Massachusetts Assisted Living
Although the overall cost of living in Massachusetts is high, the cost of health care is almost 20% less than the national average. With its rich history, range of scenery, and world-renowned health care, Massachusetts is a great place for people to retire. In addition, Social Security benefits and public pension income aren't subject to state income tax, making the Bay State moderately tax-friendly for retirees. Read on to learn more about assisted living communities in Massachusetts, what options are available, how much they cost, and how long-term care communities are regulated.
The typical resident population in Massachusetts's assisted living communities is 72% female. Overall, 84% of residents are ages 75 and older, with 34% of residents ages 75 to 84 and 50% ages 85 and older.
The Executive Office of Elder Affairs certifies assisted living residences (ALRs), which is the licensing term for ALFs in Massachusetts. These residences aim to provide an environment where seniors can age in place. Services for residents are covered under the state Medicaid program.
Adult foster care (AFC), also called adult family care, is for frail elderly adults and adults with disabilities who cannot safely live alone but want to live in a family environment. AFCs are covered under the state Medicaid program; the caregiver must be a family member.
An ALR provides room and board and personal care for three or more adult residents. Personal care services can be provided by employees or by third-party arrangements. These services include assistance with one or more of the activities of daily living (ADL) and the management of medication self-administration.
A special care residence provides enhanced services for residents with cognitive or other impairments. It can be a residence that serves this population in its entirety or in a separate section of an ALR.
Each resident or their representative will have a written contract with the facility. The contract outlines the services covered in the agreed-upon fees, a description of bundled services, and an explanation of additional services offered and the associated cost of those services. The agreement also includes refund policies, provisions for terminating the agreement, residents' rights, and limitations on the services the residence will provide, particularly relating to ADL and behavioral management, and payment arrangements.
Before finalizing the agreement, the facility must disclose the number and type of units, current staffing levels and makeup of the staff, entry and discharge policies, the cost of services offered, resident grievance procedures, and eligibility requirements for any subsidized programs, including the costs that the resident is responsible for.
Any facility that markets itself as a facility providing special care for residents must include disclosure regarding the mission and care philosophy followed.
An ALR is not permitted to admit or retain a resident that needs 24-hour skilled nursing supervision unless the services are provided by a licensed hospice or a certified provider of ancillary health services. The resident does not need these services for more than 90 consecutive days. The certified health service provider cannot train the ALR staff to provide these services.
ALRs are required to assist with ADLs, including bathing, dressing, ambulation, and related tasks as well as instrumental activities of daily living (IADLs). IADLs include laundry, housekeeping, and socialization. ALRs must also manage the self-administration of prescription medications and over-the-counter medications and provide assistance with residents’ emergency needs.
Any ALR that provides special care services must submit a plan of operations explaining how the residents will meet the needs of the residents in this unit. These facilities must also prepare a daily activity program for these residents, including motor activities, self-care activities, social activities, and sensory and memory enhancement activities.
Before admission, each resident must have a screening and assessment to determine the needs and preferences of the residents. The primary purpose of this screening is to determine if the facility can meet the resident's needs. If the facility can, the assessment and the result of a medical exam that determines the resident’s physical, cognitive, and psychosocial conditions are used to develop a service plan. The service plan will include the individual's diagnosis, current medications, allergies, dietary needs, need for assistance in an emergency situation, level of personal care needs, and ability to manage medications.
An ALR must provide three regularly scheduled meals based on the recommendations of the National Academy of Sciences. The facility must provide menu selections allowing residents to adhere to a prescribed dietary plan. The special diets must be provided include sodium-restricted, sugar-restricted, and low-fat diets. The facility must use a qualified dietitian to review the dietary needs and provide counsel to residents regarding therapeutic diets and other dietary needs. Every resident’s dietary needs must be reviewed every six months.
Each ALR must employ a manager who is in charge of the general administration of the facility as well as at least one service coordinator. The service coordinator is responsible for developing, reviewing, and revising the service plans of each resident. Personal care staff must be one of the following:
If a personal care staff member does not have one of the certifications listed above, they must pass a 54-hour training course, described in more detail in the next section.
There are no minimum staff ratio requirements other than the facility being able to provide for all residents' needs at all times according to their service plans. Staffing must also be sufficient to respond to emergencies and provide for residents' safety in emergencies and disasters.
Before beginning employment, each staff member and contract worker that has direct resident contact or provides food services must receive an initial 7-hour orientation program. This orientation must include
Employees that provide direct care services to residents must receive an additional hour of orientation on the management of self-administration of medications. Managers and service coordinators must receive two hours of training on dementia care topics.
ALR personal care services staff must complete a 54-hour training program prior to direct care contact with residents. The training must include 20 hours on the provision of personal care services, including personal hygiene, management of medication self-administration, home safety, helping families deal with grief and loss, and nutrition. This staff must be trained in first aid and is required to complete one hour of continuing education annually on the management of self-administered medications.
All employees must take 10 hours of annual continuing education and training. Two of these hours must be on the needs of residents with Alzheimer’s disease.
Apartment-style apartment units are not required in Massachusetts. Units must have lockable doors and must be either single or double occupancy. All newly constructed ALRs must provide a private bathroom for each unit, minimally equipped with one sink, one toilet, and a bathtub or shower stall.
All resident units must have a private half-bathroom equipped with a sink and toilet. There must be a shower or bathtub available for every three residents. All facilities must provide a kitchenette or access to a refrigerator, sink, and heating element for all living units.
An ALR that serves Medicaid waiver participants must provide an apartment with a separate living, sleeping, bathing, and cooking area.
There are several requirements that each assisted living community must provide for their residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
The management of medication self-administration is a required service of an ALR. This includes reminding residents to take medications, opening medication containers, reading the medication label to the resident, and observing the resident taking the medication. Only an individual who has completed a personal care service training program can perform this management service.
A licensed nurse the facility employs is permitted to administer non-injectable medications orally or by other methods.
The Massachusetts Department of Mental Health provides access to services and support to meet mental health needs. The department also has a 24-hour emergency and crisis support helpline. The National Alliance on Mental Illness of Massachusetts (NAMI) is a nonprofit organization that aims to improve the quality of life for those diagnosed with mental health conditions. NAMI provides information on programs and resources to help people improve their mental health. VA Boston healthcare offers a behavioral health program that provides veteran-focused mental health care. Veterans who qualify for VA health care can get high-quality mental health services included in their benefits. If you don't have VA health care, you may still be able to get treatment for certain mental health problems.
In Massachusetts, ALRs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 59% of communities providing skilled nursing. Many have health care specialists and on-site services, with 56% of communities offering dental care. In addition, 64% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Massachusetts, 80% of communities conduct depression screenings, and 57% offer mental health counseling. Social work programs are also found in 61% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents have access to all the resources they need.
Some assisted living residents live with various medical conditions. In Massachusetts, 43% have Alzheimer's disease or another form of dementia. In addition, 41% have high blood pressure, 29% have heart disease, 23% have depression, and 11% have diabetes.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Massachusetts’s assisted living facilities often receive help with their ADLs. In Massachusetts, 13% of residents need help eating. Other commonly used services include bed transfer (20%), toileting (31%), and walking (40%). Caregivers in ALFs help 48% of residents dress, and 59% need help bathing.
The average cost of assisted living care in Massachusetts is $6,500. This is $2,000 higher than the monthly national average of $4,500. The cost of living in Massachusetts is more than the national average by 35.0%, with health care costs more than the national average by 18.8% and housing costs more than the national average by 77.6%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $2,084 in the Pittsfield area to a high of $7,000 per month in the Barnstable area of Massachusetts.
Living close to one of Massachusetts’s borders may make assisted living in a neighboring state an affordable option. Seniors in Rhode Island pay an average of $6,826 per month for assisted living, the only state with a higher average cost greater than Massachusetts. The average monthly cost of assisted living in other bordering states includes $6,053 in New Hampshire, $5,250 in Vermont, $5,129 in Connecticut, and $4,580 in New York.
How to Pay for Assisted Living
The Executive Office of Elder Affairs regulates and oversees Massachusetts' assisted living communities. The state also has ombudsman programs that find solutions to complaints and issues relating to the health, welfare, and rights of residents living in long-term care communities. Located throughout the state, Massachusetts Councils on Aging provide older adults with information and resources to help them make informed decisions about long-term care.
The term "elder law" is often associated with estate planning, trusts, and help obtaining benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.
The Volunteer Lawyers Project of Boston provides free legal information and referrals to Massachusetts residents who are at least 60 years old. People can also use the Senior Legal Helpline for more information on legal matters. The Executive Office of Elder Affairs has a directory of Legal Resources for Low-Income Elders in Massachusetts. It contains information regarding general legal service resources, Title III-B legal service providers, and court service centers, along with training/education resources for professionals.
The typical resident population in Massachusetts's assisted living communities is 72% female. Overall, 84% of residents are ages 75 and older, with 34% of residents ages 75 to 84 and 50% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Executive Office of Elder Affairs certifies assisted living residences (ALRs), which is the licensing term for ALFs in Massachusetts. These residences aim to provide an environment where seniors can age in place. Services for residents are covered under the state Medicaid program.
Adult foster care (AFC), also called adult family care, is for frail elderly adults and adults with disabilities who cannot safely live alone but want to live in a family environment. AFCs are covered under the state Medicaid program; the caregiver must be a family member.
An ALR provides room and board and personal care for three or more adult residents. Personal care services can be provided by employees or by third-party arrangements. These services include assistance with one or more of the activities of daily living (ADL) and the management of medication self-administration.
A special care residence provides enhanced services for residents with cognitive or other impairments. It can be a residence that serves this population in its entirety or in a separate section of an ALR.
Resident Agreements and Disclosures
Each resident or their representative will have a written contract with the facility. The contract outlines the services covered in the agreed-upon fees, a description of bundled services, and an explanation of additional services offered and the associated cost of those services. The agreement also includes refund policies, provisions for terminating the agreement, residents' rights, and limitations on the services the residence will provide, particularly relating to ADL and behavioral management, and payment arrangements.
Before finalizing the agreement, the facility must disclose the number and type of units, current staffing levels and makeup of the staff, entry and discharge policies, the cost of services offered, resident grievance procedures, and eligibility requirements for any subsidized programs, including the costs that the resident is responsible for.
Any facility that markets itself as a facility providing special care for residents must include disclosure regarding the mission and care philosophy followed.
Assisted Living Admission and Retention
An ALR is not permitted to admit or retain a resident that needs 24-hour skilled nursing supervision unless the services are provided by a licensed hospice or a certified provider of ancillary health services. The resident does not need these services for more than 90 consecutive days. The certified health service provider cannot train the ALR staff to provide these services.
Assisted Living Services and Service Planning
ALRs are required to assist with ADLs, including bathing, dressing, ambulation, and related tasks as well as instrumental activities of daily living (IADLs). IADLs include laundry, housekeeping, and socialization. ALRs must also manage the self-administration of prescription medications and over-the-counter medications and provide assistance with residents’ emergency needs.
Any ALR that provides special care services must submit a plan of operations explaining how the residents will meet the needs of the residents in this unit. These facilities must also prepare a daily activity program for these residents, including motor activities, self-care activities, social activities, and sensory and memory enhancement activities.
Before admission, each resident must have a screening and assessment to determine the needs and preferences of the residents. The primary purpose of this screening is to determine if the facility can meet the resident's needs. If the facility can, the assessment and the result of a medical exam that determines the resident’s physical, cognitive, and psychosocial conditions are used to develop a service plan. The service plan will include the individual's diagnosis, current medications, allergies, dietary needs, need for assistance in an emergency situation, level of personal care needs, and ability to manage medications.
Assisted Living Food and Dietary Provisions
An ALR must provide three regularly scheduled meals based on the recommendations of the National Academy of Sciences. The facility must provide menu selections allowing residents to adhere to a prescribed dietary plan. The special diets must be provided include sodium-restricted, sugar-restricted, and low-fat diets. The facility must use a qualified dietitian to review the dietary needs and provide counsel to residents regarding therapeutic diets and other dietary needs. Every resident’s dietary needs must be reviewed every six months.
Assisted Living Staffing Requirements
Each ALR must employ a manager who is in charge of the general administration of the facility as well as at least one service coordinator. The service coordinator is responsible for developing, reviewing, and revising the service plans of each resident. Personal care staff must be one of the following:
- Licensed nurse.
- Certified nursing assistant (CNA).
- Certified home health aide.
- Qualified personal care homemaker.
If a personal care staff member does not have one of the certifications listed above, they must pass a 54-hour training course, described in more detail in the next section.
There are no minimum staff ratio requirements other than the facility being able to provide for all residents' needs at all times according to their service plans. Staffing must also be sufficient to respond to emergencies and provide for residents' safety in emergencies and disasters.
Assisted Living Staff Training Requirements
Before beginning employment, each staff member and contract worker that has direct resident contact or provides food services must receive an initial 7-hour orientation program. This orientation must include
- Philosophy of an ALR.
- Elder abuse, neglect, and financial exploitation.
- Communicable diseases.
- Communication skills.
- Facility policies and procedures for emergency and disaster preparedness.
- Resident health issues.
- Job requirements.
- Management of self-administered medications.
- Sanitation and food safety.
- Basic overview of dementia/cognitive impairment.
Employees that provide direct care services to residents must receive an additional hour of orientation on the management of self-administration of medications. Managers and service coordinators must receive two hours of training on dementia care topics.
ALR personal care services staff must complete a 54-hour training program prior to direct care contact with residents. The training must include 20 hours on the provision of personal care services, including personal hygiene, management of medication self-administration, home safety, helping families deal with grief and loss, and nutrition. This staff must be trained in first aid and is required to complete one hour of continuing education annually on the management of self-administered medications.
All employees must take 10 hours of annual continuing education and training. Two of these hours must be on the needs of residents with Alzheimer’s disease.
Assisted Living Housing Requirements
Apartment-style apartment units are not required in Massachusetts. Units must have lockable doors and must be either single or double occupancy. All newly constructed ALRs must provide a private bathroom for each unit, minimally equipped with one sink, one toilet, and a bathtub or shower stall.
All resident units must have a private half-bathroom equipped with a sink and toilet. There must be a shower or bathtub available for every three residents. All facilities must provide a kitchenette or access to a refrigerator, sink, and heating element for all living units.
An ALR that serves Medicaid waiver participants must provide an apartment with a separate living, sleeping, bathing, and cooking area.
What Is Included With Assisted Living Care In Massachusetts?
There are several requirements that each assisted living community must provide for their residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Medication Provisions
The management of medication self-administration is a required service of an ALR. This includes reminding residents to take medications, opening medication containers, reading the medication label to the resident, and observing the resident taking the medication. Only an individual who has completed a personal care service training program can perform this management service.
A licensed nurse the facility employs is permitted to administer non-injectable medications orally or by other methods.
State Mental Health Care Services
The Massachusetts Department of Mental Health provides access to services and support to meet mental health needs. The department also has a 24-hour emergency and crisis support helpline. The National Alliance on Mental Illness of Massachusetts (NAMI) is a nonprofit organization that aims to improve the quality of life for those diagnosed with mental health conditions. NAMI provides information on programs and resources to help people improve their mental health. VA Boston healthcare offers a behavioral health program that provides veteran-focused mental health care. Veterans who qualify for VA health care can get high-quality mental health services included in their benefits. If you don't have VA health care, you may still be able to get treatment for certain mental health problems.
Health Care Services
In Massachusetts, ALRs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 59% of communities providing skilled nursing. Many have health care specialists and on-site services, with 56% of communities offering dental care. In addition, 64% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Massachusetts, 80% of communities conduct depression screenings, and 57% offer mental health counseling. Social work programs are also found in 61% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents have access to all the resources they need.
Some assisted living residents live with various medical conditions. In Massachusetts, 43% have Alzheimer's disease or another form of dementia. In addition, 41% have high blood pressure, 29% have heart disease, 23% have depression, and 11% have diabetes.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Massachusetts’s assisted living facilities often receive help with their ADLs. In Massachusetts, 13% of residents need help eating. Other commonly used services include bed transfer (20%), toileting (31%), and walking (40%). Caregivers in ALFs help 48% of residents dress, and 59% need help bathing.
Cost Of Assisted Living Care In Massachusetts
The average cost of assisted living care in Massachusetts is $6,500. This is $2,000 higher than the monthly national average of $4,500. The cost of living in Massachusetts is more than the national average by 35.0%, with health care costs more than the national average by 18.8% and housing costs more than the national average by 77.6%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $2,084 in the Pittsfield area to a high of $7,000 per month in the Barnstable area of Massachusetts.
How Costs Compare In Nearby States
Living close to one of Massachusetts’s borders may make assisted living in a neighboring state an affordable option. Seniors in Rhode Island pay an average of $6,826 per month for assisted living, the only state with a higher average cost greater than Massachusetts. The average monthly cost of assisted living in other bordering states includes $6,053 in New Hampshire, $5,250 in Vermont, $5,129 in Connecticut, and $4,580 in New York.
How to Pay for Assisted Living
Massachusetts Assisted Living Oversight
The Executive Office of Elder Affairs regulates and oversees Massachusetts' assisted living communities. The state also has ombudsman programs that find solutions to complaints and issues relating to the health, welfare, and rights of residents living in long-term care communities. Located throughout the state, Massachusetts Councils on Aging provide older adults with information and resources to help them make informed decisions about long-term care.
Legal Resources
The term "elder law" is often associated with estate planning, trusts, and help obtaining benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.
The Volunteer Lawyers Project of Boston provides free legal information and referrals to Massachusetts residents who are at least 60 years old. People can also use the Senior Legal Helpline for more information on legal matters. The Executive Office of Elder Affairs has a directory of Legal Resources for Low-Income Elders in Massachusetts. It contains information regarding general legal service resources, Title III-B legal service providers, and court service centers, along with training/education resources for professionals.
