Gerontology Commons^™

From Structure To Experiences: How Facility Capacity And Staffing Shape The Adoption And Impact Of Lgbt-Affirming Policies In Long-Term Care, Andrew Alberth

Graduate Doctoral Dissertations

Long-term care (LTC) settings – including nursing homes (NHs) and assisted living facilities (ALFs) – provide necessary care for individuals with extreme health and functioning limitations. Sexual and gender minority (LGBT) older adults report challenges receiving effective, person-centered care LTC. Some LGBT older adults may hide their sexual orientation and gender identity when entering LTC settings or delay seeking needed LTC fearing discrimination from staff and other residents. Furthermore, staff in LTC settings indicate little awareness of LGBT-residents and possess inadequate LGBT-cultural competency necessary for providing person-centered care. Therefore, LGBT-residents LTC experiences remain underexplored in the broader research. Adopting LGBT-affirming …

The Effect Of State Policy On Individuals With Mental Illness In Nursing Homes: A Multilevel Analysis, Adrita Barooah

Graduate Doctoral Dissertations

ABSTRACT

THE EFFECT OF STATE POLICY ON INDIVIDUALS WITH MENTAL ILLNESS IN NURSING HOMES: A MULTILEVEL ANALYSIS

August 2026

Adrita Barooah, B.Sc., University of Delhi, India

M.S., University of Massachusetts Boston

Ph.D., University of Massachusetts Boston

Directed by Professor Pamela Nadash

The proportion of individuals living with a mental illness in U.S. nursing homes has grown substantially over the past few decades (Fashaw et al., 2020), raising serious concerns about care quality, resource adequacy, and costs to both nursing homes and government payers. The lack of adequate resources and knowledge has resulted in sub-par mental health care (O'Connor et al., …

How Far Does Social Security Go? Comparing Benefits To Elder Index 2025: Infographic, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

Social Security remains the foundation of retirement income, but for millions of older adults it does not fully cover the cost of basic necessities such as housing, health care, food, and transportation.

Economic Security & Older Adults In Massachusetts: Infographic, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

The Elder Index measures the income older adults need to meet their daily living costs while staying in their own homes. This fact sheet presents overview data of economic security of Older Adults in Massachusetts based on the 2025 Elder Index data.

Economic Security & Older Adults In The United States: Infographic, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

The Elder Index measures the income older adults need to meet their daily living costs while staying in their own homes. This fact sheet presents overview data of economic security of Older Adults in the United States based on the 2025 Elder Index data.

The Elder Economic Security Standard™ Index: Methodology Overview, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston, Jan Mutchler, Nidya Velasco Roldan, Michelle Ward, Ceara Somerville, Caitlin E. Coyle

Center for Social and Demographic Research on Aging Publications

The Elder Index illustrates how living costs vary geographically (specifically, by county, metropolitan area, and state), and based on the characteristics of households. Costs are calculated based on household size (one person age 65 or older, two persons age 65 or older), housing tenure (owner with no mortgage, renter, owner with a mortgage), and health status (excellent, good, poor). The expenses included in the Elder Index cover basic needs of older households, including shelter, medical care, food, and transportation; the costs reflect average market costs and do not take into account any needs-based subsidies. The Elder Index helps answer important …

2025 Elder Indextm For Boston: Fact Sheet, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

The Elder Index^_TM measures of the cost of living independently for older adults aged 65 or older. The Elder Index allows us to identify older people with incomes “in the gap” between the Federal Poverty Guideline (FPL) and what it takes to live with security. Older adults living “in the gap” have incomes too high to qualify for many means-tested public benefits programs, yet too low to achieve intermediate- or long-term economic stability. This fact sheet presents 2025 Elder Index for older adults living in Boston, Massachusetts.

Living Between The Lines: Economic Insecurity And Older Americans: Insecurity In The Massachusetts, 2025, Caitlin E. Coyle, Michelle Ward, Nidya Velasco Roldan, Ceara Somerville, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

New estimates from the 2025 Elder Index^TM demonstrate that the cost of living in Massachusetts has increased substantially in recent years for older adults, especially for renters. The Elder Index measures the necessary costs faced by households made up of one or two older adults, calculated county by county for the entire United States. Estimated costs are higher in Massachusetts than in any other state in the nation. Within the Commonwealth, the Elder Index is lowest in Western Massachusetts, and highest in Metro Boston, Martha’s Vineyard and Nantucket, with differences in the Elder Index across locations accounted for largely …

Community-Based Food Program Limits In Reducing Older Adult Food Insecurity, Madonna Harrington Meyer, Colleen M. Heflin

Population Health Research Brief Series

Older adults who are grappling with food insecurity may enhance their food supply through community-based programs that provide free and subsidized food. This complicated system, categorized by group meal programs, home-delivered meals, and food provided to be eaten off-site, is complex, expensive, and may be difficult for older adults to use. Based on the book, Food for Thought: Understanding Older Adults Food Insecurity, this brief describes three key limits of community-based food programs for older adults. First, the quantity and quality of community-based food programs vary markedly by where one lives. Second, the food may be of poor nutritional …

The Limits Of Snap In Addressing Older Adult Food Insecurity, Colleen M. Heflin, Madonna Harrington Meyer

Population Health Research Brief Series

The Supplemental Nutrition Assistance Program (SNAP) is designed to address the economic roots of food insecurity. However, SNAP participation rates among older adults substantially lag behind those of other age groups. Based on the book, Food for Thought: Understanding Older Adults Food Insecurity, this brief describes how SNAP is not well designed for older adults in three respects: (1) the high levels of administrative burden associated with eligibility, certification, and benefit-determination processes, (2) the low value of SNAP benefits compared with the high costs associated with redeeming them, and (3) the high levels of state variation in SNAP policies …

Policy Recommendations To Reduce Old Age Food Insecurity In The United States, Colleen M. Heflin, Madonna Harrington Meyer

Center for Policy Research

In 2023, 7.4 million adults ages 60 and over in the United States were food insecure. As the number of older people at risk of food insecurity in the U.S. continues to rise, effective policy responses are critical. The current policy responses to old age food insecurity are complex, costly, and not nearly effective enough.

Based on the book, Food for Thought: Understanding Older Adults Food Insecurity, this brief summarizes five policy recommendations to improve food insecurity among U.S. older adults. The authors recommend measuring food security in multidimensional ways, treating food insecurity as a health issue, adopting SNAP …

Assisted Living, Residential Care, And Memory Care Staffing Level Dynamics: Oregon, 2017–2023, Sarah Dys, Ozcan Tunalilar

Institute on Aging Publications

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social …

The Hidden Struggle: Challenges Older Women Face In Nevada, Annie Vong

Student Research

In 2020, almost one in five Nevadans was over the age of 65.[1] However, within this age group, women outnumber men due to longer life expectancies[2] and migration patterns. Women over 65 years of age make up an estimated 18.1% of the female population in Nevada.[3] Of the male population in Nevada, 15.1% are over 65 years of age.[4] Older women are less likely to be married, are less likely to have completed a bachelor’s degree, are more likely to drop out of the labor force, and are more likely to be living in poverty in …

Regulating The Care Boom: Labor Standards Enforcement And Paid In-Home Care Work, Isaac Jabola-Carolus

Dissertations, Theses, and Capstone Projects

In the United States, population aging has driven explosive growth in care-sector occupations, especially among low-wage home care aides who provide long-term assistance to older adults. These aides, predominantly women and disproportionately people of color, now represent one of the country’s largest and fastest-growing occupational groups. In recent decades, economic inequality and meager social policies have also spurred demand for nannies, housecleaners, and other domestic workers—occupations heavily reliant on immigrant women, many undocumented. While scholarly and public discourse has addressed labor shortages and job quality in such occupations, a related problem is the widespread violation of labor standards, including minimum …

Perspectives Of Hispanic/Latina Women Ages 60 And Over On The Impact Of Single Motherhood And Their Long-Term Financial Well-Being, Tess Juno Anselm

Graduate Doctoral Dissertations

Unmarried women over the age of 60 continue to experience disproportionate rates of adult poverty in the United States, while families headed by single mothers experience the highest poverty rates. This study explores the long-term impact of single motherhood on financial wellness through the perspective of Hispanic/Latina women ages 60 and over who have experienced single motherhood in Massachusetts. A transdisciplinary study, it utilizes intersectionality as a theoretical framework, employs feminist standpoint informed inquiry methods to document lived experiences through in-depth interviews, and engages diffraction as a mode of praxis as it intra-acts with narratives and explores the systems and …

Older Adults On Snap Experience Gaps In Benefits, Colleen Heflin, Leslie Hodges, Irma A. Arteaga, Chinedum O. Ojinnaka, Gabriella Alphonso

Population Health Research Brief Series

The Supplemental Nutrition Assistance Program (SNAP) is the largest food and nutrition assistance program in the United States. Burdens associated with SNAP recertification often lead to administrative churn, when a household experiences a gap in SNAP benefit receipt. Older adults are at risk of experiencing benefit gaps, which may negatively impact their health and nutrition. This brief summarizes results of a recent study that examined administrative churn among Missouri SNAP participants aged 60 years and older. The authors call for program changes that reduce the frequency and duration of churn among older adults.

Adult Day Services In Maine: Benefits, Challenges, And Opportunities, Elizabeth Gattine Jd, Eileen Griffin Jd, Kimberly I. Snow Mhsa, Ba

Disability & Aging

In Maine and nationally, adult day services tend to be underfunded and underutilized compared to other types of long term services and supports (LTSS). In part, investment in adult day services is hampered by a lack of standardized data collection and limited research on issues of accessibility, cost-effectiveness, and the impact of adult day services on the broader health system. Lack of uniformity in state regulatory frameworks for licensing, program design, service delivery, and other administrative requirements further complicates cross-state comparisons. Considering these limitations, a key goal of this report is to provide a more detailed and comprehensive understanding of …

Economic Security Of Older Women In Maine, Kimberly I. Snow Mhsa, Elizabeth Gattine Jd, Sammy-Ellie Mackinnon Msw

Disability & Aging

The Economic Security of Older Women in Maine: Data Report provides a snapshot of how women compare to men on measures such as wages and income, caregiving status, living arrangements, and rates of disability—factors that can impact Maine women's ability to meet their needs with the resources they have. The report, compiled by staff at the University of Southern Maine's Cutler Institute, informs an initiative led by the Maine Women's Lobby Education Fund and the Maine Council on Aging to identify gaps and pathways to support the health and economic security of older Maine women and all Mainers, now and …

The U.S. Should Expand Access To Dental Care For Older Adults, Madonna Harrington Meyer, Sarah Reilly, Julia Finan

Population Health Research Brief Series

Older adult Medicare recipients face high out-of-pocket dental expenses due to a lack of appropriate dental care coverage. Older adults with lower socioeconomic status tend to have worse oral health, less dental insurance coverage, greater difficulties finding a dentist, and low-quality care. This brief details the experiences socioeconomically disadvantaged older adults face in obtaining appropriate and affordable dental care and calls on Congress to include preventative and restorative dental care as part of the federal funding agenda.

Late-Life Gender Disparities In Economic Security In The Context Of Geography, Race And Ethnicity, And Age: Evidence From The 2020 Elder Index, Jan Mutchler, Nidya Velasco Roldán, Yang Li

Center for Social and Demographic Research on Aging Publications

New estimates from the 2020 Elder Index illustrate the elevated risk of economic insecurity experienced by older women, especially those living alone. We compare annual household incomes to the Elder Index for adults aged 65 years or older living in one- and two-person households to calculate the percentage of older adults with annual incomes that do not support economic security. National averages suggest that 54% of older women living alone, along with 45% of older men living alone, have annual incomes below the Elder Index. In addition, 24% of older adults living in couple households have annual incomes below the …

Measuring The Impact Of Covid-19 On Older Adults In Massachusetts, Ceara Somerville, Jan Mutchler, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

The spread of COVID-19 across the United States has affected every facet of life since early 2020. According to the Centers for Disease Control and Prevention (CDC), there are currently over 4 million cases across the nation and over 146,000 deaths from the virus. Massachusetts has been one of the states hit hardest, with over 100,000 confirmed cases and more than 8,000 deaths to date. The Commonwealth currently trails only New York and New Jersey in number of deaths. While cases surge around the country, Massachusetts has seen some leveling out of positive cases since the beginning of July. Though …

The Impact Of Career Experiences On Generativity And Postretirement Choices For Intelligence Community Baby Boomers, Marianne Victoria Kramer

Antioch University Dissertations & Theses

This study focused on baby boomers and explored how a career with a mission-focus in the Intelligence Community influenced boomer generativity and subsequent choices after retirement. Baby boomers make-up the majority of the population that is retirement eligible today and have the benefit of a longer life expectancy commensurate with improvements in health care over the past century. Current retirement literature covers a range of options that redefine what retirement means today. This study employed a two-phase mixed method approach to investigate the characteristics and impacts of a mission-focused career, and to understand how such experiences impact postretirement opportunities and …

Live Peabody: An Age-Friendly Action Plan, Caitlin Coyle, Beth Rouleau

Center for Social and Demographic Research on Aging Publications

The vision of the Live Peabody Initiative is to inspire change in the City of Peabody so that residents of all ages and abilities can thrive. The success of this initiative is dependent on the involvement of a dedicated and passionate group of residents and stakeholders that will proactively spearhead this age-friendly effort. These individuals will actively collaborate with civic, business and non-profit organizations as well as state and local government officials to heighten awareness of the age-friendly movement and implementation of the action items outlines in this report—all to spur positive change for the City of Peabody. This report …

To Adopt Or Not To Adopt: Factors Impacting States’ Pursuit And Implementation Of Aca’S Home And Community-Based Programs, Lisa Kalimon Beauregard

Graduate Doctoral Dissertations

The Patient Protection and Affordable Care Act (ACA) sought to improve the United States’ long-term services and supports (LTSS) system by expanding home and community-based services (HCBS). The ACA contained several optional Medicaid HCBS opportunities for states, including the Balancing Incentive Program, the 1915(k) Community First Choice personal care benefit, and the revised 1915(i) state plan benefit. This research examined these HCBS provisions to explain what factors determine whether states participate in the ACA’s new HCBS programs and, after adoption, what factors facilitate or impede implementation of these programs. To answer these questions, this study used a mixed methods research …

Developing Age-Friendly Communities: Evidence From Multiple Case Studies, Patricia A. Oh

Graduate Doctoral Dissertations

Population aging brings opportunities and challenges for local community and economic development. One policy solution that has been adopted by 325+ jurisdictions in the United States is joining the AARP Network of Age-Friendly States and Communities or the WHO Global Network of Age-Friendly States and Communities. Although the age-friendly movement is gaining momentum in the US, few studies have looked at what influences municipal decision-making about joining a network or making age-friendly changes. The purpose of this multiple case study was to explore what influences municipal decision-making about joining a formal age-friendly network and how communities mobilize the resources at …

Easthampton Council On Aging Planning Study, Caitlin Coyle, Jan Mutchler, Ceara Somerville

Center for Social and Demographic Research on Aging Publications

This report describes collaborative efforts undertaken by the City of Easthampton Council on Aging (ECOA) and the Center for Social and Demographic Research on Aging (CSDRA), within the Gerontology Institute at the McCormack Graduate School, University of Massachusetts Boston. Beginning in Fall 2017, these organizations partnered to conduct a study to investigate the needs, interests, preferences, and opinions of the City’s residents age 55 and older. During this assessment, multiple approaches were utilized to compile information that could be used to plan and implement current and future services. We examined data from the U.S. Census Bureau and from projections generated …

Marshfield Council On Aging Planning Study, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

This report describes collaborative efforts undertaken by the Town of Marshfield Council on Aging (COA) and the Center for Social and Demographic Research on Aging (CSDRA), within the Gerontology Institute at the McCormack Graduate School, University of Massachusetts Boston. Beginning in Fall 2017, these organizations partnered to conduct a study to investigate the needs, interests, preferences, and opinions of the Town’s residents age 50+, and also of participants at the Marshfield COA/Senior Center. During this assessment, several approaches were utilized to compile information that could be used to plan and implement current and future services. We examined data from the …

Planning For An Age-Friendly Belmont, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

Belmont is a primarily residential community of around 25,000 residents with a small commercial district. Public transit access to downtown Boston and neighboring Cambridge offers Belmont residents access to services, employment, and recreational activities outside of the town’s boundaries. With 22% of its population age 60 and older, Belmont is expecting to see an increase in the number of older residents in the coming years. Commissioned by the Belmont Council on Aging (COA), this report will serve to help the COA and Town to better understand Belmont’s current assets, potentials, and challenges and to plan for changing community needs.

Livable Dedham: An Age-Friendly Action Plan, Livable Dedham Steering Committee, Center For Social And Demographic Research On Aging, University Of Massachusetts Boston

Center for Social and Demographic Research on Aging Publications

The Town of Dedham was first settled in 1635 and became the county seat of Norfolk County in 1793. Dedham is situated southwest of Boston and the Town shares a border with Needham, Westwood, and Canton. Dedham encompasses over 10 square miles and has a population of over 25,000 residents, about one-quarter of which are age 60 and older1 (American Community Survey, 2016).

Despite Dedham’s urban location, the Town is rich with natural resources, including several state parks, hiking trails, and the Mother Brook. Although today the Mother Brook is known to residents for the variety of outdoor recreational activities …

Envisioning A Watertown For All Ages, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

Watertown for All Ages is a group of residents working to improve the livability of Watertown for residents of all ages and abilities. They work closely with the Watertown Council on Aging/Senior Center. The Watertown Council on Aging/Senior Center provides a variety of social, health, educational, recreational, advocacy, and support programs designed to help Watertown’s older adults age well in the community. Services provided to seniors living in the community range from transportation support to nutrition services and social services, along with a range of programs and activities meant to enhance well-being and quality of life. Similar to many Councils …