10 Best Nursing Homes in Rochester, NY

Private pay methods in Rochester refer to income sources that are used to pay for nursing home or senior care services without the assistance of government programs. These income sources include savings, Social Security benefits, pensions, and investment returns.

In addition to these income sources, seniors may consider using other financial tools to help fund their long-term care needs. These may include:

Getting benefits

Monroe County Veteran Service Officers offer free assistance to help navigate the Department of Veterans Affairs bureaucracy. They can help gather the necessary information to support a claim, file the claim, and track the claim through the VA system. They can also assist with filing appeals for denied claims. It is strongly recommended that veterans make use of the services provided by county Veterans Service Officers, as their expertise can help avoid the pitfalls and delays that can result from missing paperwork or improperly-filled-out claims forms.

In addition to helping with VA benefits, the Monroe County Veterans Service Agency can review all possible veterans benefits and programs, including state and local benefits. The director and staff are accredited representatives authorized by the VA to present claims for further development, institute appeals from decisions made by the Veterans Benefits Administration, and follow through to final disposition with representation in Washington. This accreditation enables the County Veterans Agency to offer personalized service not available from other sources. Veterans can contact the office at 585-753-6040 or email them at mcveterans@monroecounty.gov with any questions about VA benefits.

You may be eligible for VA benefits if you are a:

• veteran
• veteran’s dependent
• surviving spouse
• child or parent of a deceased veteran
• active duty military service member
• member of the Reserve or National Guard

Benefits and Programs

In Rochester, New York, veterans may be eligible for various benefits to help pay for nursing home care in a nursing home facility. These benefits include:

1. Veterans Affairs (VA) Aid and Attendance (A&A) pension: This is a tax-free monetary benefit available to wartime veterans who need help with daily activities, such as bathing, dressing, and eating. The benefit can be used to pay for care in a nursing home facility or in assisted living and memory care.
2. Veterans Affairs (VA) Home-Based Primary Care (HBPC) program: This program provides in-home medical care to eligible veterans who are unable to travel to a VA medical center. The program can be helpful for veterans who are living in a nursing home facility and require medical care.
3. Veterans Affairs (VA) Geriatrics and Extended Care (GEC) program: This program provides a range of health care services and support to eligible veterans, including those with long-term care needs. The program can help veterans access nursing home care in a nursing home facility.
4. Veterans Affairs Supportive Housing: This program combines Housing Choice Voucher (HCV) rental assistance for homeless veterans with case management and clinical services provided by the U.S. Department of Veterans Affairs (VA). The VA provides these services for participating veterans at VA medical centers (VAMCs) and community-based outreach clinics.

It’s important to note that eligibility for these benefits may depend on a variety of factors, including the veteran’s length of service, discharge status, and income. The application and acceptance process for these benefits can be long and difficult, so it’s best practice to reach out to the resources mentioned above for help before applying. If you’re a veteran in Rochester, New York, and believe you may be eligible for these benefits, we recommend contacting your local Department of Veterans Affairs (VA) office to learn more.

The Department of Veterans Affairs (VA) has a Regional Benefit Office located in Rochester, New York, that provides assistance to veterans in the area.

New York’s Medicaid program provides health coverage to more than 7 million New Yorkers,  including seniors, people with disabilities, eligible low-income adults, children, and pregnant women. Medicaid pays for a wide range of services, depending on your age, financial circumstances, family situation, or living arrangements. These services are provided through a large network of providers using a Medicaid card or through a managed care plan.

Medicaid, known as New York State Medicaid in New York, has coverage for people on lower incomes and covers regular exams, immunizations, doctor and clinic visits, relevant medical supplies and equipment, lab tests and X-rays, vision, dental, skilled nursing services, hospital stays, emergencies, and prescriptions.

What aspects does the Medicaid program in the state of New York cover for skilled nursing?

The Medicaid program covers a variety of services for skilled nursing. Some of the services potentially covered by the program include:

• Room and board
• Nursing care and supervision
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Medications
• Medical supplies and equipment
• Personal care services
• Respite care
• Hospice care
• Dietary services
• Transportation to medical appointments

Does it cover assisted living or memory care?

Yes, New York State Medicaid covers assisted living for qualified individuals. The New York State Assisted Living Program (ALP) pays for services in licensed assisted living residences throughout the state for qualified individuals, who must require a high level of care, typically equivalent to the level of care in a nursing home.

Services provided by the ALP may include personal care, room, board, housekeeping, supervision, nursing care, physical therapy, occupational therapy, speech therapy, personal emergency response services, medical supplies and equipment, adult day health care, a range of home health services, and the case management services of a registered professional nurse.

Also, eligible low-income elderly in assisted living may be able to receive medically necessary in-home care services, including in assisted living and memory care communities, through Medicaid waivers from the Home and Community-Based Services waiver program. These are also known as HCBS waivers.

For eligibility, please reference the New York eligibility chart for more information. The local ombudsman can also help as well as the representatives at the Monroe County Office for the Aging.

Medicare is a federal health insurance program for people over the age of 65 and those with disabilities. While Medicare does cover some skilled nursing care, it is limited and does not cover room and board fees in care facilities, only medical-related services. Medicare’s coverage focuses on medically necessary care and the treatment of medical conditions; services include:

• Part-time skilled nursing care.
• Physical, occupational, and speech therapy.
• Medical supplies and equipment like hospital beds and wheelchairs.

Locally, several resources can support you in the claims process and, in some cases, provide funding for Medicare deductibles. New York Medicare, which includes Medicare Advantage Plans, offers guides and assistance for those needing coverage.

Whether your loved one needs skilled nursing or a different type of senior care, the following should be taken into account regarding Medicare:

• Those seeking prescription drug coverage under the Elderly Pharmaceutical Insurance Coverage (EPIC) Program can contact EPIC for more information about options.
• Medicare Part A covers skilled nursing care for a limited time on a short-term basis if specific conditions apply, such as having days left in your benefit period to use and having a qualifying inpatient hospital stay.
• Medicare does not cover custodial care, which is care that helps with activities of daily living or personal needs that could be done safely without professional skills or training. For that type of care, Medicaid may be an option for eligible individuals.

SHIP program

New York State’s HIICAP is a statewide network of Health Insurance Information, Counseling, and Assistance Programs, headquartered at Area Agencies on Aging or their subcontractor non-profit agencies. HIICAP is the state health insurance assistance program (SHIP), which receives federal assistance from the Centers for Medicare and Medicaid Services (CMS) and the State of New York to educate the public about Medicare, Medicare Advantage plans, and other health insurance issues.

They provide free, accurate, and objective information, counseling, assistance, and advocacy on Medicare, private health insurance, and related health coverage plans. HIICAP helps people with Medicare, their representatives, or people soon to be eligible for Medicare. They also provide information on low-income programs such as the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, Medicare savings programs, Extra Help prescription assistance, and pharmacy discount programs.

If you are a Medicare beneficiary or soon to be eligible for Medicare, you can schedule an appointment with HIICAP staff and volunteer counselors to learn more about:

• Medicare and health insurance questions about benefits, options, paperwork, and resources.
• Medicare covered costs, deductibles, and programs.
• Health care costs that clients will be responsible for.
• Information on insurance products that may help pay for costs not covered by Medicare alone, such as a Medigap or a Medicare Advantage Plan.
• How to review and select a Medicare Part D prescription plan.
• Help in resolving specific health insurance problems.

Medicare Savings Program

The Medicare Savings Program (MSP) is a Medicaid-administered program that can assist people with limited income in paying for their Medicare premiums. Depending on their income, the MSP may also pay for other cost-sharing expenses. When individuals enroll in an MSP, they will also automatically get Extra Help, the federal program that helps pay most of their Medicare prescription drug (Part D) plan costs. There is no resource test for the MSP programs. This means many Medicare beneficiaries who may not qualify for Medicaid because of excess resources can qualify for an MSP.

There are three benefit levels, and each has a different income eligibility limit. All three programs pay for the Part B Medicare Premium. If qualified, individuals will no longer have this premium amount deducted from their Social Security benefit.

For more information about the MSP income limits, individuals can download the Medicare Savings Program application – DOH-4328 (PDF) and Instructions if they want help paying for their Medicare costs.

Elderly Pharmaceutical Insurance Coverage (EPIC) Program

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors that is administered by the Department of Health. They aim to help more than 325,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. To receive EPIC benefits and maintain coverage, seniors must be enrolled or eligible to be enrolled in a Medicare Part D drug plan and can apply for EPIC at any time of the year.

EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. They also cover approved Part D-excluded drugs once a member is enrolled in Part D. EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. However, higher-income members are required to pay their own Part D premiums, but EPIC provides assistance by lowering their EPIC deductible.

EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.

To join the program, seniors need to complete this application and mail or fax it to EPIC. No documentation is required, and EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.

ElderONE

For Rochester seniors who require long-term care but wish to remain independent, ElderONE may be the ideal solution. ElderONE is an innovative Program of All-Inclusive Care for the Elderly (PACE) that is affiliated with Rochester Regional Health. It provides a complete range of medical care and support services to seniors aged 55 and over with chronic care needs. The program’s interdisciplinary team of geriatric healthcare specialists, along with the participant’s family, create a unique health care plan tailored to their specific requirements. This plan allows them to stay at home for as long as feasible without jeopardizing their health or safety. As the area’s only PACE program, ElderONE represents the future of senior health care.

To be eligible for ElderONE, individuals must:

• Be 55 years of age or older
• Need community-based, long-term care for more than 120 days
• Be able to live safely in the community with ElderONE assistance
• Have Medicaid or be Medicaid-eligible (unless paying privately)

Local Social Security Administration offices

Social Security provides income for insured workers, as well as their spouses, divorced spouses, children, and surviving parents. SSI offers a basic income that can be combined with Social Security, pension, or earnings. People who are 65 years or older, disabled, or blind, and whose income and resources fall below a certain threshold, may qualify for SSI, including disabled children of any age.

For those who want guidance on both Medicaid and Medicare, New York offers integrated care plans for dual eligible New Yorkers. “Dual eligible” refers to those who qualify for both Medicare and Medicaid benefits; an integrated care plan enables qualified individuals to receive both their Medicaid and Medicare services from the same health plan.

Medicaid and Medicare eligibility can be complicated; we recommend contacting any of the resources listed for support before applying for benefits.

The Medicaid program in the State of New York is called New York State Medicaid. There are several senior-specific programs in New York that may be of interest:

• New York State Office for the Aging (NYSOFA): Provides a range of services to older adults, including health insurance counseling, caregiver support, and legal services.
• Home Energy Assistance Program (HEAP): Provides financial assistance to eligible low-income households, including seniors, to help pay for home heating and cooling costs.
• Elderly Pharmaceutical Insurance Coverage (EPIC) program: Provides financial assistance for prescription drugs to eligible seniors in New York.