By Long Island Senior Advisor Care Team · August 5, 2026
Long Island runs two of almost everything. Separate Offices for the Aging, separate Adult Protective Services, separate Medicaid offices, separate Ombudsman regions. Which side of the county line your parent lives on changes the phone number, and families waste weeks learning that the hard way.
One island, two of every agency
Long Island reads as one place. It has one Rail Road, one accent, one set of traffic patterns everybody complains about. The senior care system underneath it does not work that way. Nassau and Suffolk are two separate counties running two separate sets of agencies, and almost every office an aging family needs exists twice, with two addresses and two phone numbers.
This surprises people who have navigated care in other metro areas. Many regions run a single Area Agency on Aging across several counties. Long Island does not. Nassau County and Suffolk County each operate their own Office for the Aging, their own Department of Social Services, their own Adult Protective Services unit, and their own Veterans Service Agency. The Long-Term Care Ombudsman is split into two regions along the same line, run by two different nonprofit organizations.
Between them these agencies serve roughly 564,500 residents aged 65 and older, about 273,100 in Nassau and 291,400 in Suffolk based on 2024 Census estimates. Both counties sit above the New York State 65-plus share of 18.9 percent and well above the national 18 percent. That is a large population being served by two parallel structures that do not share intake, do not share case files, and will not transfer your call to each other.
What follows is the practical map: where the line matters, where it does not, and what to do when a parent crosses it.
Office for the Aging: two front doors, no shared intake
For most families this is the first call, and it is the one most often placed to the wrong county. The Office for the Aging is the designated Area Agency on Aging under the Older Americans Act, and it is also the local NY Connects contact point. It screens for benefits, arranges case management, runs home-delivered and congregate meals, and can route a Medicaid long-term-care inquiry to the right desk.
Nassau County Department of Human Services, Office for the Aging is at 60 Charles Lindbergh Blvd., Uniondale, NY 11553, at 516-227-8900. Nassau has a genuine claim to being first at this: it was the first county government in the nation to establish a dedicated agency for its 60-plus population.
Suffolk County Office for the Aging is in the H. Lee Dennison Building, 100 Veterans Memorial Highway, Hauppauge, NY 11788, at 631-853-8200. It has administered Older Americans Act programs for close to fifty years and serves as Suffolk's NY Connects access point.
The rule is simple and worth writing on the refrigerator: call the county where your parent lives, not the county where you live. An adult child in Massapequa whose mother lives in Smithtown calls Suffolk. Eligibility for county-administered aging services follows the older adult's residence. If you genuinely do not know which county a hamlet sits in, and on Long Island that happens more than outsiders expect, NY Connects can sort it out before you burn an afternoon.
Medicaid: the application goes to the county of residence
New York splits Medicaid intake by age and by program, and the split trips up families constantly. Most people under 65 apply through the NY State of Health marketplace. Anyone 65 or older, and anyone seeking long-term-care coverage, applies through their Local Department of Social Services instead. On Long Island that means Nassau County DSS or Suffolk County DSS, determined by where the applicant lives.
This matters because long-term-care Medicaid is not the same program as the Medicaid expansion most people have heard about. New York fully expanded Medicaid effective January 1, 2014, covering adults 19 to 64 up to 138 percent of the federal poverty level with no asset test. Long-term-care Medicaid for seniors runs on a completely separate, non-MAGI, asset-tested track. Our page on Medicaid expansion versus long-term-care Medicaid walks through why conflating the two costs families months.
The 2026 figures, from NYSDOH GIS 26 MA/03 effective January 1, 2026, are the ones your county caseworker will apply: the Community Spouse Resource Allowance runs from $74,820 to $162,660, the community spouse's Minimum Monthly Maintenance Needs Allowance is $4,066.50 per month, and the home equity limit is $1,130,000. If your parent enters a nursing home on Medicaid, the Personal Needs Allowance New York leaves them is $50 per month, a figure unchanged since the 1980s and among the lowest in the country.
One more county-line consequence: enrollment in Managed Long Term Care has been mandatory in both Nassau and Suffolk since the transition that began in 2013, for Medicaid recipients aged 21 and older who need community-based long-term care for more than 120 days and can remain safely at home. That mandate is identical on both sides of the line. The office that processes the paperwork is not.
Adult Protective Services is county-run, and there is no Long Island hotline
If you are worried that a parent is being neglected, exploited, or is no longer safe living alone, Adult Protective Services is the referral to make. New York administers APS county-by-county through each Department of Social Services. There is no single statewide APS hotline the way some states operate one, and there is certainly no Long Island number covering both counties.
Nassau County: the Office of Adult Services APS referral line is 516-227-8395. General DSS is 516-227-8519, and after-hours is 516-573-8626.
Suffolk County: the direct APS referral line is 631-854-3232. General Suffolk DSS is 631-854-9930, and the after-hours emergency line is 631-854-9100.
If you genuinely cannot determine the right county, the statewide adult services routing line at 1-844-697-3505 will send the call to the correct county office. If someone is in immediate danger, call 911 first and make the APS referral afterward.
One boundary worth understanding before you dial: APS handles impaired adults living in the community. A concern about care inside a licensed facility is a different pathway. That goes to the Ombudsman and to the state health department, described next.
The Ombudsman follows the facility, not the family
New York's Long-Term Care Ombudsman Program advocates for residents of nursing homes, adult care facilities and assisted living residences. An Ombudsman can attend a care conference with you, press a facility on a resident's behalf, and translate what an administrator is actually telling you. It is a genuinely underused resource on Long Island.
Long Island is split into two Ombudsman regions along the county line, run by two unaffiliated nonprofits. Suffolk County is Region 1, hosted by Family Service League, coordinator Elizabeth Maxim, at 1444 Fifth Ave., Bay Shore, NY 11706, phone 631-470-6755. Nassau County is Region 2, hosted by Family and Children's Association, coordinator Mary Clare Campion, at 377 Oak Street, Fifth Floor, Garden City, NY 11530, phone 516-466-9718.
The determining factor here is different from every other agency on this page. For the Office for the Aging, APS and Medicaid, the county that matters is where your parent lives. For the Ombudsman, the county that matters is where the facility physically sits. A Nassau resident who moves into a community in Bay Shore is now a Suffolk Ombudsman matter, even though every other file on that family stayed in Nassau.
Two limits worth knowing before you call. The Ombudsman acts only with the resident's consent, or their legal representative's, so an adult child without that standing cannot simply direct the program. And the Ombudsman does not license, inspect or fine anyone. If you are unsure which region covers a facility, the statewide hotline at 1-855-582-6769 will route you. Our page on the local Ombudsman and filing complaints covers how the two tracks fit together.
Where the county line does not matter at all
It is just as useful to know where the split stops, because families sometimes assume a Nassau facility is regulated differently from a Suffolk one. It is not.
Licensing is entirely a state function. New York layers it rather than issuing one flat assisted living license. The base license is an Adult Care Facility, meaning an Adult Home, an Enriched Housing Program, or a Residence for Adults, under 18 NYCRR Parts 487, 488 and 490. An Adult Home or Enriched Housing Program can then be licensed as an Assisted Living Residence under 10 NYCRR Part 1001, and an ALR can add Enhanced ALR or Special Needs ALR certification on top. Nursing homes are licensed separately under 10 NYCRR Part 415. There is no Type A / Type B split here the way some states use, and there is no county overlay. Our licensing framework page lays out the full stack.
SNALR is the one to ask for by name. New York has no standalone memory care license. Dementia-specific care runs through Special Needs Assisted Living Residence certification, layered onto an existing ALR license. "Memory care neighborhood" is marketing language. SNALR is a state certification, identical in both counties, and a family touring anywhere on Long Island should ask to see it rather than accept the label. See SNALR certification in New York.
Facility complaints go to one office for both counties. NYSDOH's Metropolitan Area Regional Office serving Long Island takes them at 631-851-3098 during business hours, and the state's online Health Facility Complaint form is available any time. That is the only major line on this page that does not double.
Costs are published statewide only. The 2025 CareScout Cost of Care Survey puts the New York median for a private one-bedroom in assisted living at $7,110 per month, a semi-private nursing home room at $15,528, a private room at $16,729, a non-medical caregiver at $6,673 at 44 hours a week, and adult day health care at $3,120. There is no published Nassau, Suffolk or Long Island figure, and no published memory care median for New York at all. Anyone quoting you a precise local number is quoting an estimate. Our cost page is explicit about that gap.
What actually changes when a parent crosses the line
Cross-county moves happen constantly here, usually because the available bed is where the available bed is. A Hempstead family finds an opening in Patchogue. A Huntington family moves a parent west to be nearer a daughter in Rockville Centre. The move itself is straightforward. The administrative tail is not, and it is where things quietly go wrong.
Three things need to be actively moved rather than assumed. First, a long-term-care Medicaid case has to be transferred to the new county's Department of Social Services. Notify both. Second, any Office for the Aging case management, meal delivery or caregiver support enrollment ends at the county line and has to be reopened with the receiving county. Third, if you have been working with an Ombudsman, you are now in a different region with a different coordinator and no shared case notes.
What does not change: the facility's license status, the SNALR question, the MLTC mandate, the NYSDOH complaint line, and the VA benefits picture. Aid and Attendance is federal and identical everywhere. For the December 1, 2025 through November 30, 2026 period the Maximum Annual Pension Rate at the Aid and Attendance level is $29,093 for a veteran with no dependents, $34,488 with one dependent, $18,697 for a surviving spouse, and $46,143 for two married veterans who both qualify, with a $163,699 net worth limit. Those are ceilings, not flat checks. Nassau and Suffolk do each run their own Veterans Service Agency, though, so the office filing the claim is county-split even when the benefit is not.
If the move is happening on a hospital discharge timeline, work the transfers in parallel rather than in sequence. Our 72-hour discharge walkthrough covers what to nail down before you sign anything.
The call list, on one page
Keep this somewhere you can find it at 4pm on a Friday, which is when these calls tend to become urgent.
Nassau County — Office for the Aging 516-227-8900. Adult Protective Services 516-227-8395, after-hours 516-573-8626. General DSS 516-227-8519. Long-Term Care Ombudsman, Region 2, 516-466-9718.
Suffolk County — Office for the Aging 631-853-8200. Adult Protective Services 631-854-3232, after-hours 631-854-9100. General DSS 631-854-9930. Long-Term Care Ombudsman, Region 1, 631-470-6755.
Both counties — NYSDOH facility complaints, Long Island regional office, 631-851-3098. Statewide Ombudsman routing 1-855-582-6769. Statewide APS routing 1-844-697-3505. NY Connects for anything you cannot place. Licensed facility lookup at NYS Health Profiles, which is where you verify a license before you sign a contract, not after.
The single sorting question, when you are staring at the list and not sure which half to use: for services and protection, use the county where your parent lives. For anything to do with a facility, use the county where the building is. That one distinction resolves most of the confusion this system creates. If you want the county-level detail, our Nassau County guide and Suffolk County guide go deeper on each.
