By Long Island Senior Advisor Care Team · August 14, 2026
The admission or residency agreement is the only document that governs what a Long Island community can charge, when it can raise the rate, and when it can ask your parent to leave. New York dictates most of what has to be in it.
The document in front of you has a specific legal name
By the time a contract is slid across the table at a Nassau or Suffolk community, most families have already made the decision. The tours are done, the deposit conversation has happened, and a hospital or a fall is setting the pace. The signing feels like paperwork closing out a decision rather than a decision of its own.
It is not. In New York, the admission agreement or residency agreement is the only document that governs what the community can charge, how much notice it owes you before raising that charge, which changes in your parent's condition let it end the arrangement, and what happens to money you have already paid. Almost nothing a marketing director says on a tour survives contact with it.
Start by establishing which document you are being handed, because New York uses two different regimes stacked on top of each other. Every licensed community on Long Island holds a base Adult Care Facility license — Adult Home, Enriched Housing Program, or Residence for Adults — regulated by the Department of Health under 18 NYCRR Parts 487, 488 and 490. That base license comes with an admission agreement governed by Social Services Law § 461-c and 18 NYCRR § 487.5(d)(6).
Many, but not all, of those same buildings also hold Assisted Living Residence (ALR) licensure under 10 NYCRR Part 1001. An ALR must additionally execute a written residency agreement that satisfies 10 NYCRR § 1001.8(f) and Public Health Law § 4658 — plain language, no smaller than 12-point type, containing the entire agreement of the parties. If a community is ALR-licensed, you should be signing something that meets both standards. Ask which one this is before you read a word of it.
The licensure paragraph tells you what your parent can never receive here
New York requires the residency agreement to contain a statement describing the licensure and certification status of the operator, updated as necessary, plus a specific listing of any home care or personal care provider working inside the building under an arrangement with the residence. That last clause matters more than it looks: it tells you which services are actually the community's obligation and which are being subcontracted to an outside agency you have not vetted.
Separately, and in conjunction with the marketing materials, the operator has to hand you a standalone disclosure sheet — again in plain language and 12-point type — that states whether the residence holds an Enhanced Assisted Living Residence (EALR) certificate, a Special Needs Assisted Living Residence (SNALR) certificate, or neither, and the maximum number of enhanced and special needs beds it is currently approved to operate.
Use those two acronyms out loud. SNALR is New York's dementia-specific certification, and EALR is the certification that lets a resident age in place with certain physical and medical needs that a base ALR would otherwise have to discharge for. A community that markets a “memory neighborhood” without SNALR certification is describing a hallway, not a regulatory status. You can check what the state actually shows for a given Long Island address on NYS Health Profiles, and our page on verifying a facility's license walks through reading the inspection record behind it.
One more requirement worth knowing, because almost no family is told about it: an ALR that holds EALR or SNALR certification has to post its then-current vacancies under those programs conspicuously in the residence, at least monthly. If your parent is admitted to the general assisted living side with the understanding that a memory care suite will open up, that posting is the reality check. Look for it on the wall.
The money clauses, and the two different notice periods
The agreement has to state the base rate and describe, in detail, what that rate buys. It also has to enumerate every supplemental service, material, or fee, with the basis for each charge, and guarantee that supplemental charges are billed only at the resident's option and only for things actually delivered. The community fee, the second-person fee, the medication management tier, the incontinence surcharge — if a number is going to appear on a bill, it belongs in this document or in a schedule attached to it.
For a base Adult Home admission agreement, 18 NYCRR § 487.5(d)(6)(vii) limits rate increases to four situations: express written approval from the resident or legal representative; an emergency affecting that resident; additional care ordered by the resident's primary physician; or 30 days' written notice of increased charges due to rising costs of maintenance and operation. That is the whole list.
If the community is ALR-licensed, the resident additionally gets the right to 45 days' written notice of any fee increase before its effective date, under 10 NYCRR § 1001.8(b)(2)(xvi). The exceptions are narrow: a written amendment the resident or representative agreed to because care needs changed, a physician's written order for additional services, or emergency charges. A verbal heads-up at a care conference is not notice.
Two clauses families routinely skip. First, the terms governing refunds of previously paid fees on discharge or termination — Adult Home agreements must provide a prorated refund of advance payments based on the rate, actual days of residency, and bed-reservation terms. Second, the bed-reservation charge itself, which cannot exceed the basic rate and must state how long the reservation holds. That is the clause that decides what you pay while your parent is at Huntington Hospital or Good Samaritan for eleven days.
For context on whether the number in front of you is plausible, CareScout's 2025 survey puts the New York statewide assisted living median at $7,110 a month. There is no published Nassau, Suffolk, or Long Island-specific median, and no published memory care median in any state — see what senior care costs for the full set of figures and caveats. Treat every quoted price as a quote for your parent's actual assessed care level, in writing.
The retention criteria paragraph is the one that decides your next two years
New York requires the agreement to spell out the criteria the operator uses to determine who may be admitted and who may continue to reside in the residence, including criteria tied to care needs and to compliance with the community's reasonable rules. Most families read the admission half of that sentence and skip the continuation half. The continuation half is the part that gets invoked eighteen months later.
Read it against a realistic version of the future rather than today. If your mother is walking with a rollator now, what does this paragraph say about a resident who becomes a two-person transfer? If your father's dementia is mild, what does it say about exit-seeking, about nighttime agitation, about a resident who needs to be checked hourly? A community without EALR or SNALR certification has a genuinely narrower ceiling, and the retention criteria are where that ceiling is written down.
The state itself has drawn a line here. In a 2025 letter to adult care facility administrators (DAL ACF 25-22), the Department of Health reminded operators that they are required to determine their own capacity and ability to care for the residents they admit, and that absent an atypical change in condition, it should be rare for a properly assessing facility to later discharge that same resident on the grounds that it cannot meet their needs. That sentence is worth quoting back to an administrator who tells you a discharge is routine.
The same letter is explicit that it is not permissible to discharge a resident based solely on payer source, on an insurance change, or on a change to the facility's own licensure or certification, outside two narrow statutory exceptions involving a revoked operating certificate or an appointed receiver. If a community's private-pay-to-Medicaid conversion policy is being explained to you verbally, get it in the document — and read our page on paying when the money runs out before you rely on it.
What actually happens if they try to move your parent out
This is the procedure New York layers on top of the contract, and it is stronger than most families assume. Under Social Services Law § 461-g and 18 NYCRR § 487.5(f)(14), an adult care facility may involuntarily terminate an admission agreement for only six reasons: the resident needs continual medical or nursing care the facility is not licensed to provide; the resident's behavior poses imminent risk of death or serious physical harm; nonpayment of authorized charges; repeated behavior that impairs another resident's safety or substantially disrupts operations; the facility's operating certificate is limited, revoked or suspended, or voluntarily surrendered; or a receiver has been appointed and is transferring everyone out.
If one of those applies, the operator must serve at least 30 days' written notice on the resident, the next of kin if known, and whoever is named as responsible party in the agreement. The notice has to state the reason, the date, that the resident has the right to object, and that if the resident objects, they may remain in the facility while the operator brings a court proceeding. The Department publishes a compliant form, DOH-5237, though it notes that at the industry's request it is not yet a prescribed form, so many facilities issue an adapted version of their own.
Along with the notice, the operator must give the resident the list of free legal services and resident advocacy agencies — and per the 2025 guidance, that list must cover the county the facility sits in and all contiguous counties. For a Nassau facility that reaches into Suffolk and Queens; for a Suffolk facility it reaches back into Nassau. The Department maintains an annually updated Guide of Community Resources Providing Resident Advocacy Services on its adult care facility resources page.
A copy of the completed 30-day notice must go to the Department's applicable regional office within five days of service on the resident. Long Island sits in the Metropolitan region, which takes these at [email protected]. If your family receives a notice, that five-day filing requirement is a reasonable thing to ask the administrator to confirm has happened.
If the resident objects within the 30 days, or is simply still there at the end of them, the operator has to commence a special proceeding under Social Services Law § 461-h, and the resident may stay pending the court's decision. While that action is in progress, the operator may not amend the agreement, may not withhold required care and services, and may not harass or intimidate the resident. Note the separate track for a no-notice transfer: if a resident is moved out for a medical emergency or imminent-risk situation, that removal is not a termination, and if the basis for the transfer disappears and the resident is appropriate for the setting, the operator must take them back — even if termination proceedings have already begun.
Who is signing, and what you are personally agreeing to
Long Island contracts frequently have a signature line for an adult child, labeled something like responsible party, resident representative, or sponsor. Those are not the same thing as a guarantor, and the difference is the difference between coordinating your mother's care and being personally liable for her bill.
New York requires an ALR residency agreement to include clear notice that the operator cannot mandate that a resident or another person agree to be a guarantor of payment as a condition of admission, unless the operator has reasonably determined, case by case, that the prospective resident lacks either the capacity to manage financial affairs or the financial means to assure payment. Read that clause, find it, and if a guarantee is being requested anyway, ask on what individualized basis.
The agreement must also name the resident's representative and legal representative, if any, and describe that representative's responsibilities. Make sure the description matches what you actually agreed to do, and that the person named is the person who holds the health care proxy or power of attorney. A mismatch here is what produces the phone call, two years later, in which nobody at the community will discuss your father's condition with you.
Two more baseline protections that cannot be waived. A waiver by the resident of any provision required by law or regulation is null and void — a signature does not make an unlawful clause enforceable. And the agreement must contain the entire agreement of the parties, which is the legal reason that anything promised on a tour and not written down is, for practical purposes, not a promise.
A Long Island reading pass, before the pen comes out
Ask for the full packet 48 hours before you are expected to sign, including every attachment and schedule referenced in the text. New York requires the resident and representative to be given a complete copy of the agreement and all supporting documents and attachments, and any changes whenever changes are made. A community that will not let you take it home to read is telling you something.
Pull the state record while you read. NYS Health Profiles shows the current adult care facility record; the licensure statement in the contract should match it. Then call the ombudsman for the correct county — Long Island is split into two separate regions, which trips up nearly everyone. Suffolk County's program runs through Family Service League in Bay Shore at 631-470-6755; Nassau County's runs through Family and Children's Association in Garden City at 516-466-9718. If you are unsure which region covers a specific building, the statewide hotline at 1-855-582-6769 will route you. Ombudsman involvement is free, confidential, and available before a problem exists, not only after.
For a regulatory concern about a licensed community on Long Island, the Department's Metropolitan Area Regional Office line is 631-851-3098. For the non-regulatory side — benefits screening, caregiver support, NY Connects — Nassau's Office for the Aging is at 516-227-8900 in Uniondale, and Suffolk's is at 631-853-8200 in Hauppauge. Each county runs its own; there is no combined Long Island agency, a distinction we cover in more detail on our Nassau and Suffolk pages.
Finally, note the grievance clock. An ALR must maintain a system that receives and responds to grievances and recommendations within 21 days of receipt, and every resident and representative has the right to raise grievances with staff, with government officials, or with the ombudsman without fear of reprisal. Knowing the number before you need it changes how the first difficult conversation goes.
None of this makes the decision for you. What it does is move the decision out of the tour and into the document, where New York has already written down most of the answers. If you are weighing two communities and the contracts are the thing separating them, that is usually a sign you are reading them correctly — our guide to choosing between two communities covers the rest of the tiebreakers.
