Assisted Living in Massachusetts: Safety Concerns and Calls for Reform

Assisted living facilities are supposed to be a place where seniors adults can go to get support with their daily living routine. These facilities did not require the intensive medical care of nursing homes. Over time, however, these residences have become home to increasingly frail seniors — many of whom use wheelchairs, oxygen, or require daily medical support.

A recent Boston Globe investigation highlights the growing concerns around safety, oversight, and transparency in assisted living homes across the state (Boston Globe, July 19, 2025).

Tragedies Prompt Calls for Action

The discussion has taken on new urgency after a devastating fire at Gabriel House, an assisted living facility in Fall River, killed nine residents. Some of those rescued had severe mobility issues or relied on medical equipment, underscoring how vulnerable the population in these facilities has become.

The tragedy follows other troubling incidents. A wrongful death lawsuit in Shrewsbury alleges that an elderly woman, Nancy McNamara, was left on the floor of her room for up to two days, suffering injuries that later contributed to her death. Advocates argue these cases highlight systemic problems in staffing, oversight, and accountability.

The Changing Face of Assisted Living

State data show that residents are now more likely to die in assisted living than to transition to a nursing home, a reversal from just a decade ago. Nearly one in five residents in 2024 required assistance with five or six daily tasks such as bathing, eating, or dressing — a level of care traditionally associated with nursing facilities.

Despite this shift, assisted living residences have far fewer regulatory requirements than nursing homes. Staffing mandates are minimal, inspections are less frequent, and detailed reports about performance are not readily available to the public. Allegations of abuse, neglect, and exploitation more than tripled between 2019 and 2024.

Regulation, Costs, and Hidden Fees

Massachusetts assisted living facilities are overseen by the Executive Office of Aging and Independence (AGE), but critics say oversight hasn’t kept pace with the growing needs of residents. While Governor Maura Healey recently announced fire safety reforms, advocates want stronger measures such as mandated staffing ratios, more frequent inspections, and higher penalties for violations.

Cost is another concern. Monthly rents range from $3,655 to over $8,000, with some homes charging up to $16,000 for premium services. Families also report hidden or “junk” fees, sparking lawsuits such as a $2 million verdict against a Framingham facility over community charges that weren’t tied to services provided.

Assisted Living Residence Commission: Oversight and Extended Review

The Massachusetts Assisted Living Residence Commission is tasked with reviewing regulations, safety standards, and care practices at the state’s assisted living facilities. In response to tragedies like the Fall River Gabriel House fire, the commission has announced it will continue its work beyond the original August 1, 2025, deadline. Gov. Maura Healey confirmed that the commission will incorporate lessons learned from the tragedy to strengthen resident safety and oversight (NBC Boston, 2025).

Some members, including Sen. Mark Montigny, have called for at least a 90-day extension to ensure a thorough review of safety practices and prevent similar incidents in the future. Aging & Independence Secretary Robin Lipson emphasized the need to balance timely reporting with careful consideration of critical safety issues. The commission’s work reflects its commitment to incorporating feedback from residents, advocates, and local officials while shaping stronger regulations for assisted living facilities.

Looking Ahead

The Assisted Living Residence Commission is expected to submit its recommendations to the state legislature after completing the extended review. Draft proposals include:

• Clearer disclosure of services included in monthly costs

• Increased access to inspection and compliance records

• Consideration of mandatory staffing ratios

• A searchable state database of assisted living residences

Attorney General Andrea Campbell is also preparing new regulations to protect residents from predatory fees and unfair evictions.

What Families Should Know

Families choosing assisted living should carefully review contracts, ask about staffing and emergency procedures, and research whether a facility has faced complaints or lawsuits.

When assisted living works well, it provides safety, independence, and community for older adults. But tragedies like the Fall River fire show why stronger oversight is urgently needed.

At KBD we have extensive experience handling nursing home abuse and neglect cases, and we also support families when abuse occurs in assisted living settings. If you or a loved one has suffered harm in either type of facility, our team is here to protect your rights and pursue justice. Contact us today if you need help for your family.

Sources:

• Boston Globe – Assisted living homes serve an increasingly frail population. Advocates say regulations haven’t kept up.

• NBC Boston – Assisted living commission eyes extended work after Fall River fire