continuing Care, which includes a resource directory of not-for-profit and public long-term care service providers, including nursing homes, senior housing, PACE and adult day care centers, home care providers and community-based residential care establishments.

New York StateWide Senior Action Council

In addition to its advocacy for the full representation of low-income older New Yorkers in legislative decisions, the NY StateWide SAC educates and promotes the rights of Medicare beneficiaries through the Senior Medicare Patrol program. Its certified SMP counselors help seniors detect and report health care insurance fraud to appropriate authorities.

LawHelpNY.org 60+ Seniors

A collaborative project of New York-based legal organizations, LawHelpNY.org provides free legal information to low-income individuals, covering issues concerning seniors. Its dedicated 60+ Seniors page includes information and resources on public benefits, nursing home and long-term care, elder abuse and wills and estates. The website has an online tool for finding lawyers based on location and legal concerns.



New York Agencies


New York State Office of the Aging

Address: 2 Empire State Plaza, 5th Floor, Albany, NY 12223
Phone Number: (844) 697-6321
Website: https://aging.ny.gov/

NYSOFA supports older New Yorkers and their families through coordinated home and community-based programs that are administered locally by Area Agencies on Aging. While this agency primarily promotes the independence of seniors in their communities of choice to help delay premature institutionalization, it also advocates the rights of nursing home residents through its Long Term Care Ombudsman Program. The NYSOFA website also provides useful information on nursing home care, as well as video tutorials on how to apply for different benefits and services.

NY Connects

Address: 2 Empire State Plaza, 5th Floor, Albany, NY 12223
Phone Number: (800) 342-9871
Website: https://www.nyconnects.ny.gov/

NY Connects is a statewide program that maintains a resource directory of services and long-term supports for seniors, people with disabilities and their caregivers. Its user-friendly website lets visitors easily make a self-guided search and explore options through organized service categories. The main categories include basic needs, health care services and supports, community engagement and legal and government services. NY Connects may also be contacted via phone, email and its local offices for further assistance.

New York State Partnership for Long-Term Care

Address: One Commerce Plaza, Room 1620, Albany, NY 12210
Phone Number: (518) 474-0662 / (866) 950-7526
Website: https://nyspltc.health.ny.gov/

A program by the Department of Health, NYSPLTC combines private long-term care insurance and Medicaid Extended Coverage to help New Yorkers pay for residential or nursing home care while protecting their assets. Partnership policyholders are not required to spend down to receive Medicaid benefits, should their long-term care needs surpass their policy period. The PLTC website provides a chart of different policy plans with daily minimum benefit amounts related to nursing home coverage.

New York State Department of Health

Address: Corning Tower, Empire State Plaza, Albany, NY 12237
Phone Number: (866) 881-2809
Website: https://www.health.ny.gov/facilities/nursing/select_nh/

NYSDOH provides a comprehensive consumer guide to nursing home care in New York, covering general information on assessment procedures, clinical services, estimated rates per region, available payment and public financing options and provider associations. This agency also maintains the NYS Nursing Home Profile database which provides quality and safety information on each provider.



Area Agencies on Aging in New York


New York’s 59 AAAs partner locally with aging services providers, government units and volunteers to deliver home and community-based services for seniors. Their local Information & Assistance hotlines offer referrals to seniors who might need nursing home care, as well as alternative long-term care options to those who do not require 24-hour skilled nursing. Other locally available services include case management, legal assistance, support groups, assistance with benefits applications and the Health Insurance Information and Counseling Program (HIICAP) for Medicare recipients.



Veteran Affairs Office in New York


The New York State Division of Veterans’ Services provides free benefits counseling to NY vets and their dependents. Its Veterans Benefits Advisors assist claimants with filing claims for federal, state, local and private benefits, as well as with follow-ups and decision appeals. VBA appointments may be scheduled in different DVS offices throughout New York. There are also several New York State Veterans' Homes in the state, operated by the Department of Health for eligible vets and their dependents who require skilled nursing and rehabilitative care.



Social Security Offices in New York


New Yorkers who are SSI recipients and residents of DOH-licensed nursing homes receive additional monthly payments called the State Supplemental Personal Needs Allowance, issued by the Office of Temporary and Disability Assistance. Seniors 65 and older may also contact local field offices to apply for SSI/SSDI and SSP/SSPNA benefits. The Social Security New York Region Office also assists Medicare recipients who qualify for extra help with their prescription drug plans.

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