Baby boomers (1945-1964) are alongside millennials (1980-1994) as the state’s largest generational groups. By 2035, the oldest of the baby boomer age cohort will be on the verge of turning 90 years old. This increase will come with large increases in the number of older adult households who are generally low- or extremely low-income; have members with limited mobility or cognitive challenges; require at-home medical services; and/or have higher sensitivity and lower adaptive capacity when it comes to climate events. At the same time, the majority of older adults own their own home and the opportunities available to them in the coming years will have an outsized influence on the housing market if they lack options that meet their respective needs.
The cost of housing is a fundamental challenge for older adults, since most see their real/effective income decline over time. Median household income for over-65 households in Massachusetts is $69,000, a little over half of the median income for householders 45- 64.10 Even those that own their own home may have challenges making ends meet, despite the real estate value of their property. University of Massachusetts researchers estimated in 2022 that more than half of Massachusetts’ older adults living alone, and one quarter of older couples, lack the financial resources required to pay for basic needs.11 This is not universal across all older adults—the top third of older adult households hold over $3.5m in wealth on average.12 However, the bottom third averages just over $50,000. Though higher than the national average, when adjusting for cost of living, research from the Elder Index shows 80% of older adult households have income less than what it takes to age in place as compared to 63% nationally.13 As a result, Massachusetts ranks among the lowest of all 50 states in economic security for older adults, with higher housing costs being the main driver.14 Both nationally and in Massachusetts, the rate of older adults experiencing homelessness has been rising substantially, and is the fastest growing component of the homeless population. In Massachusetts, the growth in older adult homelessness was 17% between 2023 and 2024 compared to 6% nationally.15
The creation of Medicare over 50 years ago has allowed for near-universal health insurance coverage for older adults, but nonetheless many older adults still struggle with healthcare 14 and long-term care costs. The average cost of assisted living in Massachusetts is $7,120 per month and is not covered by Medicare. Medicare is able to cover time-limited stays in Skilled Nursing Facilities (100 days). Medicare Savings Programs and Senior Care Options (SCO) plans help subsidize these costs for older adults with limited income. These high costs often result in many older adults on Medicare falling into medical debt and subsequently relying on receiving Medicaid benefits to receive state-subsidized medical care. The high cost of living has resulted in higher costs for home-health care. Findings from the 2023 AARP’s Long-Term Services and Supports scorecard show Massachusetts ranks 4th amongst states for LTSS performance, yet, Massachusetts ranks near the bottom of states for home-care costs (29th) and nursing home costs (44th).16
In FY 24, the Legislature amended the budget to fund a $500,000 independent actuarial study conducted by Milliman Inc. on the feasibility of a statewide benefits program for longterm supports and services (LTSS). Covered services in the study were home care, assisted living, and facility care. The study modeled three (3) public LTSS insurance programs and explored alternative plans, including covered services, eligibility criteria, and vesting requirements. The 2025 report estimated that a payroll tax between 0.68% and 2.74% would cover 5- 45% of total LTSS expenditures. Pending legislation (S.2645/H.4559) would build upon this study by establishing a special commission to analyze the Milliman actuarial study and provide a recommendation on establishing a statewide LTSS benefit program in Massachusetts. This proposed new special commission examining the potential for the program would include policymakers, industry experts, and advocates, and be charged to submit their recommendation within 2 years of passage.
Since the majority of the public is unprepared for the high costs of LTSS, the commission offers a unique opportunity for key stakeholders to collaborate and find a solution to the growing need for LTSS financing.
The ability to meet these growing needs comes at a time when our healthcare system faces historic workforce shortages—the Center for Health Information and Analysis (CHIA) reported vacancy rates amongst roles for direct care workers (20%), licensed practical nurses (19%) and registered nurses (19%) in skilled nursing facilities.17 This is slightly higher for the home healthcare workforce, with vacancy rates ranging from 17-23%, resulting in more than half home of health care providers reporting they’ve had to reject new clients.18Continuation of these trends will pose significant challenges for ensuring equitable access to care for our growing population of older adults.