Rest homes in Mass. keep closing as financial pressures mount
SOMERVILLE — When the Somerville Home announced in August that it would shut its doors this fall, 78-year-old Elena Lowry realized that the world she’d known for the past 15 years — the friendships with fellow residents, the attentive staffers who made her doctor’s appointments, the cakes and special meals on her birthday — was about to disappear.
“I loved the Somerville Home,” said Lowry, who moved into another long-term-care complex nearby last month but misses friends who were relocated as far away as Tewksbury and Worcester. “We were all sad that we had to leave. But we had no choice.”
On Dec. 1, the brick Colonial-style building perched on a hill will become the 100th rest home in the state to close and displace its residents in the past two decades, according to the Massachusetts Association of Residential Care Homes. Seventy-three rest homes still operate across the state, but whether they can survive is an open question.
Rest homes trace their roots to the 19th century, when fraternal, religious, and ethnic groups pooled their funds to furnish large Victorian homes to provide for needy widows in an era before Social Security. Those that endure remain a vital safety net for low-income older residents, many of whom have mental or behavioral disabilities.
Nursing homes, a much larger sector, provide more intensive medical care. Assisted-living developments, which are typically newer, offer more independence but cater mostly to wealthier seniors who can afford higher rents. Rest homes, by contrast, provide room and board along with some services, such as dispensing medications and offering psychosocial support for residents with bipolar disorder, schizophrenia, or traumatic brain injures.
“It’s a great option for people who don’t have a lot of options,” said Elissa Sherman, president of Leading Age Massachusetts, which represents nonprofit housing and aging services for older adults. “Many of their residents would probably be homeless without the rest homes.”
But as new assisted-living complexes have opened, drawing more affluent residents, they’ve left the rest homes with a majority of residents on public assistance. At the same time, more resources have been funneled to helping older residents stay in their homes. As a result, the number of beds at Massachusetts rest homes has fallen 57 percent, from 7,000 to 3,000, since 1998.
Without wealthier residents who can help subsidize poorer ones, financially troubled rest homes have had to rely more heavily on state funding. And until this fall, state reimbursements for rest home residents hadn’t increased for six years, even as their costs escalated.
“It’s very difficult to run a business in 2018 based on 2012 costs,” said Ron Pawelski, president of the rest home association. “When you look at all the health care facilities that are competing for funding, we get left behind. People don’t understand what rest homes are and what their role is. Many of these residents can’t afford assisted-living. Some have been homeless; some have no families in the immediate area.”
Alice Bonner, the Massachusetts secretary of elder affairs, said the Baker administration is committed to maintaining the state’s remaining 73 freestanding homes, along with 20 others housed within nursing homes.
Toward that end, it boosted reimbursement rates 9 percent and raised the daily minimum to $74, effective Dec. 1. It also convened a cross-agency team to find ways to stabilize rest homes, and it hired a consultant to help plot a way forward.
“This administration clearly recognizes the value and importance of rest homes in our communities,” Bonner said.
But the state’s reimbursement for rest home patients is still less than half of the daily per-patient rate for nursing homes, which receive a federal funding match, and many of which are owned by chains that have more clout on Beacon Hill. Most rest homes continue to be independently operated by small businesses, nonprofits, or religious groups.
The reimbursement increase came too late for the 120-year-old Somerville Home, which struggled for years, slowly draining a small endowment furnished by families of people who had lived there. Its shutdown will force 46 residents to find new places to live and 26 employees to find new jobs, including executive director Kelley Sferrazza.
Sferrazza, who has been scrambling to place all of the home’s residents in new facilities, said she won’t start looking for work herself until she has completed that task. The majority of residents have already been relocated to other rest homes, but seven have gone to assisted-living and another half dozen to nursing homes, where their care will cost the state more money. Six recently remained in the home, though Sferrazza hoped to place them by Thanksgiving.
“It could be depressing to have six residents here for Thanksgiving dinner,” she said.
A visit to the Somerville Home this month found the homey but dated three-story structure largely vacant. A van was parked outside, embossed with the motto “Over a Century of Caring.” In the front yard, an apple tree stood amid a garden with markers memorializing former residents. Some were veterans of combat in World War II or military nurses.
Inside, the dining room, game room, and hair salon were empty, as were most residents’ rooms. Although each had his or her own bedroom, they shared bathrooms and had no central air-conditioning.
“People used to come in and say it reminded them of their grandmother’s place,” Sferrazza said, walking through the dining hall. “We didn’t have all the bells and whistles.”
Almost all the Somerville Home’s residents were on public assistance, paid by the state Department of Transitional Assistance, which made it difficult to afford basic upkeep or pay for needed capital improvements, said Edwin Smith, chairman of the Somerville Home board of directors. And when the nonprofit had to install a new water heater or replace sprinkler heads, it fell deeper into a financial hole.
“We just couldn’t pay the bills anymore,” Smith said. “Over the last few years, we’ve been losing a lot of people to these spanking new assisted-living facilities.”
Audrey Proctor said her brother, who has a mental disability, had been planning to move into the Somerville Home when they learned it was closing. He had lived in public housing for 20 years but now, at age 57, he needs more supervision. They continue to search.
“Our only hope is the rest homes,” Proctor said, “but the rest homes are closing.”
Two dozen rest homes have closed in the past decade alone. One in Western Massachusetts was converted to a doggie day care. State Senator Pat Jehlen of Somerville said other health care facilities serving low-income older residents in her district, such as nursing homes and adult day care, are also struggling and need more state support.
“The state has been unwilling to adjust rates for the kinds of quality institutions that serve people who aren’t rich,” Jehlen said. “We need affordable housing for low-income people and people with disabilities.”