Assisted living residence facilities should use a standardized process to track residents’ care needs, produce annual safety documents from fire departments, and be subject to penalties for violating state requirements, according to a slate of newly vetted recommendations.
The Massachusetts Assisted Living Residences (ALRs) Commission’s work took on urgency following the July 2025 fire at the Gabriel House in Fall River. Ten residents died, and dozens more residents and first responders were injured.
The commission, which focused on improving health and safety standards at the facilities, unanimously approved a report Monday with strategies to bolster emergency preparedness, transparency and staffing requirements. Gov. Maura Healey’s office said the administration would take “immediate action” to start implementing the majority of the report’s regulatory and administrative recommendations.
“Many of these recommendations and our ability to implement them will make a real difference in the lives of the people who are served and who reside in assisted living residences,” said Robin Lipson, secretary of the Executive Office of Aging and Independence.
The final report is now headed to the Legislature. Legislative recommendations include creating a funding stream to increase state oversight and public reporting, updating state law to allow for certified medication aides in ALRs, and developing a statewide registry for ALR executive directors, according to Healey’s office.
The commission — created under the 2024 long-term care reform law — included state officials, lawmakers, ALR residents and family members, and elder care providers and advocates.
“I do think that we’ve got pretty serious work to do still with assisted living residences — again, concluding that there are many who operate really well and offer a good product, but even there, we have to straighten things out,” said commission member Sen. Mark Montigny.
The New Bedford Democrat urged his fellow commission members, particularly lawmakers, “to make sure this report does not end up on the shelf.”
The Massachusetts Assisted Living Association supports the commission’s report, said CEO Brian Doherty.
“We are especially encouraged by recommendations to develop a standardized resident assessment, integrate Certified Medication Aides into assisted living, and establish an ALR Affordability Task Force,” Doherty said.
By July 1, 2026, the commission recommends that ALRs should produce annual documentation from their local fire departments, building inspectors and boards of health that confirm inspection dates and that there are “no outstanding violations,” according to the report. Those documents must be publicly accessible and verified by state officials during compliance reviews. By Jan. 1, 2027, the Executive Office of Aging and Independence should update on-site compliance checks that incorporate life-safety criteria that’s aligned with Department of Public Health standards for long-term care facilities.
ALRs by Jan. 1, 2027 should be required to update and review their emergency plans annually with local fire departments, provide annual staff training on emergency response, complete annual hazard vulnerability studies that are approved by emergency preparedness professionals, and designate at least one staff member per shift to serve as the “resident safety coordinator.” The commission advises that ALRs maintain census documents “for immediate access by emergency services” to identify residents, their location, and their individualized emergency needs, such as “vital medications.”
The commission calls for the launch of an online, publicly accessible database this July with compliance reports that are focused on resident care, safety and regulatory compliance. By next January, the commission says the state should introduce fines for violations, including higher penalties for “repeat or serious violations.”
Those recommendations will give “families greater confidence that complaints and incidents are fully investigated,” and families and residents “can make more informed choices when choosing or evaluating an ALR,” the report says.
“We must do everything that we can to ensure the health, safety and wellbeing of all residents and employees. I’m very pleased with recommendations from the commission’s final report, ” said Rep. Tom Stanley, who co-chairs the Joint Committee on Aging and Independence.
The report says that by July 1, 2027, ALRs should be required to use a standardized approach for resident assessments to track individuals’ social, physical, medical, cognitive and emergency preparedness needs when they are admitted, at least every six months, and when their conditions change. The recommendation supports practices that ensure “clear, upfront information on services, service limits and costs—helping to avoid unplanned moves or unexpected expenses,” the report says.
ALRs should start using uniform disclosure forms that are written in “plain language” by next July that stipulate a facility’s key services and costs, fee schedules, refund policies, key contract terms, resident rights and “any limits on services or staffing that may affect a resident’s ability to age in place,” the report says.
ALRs by next January should designate at least one licensed nurse to oversee and develop service plans, work a certain number of on-site hours each week, and be on-call “24 hours a day to support staff and respond to changes in resident condition,” the commission recommends. State officials will work on developing an “acuity-informed staffing model” by July 1, 2027 that reflects resident needs, care complexity and facility size.
The commission also calls for a new task force by July focused on affordable ALRs. That panel would create an inventory of existing facilities, evaluate gaps in the continuum of care, estimate statewide need, and recommend sustainable financing models.
The panel was initially expected to submit its report in August, though members secured an extension and sought additional testimony in response to the Gabriel House blaze.
“When a sudden and tragic issue came before us, we were able to pivot and really dig deeply,” said commissioner member Jennifer Benson, state director of AARP Massachusetts.
Beyond the commission’s work, Lipson noted “two other complementary efforts” underway “that will amplify and help move forward on some of the recommendations in the report.”
Later this month, the Executive Office of Aging and Independence is expected to open public comment on proposed regulations dealing with basic health services, emergency preparedness and “other operational areas,” she said. Attorney General Andrea Campbell’s office is also working on consumer protection regulations.
