Senior housing in New York: your options compared

New York Downsizing helps people sell and buy smaller homes, and introductions go to agents on the operating team at eXp Realty, so this is not a search of the whole market and we do not claim to be neutral. A move into care or a rental is not a real estate sale in most cases, so this page points you to the official sources and gives no prices. Costs vary too widely and change too often to quote. This is general information, not legal, medical or financial advice.

Senior housing options compared

The table covers the main routes. The "who regulates" column is about the type of housing, not about any one building, and the details below it come from the agencies' own pages.

If you are weighing a sale of your home to fund a move, see costs and money, the net proceeds calculator and senior property tax exemptions. A New York attorney can speak to Medicaid planning and long-term care contracts.

Staying in your own home

Many people never move to a senior-specific setting, and that can work well with help. NYC Aging lists more than 300 older adult centers with free art, fitness and daily meals, caregiver programs and social adult day care. Aging Connect is at 212-AGING-NYC (212-244-6469) or 311. NY Connects, the state's No Wrong Door system at 1-800-342-9871, gives free information about home care, housing options, transportation and caregiver support, and helps with Medicaid and SNAP applications.

Our guide to aging in place or downsizing sets out the trade-offs, and downsizing tips for seniors in New York covers the work of moving to a smaller home if you decide on that.

Independent living in NYC

Independent living is a common phrase, but it has a specific meaning in New York. In a 2016 letter to the field, the State Department of Health says independent living is not licensed or regulated by the Department. The letter describes independent senior housing as a setting where no individual or entity provides, arranges or coordinates on-site monitoring or personal care or home care for five or more unrelated residents, and where the setting is not marketed as assisted living. Residents are expected to be able to live independently and arrange any help themselves.

Providers can offer activities and may keep a list of agencies, but cannot provide or arrange the care. The same letter says that a setting that provides, arranges or coordinates services such as 24-hour supervision, medication management or help with personal care generally needs an adult care facility or assisted living license. So if a brochure promises both, ask which license it holds. You can read the Department's letter yourself.

Continuing care retirement communities (CCRCs) bundle independent living with access to assisted living and nursing care under one contract. The Department of Health's CCRC page says residents generally must be at least 62, meet the community's financial and health criteria, be enrolled in Medicare Parts A and B and keep a Medicare supplement. It explains the entrance fee and monthly fee structure and the contract types, and it lists the communities that hold a certificate of authority. Read the contract and disclosure statement with an attorney before signing.

Assisted living in NYC

The Department of Health's adult care facility page says these facilities provide long-term, non-medical residential services to adults who are substantially unable to live independently, and are not licensed for nursing or medical care. It lists three types of adult care facility that the Department licenses and regulates:

• Adult homes, which provide room, board, housekeeping, personal care and supervision to five or more unrelated adults.
• Enriched housing programs, which provide long-term residential care in community-integrated settings resembling independent housing units, to five or more adults, primarily people 65 or older.
• Residences for adults, which provide room, board, housekeeping, case management, activities and supervision to adults unable or substantially unable to live independently.

A facility can also choose to be licensed as an assisted living residence. The page describes two further certifications: an enhanced assisted living residence, which may admit or retain residents who chronically need physical help to walk or manage stairs, depend on medical equipment or have chronic unmanaged incontinence, and a special needs assisted living residence, which serves people with dementia or cognitive impairment. Care follows an individualized service plan.

The Department runs a searchable adult care directory by region or county. The Metropolitan Area Regional Office for New York City is at 90 Church Street, 15th Floor (212-417-4440). The Long Island office is at 320 Carleton Avenue, Central Islip (631-851-3098), per the Department's page.

Assisted living in NYC and Medicaid: the Assisted Living Program

People often search for assisted living NYC Medicaid. What the Department of Health's Assisted Living Program page says, in summary, is this:

• The Assisted Living Program, or ALP, serves people who are medically eligible for nursing home placement but in a less medically intensive, lower cost setting.
• It provides personal care, room, board, housekeeping, supervision, home health aides, emergency response, nursing and therapies, among other services.
• Both Medicaid recipients and private payers must be medically eligible for nursing home placement, and the page lists further eligibility conditions you should read in full.
• Private payers and Medicaid recipients may contact the ALP directly, but Medicaid recipients need their ALP services approved in advance by the local social services district.
• The page says the program is limited to 4,200 residents.

That page was last revised in 2014, so confirm current rules and availability. The Department's adult care page adds that an adult home or enriched housing program may offer services through an ALP, which is why an ALP is not a separate building type. The page does not say how long a wait runs or how Medicaid is applied to other assisted living, so we do not either. Questions about your own eligibility go to NY Connects, which helps with Medicaid applications, or your local social services district. A New York attorney who handles elder law can advise on planning.

If you own a home and may need Medicaid for nursing home or home care, the way the house is sold or transferred can affect eligibility, because New York reviews transfers made during a look-back period. Our guide to the Medicaid look-back in New York explains the basics. It is a question for an elder law attorney.

We are not a Medicaid planner. Rules for income, assets and coverage are specific, and the State Department of Health and local social services district are the authorities.

The senior housing lottery: NYC Housing Connect and HPD

Affordable rentals in the city are advertised on NYC Housing Connect, and HPD explains the process on its application guides page. You may apply online or by mail, following the directions in the advertisement. Applications after the deadline are not considered; afterward, applications are selected for review through a lottery.

HPD's Do You Qualify page says applicants must be 18, and household income must fall in a range set for each opportunity. There are also asset limits and tenant selection criteria. Housing is considered affordable when it costs about one-third or less of household income. HPD's Housing Ambassadors give free application help, do not charge fees and cannot guarantee a unit.

For seniors specifically, HPD's Senior Affordable Rental Apartments (SARA) program gives low-interest loans to build or renovate affordable housing for seniors 62 and older with low incomes, and requires 30 percent of units to be set aside for homeless seniors referred by a City or State agency. That page describes financing for developers, not how a tenant applies. For a particular building, read the Housing Connect listing for age, income and unit rules.

55+ communities

A 55+ community is a place where owners are mostly 55 or older. Under the federal rule at 24 CFR 100.305, at least 80 percent of occupied units must have at least one occupant 55 or older, and the community must publish and follow policies showing it intends to operate as 55+ housing. New York's Human Rights Law, Executive Law 296, exempts housing intended and operated for occupancy by at least one person 55 or older per unit. The Attorney General's office oversees offering plans, including those for senior residential communities.

The communities we describe are on Long Island, not in the boroughs. Fees, rules and who may live there are set by each community, so ask for the documents. See the 55+ communities page. In the boroughs, many people who want a smaller, easier home look at co-ops, condos, townhouses or houses; buying a co-op or condo covers the process, and where to downsize compares neighborhoods.

How to choose: questions to ask

Whichever route you consider, the same questions help. Ask them in writing where you can.

• Is the setting licensed, who licenses it and can I see its record on the state's online profile?
• What services are provided, which are arranged for me and which would I have to find myself?
• What happens if my needs change? Does the contract allow me to stay, or would I have to move?
• What do the contract, residency agreement or lease say about fees, increases and ending the agreement? Have an attorney read it.
• Is the building accessible, and how do I get out in an emergency?
• How close are my doctors, family and daily needs, and how would I get there?
• If I own a home, what is my plan for selling it, and in what order?

Taking a trusted family member to visits helps. If you are helping a parent, helping a parent downsize in New York has more on the family side, and the resources page lists aging services, legal referrals and move managers.

When a smaller home you own or buy is the right step, you can ask to be introduced to an agent on the eXp Realty operating team. There is no pressure to move.