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When a loved one needs ongoing support, many families assume the options are limited. Either manage everything alone or consider a facility. In reality, New York has home and community-based options designed to help eligible people stay in their homes and remain connected to their communities.

One of the most commonly searched programs is the NHTD Waiver, short for Nursing Home Transition and Diversion. This guide explains what it is in plain English, what kinds of supports it may include, and how RES helps people on Long Island navigate services and planning.

If you are exploring waiver-related support, start with RES’s Aging at Home and waiver programs page, which outlines the program focus and the types of services RES provides through these pathways.

What Is the NHTD Waiver?

The NHTD Waiver is a Medicaid home and community-based program in New York. It is designed to help eligible individuals who would otherwise require a nursing home level of care, either:

• Transition from a nursing home back into the community
• Avoid nursing home placement by receiving supports at home and in the community

In simple terms, it is meant to help people live more independently and safely outside of an institution, with services that support daily life, health, and community participation.

Who the NHTD Waiver May Help

Every situation is different, and eligibility depends on program rules and individual circumstances. Broadly, the NHTD Waiver is often discussed for people who:

• Need a nursing home level of care, but want to live in the community
• Have ongoing support needs related to disability or age
• Could stay safe at home with the right services and structure

Families usually look into NHTD when they see needs increasing, such as safety concerns, mobility challenges, difficulty managing daily tasks, or caregiver burnout.

Signs it may be time to explore waiver support

• Your loved one’s needs are growing beyond what the family can consistently handle
• You are worried about safety at home, especially falls or medication routine issues
• Care coordination feels overwhelming or confusing
• You want a structured plan that supports long-term independence

What Services Can Be Part of an NHTD Plan?

The most helpful way to think about the NHTD Waiver is that it can bring together multiple supports under one plan so a person can live more safely and independently.

RES highlights a set of service types commonly discussed in their waiver programs overview, including:

Service Coordination

A Service Coordinator helps guide and manage services so they stay organized and aligned with the participant’s needs.

Structured Day Program

A structured day setting can support skill-building, independence, and social connection.

ILST (Independent Living Skills Training)

Skill support focused on everyday independence, such as organization, routines, budgeting, cooking, and transportation.

HCSS (Home and Community Support Services)

Support with health and safety at home, including assistance with daily activities.

PBIS (Positive Behavioral Interventions and Supports)

Support designed to reduce challenging behaviors and build healthier responses.

Transportation

Transportation support that helps make the care plan realistic and consistent.

These services are often used together, not in isolation. The goal is not just “more help,” but the right combination of help that makes life at home stable and safe.

How RES Supports People Navigating NHTD-Related Needs

Families do not only need services, but they also need clarity. RES’s waiver programs content emphasizes planning, navigation, and practical supports that help families move forward.

Here are a few ways RES can fit into the picture:

Planning and guidance through Aging at Home

Many families start with questions about cost, coverage, and what options exist. RES describes support that includes guidance around long-term care options and navigating Medicaid and waiver-related pathways. If you are comparing options, their Aging at Home and waiver programs page is the best starting point.

Service Coordination and connected support

Service coordination is a core theme across RES’s community-based service offerings. Their community services page explains that they provide services with flexible payment options, including waiver-related pathways, and describes Service Coordination as a way to oversee services and help maintain eligibility, medical needs, and transportation planning.

Skills and stability support for daily life

Programs like ILST and PBIS are designed to support practical independence and emotional stability, not just short-term help. These are the kinds of support families often need when a person’s day-to-day functioning has changed, and the goal is to build a sustainable routine again.

What Families Can Expect When Getting Started

Even if you plan to use external resources for the official rules and steps, families often benefit from a simple framework before they start calling around.

Step 1: Clarify goals

Write down what “staying at home successfully” means for your family, such as:

• Safe bathing and toileting routines
• Reliable meal routine and hydration
• Reduced fall risk
• Fewer missed appointments
• Better structure, supervision, or social connection
• Less caregiver strain

Step 2: Identify the highest-risk moments of the day

Most care plans become clearer when you pinpoint the specific times problems happen, for example:

• Morning transfers and bathing
• Medication routine
• Evening confusion or anxiety
• Meal prep and stove safety
• Leaving the home safely for appointments

Step 3: Match supports to needs

A helpful plan often includes a mix of coordination, at-home supports, and community-based services. This is where service coordination and skill-based supports can make the plan feel realistic, not theoretical.

Step 4: Build a plan that can evolve

Needs change. A good plan can increase support during high-risk periods, adjust routines, and add services without feeling like you have to start from scratch.

NHTD vs “Regular Home Care”: Why Families Get Confused

Families often mix up three separate ideas:

• Home care support at home
• Waiver services and planning
• Structured community services that support independence

Home care can be a key part of staying safe at home, but waiver services often focus on a broader plan that includes coordination, skill-building, and community supports. The right path depends on the person’s needs, support system, and how care is being funded.

If your main immediate need is hands-on help at home, it also helps to review RES’s in-home care options. If your bigger question is long-term support planning and coordination, the waiver programs and community services pages will be most relevant.

Common Mistakes Families Make When Exploring Waiver Options

Waiting until a crisis

Many families only start looking after a fall, hospitalization, or caregiver burnout. Starting earlier gives you more time to plan and reduces last-minute decisions.

Trying to solve everything with one service

A single service rarely fixes everything. The best results usually come from combining coordination, daily support, and skill-building, based on the person’s actual routine.

Focusing only on paperwork

Eligibility and steps matter, but the plan itself matters just as much. A clear picture of needs, risks, and goals helps services align better.

Not planning for transportation and follow-through

Even great care plans fail when transportation is not realistic or when appointments and services are not consistently coordinated.

Questions Families Ask About the NHTD Waiver

Is the NHTD Waiver only for people currently in a nursing home?

No. It is often discussed in two contexts: helping someone transition from a nursing home to community living, and helping someone avoid nursing home placement by using supports in the community.

What kinds of services can be included?

Plans can include coordination, skills training, home and community supports, behavioral supports, structured day programming, and transportation, depending on the person’s needs and eligibility.

Do we have to figure everything out on our own?

You do not have to. Families often benefit from guidance and service coordination support, especially when multiple services, appointments, and eligibility requirements are involved.

Can waiver support work alongside other care?

In many real-life situations, support is layered. A person may have in-home support for daily routines, plus community-based supports that build stability and independence over time.

How do we know if we should explore NHTD or another option?

A practical first step is to clarify needs, risks, and goals, then talk with a provider who can help you understand what supports fit your situation and what pathways may be available.

A Practical Next Step for Long Island Families

If you are considering the NHTD Waiver, the goal is not to memorize program rules. The goal is to build a realistic plan that supports safety, independence, and quality of life at home.

If you are in Nassau or Suffolk County and want help understanding what services could fit your situation, start by reviewing RES’s Aging at Home and waiver programs, then reach out to RES Home Care to talk through your needs and next steps.

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