State headed for a perfect storm on elder care

Paul J. Lanzikos

This month, as the United Nations marks the International Day of Older Persons, we on the North Shore have good reason to reflect — and to act. Our region takes pride in the quality of life in our communities and its health care services. Beverly, Addison Gilbert, and Salem Hospitals offer high quality acute care. But when it comes to long-term care, we are reaching a breaking point.

A new report from Dignity Alliance Massachusetts, “Massachusetts at a Crossroads: Facing a Predictable Crisis,” warns that the Commonwealth is heading into a demographic storm without an actionable plan. Over the next decade, the number of residents aged 85 and older will increase by 40%. These aren’t just numbers, they’re our parents, grandparents, partners, and neighbors. Yet, Massachusetts remains stuck in denial and delay. We are not ready!

This isn’t just about a shortage of nursing home beds properly staffed with qualified workers. It’s a failure of imagination and leadership. Most older adults and people with disabilities want to remain in their homes and communities. More than 90% say so. Yet public dollars continue to flow into outdated institutional models that fail to offer privacy and ineffective protection from infectious diseases. It’s time to redirect those funds toward home- and community-based services that preserve independence and dignity.

The gaps are especially stark outside Greater Boston. On the North Shore, communities face rising housing costs, underfunded programs and a shortage of care workers. When a nursing home closes, residents are often relocated far from family. For low-income individuals relying on Mass-Health, choices are even more limited. The message is clear: The current system wasn’t built for today’s older adults, and care is declining.

We’ve known this was coming. Advocates and caregivers have sounded the alarm for years. What’s missing is coordinated, transparent, accountable action. The Dignity Alliance report offers a roadmap: Launch a public process to assess longterm care needs over the next five to 10 years. Reinvest in home care, adult day programs, accessible transportation and workforce support — so people can age in place with dignity.

We must also improve the facilities that remain. Large, shared-room nursing homes are relics. We can build smaller, homelike settings that protect privacy and honor each person. But this vision depends on solving the workforce crisis. Direct care workers — often women and immigrants — are underpaid and overworked. They deserve fair wages, benefits and career paths. Dignity for those receiving care must include dignity for those providing it.

There are glimmers of hope. The Marsters v. Healey settlement requires the state to help thousands of nursing home residents return to community living. The new Office of Aging and Independence, if restored to full Cabinet-level authority, could coordinate across agencies. But these efforts must be accelerated and fully funded — not buried in bureaucracy.

In May, Gov. Maura Healey issued Executive Order No. 642, directing every Cabinet department to focus on “age-friendly” programs. Reports are due next month. But unless those plans include real funding and actionable steps, their words will ring hollow to those who urgently need affordable housing, transportation, health care and the staff to deliver it.

Every family in our region will feel the impact of decisions made — or not made — in the next two years. We can prepare with care and planning, or we can face a crisis by ignoring the problem as the aging population continues to grow. This is not just a financial choice. It’s a moral one.

Now is the time for elected officials, local leaders and community members to demand urgent action: invest in home- and community-based services, support fair wages for care workers, and hold state leaders accountable to implement the Dignity Alliance plan. Our dignity — and our future — depend on it.

Paul J. Lanzikos, of Beverly, is the coordinator for Dignity Alliance Massachusetts and previously served as executive director of North Shore Elder Services and is a former Mass. Secretary of Elder Affairs.