What a Nursing Home Costs on Long Island vs Assisted Living

Families ask me this question in two moods. The first is dread, usually from a hospital hallway, when a discharge planner has just said nursing home and the family is doing arithmetic in their heads. The second is relief, a few weeks later, when they learn that their parent does not need a nursing home at all and that the setting that fits is also the one that costs less. I have been in both moods with my own mother, and I want to walk you through the whole picture.

The short answer is that a nursing home is the most expensive senior care setting there is, it is priced by the day, and Long Island sits well above the national figures in the published cost surveys. I do not print numbers in a blog post because they change every year and vary by building; ask me for current numbers. What I can do is explain what the daily rate buys, what drives it, who pays for it, and how it compares in structure with assisted living and memory care, so that when you see a real figure you know what you are looking at.

The short answer: the costliest setting, priced per day, and higher here

Nursing homes charge a daily rate, not a monthly fee, and the daily rate covers room, board, nursing and most care. Private rooms cost more than shared rooms. Long term stays are billed at the facility’s private rate unless Medicaid or another payer is covering, and that private rate on Long Island, like everything else here, runs above the national median that the annual cost surveys report. Assisted living, by contrast, charges a monthly fee with a care component, and memory care sits above assisted living. My senior housing on Long Island guide lays out every setting; this post is about the money.

The thing I most want families to take from this post is that the nursing home price is only relevant if a nursing home is the right setting. For a person who needs daily skilled nursing, it is. For a person who needs help with bathing, dressing, meals and medications, it is not, and the comparison that matters is between assisted living communities, not between assisted living and a nursing home.

What you are paying for in a nursing home

A nursing home is a licensed health care facility, and the daily rate reflects that. It covers a room, usually shared, three meals, laundry, housekeeping and all of the personal care. It also covers what sets a nursing home apart: licensed nurses on every shift, around the clock, a physician who oversees each resident’s care, and the ability to deliver skilled treatments daily, such as wound care, injections, tube feeding, oxygen management and complex medication regimens. Most facilities also run physical, occupational and speech therapy on site, and most have a short term rehabilitation unit where people go after a hospital stay.

What the daily rate does not usually include are the extras: a private room upgrade, a telephone or television, beauty shop, certain medications and supplies, and physician specialists who bill separately. Families often get a second set of bills they did not expect, so ask the business office for the list of charges that fall outside the daily rate. I explain the difference between the rehab unit and the long term side of the same building in skilled nursing facility vs nursing home.

What drives the daily rate

Two nursing homes a few miles apart can quote rates that differ by a wide margin, and families want to know why. These are the drivers I see.

• Location. Nassau and the North Shore tend to run higher than Suffolk, and Queens follows the city’s cost of operating. Land, labor and property costs flow straight into the rate.
• Room type. A private room carries a premium over a shared one, and some facilities offer only a few.
• Level of care. A resident on a ventilator or with complex wound care is billed at a higher rate than a resident who needs standard nursing.
• Rehab versus long term. The short term rehabilitation unit bills differently, and Medicare covers it for a limited period after a hospital stay.
• Ownership and age of the building. Newer buildings and certain operators price above older ones, though price and quality do not always travel together.
• Staffing. Facilities with higher nurse and aide ratios have higher labor costs, and the good ones will tell you their ratios without being asked twice.

The published surveys that report national and regional medians are useful for seeing the shape of the market, but the number that matters is the one on the facility’s rate sheet for the room your parent would actually occupy. Ask for it in writing, and ask what it was a year ago.

Nursing home vs assisted living vs memory care: what the fee covers

The three settings are built differently, and that shows up in how they are priced. Here is the structure side by side, without figures.

	Nursing home	Assisted living	Memory care
How it is billed	Daily rate	Monthly base fee plus care level charge	Monthly fee, usually all inclusive or with a higher care tier
What is included	Room, meals, personal care, 24 hour nursing, physician oversight, most therapies	Apartment, meals, housekeeping, activities, personal care and medication help by level	Everything in assisted living plus a secured neighborhood, dementia trained staff and structured programming
Who it fits	People who need daily skilled nursing	People who need help with daily tasks but not daily nursing	People with dementia who need supervision and structure
Licensing	Health care facility	Residential care, licensed by the state	Assisted living with a dementia specific designation
Typical room	Shared, hospital style	Private apartment or suite	Private or shared suite in a secured wing
Main payers	Medicare for short rehab, Medicaid for long stays, private pay	Private pay, long term care insurance, veterans benefits; limited Medicaid program	Same as assisted living
Relative cost	Highest	Lowest of the three	Between, closer to assisted living at a high care level

The row families should study is the second one. A nursing home includes nursing that a person may not need, and they pay for it whether they use it or not. Assisted living charges for the care actually delivered, by level, which is why a person with moderate needs usually pays less there and has a better day. I go line by line through the assisted living side in how much assisted living costs on Long Island and the memory care side in what the average monthly cost of memory care covers.

Who pays for a nursing home

This is where the two settings diverge most, and where families are most often surprised.

Medicare, for a limited rehab stay

Medicare pays for a stay in a skilled nursing facility only after a qualifying hospital admission, generally at least three days as an inpatient, and only while the person needs daily skilled care. As a general rule the first 20 days are covered in full, days 21 through 100 carry a daily copay, and nothing is covered after day 100 in a benefit period. Coverage often ends well before day 100. Confirm the current rules; I explain them in how long Medicare pays for a nursing home after a hospital stay. Medicare does not pay for a long term nursing home stay, and it does not pay for assisted living, memory care or independent living at all.

Medicaid, the main long term payer

For people who meet New York’s income and asset rules, Medicaid pays for long term nursing home stays, with most of the resident’s income going toward the cost. The application reviews financial transfers over a look back period and can impose a penalty, which makes the house and the savings a subject for an elder law attorney well before the need; see can Medicaid take your house in New York. Confirm the current figures with the county Department of Social Services.

Long term care insurance, veterans benefits and private funds

A long term care policy that is triggered will reimburse toward a nursing home up to its daily benefit, and some older policies pay more for a nursing home than for assisted living. Veterans and surviving spouses may qualify for a pension benefit that helps. Everything else is private pay: savings, pensions, the house.

Who pays for assisted living and memory care

Assisted living and memory care on Long Island are mostly private pay. Families use savings, Social Security and pensions, the sale or rental of the house, long term care insurance when a policy exists, and for qualifying veterans and surviving spouses the Aid and Attendance benefit, which I explain in VA Aid and Attendance for senior veterans. Medicaid pays for assisted living here only through a limited program with few participating communities and waiting lists. Medicare pays nothing toward any of it.

That difference in payers shapes the decision in a way families do not expect. A person with few assets who needs daily nursing has a clear path to a Medicaid funded nursing home. A person with few assets who needs only help with daily tasks has a harder path, because the setting that fits is private pay. And a person with meaningful savings or a house often does better in assisted living than in a nursing home on both quality of life and cost, as long as the care need stays within what assisted living is licensed to do.

Does the nursing home always cost more?

Usually, but not always, and the exceptions matter. A resident in assisted living at the highest care level, with a private apartment, extra services and a privately hired aide for part of the day, can approach the private rate of a shared room in a nursing home. A memory care resident with heavy needs can get close too. When I see that gap narrowing, I ask whether the person’s needs have crossed the medical line into skilled care, because if they have, the nursing home is the right setting and the price is beside the point. I draw that line in assisted living vs nursing home on Long Island.

The other comparison families run is staying at home with aides. For a few hours a day, aides at home cost less than any facility. Around the clock, with two shifts and weekends covered, the hourly math often exceeds a memory care community and sometimes approaches a nursing home, with the house’s own costs on top. That is not an argument against staying home; it is an argument for running the real numbers for the real number of hours before deciding. I have toured more than 90 communities across Nassau, Suffolk and Queens, and I can put those offers next to the at home math on one page.

How families avoid an unplanned nursing home placement

Most long term nursing home placements I see did not have to happen. They happened because a parent went from a hospital to a rehab unit, Medicare ran out, and the family had not looked at anything else. Here is how to avoid that.

1. Get an honest picture of the care need now and 18 to 24 months out, from the doctor and from a needs assessment. Daily skilled nursing means a nursing home. Anything less means assisted living or memory care should be on the list.
2. Meet an elder law attorney early if there is a house, savings or a spouse at home, because Medicaid timing rules reward planning done years ahead.
3. Tour two or three assisted living or memory care communities before there is a crisis, so the family already knows where it would go.
4. If a hospital stay happens, ask every day whether your parent is admitted or under observation, and use the rehab days to plan the next step rather than to wait.
5. Read the rehab unit’s discharge notice the day it arrives, and have the next setting lined up before the Medicare days end.
6. Choose a community with a path to higher care in the same building, so a rising need does not force a second move.

That is the plan I build with every family, and it is free to families; communities compensate me when a family moves in. The families who do these six things rarely end up paying the nursing home’s private rate for a person who did not need a nurse at the bedside.

Ask me for the real numbers before you decide

Assisted Living Locators of Long Island helps families across Nassau, Suffolk and Queens understand what a nursing home, assisted living and memory care actually cost here, and which one fits the care need. The help is free to families; communities compensate the advisor when a family moves in. I plan 18 to 24 months past the move so that a rising level of care is already in the budget, and I will tell you plainly when a nursing home is the right answer.

My office is at 42 Prospect Ave, Glen Cove, NY 11542. Send me your parent’s situation and I will put current numbers in front of you on one call.

Questions readers ask

Read next

• How Much Assisted Living Costs on Long Island, Line by Line
• What the Average Monthly Cost of Memory Care Covers
• How Long Medicare Pays for a Nursing Home After a Hospital Stay