Assisted Living Residences Certification Program (ALR)
The Assisted Living Residences Certification Program is responsible for the oversight of over 200 certification sites throughout the Commonwealth. Administered by the Executive Office of Elder Affairs, the program certifies qualified residences and offers the Assisted Living Ombudsman Program to provide advocacy, information and complaint resolution to consumers.
Choosing an Assisted Living Residence (ALR)
One of the first things you probably want to consider when choosing an ALR is how much it will cost and how you will pay for it. The cost of ALRs vary due to the location, the size of the apartment, and the services included. The monthly fee for ALRs in Massachusetts is typically $3,000 or more. The majority of Assisted Living residents pay privately, but there are a few ways to receive assistance such as Group Adult Foster Care (GAFC) and Supplemental Security Income – Category G (SSI-G). See Section on GAFC
A few ALRs provide reduced rates for lower income residents. An example is ALRs which receive funds from MassHousing through a program called ElderCHOICE. At least 20% of the units within ElderCHOICE ALRs are reserved for low-income residents. Again, you should inquire as to whether the particular residence you are considering offers reduced rates.
Free copies of Assisted Living in Massachusetts: A Consumer’s Guide are also available.
MassHealth (Standard or CommonHealth): Not every ALR accepts GAFC residents, so consumers should inquire as to whether this is a possible option. Individuals should also have a clear understanding of the financial eligibility requirements for SSI and MassHealth. Individuals who are interested in residing in an ALR that accepts GAFC should inquire about the income guidelines for MassHealth (Standard or CommonHealth) before deciding on the most appropriate ALR.
Group Adult Foster Care (GAFC)
The Group Adult Foster Care (GAFC) program is a MassHealth program that provides personal care services in either a community or assisted living setting to individuals who are elderly and/or disabled. GAFC provides assistance with Activities of Daily Living (ADLs), nursing oversight and care management. Individuals must meet the criteria and guidelines set forth by MassHealth:
- Must be age 22 years of age or older;
- Must meet the financial criteria for MassHealth* (Standard of CommonHealth) – contact MassHealth Customer Service at 1-800-841-2900 for further information or visit the following website www.mass.gov/masshealth;
- Requires a physician’s summary confirming the appropriateness of GAFC services;
- Requires daily assistance with at least one ADL (e.g., bathing, dressing, eating, continence care, ambulation or transfer);
- Requires clinical approval from the MassHealth designated clinical screening agent, Coastline Elderly Services, Inc; and
- Must reside in identified community housing for individuals who are elderly or disabled OR live in an assisted living residence.
Financial Eligibility for GAFC
Financial eligibility for GAFC in an assisted living setting is determined by the Social Security Administration through the Supplemental Security Income Program – Category G (SSI-G).
What is SSI-G?
- Supplemental Security Income (SSI) is a Federal program administered by the Social Security Administration (SSA);
- Massachusetts implemented the SSI State Supplemental Living Arrangement (L/A) Category G, Assisted Living, as of 1998 to assist individuals who clinically meet the criteria for GAFC in an effort to assist in the payment of Room and Board in assisted living facilities;
- The Commonwealth of Massachusetts, depending and individual’s living arrangement (must live in a certified assisted living that participates in the GAFC program), supplements the Federal SSI payment;
- The income guidelines for SSI-G change on an annual, calendar year basis; and
- The 2009 income guideline for an individual is $1128.00 per month with assets of $2000. or less and for a member of a couple $846.00 per month with assets of $3000. or less. It is important to note that SSI applies a general $20.00 disregard of income.
- Requires clinical approval for GAFC services from the MassHealth designated clinical screening agent, Coastline Elderly Services, Inc.;
- Must file an SSI application with the local SSA Field Staff Office;
- Must meet all other SSI requirements; and
- Requires a Residence Verification form completed by the assisted living facility and Coastline Elderly Services, Inc., confirming residency at the assisted living facility.
Assisted Living Ombudsman
Elder Affairs also runs an Assisted Living Ombudsman Program. While Elder Affairs does not make recommendations, you may contact the Assisted Living Ombudsman Program to inquire if any complaints have been filed against any one ALR. The assisted living ombudsman also acts as a mediator and attempts to resolve problems or conflicts that arise between an assisted living residence and one or more of its residents. Anyone can bring a complaint before the ombudsman. The complaint can be on behalf of a specific resident or on behalf of residents as a whole. A complaint can range from a violation of an applicable statute or regulations to residents’ rights.
The Supportive Housing Initiative was developed by the Executive Office of Elder Affairs (Elder Affairs) and the Department of Housing and Community Development (DHCD) to create an "assisted living like" environment in state funded public elderly/disabled housing. The program was first implemented on a pilot basis in 1999 at 3 elder housing developments. It has since been expanded to 31 locations. By pooling resources that are currently being invested by an Aging Service Access Point (ASAP) and a housing authority in an existing development, frail, low-income elders have an opportunity to access a model of affordable supportive housing that promotes independence and aging in place.
Like traditional assisted living, services are offered on an as needed basis, 24 hours per day. Residents who do not qualify for state funded home care services based on their frailty level and income are able to privately purchase the entire package of supportive services or some of the services based upon their need. Residents who are home care eligible receive all or some of the services at no additional cost.
The following are some of the services that are available to elders participating in this program:
- Service coordination
- Case management
- 24-hour personal care/on-site, on-call person
- Homemaker services and laundry
- Medication reminders
- Social activities
- At least one meal per day
Congregate Housing for people 60+ or people with disabilities, who meet financial guidelines offers private bedrooms but shares one or more of the following: kitchens, dining rooms, bathrooms. Services are made available to aid residents in managing Activities of Daily Living in a supportive, but custodial living environment designed to integrate the housing and services needs of elders and disabled individuals. The goal of Congregate Housing is to increase self-sufficiency through the provision of supportive services in a residential setting. Congregate Housing is neither a nursing home nor a medical care facility.
Continuing Care Retirement Communities (CCRC)
CCRCs are different from other types of senior housing because these communities provide housing, personal services, and health care, usually at one location. CCRCs offer an environment and the services necessary for residents to "age in place." In other words, as a person’s personal and health care needs change, they are able to remain at the retirement community.
CCRCs often have a variety of housing on one campus, from townhouses or "cottages" for independent living to studio apartments for people in supportive living programs. In addition to providing housing, CCRCs provide or make available some combination of the services and amenities listed below.
- Nursing and other health-care services
- Meals usually in a community dining area
- Emergency assistance
- Personal care assistance
- Recreational and social activities
- 24 hour security
- Building and grounds maintenance
In addition to providing health services, CCRCs offer, usually for a set monthly fee, a package of services, activities, and amenities that are designed to maximize the resident’s independence. The composition of service packages varies greatly by CCRC. It is important to be clear about which services are included in the monthly fee and which are available at an additional cost. At many CCRCs, the types and amount of services, both available and included in the fee, will depend on whether the resident lives in independent or supportive housing.
The composition of service packages varies greatly by CCRC. It is important to be clear about which services are included in the monthly fee and which are available at an additional cost. At many CCRCs, the types and amount of services, both available and included in the fee, will depend on the type of accommodations in which the resident lives.
Most CCRCs also require a sizable declining-refundable entrance fee, ranging from less than $100,000 to more than $300,000.
A Consumer's Directory provides a brief introduction to continuing care retirement communities in Massachusetts. It is not meant to rank communities but to highlight some of the issues and concerns that should be evaluated before making a commitment to invest in a CCRC. We hope this guide will take some of the mystery out of choosing a CCRC. Life is full of surprises but choosing a CCRC should not be one of them. If you have any questions or concerns about CCRCs, please call the Executive Office of Elder Affairs at (617) 727-7750, (800) AGE-INFO (or 800-243-4636) or TTY/TTD (800) 872-0166.
Adult Foster Care Program
The Adult Foster Care (AFC) program is a MassHealth program that provides personal care services in a family-like setting to elderly or disabled individuals. AFC provides assistance with Activities of Daily Living (ADLs), nursing oversight and care management in a setting that provides 24 hour supervision. These individuals, the foster families, and the Adult Foster Care Program provider must meet the criteria and guidelines set forth by MassHealth.
- Must be 16 years of age or older.
- Must meet the financial criteria for MassHealth (Standard or CommonHealth) contact MassHealth Customer Service at: 1-800-841-2900 for further information or visit the following web site: www.mass.gov/masshealth.
- Requires a physician’s summary confirming the appropriateness of AFC services.
- Requires daily assistance with at least one Activity of Daily Living (ADL).
- Requires clinical approval from the MassHealth designated clinical screening agent, Coastline Elderly Services, Inc.