By Long Island Senior Advisor Care Team · October 14, 2026
Using New York State medians, about 47 hours a week of home care costs the same as an assisted living apartment. Here is the math, what Nassau and Suffolk's EISEP can add, and how to price the decision before a crisis.
The number that looks like a bargain: $6,673 a month
Start with the only cost figures anyone has actually published. The 2025 CareScout Cost of Care Survey, released in spring 2026, puts New York's median for a non-medical caregiver at $35 an hour. At a full-time 44 hours a week, that comes to $6,673 a month. The same survey's median for a private one-bedroom in an assisted living community is $7,110 a month. On paper, the aide at home is $437 a month cheaper.
Here is the catch for a Long Island family. Those are New York State medians. CareScout does not publish a Nassau or Suffolk figure, and neither does any other primary source we could find, so we will not pretend to know what an aide costs in Garden City versus Riverhead. Local prices very likely run above the state median, but "likely" is not a number. What you can do is get written quotes from two or three licensed agencies and run the math below with your own hourly rate.
The reason the comparison deserves more than a glance is that 44 hours a week is not a day. It is a little over six hours of coverage for each of seven days, or a standard work week. A parent who is safe for those hours but alone for the other 124 is the situation most adult children are actually trying to solve when they start comparing options.
Where the two lines cross: about 47 hours a week
Do the arithmetic once and it stays useful. At $35 an hour, each weekly hour of paid help costs about $152 a month ($35 times 52 weeks, divided by 12). Divide the $7,110 assisted living median by $152 and you land at roughly 47 hours a week. That is the break-even point, using state medians. Past about 47 hours of aide time a week, home care costs more than the median assisted living apartment before you add a dollar of rent, property tax, or utilities.
Now stretch it to round-the-clock coverage. Twenty-four hours a day, seven days a week is 168 hours. At the same $35 an hour, that is about $25,480 a month. We are showing that as arithmetic, not as a quote: live-in arrangements are usually priced differently from hourly care, and agencies structure them in different ways. But it shows why families who start with "just a few hours a day" are often shocked a year later.
Nobody should read this as an argument that assisted living is always cheaper or better. A parent in a paid-off house in Levittown or Massapequa who needs help getting up, dressed and fed, and then sleeps through the night, may do well at home for years at 20 to 30 hours a week. The point is that the bill does not rise gently. It climbs with each added shift, and the switch to a facility should be priced before the crisis, not during it.
What assisted living's $7,110 does and does not include
The $7,110 figure is a median for a private one-bedroom. It is not a promise about what your parent will pay. In New York's layered system, a base adult care facility can add an assisted living residence license and, on top of that, an enhanced or special needs certification. Each layer permits different levels of care, and facilities commonly charge more as needs grow. Ask every community you tour for a written breakdown of the base rate, every level-of-care charge, and what triggers a move to a higher tier.
Memory care deserves its own warning. New York's memory-care-specific state certification is called SNALR (Special Needs Assisted Living Residence), and a community that markets memory care should be able to show it to you by name. There is no published median for memory care in any source we trust, so any single figure you are quoted is that community's price and nothing more. Compare it only against other written quotes.
If your parent needs nursing-level care around the clock, the comparison changes again. The state median for a semi-private nursing home room is $15,528 a month and $16,729 for a private room. Nursing homes are licensed under a separate set of state rules (10 NYCRR Part 415), and Medicaid pays for long-term nursing home care in a way it generally does not for assisted living rent. Our cost guide lays the medians side by side.
The Long Island program most families never hear about: EISEP
Both counties run their own Office for the Aging, and the two are separate agencies with separate phone lines: Nassau at 516-227-8900 and Suffolk at 631-853-8200. Each one operates the state's Expanded In-home Services for the Elderly Program, usually shortened to EISEP. It is built for exactly the family in the middle: a parent who needs help but whose income puts them above the Medicaid line.
To qualify, a person has to be 60 or older, need help with at least one activity of daily living (bathing or dressing, for example) or two instrumental ones (shopping or cooking), be able to stay safely at home, and not be on Medicaid. Someone who looks Medicaid-eligible will be asked to apply, and EISEP can cover them only temporarily while that application is processed. Services start with a care coordinator who assesses your parent and builds a plan. Depending on the case, that can include non-medical help at home and respite for the family caregiver.
Cost is income-based. According to the New York State Office for the Aging, cost sharing begins at 150 percent of the federal poverty level and rises with income. So EISEP is not free for everyone, but it is a way to get a county case manager looking at the whole picture, and it can stretch every dollar of private pay. It is also not a substitute for a full week of care: the hours are allocated by the county, and they are often modest.
There is a Huntington-specific wrinkle. The Town of Huntington helps fund EISEP for its residents, with a local coordinator at the senior center on Park Avenue, but the county Office for the Aging still decides eligibility, cost share and which services a person receives. In other words, the town can answer questions and make the introduction, but the final call sits with Suffolk County. Nassau residents deal directly with the Nassau Office for the Aging in Uniondale.
If your parent is, or soon will be, on Medicaid
The picture shifts completely once Medicaid enters. For community-based long-term care, Medicaid recipients 21 and older who need more than 120 days of services are required to join a Managed Long Term Care plan in both Nassau and Suffolk, a rule in place on Long Island since the 2013 transition. MLTC plans coordinate and authorize the home care hours, and the number of hours depends on an assessment, not on what a family can afford to pay.
Assisted living is a separate question. Medicaid's Assisted Living Program, governed by 18 NYCRR Part 494, is available only inside certain licensed facilities that hold ALP slots, and it covers services, not room and board. Always confirm with the facility what the resident would owe each month. The NHTD waiver likewise pays for services in the community and never for housing.
A nursing home stay for a Medicaid recipient comes with a personal needs allowance of $50 a month, the amount New York has kept for decades. Married couples have special protections: for 2026 the community spouse resource allowance runs from $74,820 to $162,660, the monthly minimum needs allowance is $4,066.50, and the home equity limit is $1,130,000. These numbers are why an elder law attorney is worth an hour of your time before anyone moves anywhere. For the rules behind them, see our New York rules guide.
Adult day health care: the middle step nobody prices
There is a third option between a few hours of aide time and a full move. CareScout's New York median for adult day health care is $144 a day, which works out to $3,120 a month at five days a week. A parent who spends weekdays at a day program, with meals, supervision and nursing oversight, and then has family or a part-time aide in the evenings, can cost well under the 44-hour aide figure and still give you your workday back.
The tradeoff is transportation and tolerance. Some parents, especially those with dementia, resist a new place every morning, and a van pickup on a Suffolk County road at 8 a.m. is its own stress. It works best for someone who is social and not yet needing hands-on help overnight. We cover how the medical and social models differ in a separate guide on adult day programs.
A one-page worksheet to run before you decide
Do this on paper, with your siblings if you have them. Line one: the written hourly rate from two agencies, plus any minimum shift length. Many agencies will not send an aide for fewer than four hours, which changes the math for someone who needs ninety minutes in the morning. Line two: how many hours a week your parent needs, counting nights. Multiply line one by line two by 52, then divide by 12.
Line three: the all-in monthly price of two assisted living communities, in writing, including level-of-care charges and one-time fees. Line four: the cost you do not usually count, which is your own time and your own income. An adult child in their fifties who drops to part-time to cover the other 124 hours is paying a price that never shows up on an invoice.
Line five: the date. Ask when each choice would stop working. If the answer to "what happens if Mom falls at 2 a.m.?" is that nobody is there, then the cheapest column is not the right one. Call your county Office for the Aging, ask for an EISEP assessment and a caregiver consultation, and bring the worksheet. Asking is a low-risk step, and it can only sharpen the numbers.
Two numbers to remember
Roughly 564,500 Long Islanders are 65 or older, about 273,100 in Nassau and 291,400 in Suffolk, and a good share of them are somewhere on this spectrum right now. For most of those households the decision is not at-home versus a facility. It is how many hours of help each setting really needs, and who covers the rest.
Keep two numbers in your head. One is about 47: the weekly aide hours at which home care overtakes the state median for assisted living. The other is the date you will have to decide anyway. Price the first before you reach the second, and the choice you make will be a plan rather than a reaction. If you want help comparing communities in your part of Nassau or Suffolk, our facility directory is a good place to start.
