A deadly fire at Gabriel House assisted living facility in Fall River last year shed light on the lack of regulation of the facilities that house more than 17,000 Massachusetts residents, most of them senior citizens. On Monday, a state commission issued recommendations for how the government can better oversee the homes, which tend to attract people who need some help with everyday tasks but do not require full-time nursing care.
The problems the commission found go beyond fire safety and deserve swift attention from the Legislature. Assisted living is an important residential option, a way for seniors to age in the community — but the facilities need to be safe and residents need to know what they’re signing up for when they choose one.
Based on lessons learned from the Gabriel House fire, which killed 10 people, the report recommends new emergency preparedness requirements, including annual fire department reviews.
Addressing fire safety is perhaps the most urgent job for legislators. But the commission also found wider safety concerns, many related to the handling of acute medical or behavioral emergencies, and allegations that some facilities mislead residents about their costs.
If implemented, the report’s recommendations would make it easier for people to choose an assisted living facility by ensuring that information about fees, services, and state inspections of the facility is provided clearly.
By July 2026, facilities would need to give potential residents a standard disclosure form with information about fees and services. The state would launch a public database with records of state inspections and fines assessed for each facility.
Improving the standards for medical care will require a change in mind-set. Historically, assisted living facilities were considered residences and escaped the stricter rules applied to health care facilities. During the COVID-19 pandemic, though, the state started letting staff provide basic health services like giving insulin injections, changing wound dressings, or managing oxygen, a practice made permanent in 2024. The proposed rules would recognize the reality that assisted living facilities can house medically needy patients and offer medical services.
By January 2027, assisted living facilities would be required to employ at least one licensed nurse. The state would create staffing requirements, with staffing levels that would depend on patient acuity and facility size. There would be mandatory training for certified nursing assistants and facility directors.
A 2024 law authorized state regulators to fine assisted living residences for violating state regulations but no fines have yet been levied. The commission is recommending that these fines go into effect, with higher fines for more serious or repeat violations. The commission also called for the creation of a separate task force to explore challenges facing facilities that accept low-income populations, which often have poor conditions.
Governor Maura Healey has committed to implementing the commission’s administrative recommendations, and the Legislature should implement those that require legislation. State Representative Thomas Stanley, a Waltham Democrat and commission member, said he is writing a bill based on the commission’s recommendations, which he hopes can pass this session.
Some recommendations could pay for themselves, with money from certification fees and fines paying for state inspectors and technology, but others may cost the state money. That’s no reason to ignore them. As state Senator Pat Jehlen, a Somerville Democrat and commission member, told the editorial board, “In a time of extreme financial constraint and real cuts in services, we need to provide ongoing adequate funding sources for the things that we care about.”
The challenge will be ensuring the report doesn’t sit on a shelf. The administration is expected to release draft regulations this month related to emergency preparedness and the provision of health care services at assisted living facilities. Future regulations will need to address tricky topics like ensuring appropriate staffing, given the differences between facilities. The Legislature will have to create a trust fund to collect fees and fines and distribute money for investigations, inspections, and initiatives, like creating a new website.
Assisted living is an important option, and with an aging population in Massachusetts, the need for safe places for seniors to live is only going to grow. But facilities need to be honest about what they cost and what they provide, and must offer a safe living environment for all residents. Enacting the commission’s recommendations would be an important step toward making sure those expectations are met.
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