By Debbie Spingarn
Contributing Writer
BOSTON – There are over 62 bills in the Massachusetts State House affecting assisted living laws. Perhaps equally important for consumers is to understand the changing nature of these facilities.
Such residences house mostly senior citizens needing minor or more complicated assistance with physical, mental and memory needs. Independent living, assisted living and assisted living memory care are poorly regulated, leading to problems in what assistance can be provided when residents become sick, or need help with basic activities of daily living.
Amount of regulation subject to debate
Should assisted living memory care facilities be more strictly regulated and by which state agency? Now, many of the rules are made by the corporate entity that runs the facility and although government provides some regulation – some people think it’s not enough.
Because of public demand and situations like the tragic Gabriel House fire in Fall River in July 2025, the Assisted Living Residences Commission was formed in 2025 to study how to better regulate, monitor and take care of aging residents who live in assisted living residences and long-term care facilities. It will issue reports focusing on legal problems and possible fixes for issues faced by assisted living residences.
State Senator Patricia Jehlen has sponsored several bills including S409 which is “An Act to Authorize Common Sense Health Services in Assisted Living.” Currently, a resident residing in, for example, a memory care facility who needs assistance with eye drops, bandage changes, antibiotic creams to be applied to a cut, or oxygen services, for example, must call in a visiting nurse or other agency outside the facility for help. This complicated situation, where a resident or family needs to call his or her physician, procure an evaluation, get an order and then wait days or weeks for a nurse to come and administer the service needs to be changed, according to proposed legislation.
Staffing concerns
“Care is going downhill, it is really concerning,” said a worker at a memory care facility in the metropolitan Boston area. The front desk employee, who wanted to remain anonymous, cited unsafe practices she sees from her position at the front desk, where many of the calls from family members first come in.
“When residents pull a call cord for help,” she noted, “it could be 30 to 45 minutes for a response.”
Staffing regulations are items on a number of proposed legislative bills. Currently, “special care” units as they are named commonly refer to memory care assisted living facilities. No less than two staff members are required to be on duty at all times. Contracts written by owners of facilities often refer to staffing levels being determined by the number of people in a unit. These units often have 14 to 15 elderly residents with various needs and stages of dementia, which can include wandering, aggression, apathy, poor eating habits, mobility issues and lack of one-to-one companionship.
The front desk employee added that many residents entering such facilities are “not independent,” and this is confirmed by studies showing assisted living memory care residents in particular are sicker and frailer. There are often long waits for long-term care skilled nursing facilities to have availability. This, coupled with payment and long Medicaid waits complicate care for the elderly with degenerative brain diseases. Alzheimer’s disease, Parkinson’ s disease dementia, Lewy Body Dementia, frontotemporal dementia and other disorders often require staff with some knowledge of these disorders. But CNAs sometimes have little training in dementia care.
Dementia training involves specialized skills and requires employees to have not only the skills but also compassion and energy to deal with a difficult population of elders. Some residents with early-onset disease present a different set of challenges for care workers and families.
High demand and cost of care
Financial issues loom large. Unlike Gabriel House, which accepted Medicaid, many area facilities only accept cash. Costs can be upwards of $14,000 per month and include little more than a room and three meals a day, and help with ADLs (activities of daily living). Some residents may sit waiting for help for hours until other residents are cared for.
Massachusetts is grappling with increasing numbers of elderly needing long-term care. “A state-commissioned study,” said The Boston Globe in a December 10 story by health writer Kay Lazar, “released earlier this year envisioned a program to be funded by a mandatory payroll tax in much the same way Medicare and Social Security taxes are automatically deducted now.”
Agency to regulate assisted living in question
Which state agency is best suited to regulate assisted living? The Department of Public Health or the Department of Health and Human Services? Yet another question for the legislature to answer. Memory care units can be classified as medical units, because degenerative brain diseases that afflict such residents are medical issues.
For now, it remains to be seen how the myriad of bills addressing issues of assisted living will be passed or not, however amended, or enforced. A bill signed into law on September 9, 2024, by Gov. Maura Healey allows assisted living facilities to provide oxygen, eye drops, wound care and other basic health services. However this is something that can be accepted or not by the owners of such facilities. Many will choose not to, based on increased need for trained staff and associated costs to administer those services.
Educating the public
Many residents of the Commonwealth don’t know how assisted living residences operate. Often, when asked, they react with surprise when they learn who pays for it. “That isn’t covered by Medicare?” some people ask.
A web search indicates that “fifty-eight percent of adults think Medicare covers long-term care.” In addition to stronger laws regulating assisted living residences, stronger public education around financing and problems facing care for those over the age of 65 is likely needed.
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