By A deadly fire at a Massachusetts assisted living home on Sunday highlights the need for federal legislation strengthening oversight of such facilities, according to long-term care resident advocates.
There are federal regulations for skilled nursing facilities, but states set the standards for safety, staffing and quality at assisted living facilities. Advocates say these guidelines are too lax and poorly enforced.
“In the absence of having any type of federal quality safety staffing requirements…these facilities are really operating in a kind of a no man’s land while they’re caring for some of our most vulnerable citizens,” said Richard Mollot, executive director of the Long Term Care Community Coalition.
Sunday’s fire at the Gabriel House in Fall River, Mass., killed nine people and seriously injured 30 more. The cause of the fire, which apparently started on the third floor, remains under investigation. Officials have ruled out foul play and suspect an electrical failure was to blame.
Local news outlets reported the facility was up to date on its fire and safety assessments, including having its exit routes approved. It was reportedly cited in 2023 for failing to immediately report more than two dozen health and safety incidents.
Gabriel House and its owners did not respond to requests for comment on this article.
Growing population in residential care
More than 1 million adults lived in residential care communities like nursing homes or assisted living facilities in the United States in 2022, according to the most recent data from the Centers for Disease Control and Prevention (CDC).
As baby boomers age, more Americans will likely need to live in residential care communities, according to the CDC.
Assisted living facilities are typically a community of individual apartments or rooms for people who need daily care, but not so much that they need to be supervised 24 hours per day by a health care provider like in a nursing home.
“There needs to be more regulation standards when it comes to overseeing assisted living facilities on a federal level,” said Ed Dudensing, an elder abuse attorney and advocate for nursing home and assisted living residents in Sacramento, Calif.
Many families are attracted to the idea of having a loved one live in an assisted living facility over a nursing home given their “home-like environment,” according to Dudensing.
But many assisted living facilities are taking on higher-need patients with mobility or cognitive conditions like dementia or Alzheimer’s disease without necessarily being properly equipped to take care of them, advocates say.
“If you go into a typical assisted living residence today, it’s often hard to distinguish that between a nursing home population,” said Paul Lanzikos, co-founder of long-term care advocacy group Dignity Alliance Massachusetts.
This was the case at Gabriel House Assisted Living Facility.
“Most of them were people who needed help … these are people who are not able to move themselves,” Massachusetts Gov. Maura Healey (D) said in a press conference Monday.
“Many were in wheelchairs, many were immobile, many had oxygen tanks.”
Firefighters, police, and other first responders found some residents hanging from windows and shouting for help when they arrived on the scene late Sunday night, according to Fall River Fire Chief Jeffrey Bacon.
At least 12 of the facility’s nearly 70 residents had to be carried out of the building by first responders. And numerous air conditioning units in the facilities’ windows made it difficult for firefighters to rescue people, according to Bacon.
Advocates saddened by not surprised
Lanzikos told The Hill that while he and his fellow long-term care resident advocates were saddened by the news of the fire, they were not shocked that such a tragedy happened.
He and his colleagues have been calling for more rigorous oversight of assisted living facilities, particularly at the state level, for years. And while there have been modest improvements, he says they are not enough.
Healey signed a bill into law in 2024 seeking to strengthen oversight of assisted living facilities in the state. Under the law, fines for violations of the state’s assisted living facility certification process increased from $50 to $500 a day. The law now requires assisted living residence operators to disclose the name and address of each “officer, director, trustee and limited partner or shareholder” with 5 percent or more interest in the facility.
Previously, operators only had to disclose that information on partners or shareholders had a 25 percent interest in the assisted living facility.
Federal-level changes have been non-existent, advocates say, because of pushback from the nursing home and assisted living facility industry.
A spokesperson from the American Health Care Association/National Center for Assisted Living, a long-term care home industry group, told The Hill that states are better positioned to regulate nursing homes for a variety of reasons.
They are “robust, more dynamic and adaptable” than federal rules, while encouraging “more localized care models” that “can still uphold safety and security while maximizing independence and autonomy,” the spokesperson said.
Democrats in Congress push oversight questions
Democratic Sens. Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), and Ron Wyden (Ore.) sent a letter to Comptroller General Gene Dodaro in March requesting an investigation into whether assisted living facilities that receive Medicaid need more federal oversight.
The letter references multiple investigations that show that assisted living facility residents are vulnerable to abuse and neglect. One 2018 report from the Government Accountability Office (GAO) found that half of the 48 states that provide Medicaid-assisted living services could not tell the agency how many “critical incidents” occurred at these facilities.
Three of those states, for example, did not monitor unexpected or unexplained deaths. A spokesperson for the GAO told The Hill that the team assigned to investigating the Senators’ request will begin working on it “soon” and could not provide an estimate on when the investigation will be complete.
Gillibrand called the Gabriel House fire a “terrible tragedy” in a statement, adding that she is working with fellow lawmakers in Congress to “determine how we can best guarantee safety for the over 1 million Americans who call assisted living facilities home.”
Wyden warned that healthcare cuts in President Trump’s sprawling tax and spending package will increase the risk of “preventable tragedies” like what occurred in Fall River.
“There’s a better way that includes adequate staffing and safety planning in facilities like these,” he said in a statement.