By Robert Cassano · July 16, 2026
New York's published cost figures are state medians, not Staten Island numbers -- and Medicaid programs like MLTC, ALP and NHTD can change the real out-of-pocket cost substantially. Here is how to build an honest local estimate.
Start with the caveat, because it changes everything else
The most-cited senior care cost figures in the country come from the CareScout Cost of Care Survey, and for New York, every one of those figures is a statewide median -- not a New York City figure, not a Staten Island figure, and not even a general downstate-versus-upstate breakdown. There is no metro-specific or borough-specific figure published anywhere by CareScout or any other primary source.
That gap matters more here than in a lot of the country, because New York City real estate and labor costs run meaningfully above much of the rest of the state. A Staten Island family should reasonably expect actual quotes to land at or above the state median, not below it -- treat the state figure as a floor for planning purposes, then get written, current quotes from specific local communities for the real number.
New York's 2025 CareScout figures, by category
For 2025, New York's statewide medians are: non-medical caregiver/home health aide, $35/hour, or roughly $6,673/month full-time; adult day health care, $144/day, or about $3,120/month; assisted living private one-bedroom, $225/day, or $7,110/month; nursing home semi-private room, $511/day, or $15,528/month; nursing home private room, $550/day, or $16,729/month; and private duty nursing at $150/visit.
There is no published memory-care figure in this list, and that is deliberate on CareScout's part -- it does not survey memory care as a separate pricing category, in New York or any other state, in any year. Any "average memory care cost" quoted online is an estimate or extrapolation, not a genuine survey result. Get a written quote directly from any specific community rather than relying on a number found online.
How Medicaid programs change the real number
A private-pay family and a Medicaid-eligible family are working with two entirely different cost pictures, and conflating them produces bad planning. Inside a qualifying Adult Home or Enriched Housing Program setting, New York's Assisted Living Program (ALP), under 18 NYCRR Part 494, is Medicaid-funded and covers personal care, home health aides, nursing, therapy, PERS, and RN case management -- though how much of the room-and-board portion it offsets varies by facility and has to be confirmed directly.
For care delivered at home, Managed Long Term Care (MLTC) and the Nursing Home Transition and Diversion (NHTD) waiver are the relevant Medicaid pathways -- both administered by NYSDOH, with MLTC enrollment mandatory in New York City, including Richmond County, since 2012. Neither pays assisted living room and board, but both can substantially change what a Medicaid-eligible household actually spends on in-home services compared to the private-pay hourly figure above.
A household that is not yet Medicaid-eligible but expects to spend down assets over time should treat the private-pay CareScout figures as the realistic near-term number, and separately plan for how the picture might change once a Medicaid pathway becomes available -- these are two different planning exercises, not one continuous line.
The in-home versus facility crossover, worked through with real numbers
The $35/hour non-medical caregiver figure sounds manageable until it is multiplied by real weekly hours, and this is where families most often miscalculate. Ten hours a week runs roughly $1,517/month. Twenty hours a week runs roughly $3,033/month. Forty hours a week runs roughly $6,067/month -- already approaching the $7,110/month assisted living median. Sixty hours a week runs roughly $9,100/month, already above it. Round-the-clock coverage at 168 hours a week runs roughly $25,480/month, several times the licensed-community figure.
The crossover point sits somewhere around 40 hours a week of needed care. Below that, in-home care is usually the less expensive choice and keeps a parent in a familiar setting. Above it, a licensed assisted living community is often the less expensive option on paper -- and adds staffing depth that a single hired in-home caregiver cannot provide alone overnight, which matters as much as the raw dollar comparison.
This same crossover logic applies to adult day health care at $144/day. A working caregiver combining adult day health care on weekdays with lighter in-home coverage evenings and weekends is often working out a genuinely different, and sometimes more affordable, total cost structure than either option used alone -- worth running the actual combined numbers rather than assuming.
What Medicare does and does not touch in this math
Medicare does not pay for assisted living, memory care, or long-term custodial care anywhere in the country, in any state. It covers a limited stay in a skilled nursing facility after a qualifying inpatient hospital admission, intermittent skilled home health, and hospice -- none of which are a substitute for the ongoing custodial care costs described above.
The qualifying-admission detail catches families off guard specifically: Medicare's skilled nursing benefit requires a genuine inpatient hospital admission, and time spent under "observation status" does not count toward that requirement, even if a parent slept in a hospital bed for multiple nights. Ask the hospital directly, in writing, whether a parent was admitted as inpatient or held under observation before assuming any Medicare-covered rehab stay applies.
Nursing home private-pay versus Medicaid rate
For nursing home planning specifically, ask any facility for both its private-pay rate and its Medicaid daily rate, since the two can differ substantially. This matters for a family trying to estimate how long private funds will realistically last before a Medicaid transition becomes relevant, and it matters for understanding what a facility's finances actually look like if a resident later needs to convert from private pay to Medicaid coverage.
New York's nursing home resident Personal Needs Allowance is $50/month for Medicaid-covered residents -- unchanged since the 1980s and among the lowest in the country. This is a small but real detail worth knowing ahead of time, since it affects how much spending money a Medicaid-covered resident retains for personal items.
VA Aid and Attendance as another piece of the real number
For veterans and surviving spouses, VA Aid and Attendance is a federal pension benefit worth folding into this cost picture before assuming a private-pay number is final. For 2026, effective through November 30, 2026, a veteran with no dependents can receive up to $29,093/year (roughly $2,424/month); a surviving spouse with no dependents, up to $18,697/year (roughly $1,558/month). These rates are national, not New York-specific, and unreimbursed medical expenses -- including senior care costs -- offset countable income, which is how moderate-income veterans often still qualify once care costs begin.
Against New York's $7,110/month assisted living median, a veteran's Aid and Attendance benefit can offset roughly a third of that monthly cost -- a meaningful, recurring reduction that many families never claim, often because they assumed eligibility was ruled out under an earlier, lower-cost financial picture before care expenses were part of the calculation.
How to actually build a realistic Staten Island estimate
Start with the New York State median for the relevant care category as a floor, not a target. Get written, current quotes from specific Staten Island communities for the exact care level a parent actually needs -- not a generic "starting at" figure, which often reflects only the lowest care tier rather than a realistic all-in cost. Ask separately about each community's three-year rate increase history, since a quote today says little about the cost in year two or three.
Then separately determine which Medicaid pathway, if any, might eventually apply -- ALP for a licensed-community setting, MLTC or NHTD for care at home -- and get that answer from NY Medicaid Choice or the local NY Connects office (Community Agency for Senior Citizens, (718) 489-3954) rather than assuming eligibility either way. The real, honest number for a specific Staten Island family sits somewhere between a private-pay state median and whatever a confirmed Medicaid pathway actually offsets -- and only a direct, current conversation with both a facility and a Medicaid access point gets you there.
