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Boston Globe
3 days ago
- Health
- Boston Globe
Tips for navigating senior care in Mass.
1. Aging at home Most seniors want to remain in their homes as long as possible, said Michelle Woodbrey, cofounder of 2Sisters Senior Living Advisors, which helps families select care options. Village networks like Adult Foster Care services are for people who would like to continue living in their homes with support and can be connected through the Advertisement Then there's private in-home care, which often comes with a steep price. 'Private pay home care averages about $40 an hour in this area, with minimum shifts of three or four hours,' Woodbrey said. 'It adds up quickly, and not everyone qualifies for affordable alternatives.' Advertisement State-funded options such as the There are 24 ASAPs across Massachusetts, contracted by the Executive Office of Aging & Independence, that offer services for adults 60+ and their caregivers — from care planning and food assistance to help with housing, health, and transportation. 'People can get by with scheduled care for a while,' said Woodbrey. 'But once their needs increase, home might no longer be an option, especially if they can't pay for round-the-clock support.' Dr. Bill Thomas, a Harvard-trained geriatrician, suggested some nontraditional paths that are growing in popularity, like senior home sharing, where an older adult with extra space in their home provides housing to a compatible individual in exchange for discounted rent, companionship, or help with household tasks. In Massachusetts, Advertisement 'It's a great idea, underutilized, radically inexpensive and can do so much to improve and extend the independence of older people in their own homes,' he said. Dr. Rachel Broudy, faculty at Ariadne Labs, which is affiliated with Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, advised that home sharing can be complicated and to 'consider it with caution.' She recommends the Program of All-inclusive Care for the Elderly, known as 2. Assisted living and memory care. Assisted living is best for those who need help with daily tasks but not full medical care. Assisted living homes' median monthly rents range from $3,655 to $8,036, according to the Massachusetts' Two affordable and innovative models experts recommended are And Advertisement 3. Rest homes A more affordable and less intensive option than nursing homes, rest homes are in limited supply across Massachusetts. 'Many of them can accept MassHealth and are more affordable when paying private,' said Woodbrey. 'There is less space and privacy, but they are usually better than a nursing home if someone doesn't yet need that skilled nursing level of care.' There are 76 rest homes licensed by the Massachusetts Department of Public Health. These provide room and board, medication management, and some medical oversight in a community setting. Costs average around $100 per day, and residents may qualify for MassHealth, Supplemental Security Income, or Emergency Aid to the Elderly, Disabled, and Children to help cover expenses. 4. Skilled nursing facilities and nursing homes Many seniors are terrified of nursing homes, equating them with a total loss of independence. The good news is that experts only recommend them in rare and specific cases, and many in Massachusetts are rethinking the nursing home model of care. Broudy said the best nursing homes rely on peer support and shared responsibilities, where longtime staff take on flexible roles and the environment feels more like a home among friends. Advertisement The Green House Model, co-developed by Thomas, the Harvard-trained geriatrician, emphasizes small, home-like settings for about 10-12 seniors. Several facilities in Massachusetts, such as Continuum Care Retirement Communities have a range of independent, assisted living, skilled nursing, and memory care to allow residents to transition through levels of care without relocating. CCRCs require an entrance fee as well as monthly payments. The entrance fee is almost entirely refundable when a person moves or dies. Some must undergo a financial review to be able to afford long-term care. Experts highlighted in Dedham shares a 162-acre campus with the Rashi School, where residents mentor students from kindergarten through eighth grade. 5. Additional resources For more guidance, families can review the state's aging resources at for a fee, or the state's Serving the Health Insurance Needs of Everyone ( Sarah Rahal can be reached at
Boston Globe
16-07-2025
- Health
- Boston Globe
Deadly fire prompts scrutiny of assisted living homes that serve lower income adults
More than 75 percent of Gabriel House residents are enrolled in Medicaid, state officials have said, and it charges significantly less than a typical assisted living facility does for private-paying patients. Built in 1964, Gabriel House had been the subject of several complaints from family members about living conditions. Lipson, secretary of the Executive Office of Aging and Independence, or AGE, raised the possibility that such facilities, because they are so dependent on government housing or Medicaid payments, 'should be regulated or supported in a different way' from those that rely on private payers. Advertisement There are about 20 affordable assisted living homes in Massachusetts, said state Representative Thomas Stanley, the Waltham Democrat who sponsored legislation to improve conditions in assisted living facilities last year. He said lower income adults are particularly ill-served by the current regulatory structure. Advertisement 'What needs to happen is a deep dive into the affordable ALR (Assisted Living Residence) model,' Stanley said. 'That fire probably would have never happened in one of the private pay ALRs because they're modern buildings.' Such facilities primarily rely on public subsidies to operate. That can include housing subsidies and support from Medicaid for some services. Gabriel House accepted payments through Massachusetts' Group Adult Foster Care program, which provides personal care assistance designed to keep people out of nursing homes. 'Unless Massachusetts can get more Medicaid funding for assisted living, there is not a model that works well for low income people,' said Liane Zeitz, a member of the state commission and an elder law attorney, after the meeting. Each year more elders in Massachusetts fall into a growing gap: they don't have enough medical needs to qualify for nursing home care, but can't afford assisted living or home care services, said Michelle Woodbrey, co-owner of 2Sisters Senior Living Advisors, which works with families across New England. 'When someone's care needs increase, they have to leave assisted living and move to a nursing home for help with multiple activities of daily living,' she explained. 'But someone can't just move into a nursing home because they're out of money. There's this group of people who fall between the cracks. Gabriel House served many of those people.' The median monthly cost of assisted living facilities in Massachusetts is $3,655 to $8,036, according to AGE. Gabriel House charges $2,400 a month for assisted living in a studio apartment. The owner of Gabriel House, Dennis Etzkorn, did not return a request for comment. He is listed as the principal for two corporations in state records, Advertisement Yet public subsidies may not be able to keep up with the cost of services, state officials said. Affordable assisted living homes are often in older, repurposed buildings, Stanley said. Such buildings are likely grandfathered through some code enforcement requirements, Stanley said. Fall River officials could not be reached Tuesday evening to clarify whether Gabriel House was exempted from building or fire code requirements. Nancy Jones, 68, a retired social worker, moved her sister, Donna Murphy, 73, into Gabriel house about five years ago. It was the only 'foster group home' they could afford, she said. 'They don't charge you as much,' she said. 'Any other assisted living is thousands of dollars.' She was shocked when, two days later, all of the cereal and perishables in Murphy's apartment had been eaten by mice, she said. She called the Fall River Public Works office, which told her they were aware of 'infestations' from mice and cockroaches and the facilities were being exterminated monthly. The door in the back of the building, which was locked, had a wheelchair accessible ramp and a bell that was supposed to let staff know when a resident wanted to come inside. The bell broke, Jones said, and even when it worked, it was difficult for wheelchair users to access. She contacted a state assisted living ombudsman, Steven Ellsweig, who visited the facility. Within two days the bell was fixed, Jones said. Advertisement Still, the larger problem of access to the door was never fixed, Jones said. The family called the ombudsman three additional times to report the facility's elevator was broken, which seriously limited Murphy's ability to get around. 'You knew something had to happen in this place,' she said. 'It was an accident waiting to happen.' Ellsweig did not respond to requests for comment. Carolyn Fenn, state ombudsman and director of the Long-Term Care Ombudsman Program, declined to comment on the number of complaints from Gabriel House or other homes. Compared to heavily regulated nursing homes, state oversight of assisted living facilities is limited, experts said. Fire safety issues appear to largely be left to municipal code enforcement. Workers have told the Globe there weren't fire drills at Gabriel House, but Fall River Fire Chief Jeffrey Bacon said his department's inspections do require buildings to have an evacuation plan and fire drills. 'And we would hold them to that, and hold them to giving us dates when they were performed,' he said. The group that met Tuesday, the Assisted Living Residence Commission, was created by long term care legislation passed last year. It has primarily focused on affordability and transparency within the larger assisted living industry, and safety issues weren't supposed to be a primary focus. Draft recommendations the commission plans to send to the Legislature next month include providing low income residents more help to access assisted living facilities, more clarity about costs, and greater public access to state records about the homes. Even some of these recommendations, though, received pushback from industry representatives. Staffing requirements for assisted living facilities are virtually nonexistent. But Brian Doherty, president of the industry trade group the Massachusetts Assisted Living Association, resisted suggestions for minimum staffing standards. Advertisement 'Because residences serve different acuity levels, there is no one-size-fits-all staffing ratio,' he posted in comments during the virtual meeting. Zeitz, the elder law attorney, wrote during a virtual meeting of the commission, 'There needs to be a method by which AGE can appropriately monitor and assess whether there is appropriate staffing. The Fall River case is an example. I understand that there were only 2 overnight staff on duty (and I'm not clear if they were required to be awake). Given the size of the building — this appears to have been inadequate.' Jason Laughlin can be reached at
