Known for its rich history, a range of scenery and world-renowned healthcare, Massachusetts has a number of qualities that appeal to retirees. Seniors ages 65 and older account for 17%, nearly 1.2 million, of the state’s 7 million resident population. Though most of the state’s best healthcare, such as Massachusetts General Hospital and Tufts Medical Center, can be found in and around the Boston area, Massachusetts’ smaller square mileage means access is easier than in many larger states.  

Ranked 3rd out of 50 overall in the 2022 Senior Living Report, Massachusetts has 105 primary care physicians to every 100,000 people, much higher than the U.S. average of 77. In fact, the state came in first out of all states in terms of health care, a resulting combination of access to physicians, an average satisfaction rate and better rates of preventable hospital admissions. And while assisted living costs are much more than the national average of $4,500, other aspects of senior health in Massachusetts, like their quality of life, came in strong with high rankings.

This guide provides a comprehensive overview of assisted living in Massachusetts and highlights ways families can help fund their care expenses. The guide also takes a closer look at how costs compare across the state as well as how different types of care compare. A listing of statewide agencies that can inform, support and advocate for families is given, and a summary of the various regulations to which assisted living facilities are held liable is also provided.

The Cost of Assisted Living in Massachusetts

According to the Genworth 2021 Cost of Care Survey, assisted living facilities in Massachusetts charge $6,500 per month, which is much costlier than the national average of $4,500. Even compared to neighboring states, Massachusetts’ assisted living care is on the higher end of the spectrum, especially in comparison to Connecticut, where costs are $5,129 per month. Vermont is also much more affordably priced, at $5,250, though costs are closer in New Hampshire, at $6,053 per month. Rhode Island’s monthly average of $6,826 is actually the most similar, but it is also higher, about $300 more each month. 

$6500

Massachusetts

$4500

The United States

$6053

New Hampshire

$5250

Vermont

$5129

Connecticut

$6826

Rhode Island

Prices can vary greatly across the state, with the Boston area coming closest to the state average, at $6,819 per month. In smaller cities, costs are lower, with Worcester running approximately $5,685 each month and Springfield, $5,048. In the Cape town of Barnstable, expenses increase significantly, to $7,000, while in Pittsfield, prices are incredibly low, averaging only $2,084 per month, $4,416 less than the state average.

$7000

Barnstable

$6819

Boston Area

$5685

Worcester

$5048

Springfield

$2084

Pittsfield

Assisted living is one of several options available to seniors needing care. The most expensive option, nursing home care, is also the most intensive, providing around-the-clock care from highly trained medical professionals, for $11,406 per month. Assisted living facilities, where seniors receive residential services and personal care attention, costs $6,500 a month. Seniors who wish to remain at home have the option of receiving care services which can range in type from light housekeeping and meal prep to skilled nursing. These services cost, on average, $5,625, regardless of the kind of care received.  

$6500

Assisted Living

$5625

Home Care

$5625

Home Health Care

$11406

Nursing Home Care (semiprivate)

Does Medicaid Cover Assisted Living in Massachusetts?

In Massachusetts, Medicaid can be used to cover the costs of assisted living through three different programs: the Program of All-Inclusive Care for the Elderly (PACE), the Moving Forward Residential Supports Waiver and the Group Adult Foster Care Program. Each program has slightly different qualifications, but all cover a number of services that can be delivered in an assisted living residence.  

What Assisted Living Services Are Covered By Medicaid in Massachusetts?

The above waiver programs provide eligible seniors with a number of benefits as outlined in their care plans. These include:

  • Assistance with activities of daily living
  • Occupational, physical or other therapies
  • Medication assistance
  • Transportation 

In most cases, seniors plan their own services, and plans are overseen by a caseworker or other qualified health professional and revisited on an ongoing basis to ensure the services match the current need. For recipients who live at home, a number of additional services, such as home care, meals, and respite care may also be provided.

Assisted Living Waiver Programs in Massachusetts

Several programs exist to help cover care services in an assisted living residence. Recipients can get day-to-day help with their life activities like walking, dressing and eating, as well as medication management, therapies, medical attention and transportation.

Program 

Contact 

Description 

(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.   

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.  

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. 

How to Know If You’re Eligible for Medicaid in Massachusetts

In Massachusetts, Medicaid eligibility is determined through MassHealth, which pays for health care for the low-income or disabled. However, if interested seniors already qualify for Social Security Supplemental Income, the Social Security administration conducts the Medicaid screening.

General requirements include:

  • Being 65 and older
  • Being blind or disabled
  • Meeting income and asset guidelines  

As of 2022, single applicants must bring home no more than $30,276 a year in income and the same is true of single applicants in two-family households. In households where both spouses are applying, income limits increase to $60,552. Asset limits for individuals cap at $2,000, and $4,000 when both spouses are seeking coverage.   

2022 Medicaid Income Limits for Seniors in Massachusetts

Income Limits* 

Asset Limits

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

*Per year

In addition to these income and asset limits, some additional guidelines must be met by those who receive PACE or the GAFCP. Assessments must show, to qualify for PACE, that the applicant requires a nursing level of care, and in the case of the GAFCP, that they need help with daily living activities instead. These daily living activities can include:

  • Help with personal hygiene
  • Assistance dressing and undressing
  • Assistance moving from one location to another
  • Help eating or drinking

In the case of the GAFCP and the MFP-RS, recipients must also currently reside in a group setting and a nursing home, hospital or rehabilitation facility. 

How To Apply For Medicaid in Massachusetts

Applying for Medicaid in Massachusetts can be done online, at the MA Health Connector. Seniors who prefer completing a paper application can print and fill out the Massachusetts Application for Health and Dental Coverage and Help Paying Costs. Applications can also be submitted in person, at one of the state’s Enrollment Centers, or by calling the MassHealth Customer Service Center at (800) 841-2900 Monday through Friday between 8 a.m. and 5 p.m.  

Information You Will Need 

Before applying, the following documents should be gathered and ready:

  • Proof of age
  • Proof of Massachusetts state residency and citizenship
  • Social Security number
  • Policy numbers for any current health care 
  • Proof of all sources of income: tax returns, veterans’ benefits, retirement income, Social Security and any disability income
  • Proof of all assets bought or sold within the past five years, including bank account, investments, trusts and properties 

How to Get Help Applying for Medicaid

Massachusetts has several state programs to help seniors with Medicaid-related issues, including the application process and questions about benefits, claims and disputes. Individuals can use these resources to find information about filing a complaint or an appeal for a fair hearing and get one-on-one benefits counseling for free.

Resource 

Contact 

Description 

(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. 

(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. 

(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.  

Does Medicare Cover Assisted Living in Massachusetts?

The short answer is that no, Medicare does not cover the cost of assisted living in Massachusetts. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Massachusetts.

Other Financial Assistance Options for Assisted Living in Massachusetts

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

 

How to Apply

How It Works

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.

Free and Low-Cost Resources for Seniors in Massachusetts

Seniors can get assistance understanding their care options and finding the care that fits their unique circumstances with the help of various government and non-profit agencies in the state. The below resources can also connect seniors with advocacy, benefits and community services, such as transportation, congregate meals and social activities. 

Resource 

Contact 

Service 

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.   

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.

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.  

(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,

COVID-19 Rules for Assisted Living in Massachusetts

The following information is based on research done on several government websites, including mass.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 4/23/22, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for Massachusetts Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

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

Yes

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

No

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

Yes

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

Yes

Are visitors checked for elevated temperatures?

Yes

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

Yes

Outings & Social Activities

Rules for Massachusetts Communities

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

Yes

Are residents who leave required to quarantine when they return?

Not Available*

Are senior living communities required to cancel all group outings?

No

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

Yes (Conditions Apply)

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

Yes (Conditions Apply)

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.

COVID-19 Safety Measures for Staff and Residents

Rules for Massachusetts Communities

Are staff members regularly required to do a temperature check?

Yes

Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

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

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Assisted Living Laws and Regulations in Massachusetts

In Massachusetts, the Executive Office of Elder Affairs is responsible for ensuring assisted living residential facilities comply with particular regulations that set the standard for care statewide as well as standards for staffing, environmental and safety features. 

MASSACHUSETTS LAWS AND REGULATIONS

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.