Assisted living facilities (ALFs) appeal to seniors who would like the security of round-the-clock assistance in a residential, non‑institutional environment. They offer peace of mind and the promise of being able to “age in place.”
ALFs offer a combination of housing, meals and personal care services to adults on a rental basis. Assisted living is appropriate for those who need help with activities such as housecleaning, meals, bathing, dressing and/or medication reminders, but does not offer medical or skilled nursing services.
There are no federal laws or regulations concerning ALFs. By statute and regulation, Massachusetts ALFs are subject to certification and oversight by the Executive Office of Elder Affairs (EOEA). This outline discusses the legal requirements for Massachusetts ALFs, mandated consumer disclosures, admission agreement requirements, and residents’ rights, including protection from arbitrary eviction.
Consumer Protection Issues
Massachusetts ALFs typically charge monthly fees between $3,000 and $6,000. Providers are now offering specialized “dementia care” units in ALFs, which may allow frail elders to avoid nursing home placement. Subsidies for ALF care are available through the SSI-G, Group Adult Foster Care, and PACE programs, but not all facilities participate in these programs and the number of subsidized units is limited.
1. Legal Requirements for Massachusetts ALFs
Massachusetts ALFs are required to obtain and maintain certification from the Executive Office of Elder Affairs (EOEA). By statute, EOEA is authorized to certify and review compliance for ALFs. Massachusetts General Laws, Chapter 19D. EOEA regulations specify the certification procedures and standards for Massachusetts ALFs, including the requirements for recordkeeping, staffing, training, and compliance reviews. 651 CMR 12.00.
2. Mandated Disclosures
ALF providers are required to disclose their fee schedules to prospective residents, who should review the fee disclosures closely. Otherwise, residents may be surprised to discover that the facility has imposed fees for various “supplemental” services, such as incontinence care and medication management.
ALFs are required to provide a copy of the EOEA consumer guide and certain consumer disclosures to all current and prospective ALF residents. 651 CMR 12.08(3). Among other things, the disclosure statements must include:
3. Residents’ rights
Residents of ALFs are entitled to dignity, choice, independence, and privacy, among other rights. 651 CMR 12.08. ALF providers are required to post a written notice of the residents' rights in a prominent place or places in the facility where it can be easily seen by all residents. This notice shall include the address, and telephone number of the EOEA Assisted Living Ombudsman Program, and the telephone number of the Elder Abuse Hotline. 651 CMR 12.08(1)(u).
Among other protections, an ALF resident has the right to:
4. Eviction Protection
Assisted living residents are guaranteed the same protections against eviction as are other tenants under Massachusetts landlord-tenant law. The ALF regulations prohibit a provider from evicting a resident “except in accordance with the provisions of landlord/tenant law as established by [General Laws Chapters 186 and 239] including, but not limited to, an eviction notice and utilization of such court proceedings as are required by law.” 651 CMR 12.08(1)(r).
ALF providers must inform residents of the community resources available to assist them in the event of an eviction procedure, including the the name, address and telephone number of the Assisted Living Ombudsman Program. 651 CMR 12.08(1)(v).
Some Massachusetts ALFs charge $5,000 per month or more for a “basic service package.” Prospective ALF residents may want to consider seeking the assistance of a financial professional for help in evaluating a provider’s financial strength. They should also consider consulting with counsel to review the terms of the admission agreement. Although the agreements are typically contracts of adhesion, in some instances, residents may be able to negotiate over the contract terms. At a minimum, a prospective resident needs to be able to make an informed decision before signing an entrance agreement.
Resources – Assisted Living
Assisted Living Consumer Alliance (ALCA) – A national alliance to promote and preserve choice, safety, and legal rights and protections for assisted living consumers. ALCA resources include information on choosing a facility, advocacy materials, and information on medication management. http://www.assistedlivingconsumers.org/
Eric Carlson, Critical Issues in Assisted Living: Who’s In, Who’s Out, and Who’s Providing the Care (National Senior Citizens’ Law Center 2005) – Available on the ALCA website.
Massachusetts Executive Office of Elder Affairs (EOEA) – Provides a Consumer Guide to Assisted Living Facilities, a list of ALRs, and other consumer information on its website. The ALF Ombudsman program is headed by Donna Bucca. 617-727-7750.
Emily Starr, Assisted Living, Estate Planning for the Aged or Incapacitated Client in Massachusetts, Chapter 22 (MCLE 2009).