Brian Doherty
Massachusetts stands at a critical crossroads in addressing the housing and care needs of its aging population.
Assisted living residences (ALRs) provide a vital, hybrid model that blends housing with supportive care – offering older adults a home-like environment where assistance with daily living is available without intensive medical interventions and clinical settings typical of nursing homes.
Yet, the legal framework governing these residences remains unclear, hampering providers’ ability to deliver quality care and innovate in housing design.
House Bill 770, “An Act Clarifying the Classification of Assisted Living Residences,” is essential legislation that will resolve this ambiguity and strengthen the role of assisted living in our commonwealth’s housing ecosystem.
Not Ordinary Rental Housing
Assisted living residences in Massachusetts are fundamentally different from traditional rental housing.
Unlike standard landlord-tenant arrangements, ALRs must provide not only housing and meals but also personalized assistance with daily activities such as dressing and bathing.
While Chapter 19D of Massachusetts General Law has long offered the eviction protections of landlord-tenant law, recent court decisions – particularly a 2019 Supreme Judicial Court ruling – have created uncertainty about how much of landlord-tenant law applies to assisted living.
This ambiguity poses significant operational challenges for providers, whose responsibilities go far beyond those of typical landlords – just look at an all-too-common disease: Alzheimer’s.
According to the latest “Assisted Living Residences Census” report from the state Executive Office of Aging & Independence, 23 percent of traditional unit residents and 89 percent of “special care residence” residents in Massachusetts ALRs are diagnosed with Alzheimer’s disease and related dementias.
Each ALR is required to develop individualized service plans, offering a broad range of supportive services and activities tailored to residents’ unique needs. These obligations – spanning from personal care and transportation to community programming – underscore the distinct role of assisted living, which is centered on resident wellbeing rather than simply providing housing.
Help Unlock More – and Better – Units
As housing developers have been working with policymakers to address the critical shortage of housing, assisted living must be a part of the conversation as Massachusetts seeks to meet the needs of an aging population.
By recognizing assisted living as a unique classification separate from conventional rental housing, the legislation will enable more appropriate regulatory oversight and operational flexibility.
This, in turn, will facilitate innovative design and development of assisted living communities that integrate health and supportive services seamlessly with residential living. Such innovation is crucial to meeting the growing demand for housing options that support aging in place while fostering vibrant community environments.
From a housing policy and financing perspective, H.770 will also provide much-needed clarity for lenders and investors.
The current regulatory and judicial uncertainty complicates risk assessment, operations and financing for assisted living projects, limiting the expansion of this critical housing option and distinct setting for older adults who want independence, community and supportive care supported by the hybrid model of assisted living.
Clear classification will encourage investment and development, helping to expand the stock of affordable, quality assisted living residences across Massachusetts. This is particularly important as the commonwealth seeks to diversify its housing portfolio to better serve older adults who require supportive care but do not need nursing home-level services.
Balances Safety, Quality, Autonomy and Dignity
Most importantly, this legislation supports better outcomes for residents by ensuring that assisted living providers can operate under regulations tailored to their unique mission.
It balances safety and quality of care with residents’ autonomy and dignity, empowering providers to innovate in service delivery and respond effectively to evolving needs. H.770 aligns with recent state efforts to enhance long-term care quality and oversight, reinforcing Massachusetts’ commitment to protecting and supporting older adults.
H.770 is more than a technical fix – it is a foundational reform that acknowledges the distinctive nature of assisted living and its essential role in the commonwealth’s housing and care landscape.
By advancing this legislation, we can ensure that older adults have access to housing that truly supports their independence and wellbeing, while fostering innovation, investment and sustainability in this growing landscape.
Additionally, this clarity can also help both families better plan for the long-term care needs of their loved ones, knowing that assisted living is a financially viable and legally sound choice, and investors who will benefit from increased certainty and protections.
The time to act is now as the Supreme Judicial Court is set to revisit this issue. By clarifying the classification of assisted living residences we can unlock the full potential of this distinct and hybrid setting, for the benefit of our older adults, our communities and our commonwealth.
Brian Doherty is the president and CEO of the Massachusetts Assisted Living Association.
