Massachusetts has an elder care crisis – and it’s about to get a lot worse

Reprinted with Permission

by Harry S. Margolis, CommonWealth Beacon
February 28, 2026

WHAT TOTALLY PREDICTABLE crisis will start in just five years? The doubling of the need for elder care. And Massachusetts is not prepared for it.

A dangerous demographic cliff lies just ahead: There’s been a lot of chatter about the vast demographic bulge that we call “baby boomers” passing 65; but the real news is that the oldest baby boomers will begin celebrating their 85th birthdays in 2031.

The Census Bureau projects that, nationally, the number of people 85 and over will double from 2030 to 2050. Here in Massachusetts, the University of Massachusetts Donahue Institute projects that our 85-plus population will expand by about two-thirds – a smaller increase because we’re already one of the older states.

Eighty-five is the magic age when older adults face dramatic increases in their chances of physical and cognitive disability.

This means we will need a lot more elder care. By 2034, according to the Bureau of Labor Statistics, we will need 740,000 more home health and personal care aides nationally than are working today. And that’s when the need will have just started growing. 

Finding the appropriate care is already extremely difficult, whether that's patching together a schedule of family members helping out, hiring home health aides, or finding an appropriate assisted living or nursing home placement. Many families feel particularly desperate when an elder who was unexpectedly hospitalized is about to be discharged and they’re faced with the Hobson’s choice of either taking mom home and caring for her themselves or placing her somewhere that feels inadequate. 

To be sure, Massachusetts is working to improve care for our older citizens. Partly in response to nursing home deaths during the COVID-19 epidemic, Massachusetts passed a 2024 law that will improve nursing home care – if it's enforced. Unfortunately, while Massachusetts does evaluate nursing homes, facilities are rarely penalized for providing inadequate care.

Further, the Massachusetts Executive Office of Health and Human Services commissioned a 2025 study of possible funding mechanisms for long-term care services, partly modeled on one offered in the state of Washington. Known as the WA Cares Fund, it provides all state residents with $36,500 to spend on care needs in defined circumstances.

What’s more, the Healey administration has released a ReiMAgine Aging 2030 plan for older residents. But it only looks ahead five years, stopping just when the need for elder care will begin growing.

The Massachusetts House recently passed bills championed by Rep. Thomas Stanley to begin licensing for home health agencies and establish a caregiver commission to focus on supporting family caregivers. The commission would be one of many that have been established to improve nursing homes, assisted living facilities, senior housing, and rest homes.

All these have good aims. But they work piecemeal in an effort to improve what’s happening inside each individual institution. The real problems lie in the lack of coordination. 

Most elders who need care start in one system – say, getting looked in on by home health aides – but need to move to another – say, assisted living or full nursing home care. Getting from here to there can be fractiously difficult, consuming all of a family member’s time, energy, and resources.

And that’s when there are family members who can step in. Prospects are much worse for the increasing number of “solo” agers with no family member who can drop everything to oversee care or manage the elder’s transition from one system to another.

One organization in the state recognizes this. Dignity Alliance Massachusetts, a coalition of disability and senior advocacy organizations formed after the high number of pandemic deaths in nursing homes, has called for the state to start a planning process that includes every institution with a stake in making this work – and with a grasp of what is working and what is not. 

Former state senator Richard Moore, who is part of Dignity Alliance’s leadership team, told me that they want to push the state to action, to figure out the needs of seniors and people with disabilities, the size of the challenge, and the depth of the problem -- and then to come up with a plan to address it. He emphasized that we’re heading into a widening crisis without a plan – and that we need one now. 

That plan must include the various state agencies working together with local commissions on aging, hospital and nursing home administrators, home health nonprofits and for-profits, and groups representing elders and families. All these stakeholders need to coordinate efforts so that things work smoothly – and so that they have what they need to support boomers as they age. 

New York and California have both developed such a plan. New York’s Master Plan for Aging seeks to integrate local organizations that support families and caregivers with institutional providers so that there’s a smoother continuum of care. California’s version of a Master Plan for Aging includes admirable measures for accountability, such as annual reports on progress and a dynamic dashboard showing the status of seniors both statewide and by county.

US Sens. Kirsten Gillibrand of New York, Angela Alsobrooks of Maryland, and Andy Kim of New Jersey have introduced legislation to create a nationwide grant program to support states’ efforts to create their own master plans for aging.

Massachusetts can’t wait for Congress. With the oldest baby boomers turning 85 in five years, now is the time to create our own plan that recognizes our unique strengths and challenges.

Harry S. Margolis, an elder law attorney in Massachusetts, writes the Substack Risking Old Age in America. 

This article first appeared on CommonWealth Beacon and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

PARSELY = { autotrack: false, onload: function() { PARSELY.beacon.trackPageView({ url: "https://commonwealthbeacon.org/government/state-government/massachusett…", urlref: window.location.href }); } }