2011 LTCCC Study on Assisted Living Care & Government Oversight in NY
2010: Vulnerable and Unprotected: The Status of Elderly & Disabled Assisted Living Residents in New York State
This brief on assisted living in New York State argues that the assisted living marketplace in New York is a mess and, due to provider pressure and greed, the 2004 assisted living law has not lived up to its promise.
NY Assisted Living Law:
In 2004, NY State passed a bill requiring licensure for all assisted living in the state. Prior to that time, a bifurcated system existed, in which there were licensed adult homes and enriched housing and unlicensed residences (often calling themselves assisted living) providing similar services but with little oversight or accountability. LTCCC, worked hard to ensure passage of a law with a good basis for consumer protection.
The new law, for which regulations were promulgated in 2008, requires licensure for all communities and has specific requirements for residences that wish to care for people with dementia or allow residents to "age in place" (stay in the home as they become more frail).
Follow the links below to learn more. NOTE: All of these rules and requirements apply only to facilities that have been licensed as an "assisted living residence." They do not apply to adult homes, enriched housing or the "Assisted Living Program" (see column on right for more information).
Text of Law (NYS Website)
Summary of Adopted Regulations
List of Licensed Assisted Living Residences (NYS Website)
Rights of Residents of Assisted Living Residences (NYS Website)
Speak Out On Assisted Living Applications in Your Community
Find Out More
State Task Force on Assisted Living:
According to the Assisted Living law that passed in 2004, the State Task Force was created to update and revise the requirements and regulations applicable to adult care facilities and assisted living residences to better promote resident choice, autonomy and independence. The task force has been charged to make recommendations (a) minimizing duplicative or unnecessary regulatory oversight; (b) ensuring that the indigent have adequate access to, and that there are a sufficient number of enhanced assisted living residences; (c) developing affordable assisted living; (d) promoting resident choice and independence; (e) the evaluation tool as required by section 4657 of the public health law; and, (f) specific standards and criteria relating to the special needs certificates required by section 4655 of the public health law.
As of this date, the Task Force has accomplished (e) and (f) and is focusing on the other tasks. LTCCC and its Assisted Living committee has proposed changes to current adult home regulations to promote resident choice, autonomy and independence. Click here to see the recommended changes.
2009: Court Nullifies Vital Protections For Assisted Living Residents: “Win” by Provider Industry Lobbyists Removes Requirement to Hire Professional Care Staff, Sharply Reduces Standards for Care of Alzheimer’s Residents & Frail Elderly
In two long awaited decisions, Albany County (New York) Supreme Court judge Michael Lynch has ruled invalid key components of New York State’s assisted living regulations. The cases were brought by two adult home industry trade associations: “New York Coalition for Quality Assisted Living, Inc.” and “Empire State Association of Assisted Living, Inc.” and several individual adult home facilities against Richard F. Daines, MD, in his capacity as Commissioner of the NY Department of Health. They both sought to weaken regulatory safeguards and consumer protections in the assisted living regulations promulgated in 2008. These regulations put into effect the state’s assisted living law, which passed in 2004 following years of mounting scandals in the adult home industry in New York State.
Click on title, above for more information and copies of the judges decisions.
For a more detailed description of the lawsuit, and LTCCC's work to support the law's vital consumer safeguards, see the article below.
Providers Sue NY Department of Health to Stop Assisted Living Regulations: LTCCC Files Amicus Curiae Brief in Support of the Regulations
Despite substantial input by providers and industry lobbyists in both developing the assisted living legislation and developing the regulations, two of the major industry associations, The Empire State Association of Assisted Living and the New York Coalition for Quality Assisted Living have filed separate lawsuits seeking to invalidate the regulations. LTCCC is disappointed that, after so many years of negotiation and compromise to obtain a law that helps New York's families, as well as the assisted living industry, certain providers have taken this step that, if successful, will jeopardize the standards and requirements that so many New York families need and want so that they can feel secure when a loved one moves to an assisted living community.
In response to the lawsuits, LTCCC has filed an amicus curiae brief supporting the state’s regulations and the NY Department of Health’s interpretation of the assisted living law. LTCCC is strongly supporting the assisted living regulations, which we believe provide crucial protections for assisted living residents and their families. A number of state and national groups have joined us as signatories to the brief: Alzheimer’s Association New York City, The National Consumer Voice for Quality Long-Term Care, New York State Nurses Association, New York State Long Term Care Ombudsman Program, Assisted Living Consumer Alliance, Friends and Relatives of Institutionalized Aged, Suffolk County Long Term Care Ombudsman Program and Coalition of Institutionalized Aged and Disabled.
In addition to these organizations, we would like to take this opportunity to recognize LTCCC board member Deborah Truhowsky who filed the brief on our behalf. Their help was greatly appreciated. Click here to see the full brief.
Assisted Living Program vs. Assisted Living Residences
There are two types of assisted living "beds" in New York State: the assisted living program (ALP) and the assisted living residence (ALR). The ALP provides supportive housing and home care services to people who are eligible for placement in a nursing home, but instead choose to live in a more homelike setting. ALP residents receive home care services through Medicaid or private insurance, and residential services from federal Supplemental Security Income (SSI) or private resources. Beds in assisted living residences are paid for by private funds at this time and must function under the new regulations that were adopted in 2008 (see first column on this page, "NY Assisted Living Law").
LTCC has long had significant concerns about the ALP Program. The ALP program does not have to follow the new regulations (which has the basic standards that the state has identified as important). Many of the facilities that house ALP beds are very institutional settings which do not foster resident dignity or autonomy - they do not fulfill the most basic ideas of assisted living. Some of these ALP facilities are, in fact, terrible places to live.
Spring 2009: State Expands ALP Program by 6000 Beds Despite Consumer Concerns
A major disappointment for consumers in the state budget was
in the addition of 6000 slots for the assisted living
program (ALP). LTCCC had argued that any
provider receiving approval for additional ALP beds
be required to follow the assisted living law which
has a number of important protections.
Unfortunately, the final bill just expands the current
ALP program, which is housed in the traditional
licensed adult home, many of which are very institutional
By not requiring that the Assisted Living
Program be required to follow the assisted living law,
the state has created two models of assisted living;
one for the poor and middle class (ALP beds, paid for
by Medicaid as well as private pay) and one for the rich (assisted living residences are entirely private
pay). Individuals eligible for ALP beds are people
who need nursing home care but are able to be cared
for in an adult home or enriched housing. They are
vulnerable and need the same protections given to
individuals who reside in assisted living residences
with an enhanced certificate.
June 2008: Health Department Approves a 40 Percent Increase in
Assisted Living Program (ALP) Beds
On June 4, 2008, the Department added the legislatively mandated additional 1,584 beds to 32 adult homes. Prior to this award, there were approximately 4,000 operational ALP beds statewide.
The additional ALP beds were mandated by legislation passed last year. LTCCC and other organizations had argued against this expansion because we believe that expanding a program that is exempt from the new assisted living residence regulations consumer protection statutes would further a system of assisted living that serves low-income people who will be governed by an inferior set of rules, and one serving non-Medicaid assisted living residents who would benefit from the strong consumer protections; Medicaid funding should only go to those models of assisted living that comply with the new regulations.
LTCCC and other organizations then urged the state to make sure that any beds approved only go to those adult homes or enriched housing programs that:
1. Do not discriminate on the basis of source of payment, disability, race, religion or sexual orientation;
2. Provide a wide range of resident choice;
3. Respect residents’ self-direction;
4. Encourage residents’ independence;
5. Promote and honor resident decision-making power;
6. Deliver care in a culturally competent manner;
7. Provides a setting that is in compliance with the Americans with Disabilities Act and allows people with disabilities to interact with people without disabilities to the fullest extent possible; and
8. Do not have a history of spending significantly less than it received in ALP reimbursement; inflating Medicaid payment levels; substantive disparities between level of need ratings and plans of care and between plans of care and actual services provided; and ignoring the need to give adequate disclosure on related party transactions on annual financial reports filed with the Department of Health.
We will be looking to see if the 32 homes given approval meet these recommendations. Click here to find a list of the 32 homes.