Building for Aging: Recommendations

This section lays out key recommendations put forth by the Commission to advance solutions to meet the current and future housing needs of older adults in Massachusetts.

Although each recommendation provided may not be immediately implementable, the Commission has provided an accompanying implementation pathway for each proposed recommendation. These recommendations incorporate the current context in which Massachusetts faces a challenging fiscal situation and a shortage of hundreds of thousands of housing units overall.
 

Section 1: Finance and General Development

This section addresses potential pathways to address existing barriers and incentives to increase new housing production of affordable older adult housing.

Recommendation 1.1: Create Standardized Designs for Older Adult Supportive Housing Projects

Permitting and other regulatory approvals often slow down development and increase costs that hamper affordable housing projects often relying on significant government funding resources. The Commonwealth has a set of important design guidelines for older adult housing³⁹ which lay out some critical elements of quality environments for older adults. However, developers serving on the Commission and/or engaged in the process have identified a process of “reinventing the wheel” for each new project as they work with an architect to map out specific design elements—specifically accessibility requirements for older adult housing. 

Pre-approved housing plans or standardized designs could provide common templates for apartment designs that have already been reviewed and approved to meet necessary zoning, safety, and building code requirements. The Administration, in partnership with affordable older adult housing developers and other key stakeholders, could develop common templates for apartment design, common space configurations and spatial considerations for quality programming. Such design guidelines (or templates) will save time and money during the pre-development process. 

Implementation Pathway: The recommendation could be implemented administratively through amendments to the Commonwealth’s Qualified Allocation Plan (QAP). The Commission has recommended the creation of an initial working group that will examine key considerations including, but not limited to, the following:

• Review current design guidelines to identify areas for updating and adding.
• Articulate the most critical elements for successful older adult housing design that promotes apartments-for-life40 and incorporates full adaptability as a key element in standard design.
• Share findings from any post-occupancy evaluations for buildings developed in the last 10 years.
• Determine the most critical design features for bathrooms, bedrooms, kitchens and common areas that should be standardized.
• Identify efficiencies that can be achieved with standardized design.

Recommendation 1.2: Align Affordable Older Adult Housing Development with Older Adults’ Economics

Older adults who need subsidized housing are overwhelmingly extremely low income (ELI) or very low income (VLI). According to HUD, 63% of all households within affordable rental housing funded by the Low-Income Housing Tax Credit (LIHTC) in Massachusetts are at or below 30% area median income.⁴¹ This is slightly higher than national averages and further complicates the ability to make projects work financially given the coupling of the high costs of development and area rents. Financial feasibility for these projects is underwritten with rents closer to the maximum affordability restriction, which do not include a high share of rents affordable to ELI or VLI households. A disproportionate percentage of ELI tenants requires that developers are awarded project-based vouchers. However, current limitations on MRVP-project based vouchers—including caps on the number of vouchers per project and the underwritten maximum rent thresholds—can make developing projects that serve ELI and VLI households, including those with older adults, difficult. 

Implementation Pathway: Given current state and federal revenue constraints, HLC can explore the following steps in addition to efforts to increase current MRVP funding levels and raise voucher caps: 

• Document challenges in leasing up and maintaining long tenures for LIHTC-only units. Analyze, by region, the income distribution among older adult households.
• Evaluate options in addition to 100% project-based vouchers for all older adult supportive housing, including writing down LIHTC rents to match area incomes.
• Design outreach and education programs to promote the advantages of aging in community to attract more moderate-income older adults who can afford LIHTC-only units. 
   

The recommendation would require legislative action to increase funding for state-rental assistance programs and capital investment plan (CIP) as well as administrative action through amendments to the Commonwealth’s Qualified Allocation Plan and Massachusetts Rental Voucher Program.

Recommendation 1.3: Create a Program to Develop Moderate-Income Housing for Older Adults

Middle-income older adults, those earning between 50-80% area median income, face significant challenges in high-cost states—earning too much to qualify for affordable housing while the private market only provides older adult supportive housing for the wealthiest of older adults. According to a recent study by the UMass Gerontology Center, 80% of older adults have insufficient wealth to withstand even one financial shock without falling into poverty.⁴² Most studies identify this “missing middle” as the majority of older adults. Existing older adult housing developers have explored this model, yet many of the households earn too much to qualify for units supported with public financing, such as LIHTC-funded affordable older adult housing projects—thus exacerbating the financial feasibility of these projects as outlined in Solution 1.2. 

Implementation Pathway: Convene a working group of nonprofit developers who are interested in learning about middle-income-affordable supportive housing with MassHousing, MassDevelopment, and the Massachusetts Housing Partnership (MHP). The group would examine potential models, including the existing Opus model43, as a potential development pathway. The Commission would explore potential models that allow: 

• Residents to capture the asset value of their homes to ensure long-term financial security and care.
• Up-front resident fees sufficient to pay off the entire construction debt.
• Monthly fees that can be affordable under Social Security income with enough resources left to pay for care, when needed—and with special arrangements to make care more affordable and accessible.

Section 2: Place-Based Services

This section addresses potential pathways to address existing silos between funding affordable housing and necessary care services to ensure older adults can age in place.

Recommendation 2.1: Create a Universal Place-Based Service Program for Affordable Housing for Older Adults

Older adults living in affordable housing often struggle to maintain health and independence. Persistent eligibility gaps, along with limited communication and coordination between housing staff and health care providers or plans, lead to fragmented supports that are costly and inefficient. Affordable older adult housing can serve as an ideal setting for delivering place-based care, but today’s health care system is not organized to take advantage of this opportunity. One key barrier for payers is the lack of a critical mass of their members within any single housing community, making it challenging for them to provide and sustain on-site services. 

The supports available to residents have been built in disconnected silos, resulting in an inefficient use of the workforce and limited flexibility to meet the growing and diverse needs of older adults. This includes a lack of broader services, such as transportation, food, and digital connection that influences one’s overall health. Affordable housing has also not traditionally been financed or operated with the expectation of proactive outreach and integrated services to support healthy aging. As a result, many residents experience avoidable health crises, shortened housing tenure, and premature moves to more costly care settings. These gaps also contribute to an inefficient delivery of home and community-based services, dissatisfaction and turnover among direct care workers, and, most importantly, unnecessary disruption and reduced quality of life for older residents. 

Older adults living in affordable housing in the Commonwealth with access to place-based services and supports can more readily remain in their homes and communities. Research has shown that wellness-focused supportive services intervention was effective in reducing selective health service usage⁴⁴. As the Commonwealth seeks cost-saving measures, place-based services and supports may generate savings for healthcare, through improved health outcomes and reduced and delayed long-term care. From a systems perspective, affordable older adult housing serves as the organizing framework for integrating housing and care, leveraging a structured funding mechanism to serve residents and deliver the following outcomes:

• Housing preservation
• Long-term care avoidance or delay
• Positive health outcomes (e.g., reduced hospitalizations, reduced ER trips, reduced falls)
• Increased health activation, such as primary care visits, vaccinations, completed health care proxies, and program engagement
• Satisfaction with providers and life as a whole 

Implementation Pathway: Through new or modified legislation⁴⁵ and identified funding sources, establish a defined Place-Based Services Program in affordable older adult housing communities. The program could be launched through a phased implementation, supported by a Place-Based Services Pool Fund. The program and fund could define core service elements and standards, establish staffing and training requirements, set documentation protocols, and implement outcomes and reporting expectations. 

The Place-Based Services Pool Fund could combine multiple new and existing funding sources, including an investment from health plans, housing providers, and the Commonwealth. In Phase I, the fund and program will be launched in a limited number of housing sites to integrate with existing housing and health programs, refine program components and workflows, and test and finalize the logistics of pooled funding. The Place-Based Services Pool Fund could be jointly managed by the Executive Office of Housing and Livable Communities (HLC) and the Executive Office of Health and Human Services (EOHHS), with an Advisory Board to review and approve program awards, recommend fund growth strategies, and define success metrics and evaluation priorities.

 The programs funded through the Place-Based Services Pool Fund could be required to have the following elements: 

• Embedded on-site wellness teams and trained staff
• Proactive outreach to all residents, creating established, trusted relationships
• Comprehensive needs assessment with documented risk profiles
• Integrated care and service coordination • Health and wellness programming, including fitness, nutrition, and engagement • Established connections to transportation and digital access to address socioemotional health needs
• Mental and behavioral health and isolation mitigation
• Housing stability supports
• Clustered delivery of in-home services and case management
• Documentation and outcomes tracking as standard practice

Section 3: Accessibility, Maintenance, and Modification

This section addresses potential pathways to address existing challenges to funding both new accessible housing as well as much needed modifications to meet accessibility needs in existing affordable older adult housing.

Recommendation 3.1: Require 100% Adaptability in New Senior Housing Construction

The Massachusetts Architectural Access Board, through 521 CMR, requires multifamily rental buildings with at least 20 units to make 5% of units fully accessible and 95% of units fully adaptable. However, many senior housing developers report that their older adult residents prefer units built for future adaptability that allow for any future necessary modifications rather than the units designed under the 5% accessibility requirement. Current law in Massachusetts exempts buildings constructed before March 13, 1991 from AAB requirements if they undergo rehabilitation projects. As the Commonwealth confronts a critical need for more adaptable units, there is current legislation⁴⁶ that would remove this exemption. While this legislative change would create more adaptable units, it could also make some projects financially infeasible or require months-long delays to apply for and receive a variance from AAB. On the other hand, because of the full exemption that gut rehabs presently receive for pre-1991 buildings, some developers and architects don’t consider making even minor modifications that could increase accessibility in the building. 

The commission recommends that HLC update the Qualified Allocation Plan (QAP) so that all new construction projects receiving funding through that process must include 100% of units as adaptable in addition to the 5% accessibility requirement. Furthermore, the Commission recommends that HLC, AAB, housing developers, and advocates further explore how to increase the number of adaptable units for pre-1991 rehab projects without suppressing the production of much-needed housing across the state. This could include requiring developers to submit a feasibility analysis. It could also include requirements for developments that don’t apply via the QAP but receive state funding. Or it could include some other approach that increases the prevalence of adaptable units without disincentivizing the conversion of older buildings into housing. 

Implementation Pathway: This could be implemented through legislative action to amend the statute or through administrative action by HLC to change the QAP program guidelines. Further study could be conducted administratively by HLC in partnership with the AAB and developers on what is feasible for adjustments to adaptable requirements in pre-1991 rehab projects. 

Note: Adaptability considerations related to new development and costs are addressed in recommendation 1.1 of this report. These recommendations are similar to recommendations 1.2 and 1.3 of the Accessible Housing Commission report.

Recommendation 3.2: Increase Funding for Capital Repairs to Improve Accessibility in Housing for Older Adults

Given the age of Massachusetts’ housing stock—both public and private—much of it is unable to meet the needs of older adults without significant accessibility upgrades. As noted earlier in the report, this challenge is most evident in public housing, where deferred capital maintenance needs are estimated at $4 billion. 

However, procurement requirements and limited public resources have made it difficult to address these accessibility gaps. Smaller-scale repairs in public housing often do not justify the time and cost needed to navigate full procurement processes. In addition, both local housing authorities and homeowners struggle to access the limited funding that does 28 exist for accessibility modifications, and many are not even aware of the programs currently available. 

This recommendation aims to ensure that funding for essential capital repairs is not only provided at the levels authorized in the Affordable Homes Act, but that the process is also made easier to access—particularly for smaller, lower-cost projects.

Implementation Pathway: Implementing this recommendation could include the following steps: 

• Explore exemptions from part of the construction procurement requirements under M.G.L. ch. 149 – to reduce the cost of accessibility-related unit production.
• Ensure that all authorizations in the Affordable Homes Act for capital funds to improve public housing, including those for accessibility upgrades, are fully utilized in the Capital Investment Plan (CIP).
• Ensure all public housing authorities know about the public housing capital fund – compliance reserve (reasonable accommodation, code/law compliance) and the Regional Capital Assistance Team to leverage funding throughout the year that may not rise to the CIP level but are over operating budgets to meet new accessibility needs.
• Help public housing to identify and connect residents with health plan payers who may be able to pay for modifications when outside of grant cycles when individual needs arise.
• Increase funding for the Home Modification Loan Program, which supports accessibility upgrades for the homes of older adults, in the state’s CIP. 

Note: this broadly aligns with recommendation 1.1 of the preservation section in the report from the Extremely Low-Income Housing Commission

Section 4: Housing Lifecycle Management and Search

Over 1.8 million residents are aged 60 and older and many cities and towns have 25% or more of their population over the age of 60. Massachusetts is committed to making its communities more welcoming and livable for older residents and people of all ages. 

While a large share of older adults are homeowners, housing affordability remains a central concern, particularly as household income typically decreases with age. Rising housing costs create substantial obstacles for older adults, especially renters, who wish to remain in their communities. With the number of older adults projected to grow significantly in the coming years, addressing these challenges is increasingly urgent. 

Together, these recommendations aim to strengthen the Commonwealth’s ability to support older adults in aging safely and comfortably in their communities. They call for reframing how we communicate about older adult housing to combat ageism; building tools and resources that help older adults and caregivers plan for future housing and financial needs; expanding training, technical assistance, and digital-access supports for the aging services network; and advancing new models of housing assistance that reflect the diverse circumstances of older adults. These actions provide a comprehensive framework to meet the growing and varied housing needs of an aging population.

Recommendation 4.1: Reframe Language and Communication on Older Adult Housing

In May 2025, Governor Healey issued Executive Order 642, “Instituting Age-Friendly Practices.”⁴⁷ This work was announced alongside the ReiMAgine Aging 2030 Plan. 

Executive Order 642 directs all Executive Branch agencies to adopt “age-friendly” practices in their operations, programs, and communications. The order establishes a coordinated statewide approach to supporting healthy aging, ensuring that policies, public messaging, and service delivery reflect the needs and strengths of older adults. Announced in tandem, the ReiMAgine Aging 2030 Plan provides the Commonwealth’s long-term roadmap for building age-ready communities, reducing barriers that older adults face, and promoting inclusive, intergenerational environments. 

Together, EO642 and the ReiMAgine Aging 2030 Plan set a statewide vision that HLC can model through clearer, more inclusive language and communication about housing options for older adults, ultimately helping partners across Massachusetts adopt similar practices. 

Implementation Pathway: HLC can implement this recommendation administratively by adopting an agency-wide age-friendly communication framework aligned with EO642 and the ReiMAgine Aging 2030 Plan. This would include the following action items to implement: 

• The Healey-Driscoll Administration, including HLC, update existing materials to use inclusive, strengths-based language; training staff on age-friendly communication principles;
• Integrate these standards into future policy development, program guidance, and public messaging by modeling these practices across its own operations;
• Coordinate policy review within HLC to identify ways the goals of age-friendly policy and practice, including those described in this Order, can inform agencies’ programs and resources to best meet the needs of older adults. This will include reviewing and updating the language, concepts, and images used to describe or address older adults to be inclusive and person-centered.
• Partner with the Executive Office of Aging and Independence (AGE) to share templates and tools with local housing authorities, municipalities, and partner organizations to help set a consistent statewide standard for clear, respectful communication about older adult housing, aging, and service connection.

Recommendation 4.2: Build and Promote Resources to Help People Plan for Housing Needs

The anticipated increase in older adults entering retirement and transitioning to fixed incomes has major implications for how households plan for both housing and health needs. To reduce the risk of unexpected costs and disruptions that can lead to premature nursing home admission or involvement with emergency systems of care, the Commonwealth can take proactive steps to help older adults and their caregivers prepare for this transition. Doing so will support individual stability while also protecting the State’s broader economic well-being.

Implementation Pathway: The Commission recommends the following steps:

• Convening state agencies and organizations to create and collect resources to help people, including older adults and caregivers, plan for housing transitions and costs similar to health care proxies and other legal and financial considerations.
• Passage of H.777,⁴⁸ An Act Supporting Seniors’ Financial Stability, which directs the State Treasurer’s Office to establish a curriculum to support financial literacy among older adults.

Recommendation 4.3: Improve Access to Housing Guidance for Older Adults and Training for Older Adult Service Providers

HLC recently released new webpages and tools, including a “step-by-step guide” to help users understand affordable housing eligibility, search processes, and applications. However, many older adults and the providers who support them may be unaware of these resources or may struggle to navigate the range of housing options available in their communities. 

To address this, the Commission recommends developing a training program, in collaboration with other state agencies and partner organizations, to equip staff at Aging Services Access Points (ASAPs), Councils on Aging (COAs), and similar entities with the knowledge needed to guide older adults seeking housing assistance. 

Implementation Pathway: The Commission recommends that HLC, in partnership with EOAGE and other relevant Secretariats, develop trainings to support awareness for direct care staff within community-based organizations supporting older adults around housing search.

Recommendation 4.4: Pilot Innovative Housing Modes for Older Adults

Massachusetts’ older adult population is growing rapidly, and their housing needs are becoming increasingly diverse. While a majority of older adults own their homes, many are “house-rich but cash-poor,” facing rising costs on fixed incomes. At the same time, older adult renters often struggle to afford market rents and remain stably housed. Meeting the full range of needs—from those wishing to remain safely in their homes to those facing immediate housing instability—will require new, flexible, and accessible models of housing assistance. The following recommendations outline innovative approaches, including intergenerational homesharing, targeted bridge subsidies, and the expansion of adaptable ADUs, that together support a true lifecycle approach to aging in community. 

Implementation Pathway: The Commission recommends the following legislative and funding pathways to facilitate a “lifecycle approach” to meeting older adults housing needs.

• Creation of an Intergenerational Homeshare Program: Support intergenerational and older-adult homesharing by advancing S.992/HB.4695⁴⁹ , An Act to Expand Housing Options Through Homesharing. This legislation would establish a 32 comprehensive legal framework for homesharing in Massachusetts, clearly defining roles, responsibilities, and occupancy guidelines. Boston has already demonstrated success with an intergenerational homesharing pilot, where average rents were approximately $700. Vermont operates a statewide homesharing program, and Maine is launching a statewide pilot through a partnership among MaineHousing, the Maine Council on Aging, AARP Maine, the Governor’s Cabinet on Aging, and Nesterly.
• Bridge subsidies for older adults facing housing instability: Create a steering committee, convened by HLC, to assess the impact and guide potential expansion of the bridge subsidy program for low-income older adults age 60 and over who are experiencing housing instability. Current legislation, S.475,⁵⁰ would enable eligible older adults to remain safely housed while they await long-term subsidized options such as MRVP or state-funded public housing. The Commission further recommends that HLC examine opportunities to align this effort with other programs, such as HOME Tenant-Based Rental Assistance, and ensure that participating older adults maintain eligibility for applicable housing waitlist preferences.
• Introduce a tax credit for adaptable ADUs: In 2024, the Affordable Homes Act legalized Accessory Dwelling Units (ADUs) statewide by-right, subject to reasonable local regulations. While ADUs help address the broader housing shortage, they also offer significant potential to expand the supply of accessible homes. Because many ADUs are ground-floor structures and newly built, they can be designed with adaptability in mind from the outset. The Commission recommends creating a $5,000 refundable state income tax credit for ADUs that include adaptable features. This incentive would encourage homeowners and builders to incorporate adaptable design as a standard practice, making future conversion to full accessibility far easier. In addition to promoting accessible housing, the tax credit would help lowerincome homeowners participate in ADU production and support the Commonwealth’s efforts to meet its housing needs.