The real state of the (elder) commonwealth


By Al Normanalnorman_headshot

For the past decade, I have reviewed the text of the annual State of the Commonwealth (SOTC) speeches by three governors. I look carefully for use of the word “elderly” or “seniors” to see if there are any significant policy statements about our growing elderly population.

Between 2010 and 2020, the Massachusetts population 60+ is projected to grow from 1.27 million to 1.63 million, a 31-percent increase of 359,845 elders. One-quarter of all of the households in Massachusetts includes at least one person aged 65 and over. The population of people aged 65 and over in Massachusetts, as a percentage of total state population, will jump 50 percent between 2010 and 2030, from 14 percent of the population, to 21 percent of the population.

The last time a sitting governor actually mentioned the elderly was in January of 2006. Then-Governor Mitt Romney said the following in his SOTC speech: “And, there’s more on my agenda for the coming year. I’ll work for a program that gives seniors a better choice to age in their homes.” Several months later, Romney signed into law the “Equal Choice” bill, which promised that enrollees in MassHealth would be cared for in “the least restrictive setting” of their choice.

Since 2006, elders have not made an appearance in any State of the Commonwealth speech. It is striking that the fastest growing demographic in the state does not warrant even a mention. Here are some challenges worth a line or two in a major policy speech:

* Massachusetts has a higher proportion of its population enrolled in Medicare and Medicaid than the national average. Across the U.S., the Medicare and Medicaid populations have greater health care needs and spending levels than those in commercial insurance.

* Five percent of patients account for nearly half of all spending among the Medicare and Medicaid populations in Massachusetts. Significant savings can be captured by focusing on high-cost patients, and high-cost patients generally have more clinical conditions than the rest of the population.

* Despite the fact that the commonwealth has shifted spending from nursing facilities to a “community first” approach, Massachusetts still has many opportunities to improve long-term supports outcomes and reduce costs.

* Unprecedented growth in the elder population will create a marked increase in the demand for quality long-term services and supports (LTSS) in the commonwealth. Nearly 70 percent of people turning age 65 will need some level of LTSS in their lifetime, with 40 percent of people needing services for more than two years and 16 percent of people needing over $100,000 in services.

* For low-income elders, the cost of these services will be borne primarily by MassHealth. Policy makers need to plan for the expanded service needs of this population.

* The rate of residents in nursing facilities in Massachusetts is 46 percent greater than the U.S. average. If we could reduce our bed rate in nursing facilities to the national average, we could save $774 million over the next five years, and $6.3 billion by the year 2030.

* Massachusetts spends 63 percent more on Medicare per capita spending for nursing facility care, and 29 percent more for Medicaid per capita spending on nursing homes than the national average in 2009.

* Massachusetts has a higher rate of discharge from hospitals to nursing facilities relative to the national average, suggesting an opportunity to manage post-acute care more efficiently. Hospitals in Massachusetts discharge patients into nursing facilities at a rate 8 percent higher than the U.S. average.

* Our state does not allow spouses to be paid caregivers, and doesn’t allow people with dementia to get personal care attendants.

* Massachusetts should guarantee that any senior who enrolls in a managed care plan has access to an independent agent to assess what home-based services they need to end provider conflicts of interest.

An entire speech could be written about the state of the elderly commonwealth. I am still waiting for it to be written.

Al Norman is the executive director of Mass Home Care. He can be reached at, or at 978-502-3794. Archives of articles from previous issues can be read at