Every Agency Told You 
Something Different Answered straight, including the parts that don’t help us sell

Almost never for the care most families need.

Medicare covers short, skilled episodes after a hospital stay — a nurse or physical therapist visiting a few times a week for a few weeks, and only if a doctor certifies the patient as homebound. It does not cover an aide who comes daily to help with bathing, meals and getting around. That is what most families are looking for, and Medicare treats it as custodial care, not covered, no matter how much it is needed.

When someone does qualify for the short skilled benefit, we coordinate it with a Medicare-certified agency, because that benefit can only be billed by a certified agency — a different license type than ours. For the ongoing daily care afterward, we take over.

In New York, three sources: Medicaid, long-term care insurance, or you.

Medicaid is what most long-term home care in New York runs on, and it has no age limit — people under 65 qualify too, as long as they meet the financial and functional rules.

Long-term care insurance policies vary. If there is one, the policy document states how many hours and at what rate.

Private pay means paying hourly with no insurer involved. It is the fastest way to start — no assessment, no approval, no waiting.

From $35 an hour for an aide, $40 for a specialized aide, $120 for a nurse, and from $400 a day for live-in care.

The specialized rate covers dementia, Alzheimer’s, stroke and rehab cases — work that needs training beyond the basics. The nursing rate is the same whether the case calls for an LPN or an RN.

Three things move the number more than anything else: how many hours a day, whether nights are included, and whether the case needs a nurse rather than an aide. A four-hour weekday shift and round-the-clock coverage are different conversations.

Our minimum is four hours per visit. Full breakdown on the private pay page.

Yes, and we help you apply.

Our staff walks families through the Medicaid application for home care — which documents to gather, what the financial rules are, and where applications usually stall. This costs nothing and does not obligate you to use us afterward.

Not for home care. Not as of 2026.

New York passed a law in 2020 creating a 30-month look-back at asset transfers for home care Medicaid. Six years later it still has not taken effect — no federal approval, no state guidance, and no application form that asks for it.

You will find agency and law-firm websites saying the look-back is already in force. It is not. It may start with notice, so if transfers are being planned, ask an elder law attorney about timing. But right now, community Medicaid for home care does not review past transfers.

Verified August 2026 against New York State Department of Health guidance.

Since September 2025 she needs help with at least three everyday activities. With dementia, two are enough.

New York raised the bar. It used to be two activities; for anyone applying now it is three. These are the seven the state counts:

• Bathing — washing, and getting in and out of the tub or shower
• Personal hygiene — grooming, teeth, face, hair
• Dressing — upper body and lower body
• Eating — actually consuming food and drink
• Toileting and transferring — on and off the toilet, in and out of bed
• Walking indoors
• Continence — managing bladder and bowels

The requirement is hands-on physical assistance with three of them. Reminding someone does not count toward the three.

With a diagnosis of Alzheimer’s or dementia the rule is softer: two activities, and supervision or cuing is enough — you do not have to be physically doing it for them.

Cooking, cleaning, shopping and managing money are assessed as well, but separately. They do not substitute for the three.

With an assessment by the state, not by us.

For Medicaid home care in New York the gateway is the New York Independent Assessor, known as NYIA. A nurse contracted by the state evaluates what the person can and cannot do alone. That evaluation determines whether care is approved and how many hours.

We help schedule it and prepare for it. What we cannot do is decide the outcome — that is the state’s call, deliberately.

A nurse asks what a normal day looks like and observes how the person manages.

The most common mistake families make is answering for the good days. People describe how their mother manages when she is feeling alright, and the assessment records that as her baseline. Answer for the hard days, because that is what the hours are meant to cover.

Have the medication list, recent hospital paperwork and doctor’s notes on the table. Documented limitations count. Undocumented ones are one person’s word against a checklist.

Anywhere from a few hours a week to around the clock.

It depends on what the assessment finds, not on what you ask for. Someone who needs help with bathing and meals gets a different number than someone who cannot safely be left alone.

Families are often offered fewer hours than expected. That number is not final.

Privately, usually within 48 hours. Through Medicaid, it depends where the case already stands.

If you are paying privately there is no approval to wait for. We go through the case, match a caregiver and start — two days is the usual figure, sometimes sooner.

Through Medicaid the timeline is not ours to promise. If the NYIA assessment is already done and hours are approved, we can start quickly. If nothing has been filed yet, the state sets the pace and no agency can honestly give you a date. What we can do is tell you which stage you are at and what happens next.

You appeal, and appeals succeed often enough to be worth filing.

There are two routes: an internal appeal with the plan, and a state fair hearing. Both have deadlines printed on the denial notice, and both turn on the same thing — documentation showing what happens during the hours that are not covered.

We help clients put that documentation together.

In New York, yes — through a program called CDPAP. Not through us.

CDPAP lets a Medicaid recipient hire someone they choose, including most family members, and that person gets paid. Spouses cannot be hired. Neither can the parent of a consumer under 21.

Since April 2025 the entire program runs through a single statewide administrator called PPL. The roughly 600 agencies that used to handle CDPAP payroll no longer do, and many of them still advertise it. We are not one of them and we do not administer CDPAP.

We are telling you this to save you a phone call. If CDPAP is what you want, go directly to PPL or to your Medicaid plan.

An aide helps with the body and the household. Anything clinical requires a nurse.

The line that surprises families most is medication. An aide can remind, can bring the bottle, can watch the person take it. An aide cannot open it, measure the dose, or place it in their hand. That is not our policy — it is the state’s, and it applies to every licensed agency in New York.

Anything below that line is nursing work. See private duty nursing.

A Licensed Home Care Services Agency — a LHCSA — licensed by the New York State Department of Health, license NY DOH License #2572L001.

That means long-term care at home: aides, personal care and nursing oversight, paid through Medicaid, long-term care insurance, or privately.

It also defines what we are not. Medicare’s short skilled benefit is billed by certified agencies, which is a different license. When a client needs that, we coordinate with one rather than pretend we can do it ourselves.

Employees, not contractors — every one screened before the first shift.

Criminal background check. New York State abuse and neglect registry. Reference checks with previous employers. Medical clearance. And an in-person interview, not a phone screen.

Everyone we send is our direct employee, covered by our insurance. Nobody is subcontracted to you.

Call us and we replace them. You do not owe an explanation.

Personality matters more in this work than people expect. Someone can be perfectly competent and still be wrong for your household. We would rather change the assignment than have you quietly put up with it.

Call (718) 232-2777.

They are not the same thing, and confusing them is the most expensive mistake families make.

Live-in. One caregiver lives in the home. New York counts a live-in day as thirteen working hours out of twenty-four: eight hours are set aside for sleep and three for meals, and the caregiver needs a room of their own. That is why live-in costs roughly half of what continuous coverage costs — you are not paying for someone to be awake all night, and you should not expect it.

The sleep has to be real. The rule requires eight hours off with at least five of them uninterrupted. If the caregiver is woken repeatedly night after night, the arrangement stops being live-in and the whole day becomes payable. So if your mother is up three times a night, live-in is the wrong product — not because we would not staff it, but because it will not hold.

This is normally how around-the-clock coverage is structured when a government program is paying.

Split shifts. Several caregivers cover the day in blocks, six hours on average, divided however suits the person. Nobody sleeps. This is what private-pay clients arrange, and it is what you want when someone genuinely needs an awake caregiver at three in the morning — after a stroke, with advanced dementia, or with a condition that does not wait for daylight.

Ask any agency which of the two they are quoting you before you compare prices. A live-in day and a 24-hour day are different amounts of care, and quoting them side by side without saying so is how people end up disappointed.

The thirteen-hour rule was upheld by New York’s Court of Appeals and remains in effect. It is contested, and the State Department of Labor opened rulemaking on it in late 2025 — verified August 2026.

We aim to cover the shift without a gap.

We are not going to promise that a replacement is always instant — no honest agency can. What we do is treat an uncovered shift as our problem to solve rather than yours, and we say so plainly when a case is hard to cover.

A registered nurse, on the schedule the state requires — and sooner when something needs attention.

An RN builds the plan of care, visits to see it working, and adjusts it as the condition changes. The frequency is regulated and not ours to skip.

Between scheduled visits, the trigger is the caregiver. If an aide reports something — a pressure sore starting, a change in appetite, a fall that did not get mentioned — a nurse comes out then, not at the next scheduled date. That is most of what early intervention actually is: someone in the room who notices, and a system that responds when they say something.

Thirteen languages across our caregivers. Six in the office.

Those are two different things and worth separating. The office answers in six languages — that is who picks up when you call. Our caregivers between them speak thirteen, which is what matters for the person actually being cared for.

For an older person with dementia, language is not a convenience. First languages come back as recent ones fade — someone who spoke English for fifty years may end up answering only in the language of their childhood. Being understood by the person in your kitchen at seven in the morning is part of the care, not an extra.

Tell us which language you need when you call and we will say plainly whether we can match it.

Brooklyn, Queens, Manhattan, the Bronx, Staten Island and Nassau County.

Two offices: 8718 Bay Pkwy, 7th Floor in Brooklyn and 136-20 38th Ave, Ste 3A1 in Flushing.