In New York, live-in vs. split-shift home care comes down to one test: whether a single aide is likely to get five hours of uninterrupted sleep during an eight-hour sleep period. If your parent can no longer be alone overnight, that test decides whether New York Medicaid sends one live-in aide or a team of aides working awake shifts. If you hire a live-in caregiver yourself, New York labor law adds its own rules, starting with overtime after 44 hours a week.,

In This Guide

Live-In vs. Split-Shift at a Glance

When the nights start going badly, families often hear two terms used as if they were interchangeable. They aren't. New York's personal care regulation, 18 NYCRR 505.14, defines them separately, and the difference is the number of aides in the home and how much sleep the aide can count on.

Live-in 24-hour care Split-shift (continuous) care
Aides One personal care aide More than one aide, for more than 16 hours in a calendar day
The sleep test Your parent's needs are infrequent enough that the aide is likely to get 5 hours of uninterrupted sleep during an 8-hour sleep period Your parent's needs are so frequent that a live-in aide would be unlikely to get those 5 uninterrupted hours
Needs that count Help with toileting, walking, transferring, turning and positioning, or feeding The same needs, at a higher frequency
Sleeping space The home must have somewhere for the aide to sleep Required when the home has no sleeping accommodations for an aide

These definitions come from New York's 2015 amendments to the regulation, and the New York State Department of Health applies parallel definitions to consumer directed personal assistance and directs Managed Long Term Care (MLTC) plans to use them. For the federal side of live-in care (who counts as a live-in, and the federal sleep-time rules), see our national guide to live-in caregivers.

How New York Medicaid Decides Between Live-In and Split-Shift Care

Here's the hard part to hear: Medicaid in New York does not start from "my mother needs someone 24 hours a day." It starts from what your mother needs help with, how often, and who else can provide it. Knowing that going in helps you describe her nights accurately rather than in general terms.

Who can get personal care at all

Since September 1, 2025, New York has applied a Minimum Needs Requirement to Medicaid personal care services and consumer directed personal assistance services, the services behind the CDPAP program. For adult New York Medicaid recipients age 21 or older, the Minimum Needs Requirement is needing at least limited assistance with physical maneuvering with more than two activities of daily living, or, for someone with an Alzheimer's or dementia diagnosis, at least supervision with more than one. People assessed and authorized for either service before September 1, 2025, or continuously enrolled in MLTC, keep Legacy Status and aren't held to the new requirement.

How the hours get set

The New York Independent Assessor Program (NYIAP) does a Community Health Assessment, and an independent practitioner panel issues the order. When someone needs, for the first time, more than 12 hours of care a day on average, the case also gets a secondary medical review by the Independent Review Panel. A first request for round-the-clock care is well above that 12-hour line.

The sleep test decides live-in or split-shift

Under 18 NYCRR 505.14, split-shift care is for a patient who, because of a medical condition, needs help with toileting, walking, transferring, turning and positioning, or feeding so often that a live-in aide would be unlikely to get five hours of uninterrupted sleep, on a regular basis, during the aide's eight-hour sleep period. If your father needs to be turned and helped to the bathroom several times between midnight and 6 a.m., say so plainly, with times, because that frequency is the whole question.

Family help is subtracted, not added

New York's regulation says personal care, including live-in and split-shift care, shall not be authorized to the extent your parent's needs can be met by voluntary help from informal caregivers (family, friends or another responsible adult), by formal services funded outside Medicaid, or by equipment such as a bedside commode, urinal, walker or wheelchair that can be provided safely and cost-effectively. So if you tell the assessor you sleep over every weekend, those nights can be counted as care Medicaid doesn't need to provide. Be honest, and be specific about what you can keep doing and what you can't.

No place for an aide to sleep

When your parent's home has no sleeping accommodations for a personal care aide, New York's regulation says continuous (split-shift) care must be authorized, and the district must review the case promptly if sleeping space later becomes available. A one-bedroom apartment where the only bed is your parent's is exactly the situation this rule addresses.

Not sure whether your parent's nights point to live-in or split-shift care? Brevy's care navigator can help you list the overnight needs to bring to the assessment.

Why a Live-In Aide Isn't Paid for All 24 Hours: The 13-Hour Rule

It can come as a surprise that a "24-hour" live-in aide from an agency is not paid for 24 hours. The reason is New York's Minimum Wage Order for Miscellaneous Industries and Occupations (12 NYCRR Part 142), which doesn't require minimum wage for meal periods and sleep times excluded from hours worked under the federal Fair Labor Standards Act, for a home care aide who works a shift of 24 hours or more.

In 2019, in Andryeyeva v New York Health Care, Inc., the New York Court of Appeals upheld the New York Department of Labor's reading of that wage order, often called the 13-hour rule. Under New York's 13-hour rule, a home health care aide on a 24-hour shift must be paid for at least 13 hours if the aide is allowed a sleep break of at least eight hours, actually gets five hours of uninterrupted sleep, and is allowed three hours for meals.

The conditions carry real weight. As the New York Court of Appeals described the New York State Department of Labor's position, a home health care aide on a 24-hour shift who doesn't get five hours of uninterrupted sleep must be paid for all eight sleep hours, and if the aide isn't actually given three work-free hours for meals, the three-hour meal exclusion doesn't apply either.

Notice that the same five-hour sleep line appears in both rules. If an agency's live-in aide is regularly up with your parent through the night, that's a pay problem for the aide and a sign the Medicaid category may be wrong.,

Hiring a Live-In Caregiver Yourself in New York

Some families hire privately, for the hours Medicaid won't cover or because your parent isn't on Medicaid. If you do, you're the employer, and New York's rules apply to you directly.

Overtime after 44 hours

Under New York Labor Law section 170, you can't require a domestic worker who lives in your home to work more than 44 hours a week (40 hours for one who doesn't live in) unless you pay overtime of at least one and one-half times the normal wage rate. New York's definition of "domestic worker" includes someone employed in a home as a companion for a sick, convalescing or elderly person, which describes the job this guide is about.

What that means for your budget: if the schedule you have in mind runs past 44 hours a week, price those extra hours at time and a half from the start, rather than finding the cost on the first paycheck. Getting it right from the first week protects you as the employer and the person caring for your parent.

Under the federal Fair Labor Standards Act, a household that employs a live-in worker may claim the federal live-in overtime exemption. That exemption is federal and covers overtime only; the federal live-in rule still requires at least the minimum wage for every hour worked, and the U.S. Department of Labor notes a live-in may be owed a higher wage under state law. New York's Labor Law 170 still sets the 44-hour overtime line for a live-in domestic worker the household employs.

Who New York's rule doesn't cover

This part matters most if you're thinking of paying a relative, or if the caregiver actually works for an agency. New York Labor Law section 2(16) leaves some people out of the definition of domestic worker. It excludes anyone working on a casual basis, someone providing companionship services (as federal law defines them) who is employed by an agency or employer other than the family using the services, and a relative by blood, marriage or adoption of the employer. New York Labor Law section 2(16) also excludes a relative of the person receiving care when the services are delivered under a program funded or administered by the government.

Rest days

Under New York Labor Law section 161, a domestic worker must be allowed at least 24 consecutive hours of rest each calendar week, and can work that day only by agreeing to it and being paid the overtime rate for those hours. After one year with the same employer, a New York domestic worker is also entitled under section 161 to at least three days of rest a year at the regular rate of pay.

In practice, one live-in caregiver is not a seven-day plan. Decide before the first week who stays with your parent on the aide's day off, whether that's you, a sibling or a second part-time caregiver, because asking the aide to work that day means paying the overtime rate.

Sleep and time off for a live-in

New York's wage order says a residential employee, someone who lives on the employer's premises, isn't treated as working during normal sleeping hours just because they're on call, or at any other time when they're free to leave. Write down the schedule you agree on, and keep a record of the hours actually worked; the federal live-in rule requires an hours record for a worker who lives on the premises, though the U.S. Department of Labor has suspended enforcement of that 2013 requirement pending a final rule.

When a Family Member Is the Paid Aide

Many New York families fill overnight care through CDPAP, where your parent hires and directs their own personal assistant. A spouse, a designated representative, and a person legally responsible for the consumer can't be the paid assistant, but another adult relative can, as long as the services fit the plan of care and cost no more than the same services from a non-relative. Since April 1, 2025, Public Partnerships LLC (PPL) has been the only fiscal intermediary for CDPAP.

As of January 1, 2026, New York's home care aide minimum wage is $19.65 an hour in New York City, Long Island and Westchester County, and $18.65 an hour in the rest of the state.

Paid hours are the authorized hours. Federal guidance says that in programs paying a family member, a relative with a close prior relationship usually isn't treated as employed beyond the hours in a reasonable plan of care, and a program may not cut paid hours because the caregiver is family. Our guide to getting paid as a family caregiver in New York walks through CDPAP enrollment step by step.

If Medicaid Approves Live-In and Your Parent Needs Split-Shift

It's discouraging to fight for more help when you're already exhausted. But a live-in authorization isn't the last word, and the rules give you a clock to work with.

If your parent's care comes through the county (fee-for-service Medicaid), you can ask the New York Office of Temporary and Disability Assistance (OTDA) for a State Fair Hearing within 60 days of the date of the notice. OTDA says to check the notice itself, because it states whether the limit is 60 or 90 days. If you ask before the effective date on a notice reducing services, OTDA says the help will, in most instances, stay the same until the decision.

If your parent is in an MLTC plan, you generally file the plan's internal appeal first. After the plan's Final Adverse Determination, the enrollee has no less than 120 days to request a fair hearing, but services under aid continuing end if the enrollee doesn't request the fair hearing within 10 days of that determination. Our guide to New York Medicaid appeals and fair hearings covers both routes in detail.

For the hearing, bring what the regulation asks about: a log of how often your parent needed turning, toileting or transfers each night, and whether there's anywhere for an aide to sleep.

What to Do This Week

  1. Keep a one-week night log: each time your parent needs toileting, turning, a transfer or feeding, and how long it took.
  2. Look at the home honestly. Is there a separate place for an aide to sleep?
  3. Write down which nights and hours family can reliably cover, and which they can't.
  4. If your parent is already authorized for care, find the most recent notice and note its date.
  5. If you're hiring privately, put the weekly schedule, rest day and pay rate in writing before the first shift.

Frequently Asked Questions

Is a 24-hour live-in home care aide paid for all 24 hours in New York?

Usually not, but the unpaid hours come with conditions. New York's 13-hour rule, upheld by the New York Court of Appeals in 2019, lets a home health care aide on a 24-hour shift be paid for as few as 13 hours only when the aide actually gets five uninterrupted hours of sleep and three work-free hours for meals.

What if my parent keeps a live-in aide up most nights in New York?

It matters in two ways. Under New York's 13-hour rule, an aide who doesn't get five uninterrupted hours of sleep must be paid for all eight sleep hours, and needs that frequent are what New York Medicaid's split-shift care exists for, so a night log of them is the evidence to bring to a fair hearing.

Do I have to pay overtime to a live-in caregiver I hire in New York?

Yes, at time and a half for every hour past 44 in a week, unless the caregiver falls outside New York's definition of a domestic worker, for example because they're your relative. If the caregiver agrees to work the weekly day of rest, those hours are paid at the overtime rate too.

Can a family member be paid to be my parent's overnight aide in New York?

Yes, through CDPAP, as long as the relative isn't your parent's spouse, designated representative, or someone legally responsible for them. Pay generally follows the hours in the plan of care, not every hour a relative spends in the house overnight.

Learn More

CaregiverLive-In Caregiver for an Elderly Parent: The Rules, the Real Cost, and Who PaysA live-in caregiver is usually owed minimum wage for every hour worked; room and board is only a capped credit. The rules, agency vs. private hire, who pays. MedicaidHow to Get Paid Through CDPAP in New YorkNew York CDPAP in 2026: who can be paid (and who can't), the 2026 pay rates, the new Sept 1 minimum-needs test, the PPL switch, and how to apply step by step. MedicaidYour Guide to New York Managed Long Term Care (MLTC)How New York Managed Long Term Care (MLTC) pays for home care in 2026: who qualifies, MLTCP vs. MAP vs. PACE, the new minimum-needs rule, and how to enroll. MedicaidNew York Medicaid Appeals and Fair HearingsHow to appeal a New York Medicaid denial, request a State Fair Hearing through OTDA, exhaust a managed care plan appeal, and keep your benefits while you wait. Care TypesHome Care vs. Home Health in New YorkHome care vs. home health in New York: home health is skilled care from a CHHA that Medicare covers; home care is non-medical help from an LHCSA or via CDPAP. MedicaidNew York Community Medicaid: The Complete GuideNew York Community Medicaid in 2026: home-care eligibility limits, the Excess Income Program, pooled income trusts, MLTC, CDPAP, and the 30-month lookback.

Find personalized help arranging overnight home care for your parent in New York at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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