Western Massachusetts prides itself on community and mutual support, from neighbors to families. But we are reaching our limits. The long-term care system meant to help us as we age is failing, and Western countries are set to face the worst of the coming crisis. A new Dignity Alliance Massachusetts report, “Facing a Predictable Crisis,” warns of trouble. The state is heading into a demographic storm without a plan. Over the next decade, the number of residents aged 85 and older is expected to increase by 40 percent. These numbers are not just statistics; they represent our mothers, fathers, and partners. Yet Massachusetts is stuck — denial, delay, no clear, data-driven planning. We are not ready.
The issue isn’t just a shortage of nursing home beds. It’s a failure of imagination and leadership. Most older adults and people with disabilities want to stay in their homes and communities. Still, public funds are poured into outdated institutional models instead. We should redirect those dollars. Home and community-based services can help preserve independence and dignity.
This gap is especially clear in western Massachusetts. From the Berkshires to Franklin County, rural towns are facing challenges, including a shortage of care workers, rising housing costs, and a mix of underfunded programs. When a local nursing home closes, as several have already, residents are often relocated far from their families. For low-income individuals who rely on MassHealth, options are even more limited. The message is clear: the system is not designed for us, and it is not built to last.
We’ve known this was coming. Advocates and caregivers have sounded the alarm for years. What’s missing is action — coordinated, transparent, and accountable. The Dignity Alliance report outlines a plan: to initiate a thorough public process to determine the actual need for long-term services and supports over the next five to ten years. After that, we need to reinvest in home care, adult day programs, accessible transportation, and workforce supports so people can age in place with dignity.
We also need to improve the facilities that are still in place. Large, shared-room nursing homes are a thing of the past. We can create smaller, homelike settings to protect privacy and focus on each person. However, this vision hinges also on addressing the workforce crisis. Direct care workers, who are often women and immigrants, are typically underpaid. They deserve fair wages, benefits, and advancement. Dignity for those receiving care means dignity for those providing it too.
Meanwhile, families in western Massachusetts are already devising their own solutions, such as caregiving across generations, adjusting work schedules, and piecing together community support. We are stepping in where government planning has fallen short. But individual efforts cannot replace public responsibility.
There are glimmers of progress. The Marsters v. Healey settlement — a federal case requiring the state to help thousands of nursing home residents return to community living — offers a path forward. Similarly, the creation of the new Office of Aging and Independence, if restored to full cabinet-level authority and empowered to coordinate across agencies, would also be beneficial. However, these efforts must be accelerated and fully funded, rather than being bogged down in bureaucracy. Western Massachusetts has consistently demonstrated what is possible when communities collaborate, but only if the state acknowledges the magnitude of the crisis and begins planning for it now.
Every family in this region will feel the impact of the 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. This is not just a financial choice, but a moral one. Now is the time for our elected officials, local leaders, and community members to demand urgent action: support investments in home and community-based services, advocate for fair wages for care workers, and hold state leaders accountable to implement the Dignity Alliance plan. Our dignity and future depend on what we do next.
James A. Lomastro of Conway is a member of the Coordinating Committee of Dignity Alliance, an international surveyor of aging and rehabilitation programs and member of the Board of Registration of Nursing Home Administrators.
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