1) Define the Care You Need 

Daily tasks: bathing, dressing, toileting, mobility, meals, medication reminders, supervision/safety.
Clinical add-ons: occasional RN/PT/OT visits, wound care, injections (usually intermittent).
Household support: laundry, light cleaning, shopping, dishes (when tied to care).

Quick hour guide (start here):

• Light help: 3–4 hrs/day 
• Moderate: 6–8 hrs/day 
• High/safety: 10–12 hrs/day 
• Continuous supervision: live-in or split 24/7 shifts

2) Pick the Staffing Model 

1. Agency (hourly aide)

• Turnkey: they recruit, insure, supervise, run payroll. 
• Cost: hourly (live-in sometimes priced per day). 
• Best for: fast start, minimal admin. 

1. CDPAP (Consumer Directed, Medicaid)

• You choose/train the worker (often family; not a spouse). 
• Cost: wages covered once Medicaid plan approves hours. 
• Best for: trust, language/cultural fit, schedule control. 

1. Live-in (private pay)

• One aide lives in the home; priced per day if safe sleep/breaks are possible. 
• Best for: steady supervision at lower cost than 24/7 hourly.

1. Adult Day Services

• Daytime supervision, meals, activities, often transportation. 
• Best for: socialization + fewer home hours.

3) Build Your Monthly Number (simple worksheet)

1. Care hours & labor

• In-home aide: ___ hrs/day × 30 = ___ hrs/mo × $/hr = **$** 
• Live-in: ___ days × $/day = **$** 
• CDPAP (Medicaid): $0 for wages (if eligible); note any spend-down: $___

1. Programs offsetting cost

• Medicaid MLTC/CDPAP or waivers 
• Long-Term Care insurance (daily/monthly benefit, elimination period) 
• VA Aid & Attendance (if eligible)

1. Non-labor essentials

• Supplies/DME not covered (incontinence items, gloves, shower chair): $___ 
• Meds/copays: $___ 
• Transportation (paratransit, ambulette, rides): $___ 
• Food/household increase: $___ 
• Home modifications (grab bars, ramps; amortize if helpful): $___ 
• Contingency 5–10%: $___ 

Estimated Monthly Total: $___

4) How Medicaid Changes the Math (New York)

• Eligibility: Meet income/resource rules (single vs. married differ). 
• Excess income: Qualify via spend-down or, if disabled, a pooled income trust so excess income can pay essentials while keeping eligibility. 
• Authorizations: A plan nurse sets approved weekly hours. If needs rise (falls, wandering, night care), request reassessment or appeal. 
• CDPAP vs. Agency: Both depend on authorized hours. CDPAP lets you pick and schedule the worker; the plan still sets the hour cap.

5) Fast Scenarios 

1. A) Moderate help via agency

• 6 hrs/day × 30 = 180 hrs/mo × local hourly rate → Labor total 
• Supplies/DME: add $100–$150 
• Transport/misc: add $75–$150 
• Total: Labor + $175–$300

1. B) Weekday live-in + family weekends

• Daily live-in rate × 22 days → Labor total 
• Supplies/meds/transport: $200–$300 
• Total: Labor + $200–$300

1. C) Medicaid MLTC + CDPAP

• Authorized 8 hrs/day (≈240 hrs/mo) → $0 wages out-of-pocket 
• Pooled trust admin fee (if used): $25–$50 
• Supplies/transport: $100–$200 
• Total: $125–$250 (+ any required spend-down)

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Important: This guide is educational and not legal or tax advice. Always consult a NY elder-law attorney and tax professional before transferring assets.