On April 6, the Massachusetts Attorney General proposed new rules that would force assisted living facilities to give families a standardized disclosure form before move-in. Costs broken out clearly. What care is included versus what costs extra. When the price can go up. Tenant-like protections so a parent can't be quietly moved or discharged. The state's own Assisted Living Residences Commission flat-out admitted that the existing paperwork is too inconsistent for families to compare two facilities side by side.
That tracks with everything I have seen on the ground.
I read assisted living contracts during my house flipping years. The common thread, in every single one, was that the headline monthly rate was almost never what the family ended up paying once the first invoice arrived.
Why the contract is so hard to read
A typical assisted living contract is 60 to 80 pages. The headline number on page one is the base rent. That covers the room and the meals. After that, almost everything is priced separately.
Care levels are usually broken into tiers. Level one is light support: medication reminders, an occasional check-in, help with a few activities of daily living. Level four is heavy care: full medication management, two-person transfers, incontinence care, dementia oversight. The difference between level one and level four can be $1,500 to $4,000 per month at the same facility, in the same room.
Memory care, if needed, is usually a separate wing with a separate rate. So is transportation. So is laundry above a certain frequency. Some facilities even price the bath schedule. Two assisted baths per week is in the base. Five baths per week is an upcharge.
None of this is fraud. It is just unbundled pricing. But unbundled pricing only protects families when families know to ask for the bundle ahead of time. And families almost never do.
What Massachusetts is trying to fix
The MA proposal would do three things, per WBUR's coverage of the April 6 release.
It would require a standardized service agreement that breaks costs into discrete categories so families can actually compare facility A to facility B. Right now the cost summary in one facility's paperwork bears no resemblance to the format of another's, even within the same state.
It would specify when prices can change and what notice is required, eliminating the practice of raising rates on short notice for residents who have already moved in and are difficult to relocate.
It would extend tenant-like protections to residents, addressing one of the more uncomfortable gaps in senior housing law: an assisted living resident has fewer eviction protections than a typical apartment renter, even though they pay significantly more and are physically more vulnerable.
The Massachusetts Assisted Living Residences Commission's findings supporting the rule are the part worth circling. The state's own regulators went on the record saying the existing paperwork was confusing enough that comparison shopping was effectively impossible. That is the system families have been operating in for years.
What other states are doing
Massachusetts is the most aggressive state on this in 2026, but it is not alone. California, Iowa, Hawaii, and North Carolina have all updated their assisted living regulatory frameworks in the past 12 months. The trend is toward more disclosure, not less. Even so, most states are still well behind where Massachusetts is now headed. Until federal floor standards exist, the patchwork is the patchwork.
The questions every family should ask before signing
Until your state catches up to where Massachusetts is going, the protection has to come from the family side of the table.
Ask for an itemized monthly cost broken into three buckets: base rent, care fees, and add-ons. Ask the staff member to write the bucket totals down for the specific level of care your parent will need today, not the marketing-brochure level.
Ask when prices can change, in writing. Ask what notice the facility is required to give. Ask whether rate increases apply to existing residents or only new ones.
Ask under what conditions a resident can be moved or discharged. Ask whether the facility uses any kind of "safe-discharge" policy that allows them to remove a resident whose care needs increase beyond a certain level. Ask what happens if your parent's needs change in six months.
Ask what happens if your parent runs out of private-pay money. Some facilities accept Medicaid waivers. Most do not. Some have a small number of Medicaid beds that residents transition into after exhausting private funds. Most do not. The answer determines whether the facility can house your parent for the rest of their life or only until the savings account hits zero.
Ask all of these questions before any deposit changes hands. If a facility will not put the answers in writing, that is the answer.
What the Senior Transition Blueprint Core does with this
The Senior Transition Blueprint Core has the full 23-question vetting list for any assisted living facility, plus a side-by-side cost-decoder that translates each facility's pricing into apples-to-apples numbers across base rent, care tiers, and add-on services. It includes the contract red-flag checklist (move-out clauses, rate-change notice periods, level-of-care reassessment language) and a script for the financial conversation with the admissions director.
It is $47. It is 19 modules and 60-plus tools. The contract literacy module is module twelve.
The reason it exists is the reason Massachusetts is having this conversation. Most families do not know what they don't know going into the most expensive financial decision of their parent's later life. Until federal or state regulators close the contract-literacy gap, the family has to close it themselves.
Want a step-by-step guide? The free Simple Blueprint walks through every stage of a senior transition: rigginsstrategicsolutions.com/freeguide
Ready for the full system? Senior Transition Blueprint Core, 19 modules and 60+ tools: rigginsstrategicsolutions.com/the-blueprint
Need a personalized plan? Blueprint Premium adds a 60-min call and 90 days of email support: rigginsstrategicsolutions.com/blueprint-premium
Coordinate your family in one place. SeniorSafe app (web, iPhone, Android): app.seniorsafeapp.com
Talk it through. Book a free 20-min call with Ryan: rigginsstrategicsolutions.com/work-with-ryan
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Ryan Riggins is the founder of Riggins Strategic Solutions, a consumer protection company for families navigating senior transitions. He spent 8 years in construction project management and house flipping before switching sides. Two books on Amazon. Free resources at rigginsstrategicsolutions.com.
Ryan Riggins • NC Real Estate License #361546 • eXp Realty
