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Office Location 77 Pond Avenue,
Brookline, MA
Phone: (617) 232-4186
Fax: (617) 232-7954

                       
Commonwealth of Massachusetts
Executive Office of Elder Affairs
Assisted Living in Massachusetts:
A Consumer's Guide
Assisted Living Program Overview

The goal of the assisted living residence programs is to provide the resident with the maximum amount of independence, in a residential setting, with personalized assistance. By offering an individualized combination of housing and personal care services, Assisted Living Residences (ALRs) serve as an essential part of the continuum of care that allows elders to age in their communities.   

Assisted Living is intended for adults who need some help with activities such as housecleaning, meals, bathing, dressing, and/or medication reminders and who would like the security of having the assistance available on a 24 hour basis in a residential and non-residential environment.

Residents have the right to make choices in all aspects of their lives. Assisted Living is a residential option which stresses privacy, dignity, autonomy, and individuality. The assisted living package can be tailored to meet the consumer's need and preferences.           

The residences vary in size and style from a high-rise apartment complex to a converted Victorian home or a renovated school. Residences may be free standing or on a campus with other residential options. They may be operated by non-profit organizations or for-profit companies. Most residences have between 25 and 120 apartments which may vary in size from a studio to a 2 bedroom apartment. There is no blueprint for an assisted living residence because consumers preferences and needs vary.

Some Assisted Living Residences have a section of the building set aside for people who need a specialized or secure environment. These are referred to as Special Care Residences (SCR) and the individual residential units within them are referred to as Special Care Units (SCUs).

Some examples of SCRs are those established specifically for residents with:                           

  •   Alzheimers and related dementia:
  •   Huntingtons disease; or
  •   Mental Health issues or other related cognitive impairments.                                                                
Once you have a general ides of the setting, service, and price range you prefer, call several Residences in the location you are considering. You may want to ask the following questions to help you narrow your search:
 

 What is the size of the Residence?                                                                                                      
 What type of living units are available?                                                                                                 
 What is the monthly fee?                                                                                                                     
 Do you require a deposit? If so how much?                                                                                             
 What services do you provide?                                                                                                            
 What services are included in the monthly fee?                                                                                   
 What services are extra?                                                                                                                                                 
Click on this link to read and print a copy of the Consumer Guide for Assisted Living Residences. Read the questions before you visit an assisted living residence. Use the questions to guide your discussion with staff.

Plan to request a brochure, a price list, a copy of the Residency Agreement ( which may be called the lease or contract), and the Disclosure of Rights and Service Statement so that you can review those items during your selection process.  Read the Residency Agreement closely, paying special attention to cost, services provided, as well as what services are not provided, and the criteria and costs for termination of the agreement.

It is to your advantage to tour the Residence that you are interested in. Initially, it is advisable to call and schedule a tour, which is usually given by a marketing representative. If possible, try to make a few visits at different times during the day. You may wish to have lunch or dinner at the ALR in order to try the food and see what the service is like, as well as participate in an activity or social event to meet and talk with current residents and staff. You may also wish to inquire as to whether an ALR offers respite or trial stays.
  
 
 I only touched on the first five pages of this informative document. The remaining 26 pages discuss:
 
winding_arrow   Standards Required by Law for Assisted Living Residences in Massachusetts
By Law, all ALRs in Massachusetts are required to obtain and maintain certification from the Massachusetts Executive Office of Elder Affairs.  To do this, an ALR must meet the regulatory standards which were designed to increase consumer protection, while also allowing an individual ALR to be flexible in meeting the needs and desires of residents. 
 
winding_arrow   Cost of Assisted Living
While Assisted Living is usually ,more affordable than a nursing home, it can still be expensive. The cost of Assisted Living varies greatly.  The base monthly fee for an ALR in Massachusetts is typically between $3,000 and $5,000, but can be higher depending upon the level of care needed. The variation in the cost is based on many factors, including:                                                                                                           
  • The kind and number of services you need;
  • The size, design and amenities of the Residence;
  • The size of the apartment you choose;
  • The location of the Residence
    • Most Assisted Living Residences charge a base monthly fee.  The fee may increase, and the amount of the increase, as well as how often the ALR may increase the fee, is determined by the terms of the Residency Agreement. It is vital that you read and understand all the terms in your agreement prior to signing it.                                                                                                                                           
    In addition, most Assisted Living Residences require an additional fee before you move in.  These initial fees may be called entrance fees or community fees. They can range from a hundred to thousands of dollars and are usually non refundable.     
     
    winding_arrow  MassHealth Group Adult Foster Care (GFAC) Program 
    GAFC is a MassHealth funded program that provides additional medical services in a group residential setting such as an Assisted Living Residence. Services include assistance with Activities of Daily Living (ADLs), Instrumental Activities of Daily Living(IADLs), other personal care, and case management. The GAFC provider monitors the participant's care through regular nursing and social work team visits.

    To be eligible for the MassHealth GAFC program, an individual must meet the following criteria:
     Be clinically approved to receive Mass Health GAFC services:
     Maintain a personal physician and receive a physician's order for GAFC services;
     Require a supervised environment for the provision of these services;
     Be at least 22 years old
     Reside in an ALR that participates in the GAFC Program
     
    winding_arrow  Disclosure Statement 
    The disclosure statement is an important document you will receive from the ALR at the time or or prior to paying any money to the ALR or signing a Residency Agreement.  The purpose of the Disclosure Statement is to make you, the prospective resident, aware of the services which are or are not offered by the ALR before you enter into  formal agreement with the ALR or pay any fees.  It is important to read the document thoroughly and ask questions about any of the information provided. The Disclosure Statement may also be used as a comparative tool to narrow your choices among ALRs. At a minimum, you should find the following information in the Disclosure Statement:
     

     The number and type of units the ALR is certified to operate                                                                           
     The number of units available under a subsidy program and whether they are shared units                       
     The number of staff employed by the ALR by shift and the availability of overnight staff                                            
     List of Resident Rights                                                                                                                        
     An explanation of the eligibility requirements of any subsidy programs offered at the ALR. This should   include a statement of any additional costs for which you would be responsible that are beyond the scope  of the subsidy program.                                                                                                                      
     The ALRs policy on assisting residents with medications                                                                      
     Limitations of services the ALR will provide, as well as limits on behavioral management                                                       
     Explanation of the role of the nurse.

      Entry criteria to the ALR and the assessment process                                                                                               
     The ALR policy on CPR and the number of staff who are trained to provide CPR                                     
     The conditions of termination by either party of the Residency Agreement                                         
     The layout of the ALR and any Special Care Units (SCU)                                                                                                                                           
     A description of the service plan                                                                                                        
     An explanation of special diets                                                                                                            
     Enrichment activities; the type and the number of activities offered each day                                                                                         
     The ALR disaster and emergency preparedness plan                                                                             
     The option to include the family in meetings                                                                                    
     The ALR security policy and the method of admitting guest                                                                      
     If applicable, the philosophy and mission of the Special Care Residence.

     
    winding_arrow  Residency Agreement /Lease 
    The Resident Agreement, or lease, is a contract that is between you and the ALR. It is the most important document that you will receive. The document includes the following important information, much of with you will have already received in the Disclosure Statement:

     

  • An explanation of the fees;
  • Services the resident will receive;
  • Conditions which govern the residents stay;
  • List of resident rights;
  • Circumstances under which the agreement can be terminated by either the resident or the ALR;
  • A resident grievance policy;
  • Staffing levels and information about the health care:
                 checkmark_16_04 The nurses function (what she or he may and may not do);
                 checkmark_16_04  The ALRs policy on assisting residents with medications; and
                 checkmark_16_04  Limitations on the services the ALR can or will provide.
    •  
    winding_arrow  Do I have to Use the Residences Personal Care Services Staff to Provide Services? 
    Residents have the right to have their personal care companion services provided by the assisted living residences, their family or by any outside companion or provider of their choice. The residence may want outside companions or providers to register with the residence.
     
     
    What I have not covered: 

    winding_arrow Physical Environment of the Assisted Living Residence
    winding_arrow Services
    winding_arrow Staffing
    winding_arrow Activities
    winding_arrow Meals
    winding_arrow Residents Rights
    winding_arrow Notice of Non-Discrimination Against Persons with Disabilities
    winding_arrow Accessibility and Reasonable Accommodations

     
     

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