Levels of care · 6 min read
Levels of care in New York, in plain words
Independent living, assisted living, ALP, enhanced, memory care, skilled nursing, home care, home health. What each one is, who it fits, and how to tell them apart.
Written and reviewed by Cardinal Care Advisors, Buffalo, New York. Published September 15, 2026.
Why the names are confusing
New York licenses senior living in layers, and communities use marketing names on top of the license. The license is what matters, because it decides what care the building is allowed to give. When a community says memory care, ask what license it holds.
Independent living
An apartment with meals, housekeeping, and activities. No care license. Good for someone who is safe alone but tired of the house. If care is needed later, it comes from an outside agency or a move.
Assisted living (adult home or ALR)
Help with bathing, dressing, medications, and meals, with staff in the building around the clock. In New York this is an adult home or an Assisted Living Residence. Residents need help but do not need daily nursing.
ALP, the Assisted Living Program
The same kind of building, but with Medicaid paying. ALP beds are limited and many communities have a waitlist for them. If Medicaid is how care will be paid, ALP is the door to look for, and CarePair filters for it.
Enhanced and special needs (EALR and SNALR)
Enhanced lets an assisted living residence keep someone as needs grow, for example with a wheelchair or more nursing. Special needs is the license for a secured memory care unit. A community without one of these may have to ask a resident to move when needs change; ask up front.
Memory care
Assisted living built for dementia: a secured unit so wandering is safe, staff trained for it, a calmer routine. The license is usually SNALR. Some skilled nursing homes also run secured units for people who need nursing as well.
Skilled nursing (nursing home)
Nurses on site every hour of the day. Two very different uses: short-term rehab after a hospital stay, often paid by Medicare for a limited number of days, and long-term care when someone needs daily nursing, usually paid privately or by Medicaid.
Home care and home health
Home care is aides and companions at the house: bathing, meals, company. Usually private pay or Medicaid. Home health is nurses and therapists at the house after a hospital stay, ordered by a doctor and usually covered by Medicare for a period. Different agencies, different licenses, often used together.
What this is not
A guide to vocabulary, not an assessment. A physician and, for some settings, a state assessment decide the level of care. A Cardinal advisor helps you get there.
Official sources
- New York State Health Profiles · The state's own directory and inspection records for licensed facilities.
- Medicare Care Compare · Federal ratings for nursing homes and home health agencies.
Read next
General information for families in Western New York, written by Cardinal Care Advisors. Not medical or legal advice; a physician, an elder law attorney, or a licensed assessor decides the things that need deciding. Tell us if something here is wrong or out of date: hello@thecardinalgroup.org.