Which level of care fits? The New York ladder, rung by rung

Start with the day, not the building

Before you compare communities, write down an ordinary day for the person you care for. Mark the moments that need another person: getting out of bed, the shower, medicines, meals, the evening, the night. Then mark how often those moments go wrong. That list is what every community, every doctor, and every state form is going to ask about, and it tells you which rung of the ladder to look at first.

This is a vocabulary guide. The doctor, and for some settings a state assessment, decide the level of care. A Cardinal advisor can walk the list with you.

The ladder, in plain words

New York licenses senior living in layers. Communities put marketing names on top, so always ask what the license is.

• Independent living: an apartment or cottage with meals, housekeeping, and activities. No care license. Fits someone who is safe alone, sleeps through the night, and manages their own medicines. If help is needed later it comes from an outside agency or a move.
• Family type home for adults: a licensed home where the operator cares for four or fewer unrelated adults in their own house. Overseen by county social services and the state Office of Children and Family Services. Small, homelike, and for people who need supervision and personal care but not nursing.
• Adult home: state-licensed residential care for five or more adults, with meals, housekeeping, personal care, and supervision around the clock. Some have a handful of residents, some have two hundred.
• Enriched housing: the same license family, but in apartment-style units for people 65 and over, with at least one hot meal a day and help with medicines and personal care for part of the day.
• Assisted living residence (ALR): an adult home or enriched housing program that has also been certified as an assisted living residence. This is what most people mean by assisted living. Residents get a written residency agreement and a disclosure statement about what the community can and cannot do.
• Enhanced assisted living (EALR): an ALR certified to keep a resident whose needs grow, for example someone who now needs a wheelchair or more nursing, as long as the community can safely meet those needs.
• Special needs assisted living (SNALR): an ALR certified to serve people with a specific condition, most often dementia, in a secured setting with trained staff. This is the license behind most memory care in assisted living.
• Memory care: a marketing name, not a license. In assisted living it usually means a SNALR unit. Some nursing homes also run secured units for people who need nursing care too. Ask which one you are looking at.
• Skilled nursing (nursing home): nurses on site 24 hours a day, three meals, help with everything, plus physical, occupational, and speech therapy. Two very different uses: short-term rehab after a hospital stay, and long-term care for someone who needs daily nursing.
• Continuing care retirement community (CCRC): one contract, one campus, and a promise of care at each level as needs change, in exchange for an entrance fee and a monthly fee. Our CCRC article goes deeper.

How to tell which rung

No list can decide this for you, but these questions sort most families quickly.

• Safe alone for a whole day and night, and managing their own pills? Independent living, or home with a little help.
• Needs a person for bathing, dressing, or medicines, but not a nurse every day? Assisted living, an adult home, enriched housing, or a family type home.
• Has dementia and has wandered, or nights are unsafe? A secured setting: SNALR memory care or a nursing home with a secured unit. Ask the doctor and the community about the stage.
• Needs a nurse every day, has wounds or tubes, or cannot get out of bed without two people? Skilled nursing.
• Needs three weeks of therapy after a hospital stay, then plans to go home? Short-term rehab in a skilled nursing home, which is a different door than long-term care.
• Wants to move once and never again? Look at CCRCs and enhanced ALRs, and ask hard questions about what happens at the top of the ladder.

The question to ask every community

What happens when needs grow? A community without an enhanced or special needs certification may have to ask a resident to move when they need more than the license allows. Ask for the answer in writing, and ask what the last three residents who left went on to.

In CarePair

Find care lets you filter by license, county, and whether the community takes the Assisted Living Program. Save the ones you like to your case, and a Cardinal advisor can help you tell the rungs apart for your person.