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As individuals age or experience changes in health, choosing the right level of care becomes a critical decision, for both quality of life and financial security. In New York, long-term care options range from independent senior living to skilled nursing facilities. Each provides a different level of support, care, and cost. Understanding these distinctions, and planning ahead with the help of an experienced elder law attorney, can make a significant difference in both comfort and financial outcomes.

1. Independent Living

What it is:
Independent living communities are designed for older adults who can manage their daily activities without assistance but prefer a maintenance-free lifestyle. Residents enjoy private apartments or cottages, along with social activities, dining services, and access to community amenities.

Average cost:
Typically $2,500–$4,500 per month, depending on location and amenities. Independent living is generally private pay, and Medicaid does not cover these costs.

Entry requirements:
Residents must be able to live independently and safely. Most communities have a minimum age requirement (often 55+), but no health or financial screening beyond ensuring affordability.

2. Assisted Living

What it is:
Assisted living facilities (ALFs) provide housing and personal care for individuals who need help with activities of daily living, such as bathing, dressing, and medication management, but do not require around-the-clock medical supervision. Care plans are customized to each resident’s needs.

Average cost:
$4,000–$8,000 per month in most parts of New York. Assisted living costs are usually private pay, although limited Medicaid coverage is available through certain Assisted Living Programs (ALPs).

Entry requirements:
Residents must be generally mobile and able to participate in daily activities. Facilities conduct assessments before admission to ensure that assisted living is the right fit.

3. Enhanced Assisted Living (EALR)

What it is:
Some facilities in New York hold an Enhanced Assisted Living Residence (EALR) certification. These residences can provide higher levels of care than standard assisted living, such as help with transfers, continence management, and certain medical needs. Enhanced assisted living can often delay or even eliminate the need for nursing home placement.

Average cost:
$6,000–$10,000 per month, depending on care needs and location. EALR services are typically private pay, though some facilities offer limited Medicaid options.

Entry requirements:
Residents must be medically stable but may require significant assistance with daily activities. EALR licensing allows facilities to retain residents who might otherwise need skilled nursing care.

4. Skilled Nursing Facilities (Nursing Homes)

What it is:
Skilled nursing facilities, commonly known as nursing homes, provide 24-hour medical care and personal assistance for individuals who need ongoing supervision by licensed nurses. They serve those recovering from hospitalization or requiring long-term medical management. These facilities are heavily regulated under both state and federal law and are the only long-term care option routinely covered by Medicaid.

Average cost:
In the Rochester and Finger Lakes region and across New York State, nursing home care averages $15,000–$20,000 per month (or up to $240,000 annually). Without proper planning, these costs can rapidly deplete a family’s life savings.

Entry requirements:
Admission typically requires a physician’s order and documented medical need for skilled nursing or rehabilitation.

Asset Preservation and Medicaid Planning

The transition to nursing home care often raises a critical question: Will I lose everything I’ve worked for?
With proper Medicaid planning, much of a person’s assets can often be preserved, even after long-term care becomes necessary.

For Single Individuals

A single individual entering a nursing home can typically protect about 50% of their assets through a gift and note plan. This strategy involves transferring a portion of assets to the beneficiaries of the individual’s current estate plan while using the remainder to privately pay during Medicaid’s penalty period. When structured correctly, the plan enables eligibility for Medicaid nursing home coverage while preserving roughly half of the person’s savings for their heirs.
Because this strategy must comply with New York’s five-year Medicaid lookback period, it is crucial to work with an experienced Medicaid planning attorney before making any transfers.

For Married Couples

Married couples have even greater asset protection options. Under New York’s spousal refusal rules, the healthy spouse (the “community spouse”) can legally refuse to contribute assets toward the cost of the institutionalized spouse’s care. Despite the refusal, the spouse in the nursing home can still qualify for Medicaid, allowing the community spouse to retain nearly all of their income and resources.

This spousal refusal planning is available in only a few states, making New York especially favorable for Medicaid asset protection. With proper legal planning, a married couple can often preserve nearly all of their combined assets while still obtaining Medicaid coverage for nursing home care.

The Importance of Early Planning

Planning ahead for long-term care is about more than just finances, it’s about maintaining control, dignity, and peace of mind. Understanding the available care options and legal tools can prevent last-minute decisions that lead to unnecessary financial loss.

One of the most powerful planning tools for asset protection is the irrevocable Medicaid trust. By transferring a home or other major assets into an irrevocable trust, individuals can remove those assets from Medicaid’s countable resources while often retaining the right to live in or manage the property.

However, these transfers are subject to Medicaid’s five-year lookback period. Any gifts or transfers made within five years of applying for nursing home Medicaid can trigger a period of ineligibility. Completing this planning early, ideally before care is needed, ensures that assets are fully protected when the time comes.

At McConville, Considine, Cooman & Morin, P.C., we help clients across Rochester and Upstate New York navigate the complexities of elder law, Medicaid eligibility, and long-term care planning. Whether you are planning ahead or facing an immediate care need, our attorneys can design a strategy that protects your assets and ensures access to quality care.

If you would like to schedule a consultation to discuss Medicaid planning, please contact our medicaid planning attorneys: Daniel S. Williford at 585-512-3511 or dwilliford@mccmlaw.com;  Spencer C. Malone at 585-512-3550 or smalone@mccmlaw.com; or Michael F. McConville at 585-512-3517 or mmconville@mccmlaw.com.

This publication is intended as an information source for clients, prospective clients, and colleagues and constitutes attorney advertising. The content should not be considered legal advice and readers should not act upon information in this publication without individualized professional counsel.

About MCCM

McConville Considine Cooman & Morin, P.C. is a full-service law firm based in Rochester, New York, providing high-quality legal services to businesses and individuals since 1979.  With over a dozen attorneys and a full paralegal support staff, the firm is well-positioned to right-size services tailored to each client. We are large enough to provide expertise in a broad range of practice areas, yet small enough to devote prompt, personal attention to our clients.

We represent a diverse range of clients located throughout New York State and New England.  They include individuals, numerous manufacturing and service industry businesses, local governments, and health care professionals, provider groups, facilities and associations. We also serve as local counsel to out-of-state clients and their attorneys who have litigation pending in Western New York courts.  For more information, please contact us at 585.546.2500.