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New rules to let frail elders stay in assisted living

Regulators also mandate training, evacuation plans

Regulators backed off a rule banning assisted living facilities from accepting residents needing long-term skilled care.Suzanne Kreiter/Globe staff

Frail elderly residents will still be allowed to live in assisted living facilities under hotly contested rules unveiled this week by Massachusetts regulators.

The regulations, aimed at strengthening protections for some of the state’s most vulnerable residents, mandate expanded training for facility workers and require detailed emergency evacuation plans, including enough equipment and medicine if extreme weather threatens.

But regulators backed off one of the most closely watched provisions, which would have prohibited assisted living facilities from accepting residents, or allowing them to remain there, if residents require more than 90 consecutive days of skilled nursing care.

Many elders who once would have moved to a nursing home when their health declined are instead choosing to remain in assisted living, often because it costs significantly less than nursing homes. Over time, the population in these loosely regulated, apartment-like facilities has grown increasingly frail.


About 14,000 people in Massachusetts live in about 225 of these facilities.

Elder advocates had lobbied for updated rules, saying the guidelines to protect residents had not kept pace and had not been updated since 2006.

The state’s assisted living law, written in 1994, included a prohibition on frail residents who required months of skilled nursing care, but the state never took the last step to ensure the law would be enforced, by including it in regulations.

Industry officials quoted in a Globe story last fall suggested that rule had not been widely enforced. Instead, they said, residents requiring skilled nursing have been allowed to stay in assisted living and hire private nurses.

Shortly after that story appeared, the Executive Office of Elder Affairs, which is charged with overseeing the facilities, included the prohibition in proposed new regulations.

The action infuriated industry leaders, who packed a December public hearing, and said enforcing such a rule would be traumatic for frail elders, and would require administrators to evict residents from facilities that had become their home.


Michael Banville, acting president of the Massachusetts Assisted Living Facilities Association, said in a statement Thursday the association is pleased with the final rules.

“While there are a number of aspects to these new regulations that will require changes in the way residences operate, we feel confident that the final regulations strike the right balance between the desire for safe residence environments and the values of dignity, choice, and independence that make assisted living an option that older adults want and deserve,” Banville said.

Martina Jackson, spokeswoman for the Executive Office of Elder Affairs, said in a statement the agency eliminated the controversial provision because “that already exists in the statute.”

Some attorneys who specialize in elder abuse cases said they believe insufficient training and staffing are at the heart of most of the abuse cases they see in assisted living residences.

The new rules mandate additional education in two areas of special concern raised by advocates: recognizing and reporting elder abuse, and techniques for managing and calming aggressive behavior, something commonly encountered in caring for patients with dementia.

But the rules stopped short of requiring some measures advocates had long sought, including minimum staffing levels for all assisted living residences. Instead, the rules stipulate only that it “shall never be considered sufficient to have less than two staff members in a Special Care Residence,” which typically cater to residents with dementia.


James Wessler, president of the Alzheimer’s Association of Massachusetts and New Hampshire, said in a statement that the organization is pleased to see the new rules enacted but felt that some critical issues remain.

The association had urged regulators to beef up rules regarding activities, saying they significantly improve the quality of residents’ lives, especially for those with dementia.

Kay Lazar can be reached at Kay.Lazar@globe.com .