A State Policymaker Discusses Lessons Learned from COVID

In a recent podcast, I had the opportunity to speak with Marylou Sudders, the Secretary of Health and Human Services for Massachusetts throughout the COVID-19 pandemic. But COVID was only part of what she faced during her eight-year term.

Sudders pointed out that Massachusetts has an older population than most states and by 2050 almost a third of people will be 65+. As a result, she and Governor Charlie Baker created a Council to Address Aging in Massachusetts to get the entire cabinet to think about how to become an age-friendly state. The Commission’s approach was to urge every community to plan locally on how to help their residents age in place.

Lack of Continuum of Housing Options

One of the state’s biggest challenges is housing. Not only is there a shortage in general, but there are gaps in the continuum of housing for older residents to be able to move from their homes but stay in their communities. Two initiatives during Governor Baker’s tenure aimed to help address this issue: 1) the MBTA Communities Law that requires towns in eastern Massachusetts that are part of the regional mass transit system to free up zoning for multifamily housing; and 2) the requirement that all towns allow the creation of accessory dwelling units (ADUs), which can be used to accommodate an aging parent moving in with their adult children. They also changed the building code to make new housing more accessible to older residents and others with disabilities.

A recent Boston Globe article describes how the lack of alternative housing contributes to baby boomers staying in the houses where they raised their families, creating a shortage of housing for younger families.

Sudders also explained how assisted living in Massachusetts is a very different model from many other states. Massachusetts has always seen assisted living as a housing option and distinguished it from nursing homes, which provide medical care. Sudders pointed out that “you can’t even have a hospital bed in assisted living here.”

“We should have a continuum and not so much these bright lines,” she said. “If you are in assisted living and your care needs increase, you should be able to receive that care where you are until and unless you ultimately do need a nursing home level of care.”

Learning from the Pandemic

Sudders led the state’s COVID-19 Command Center. It’s now been five years since the first “index” case in Massachusetts – the first case where you could not trace the infection indicating community spread. It hit institutional care especially and tragically hard.

She cited several early developments that impeded the state’s response:

• the World Health Organization said COVID was not an airborne virus;
• it took a while to learn that you could be an asymptomatic carrier;
• testing capacity and facemasks were very limited;
• it wasn’t immediately clear that COVID disproportionately affected older adults;
• the density of nursing homes facilitated the spread of the infection; and
• the state realized that they lacked the testing capacity to identify who was infected in nursing homes, impeding efforts to segregate those with the virus.

Sudders also listed some of the lessons learned from the pandemic and steps the state has taken to better prepare for the next one:

• First, we need to reduce density as much as possible in nursing homes, prisons, and group homes.
• Second, our supply chain vulnerability was exposed. A number of manufacturers stepped up at the time to create gowns, reagents, and facemasks; and they have the ability to step that back up quickly if necessary in the future.
• Third, emergency preparedness plans can’t just sit on a shelf. They need to be regularly reviewed and updated. Now our public health warehouse has been completely automated.

Improving Nursing Homes

The state also increased financial compensation to nursing homes with strings attached, including: no more four-person rooms, increased nursing-resident ratio, increased oversight including closing admissions if they find problems, and revising the role of inspectors. It’s now easier to place nursing homes in receivership, but it still requires going to court.

These changes have resulted in fewer nursing home beds in the state, but Sudders said that Massachusetts is making it easier to age in the community, so her hope is that a smaller share of seniors will require nursing home care going forward and that those who do will not need it for as long.

“I’d like to think that [we could] provide health care for people in the community so that people can maintain their independence for as long as possible and not need an institutional level of care perhaps ever or not until the very end part of life. It’s about building capacity and choice and not being dependent on one model of care.”

What You Can Do

Sudders recommended that all seniors actively plan their next housing chapter and make sure their homes are adaptable if they experience mobility issues. Don’t wait for a crisis.

“And have the conversation with your loved ones. I didn’t just say family, there’s the family you choose. It’s not morbid; it’s about having control over your life. It’s life-affirming.”

For more from Harry Margolis, check out his Risking Old Age in America blog and podcast.  He also answers consumer estate planning questions at AskHarry.info.  To stay current on the Squared Away blog, join our free email list.  You’ll receive just one email each week.