Strong secretariat key to reversing state’s dismal care record


By Sondra L. Shapiro

There was a time when a sound argument could be made that Massachusetts was on the right track when it came to aging residents in need of long-term care services and their caregivers.

Massachusetts was nationally respected for its attention to its aging citizens, most especially because in 1974, the state had the foresight to elevate Elder Affairs to a cabinet level secretariat.

The distinction meant the secretary — who was usually a professional plucked from the aging network — reported directly to the governor. That person’s expertise allowed him or her to develop and implement a plethora of creative initiatives.

Under the best of circumstances, The Executive Office of Elder Affairs (EOEA) provided strong leadership with regard to aging concerns. That’s not to say there wasn’t room for improvement or, for that matter, better coordination of care; but the office was on the right track and made an impressive impact in service and program delivery.

How low we have fallen since those glory days. EOEA is now just a cog in the Health and Human Services (HHS) wheel, with little power or authority to act on behalf of the state’s aging population, thanks to its demotion under the Romney administration in 2003. It was a crushing blow at the time, with advocates and those who worked with the elder population prophetically warning that the quality of life for the elderly and caregivers would suffer the consequences.

Though Romney’s aim was to improve efficiency, consolidation was done with no thought to real people whose needs transcend health to include legal issues, housing, employment, transportation and consumer protection as well as social services. Or that the state’s aging population was growing, not shrinking.

Today Massachusetts ranks an embarrassing 30th among all states in terms of how it services individuals receiving long-term care in a nursing home or in their own home, according to a new study by AARP and the SCAN Foundation. (Related story)

This is not to say that the demise of EOEA is solely responsible for this dismal score, I just wonder where we would be if we still had that strong, independent voice at the statehouse, advocating on behalf of the aging population and caregivers?

The report, Raising Expectations:  A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, examined performance in four areas: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. It assessed each state’s performance as a whole and on 25 individual indicators. The review included adult day health services, assisted living, nursing homes, home and respite care.

Though, Minnesota, Washington and Oregon rank in the top three, the study shows that all states need to vastly improve in all areas studied.

“While there is definite room for improvement in all areas, Massachusetts ranks too close to the bottom when it comes to the cost of care and an overreliance on institutional care,” said Deborah Banda, director of AARP Massachusetts.

Although Massachusetts ranked 17th overall for affordability and access, the state scored extremely low (46th) in two key indicators within that measurement:  median annual nursing home private pay and median annual home care private pay costs as a percentage of median household income. Despite its middle-of-the-pack ranking for overall affordability, Massachusetts is ranked as one of the most expensive states in the nation for those paying for nursing home care.

The state ranked in 14th place for choice of setting and provider, but scored 40th place for the percentage of new Medicaid long-term services and supports users first receiving services in community.

The state’s worst rankings among the four overall dimensions came in quality of life and quality of care (34th) and support for family caregivers (39th).  In both, improvement is needed across the board, from adults with disabilities getting needed support in the community (27th) and being satisfied with life (38th) to the use of physical restraints in long-stay nursing homes (35th) and intervention for pressure sores in home health plans for at risk patients (40th).

“This Scorecard is a critical first step toward creating a much more person- and family-centered system of care that delivers services honoring each individual’s dignity and choices,” said Bruce Chernof, president and CEO of The SCAN Foundation.

HHS Secretary Dr. JudyAnn Bigby told the Boston Globe that the state wants to create more community-based group homes for seniors. That’s a proclamation we have heard for years. When the Executive Office of Elder Affairs was a strong secretariat, that office came up with very creative housing ideas that ultimately were cut during budget negotiations.

Bigby also acknowledged the need to pull together the fragmented long-term care network. Yet, this is another long-claimed declaration of hollow words. The obvious lip service teeters on insult, given the seriousness of the issue.

A few years ago, advocates made a plea to Gov. Patrick to restore EOEA to a full secretariat. Nothing came of it. The time to remedy the situation is way overdue. A strong secretariat and an empathetic legislature is the only way to catapult Massachusetts to the top of the national list — to reclaim our state’s standing as a place that supports frail aging residents and their caregivers to live with dignity, and security.

Some information came from the Mass Home Care Bulletin. Sondra Shapiro is the executive editor of the Fifty Plus Advocate. Email her at or read more at