By Richard T. Moore
Every January, we gather around our screens or sit in the House chamber waiting for the Governor to tell us who we are and where we’re going. It’s a ritual of optimism, a chance to imagine a better Commonwealth. But there’s one truth I wish she would say out loud this year—one that would take real courage, and one that would change thousands of lives if she did.
I wish she would say this:
“We will no longer tolerate a long-term care system that fails the very people it exists to protect. We will lead the nation in transforming how we care for older adults and people with disabilities—because dignity is not optional, and safety is not negotiable.”
But she probably won’t.
Not because she doesn’t care. Not because she doesn’t understand the crisis. But because transformational reform of long-term care requires confronting powerful interests, rethinking decades-old funding structures, and acknowledging a painful truth: our current system is not broken, it is working exactly as designed, and that design is unacceptable.
The quiet crisis we pretend not to see
Long-term care facilities across the Commonwealth are struggling with chronic understaffing, high turnover, and financial practices that too often prioritize profit over care. Families know this. Workers know this. Residents know this most of all. Yet year after year, we treat these failures as unfortunate but inevitable. We talk about “challenges” and “pressures” instead of what they really are: policy choices. We could choose differently.
A blueprint for real change
If the Governor wanted to make Massachusetts a national leader, she could champion a bold, evidence-based plan built on five pillars:
- Enforceable staffing standards: Not vague promises. Not “as resources allow.” Real, statutory minimum staffing ratios—RNs, LPNs, CNAs—with 24/7 RN coverage and adjustments for resident acuity. States like New Jersey and Minnesota have already shown this is possible.
- Transparency and accountability: Public dollars should buy care, not disappear into related-party real estate deals or management fees. Facilities should disclose ownership, finances, staffing levels, and turnover in a clear, searchable format. Families deserve to know where their money—and their trust—is going.
- A workforce worthy of the work: We cannot fix long-term care without fixing the jobs. That means tuition-free CNA and LPN training, wage floors that reflect the skill and responsibility of the work, paid career ladders, and safe working conditions. Investing in this workforce is not a cost, it’s an economic engine.
- Innovation, not stagnation: The traditional institutional nursing home is not the only model. Small-home designs, like the Green House model, deliver better outcomes and higher satisfaction. States should fund pilots, support conversions, and expand home- and community-based services so institutionalization is a last resort, not the default.
- A public dashboard that tells the truth: Residents and families shouldn’t need a law degree to understand the facility’s quality. A state-run dashboard—updated in real time—can shine sunlight on the system and empower consumers.
Why the Governor probably won’t say it
Because transformational reform requires saying uncomfortable things:
- That some facilities will need to change or close.
- That public dollars must come with strings attached.
- That the workforce crisis is not a mystery, it’s the predictable result of low wages and impossible workloads.
- That we cannot keep pretending that “more oversight” alone will fix a system built on scarcity.
It also requires confronting well-funded industry groups who will warn of closures, costs, and catastrophe. But the real catastrophe is the status quo.
Why she should say it anyway
Because the people living in long-term care facilities are not abstractions. They are our parents, our spouses, our neighbors, our future selves. They deserve more than incrementalism. They deserve a system designed for dignity, not survival.
Because the workers who show up every day—lifting, bathing, feeding, comforting—deserve more than applause. They deserve a career with stability, respect, and a living wage.
Because the Commonwealth has always led on issues of justice and human dignity. We were first on public education, first on marriage equality, first on health reform. We can be first on long-term care transformation too.
And because leadership is not about what is easy to say. It’s about what is necessary to say.
A final hope
Maybe the Governor won’t say these words this year. But someone should. And if enough of us demand it, families, workers, advocates, voters—maybe next year she will. The Commonwealth is judged not by how it treats the powerful, but by how it treats the vulnerable. It’s time to build a long-term care system worthy of the people who depend on it.
Download What I Wish the Governor Would Say in Her State of the Commonwealth Address — But Probably Won’t (pdf) by Richard Moore.