Introduction
As we celebrate the 250th year of our national independence, older adults, people with disabilities, and caregivers in Massachusetts face a moment of profound contradiction. We honor the ideals of life, liberty, and the pursuit of happiness, yet too many residents, especially those aging alone or living with disabilities, find these ideals slipping further from reach.
Nearly 19% of the Commonwealth’s residents are now over age 65, with those over 85 projected to grow by more than 30% in the coming decade. Massachusetts boasts the second‑best longevity rate and the highest insurance coverage in the nation. Yet longevity collides with affordability: one‑third of older households fall below the Elder Index, a measure of the income that older adults need to meet their basic needs and age in place with dignity, and nearly 57% of adults 65+ living alone cannot afford even a no‑frills lifestyle.
At the same time, federal policy shifts threaten the very programs that sustain vulnerable populations. The “One Big Beautiful Bill Act” of 2025 is expected to cut $1.75 billion from MassHealth beginning in FY2026—cuts that state officials warn will force “very difficult choices” and could leave tens of thousands without adequate coverage.
These pressures demand not incremental adjustments, but a bold, comprehensive response that protects independence, strengthens community living, and ensures dignity for all.
The Current Reality in Massachusetts
Aging at Home vs. Institutional Bias
Most people want to age at home, and Massachusetts has made a remarkable, nationally recognized commitment to home‑ and community‑based services (HCBS). By several measures, the Commonwealth is among the most generous states in the country—driven especially by the Personal Care Attendant (PCA) program.
The real issue, in part, is not simply insufficient HCBS spending which creates waiting lists—it is the Commonwealth’s long-established and anachronistic commitment to maintaining nursing home “heads in beds,” which continues to shape long‑term care policy and restrict consumer choice.
Massachusetts must commit to a system where long‑term care settings are driven by individual preference and willingness to accept risk, not by institutional inertia or industry influence. This requires fully installing strong, independent gatekeeper roles for nursing home admissions—gatekeepers deliberately trained and empowered with a community‑first bias. This approach aligns with the Olmstead mandate, a U.S. Supreme Court ruling that requires states to eliminate unnecessary segregation of persons with disabilities and to ensure that persons with disabilities receive services, and with the principle that every person has the right to receive services in the least restrictive setting of care of their choice.
Rental Subsidies Out of Reach
The Massachusetts Rental Voucher Program (MRVP) remains overwhelmed, with waiting lists stretching for years. For older adults living alone—many of whom are financially eligible —this means independence is deferred indefinitely.
Assisted Living Costs and the Lack of a Medicaid Alternative
While assisted living in Massachusetts is expensive, the core problem is not the market price of assisted living itself. Assisted living is, in fact, a less expensive and often more appropriate alternative to nursing home placement. The real barrier is that Massachusetts remains an outlier among states in failing to offer a robust Medicaid‑funded assisted living option.
For decades, MassHealth has maintained a posture overly deferential to the nursing home lobby, resulting in a system where thousands who could thrive in assisted living are instead funneled into nursing homes simply because Medicaid will pay for one but not the other.
We strongly support H.791/S.474 – An Act Relative to Assisted Living and the Frail Elder Waiver, which directs MassHealth to deploy an assisted living alternative priced at no more than 80% of the average cost of a nursing home placement. This reform is essential to restoring balance, dignity, and autonomy in long‑term care.
Home Modifications Underfunded
The Home Modification Loan Program offers 0% loans up to $50,000, but funding lags far behind need. With 80% of low‑income seniors lacking sufficient assets, even modest-accessibility investments are impossible without public support.
Community Infrastructure Crumbling
Broken sidewalks, inaccessible pedestrian signals, and costly public transportation undermine safe, independent living.
Civic Participation Restricted
Many municipalities still fail to provide hybrid access to public meetings, effectively silencing older adults and people with disabilities.
Nursing Home Residents Left Behind
The Personal Needs Allowance for MassHealth‑funded nursing home residents remains frozen at $72.80 per month—unchanged for decades despite soaring costs.
Behavioral Health Neglected
Line item 9110‑1640 has been level‑funded for three years, leaving community behavioral health services underdeveloped and forcing preventable hospitalizations.
Outdated Social Work Regulations
Nursing home social work rules, written in the 1970s, fail to meet modern needs. Facilities struggle to recruit and retain social workers, leaving residents without adequate psychosocial support.
Wheelchair Repairs Delayed
People who rely on wheelchairs often wait weeks or months for repairs. Wheelchair related legislation to fix this problem continues to languish.
Federal Cuts to Medicaid and SNAP
Older adults and people with disabilities face heightened risks of homelessness and food insecurity.
AI and Aging and Disability
AI will transform aging and disability—not by replacing care, but by extending autonomy, reducing administrative burdens, and helping people navigate already overwhelming systems. Its greatest impact will be in cognitive and organizational support: memory, planning, communication, and coordination—areas where current systems often fail people first. The real risk is not the existence of AI, but that it is designed without the voices of older adults and people with disabilities.
The Human Cost
Behind every statistic is a life diminished:
- A widow who cannot access assisted living because Medicaid will not cover it.
- A man with disabilities waiting years for a rental subsidy.
- A grandmother risking injury at a crosswalk timed against her.
- A nursing home resident unable to afford basic toiletries.
- An older adult denied behavioral health support until crisis forces hospitalization.
- A facility unable to staff a social worker, leaving residents isolated and depressed.
These are not isolated tragedies; they are systemic failures.
Industry vs. the Public Interest
- Industry lobbyists secure billions for facilities while families wait months or years for home care services.
- National associations resist staffing standards and social work requirements.
- Developers profit from assisted living while MassHealth refuses to fund it.
- Municipalities save money by limiting accessibility and hybrid meeting access.
- The Commonwealth continues to fund institutional care without tying dollars to measurable quality outcomes.
- Workers providing essential non-medical support remain largely unregulated and unsupported.
The Path Forward
- Honor consumer choice: Ensure long‑term care settings reflect individual preference and willingness to accept risk.
- Install community‑first gatekeepers: Require independent review of nursing home admissions with a bias toward community living.
- Implement the Olmstead principle: Guarantee services in the least restrictive setting.
- Adopt a Medicaid‑funded assisted living benefit: Pass H.791/S.474 and end Massachusetts’ status as a national outlier.
- Expand rental subsidies and home care: Reduce waiting lists and close the Elder Index gap.
- Support accessibility: Fund home modifications, repair sidewalks, improve transit, and pass the wheelchair repair bill.
- Mandate hybrid civic access: Ensure public meetings are accessible to all.
- Raise the Personal Needs Allowance: Adjust for the state’s high cost of living and index it annually.
- Enforce staffing and transparency: Hold nursing homes accountable for billions in public dollars.
- Expand behavioral health services: Build statewide capacity to prevent crises.
- Modernize social work regulations: Require at least one licensed social worker per sixty beds.
- Strengthen home care oversight: Ensure proper training, vetting, and support for all workers entering vulnerable people’s homes.
- Adopt quality‑based reimbursement: Link MassHealth rates to CMS Five‑Star ratings.
- Nursing home inspections: Increase the frequency of unscheduled visits for facilities with a record of poor performance.
- Future of AI: AI can expand autonomy for older adults and people with disabilities by supporting memory, planning, communication, and system navigation. They need to be fully involved in its design and use.
Moral Imperative
This is not simply about budgets—it is about values. Affordability is dignity. Independence is dignity. Civic participation is dignity. If older adults cannot afford independence in Massachusetts, then our Commonwealth fails its promise.
As we mark 250 years since our nation’s founding, we are called to renew the promise of a Commonwealth where:
- Sidewalks are safe,
- Homes are accessible,
- Care is affordable,
- Civic life is open to all, and
- Long-term care reflects the values of justice, compassion, and shared responsibility.
Closing
In this 250th year of our national independence, let us resolve to speak truth to power. Let us demand a system that invests in people, not profits. A system that makes aging in place a reality, not a dream. A system that values caregivers, empowers residents, and strengthens communities.
This is not only a matter of policy; it is a matter of identity. The founders of Massachusetts envisioned a “city on a hill,” a model society where neighbor helps neighbor, where the vulnerable are cared for, and where every citizen plays their part in sustaining the common good. That vision was not meant to be a relic of history—it was meant to be a living promise.
Today, as we mark 250 years since our nation’s founding, we are called to renew that promise. To show the nation and the world that Massachusetts can be an example of justice, compassion, and shared responsibility. A Commonwealth where sidewalks are safe, homes are accessible, care is affordable, and civic life is open to all. A Commonwealth where long-term care is not a burden, but a covenant kept with those who built the society we inherit.
Together, we can build that Commonwealth. Together, we can ensure that dignity, independence, and participation are not privileges, but rights. That is the Commonwealth we must build—and that is the legacy we must leave, worthy of the ideals of 1776 and the generations who entrusted us with their vision of liberty and justice for all.
Endorsed by thirty-one DignityMA participants including:
| Frank Baskin, LICSW, Lowell Boston Center for Independent Living, Boston Center for Living & Working Inc., Worcester Easterseals Massachusetts, Worcester Judi Fonsh MSW, Leverett John J. Ford, JD, Quincy Lachlan Forrow, MD, Newton Wynn Gerhard, JD, Plymouth Rick Glassman, JD, Arlington Margaret M. Gullette, PhD, Newton Jerry Halberstadt, Stop Bullying Coalition, Peabody Dennis Heaphy, Boston Chris Hoeh, Jamaica Plain Hailey How, CareCorgi, Cambridge Paul J. Lanzikos, Beverly Rich Levasseur, Tewksbury James Lomastro, PhD, Conway Michael Martignetti, Lexington | Gerard Miller LICSW, CEAP Geriatric Care Consultant, Boston K. Moore & Associates, Arlington Patricia Moore, West Tisbury Former Senate President Pro Tempore Richard T. Moore, Uxbridge Thea Nolan PA-C, Sutton Sandy Novack, MBA, MSW, Chestnut Hill Lisa Orgettas, Disability Resource Center, Salem Susan Rorke, Medway SeniorCare Inc., Gloucester Dr. Patricia P. Shopland, Marshfield Stephen Spano, Spano Dawicki & Witt, Saugus Stavros Center for Independent Living, Amherst Mary-Ann Walsh, East Bridgewater Dorothy Weitzmzn, MA, MSW, Newton Women’s Health Institute, Boston |
Dignity Alliance Massachusetts is a broad-based group dedicated to transformative change to ensure the dignity of older adults, people with disabilities, and their caregivers. DignityMA participants encompass a wide range of individual and organizational stakeholders, including nursing home resident advocates, disability rights organizations, legal service entities, mental health organizations, health policy experts, faith-based groups, and labor organizations, and those representing the voices of older adults and individuals with disabilities. Our aim is to advance policies that revolutionize long-term care, putting the dignity of individuals first, ensuring affordable options for community living and personalized care, and providing living wages and benefits for caregivers and service workers in facility, home, and community- based settings. Through education, legislation, regulatory reform, and legal strategies, our mission will become reality throughout the Commonwealth.
For more information contact:
Paul Lanzikos, paul.lanzikos@gmail.com
Richard Moore, dickmoore1943@gmail.com
Download the State of the Commonwealth (pdf).