Assisted Living Massachusetts

Moving Forward Plan Residential Supports Waiver

(855) 499-5109

This home and community-based services waiver is for seniors who are already in a nursing facility, hospital or rehabilitation facility to move back into the community. In addition, individuals must be 65 or older, meet clinical and financial requirements, and be able to safely be served in the community. For the MFP-RS specifically, applicants must require the presence of support staff 24 hours a day. In addition to assisted living services, the MFP-RS waiver benefits include therapies, mobility services, specialized medical equipment, transportation and assistance transitioning from the clinical setting to the residential assisted living facility.   

PACE

Varies by location

Available only in specific Massachusetts counties, PACE is administered by Massachusetts’ Medicaid program, MassHealth, and Medicare to give seniors a broad array of services and supports. Recipients do not need to be Medicaid-qualified, but their premiums can only be paid if they also meet Medicaid’s income and asset eligibility criteria. PACE recipients receive medical care, social services, therapies and transportation in an assisted living residential setting.  

Group Adult Foster Care Program

Online

Available through Massachusetts’ regular Medicaid program, the Group Adult Foster Care Program provides care assistance in a group setting such as an assisted living residence. Recipients must need help with daily living activities such as grooming, dressing or bathing, and also receive help with laundry and cleaning. To qualify, seniors’ income must be equal to 100% of the Federal Poverty Level. Unlike other programs, the GAFCP requires that recipients not be in need of skilled nursing but rather assistance with daily living activities like being transferred from bed to a chair, personal hygiene and eating. 

Single Applicant

$30,276

$2,000

Two-Person Household

(Only One Person Applying)

$30,276

$2,000 for applicant and $137,400 for non-applicant

Two-Person Household
(Both People Applying)

$60,552

$4,000

My Ombudsman 

(855) 781-9898

Available to any MassHealth member currently enrolled in a MassHealth plan, My Ombudsman can help members with questions about their benefits or services, including long-term care benefits. Ombudsmen can explain the different types of benefits offered and help address problems. Although they cannot act as legal representation, they can help individuals file complaints. 

Medicaid Fair Hearings 

(800) 655-0338

If Medicaid coverage is denied for a previously eligible service or Medicaid ended payments for a recurring service, individuals have the right to submit an appeal for a fair hearing. Decisions they feel weren’t made in their favor can then be disputed. 

SHINE Program 

(800) 243-4636 

SHINE provides free statewide health insurance counseling to seniors to help them understand the differences between the six kinds of MassHealth coverage needing long-term care services. Seniors can speak one-on-one with a counselor in-person or by phone to have their questions answered, and general eligibility guidelines can be obtained via the website.  

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

Massachusetts Councils on Aging 

Varies by location

The gateway to identifying the most pertinent form of long-term care, Councils on Aging are located throughout the state to help seniors in a number of tangible ways. From explaining forms of potential financial care assistance to health coverage comparisons to referrals for local services, they are the best first step to take when planning care.   

Veteran Administration Centers 

Varies by location

VA Centers provide advocacy, support and information to senior veterans and their dependents. Families can get assistance applying for pension benefits or burial benefits, as well as help with obtaining survivor’s benefits or Aid and Attendance. Seniors can also obtain referrals for healthcare services at local VA hospitals, which offer a broad spectrum of specialist health services including mental health, dentistry and lab services.

Massachusetts Social Security Offices 

Varies by location

At their local SS office, seniors can receive their Social Security and Medicare cards and apply for benefits such as Medicare, Supplemental Security Income and Social Security Disability Insurance.  

Long-Term Care Ombudsman 

(617) 727-7750

The long-term care Ombudsman works on behalf of residents to find a satisfactory solution to issues relating to care in assisted living and other facilities. Individual or groups of residents begin by filing a complaint, which the Ombudsman then works to resolve while providing education and information to residents and families about their long-term care rights,

Are loved ones allowed to visit to provide emotional support?

Are relatives allowed to visit for end-of-life care?

Are residents required to quarantine after visiting with a loved one?

Are visitors required to wear PPE (including masks) in order to visit residents?

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Are visitors checked for elevated temperatures?

Are visitors required to answer questions about health, travel, and potential virus contact?

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Are residents who leave required to quarantine when they return?

Are senior living communities required to cancel all group outings?

Are residents allowed to eat meals together in a common area?

Are residents allowed to gather in common areas for group activites?

Are staff members regularly required to do a temperature check?

Are staff members regularly tested for COVID-19?

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Are residents regularly screened for COVID-19 symptoms?

Are residents regularly checked for elevated temperatures?

Are residents regularly tested for COVID-19?

Assisted Living Service Plan Requirements 

Before a resident is admitted to an assisted living facility in Massachusetts, they must have a care or service plan for each resident based on information provided by the resident themselves and “Resident Representatives”, their loved ones or legal guardian. Plans have a wide scope and include any psychosocial history, level of needed daily living activities assistance, and dietary needs or allergies. Also included in the plan are recent results given by a doctor that gives a picture of the prospective resident’s overall condition. This plan must be reviewed on a semi-annual basis by a nurse or the community’s service coordinator.     

Assisted Living Admission Requirements 

While there is no specific age requirement set forth by the state, admission to an assisted living facility is contingent upon the resident’s needs falling within the scope of care offered. So, if it is determined that a prospective resident’s needs exceed those offered by the assisted living facility, and they need nursing care, for instance, that individual would not be admitted. For this reason, it is important to discuss your loved one’s care needs with AL staff to determine whether they would be eligible for admission.

Assisted Living Scope of Care 

The scope of care offered by assisted living facilities includes housing and personal care services. Medication management and assistance with daily living activities such as grooming or eating are included. Memory care is also offered by some assisted living communities in Massachusetts. Skilled nursing care, such as wound dressing or catheter management, is not typically offered by AL facilities. But in some cases, health care agencies will come to facilities to provide these services to qualified individuals.  

Assisted Living Medicaid Policy 

Medicaid is accepted by some assisted living facilities in the state for residents who qualify under the MassHealth program, which has certified some AL facilities as Group Adult Foster Care-approved housing so funding can be provided to cover personal care services (only, as room and board are not covered) a resident receives in the AR facility.  

Assisted Living Facility Requirements 

Every community in Massachusetts has a number of safety and accessibility requirements that must be satisfied on an ongoing basis. These include lockable doors on each unit, whether shared or individual and access to a kitchenette or to a refrigerator, sink, and heating appliance. A washstand, toilet, and bathtub or shower are required for every resident in older facilities, and newer facilities must have private bathrooms for each unit. Additionally, each assisted living facility is required to meet state codes for building and fire safety as well as sanitary conditions.

Medication Management Regulations 

Staff at assisted living facilities are responsible for managing each resident’s medication, and for delivering their medications, either with reminders and assistance on a daily basis or at a higher level of medication supervision that may include administration of eye drops, application of medicated creams or crushing up of medicines and feeding them to residents. As outlined by the Executive Office of Elder Affairs, staff may not administer injections to residents.   

Staffing Requirements 

While there is no exact number of staff required to be employed by assisted living facilities, the Executive Office of Elder Affairs stipulates that assisted living facilities must retain sufficient staff at all times to “ensure the health, safety, and welfare of the residents”. Residences with Special Care Residents are required to have a minimum of two staff members present at all times in that unit to assist residents. 

Staff Training Requirements 

Staff at ALR are required to begin their employment with a seven-hour orientation run by qualified facilitators which includes resident-centered topics such as elder abuse, financial exploitation, infection control, emergency preparedness, cognitive impairment, food safety and sanitation. Orientation also includes an additional hour of medication management training, and the first days on the job include shadowing with more experienced staff members. Staff working in SCR must complete an additional seven hours of training to equip them for working with their residents’ special care needs. A minimum of 10 hours of ongoing education and training are required each year for staff. Two of those hours must be dementia-focused. 

Background Checks for Assisted Living 

Background checks are required by all would-be AL employees, and Massachusetts’ assisted living residencies may not employ any individual convicted of a felony related to illegal sale or theft of controlled substances. 

Requirements for Reporting Abuse 

In ALRs, managers, whom Massachusetts law classifies as mandated reporters, are legally obligated to report any suspected cases of abuse or neglect, which includes any instance of financial abuse, emotional, physical or sexual abuse or caregiver neglect. Staff members are trained to recognize and report suspected cases of neglect or abuse, and residents are encouraged to report abuse in the assisted living residence by calling (800) 922-2275 or by filing a report online.