Deadly Massachusetts fire highlights the minimal regulations that govern assisted-living facilities

The Massachusetts assisted-living facility where a fatal fire killed nine people was caring for dozens of aging residents reliant on wheelchairs and oxygen tanks, but it lacked the safety measures and most of the staffing requirements that are commonplace in nursing homes.

As an assisted-living center, Gabriel House in Fall River, about 50 miles (80 kilometers) south of Boston, offered a type of housing for older residents that has expanded nationally in recent decades. But advocates argue that the absence of any federal regulations and spotty state rules mean the sector is largely left to police itself.

“The real issue is that assisted livings operate in an environment like the Wild West,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for improved care in nursing and assisted-living facilities. “They can pretty much do what they want with impunity, and that results in a lot of, I would say, mini-catastrophes every day, frankly.”

The fire that tore through the three-story, 100-unit structure late Sunday raised a host of questions about conditions at the dilapidated facility and put the spotlight on the growing number of assisted-living centers in the state and nationwide.

Created in the 1980s, assisted living has been marketed as an option for older adults who need some assistance but not as much help as a nursing home. Advocates argue that regulations for the facilities have not kept up as more locations have opened. They also worry that the outlook could get worse with expected Medicaid cuts and the challenge of finding enough staff during an immigration crackdown.

“Unlike nursing homes, assisted living has no federal state requirements, no requirement for staffing, no requirements for staff training, no requirements for safety protocols, no requirements for inspections,” Mollot said. “That falls to the states, and the states have overall very weak rules.”

Nursing homes, for example, are governed by federal regulations because they receive Medicare and Medicaid. There are no federal regulations for assisted-living facilities. Nursing homes must have a minimum number of staffers and trained medical professionals such as doctors and nurses, but assisted-living facilities have no such requirements. In Massachusetts, both are required to have emergency plans, but assisted-living facilities are not required to update them annually.

“The regulations are minimal,” said Liane Zeitz, an attorney who is also a member of the state Assisted Living Residences Commission, a body created to make recommendations about the sector. She has advocated for more regulations for assisted-living facilities.

The facilities were lightly regulated because initially they were regarded as residential housing, with lower levels of care and less oversight, she said. But now those facilities are caring for a population "that is much frailer, and the population is growing.”

Not only are the regulations weaker for assisted-living facilities, but advocates argue that the enforcement of the existing rules is often lax.

Paul Lanzikos, a former Massachusetts secretary of elder affairs and co-founder of the advocacy group Dignity Alliance, described a “patchwork” of regulations across the country, with different agencies involved depending on the state.

“Some of the states are much more regulated. Some are regulated as a health care entity. Others, as we do here in Massachusetts, are considered a residential housing model,” he said.

U.S. Sen. Elizabeth Warren, a Massachusetts Democrat, has been advocating for increased oversight for years, particularly after the release of reports about health and safety problems in 2018.

“These are serious problems that have been going on for years,” she said at a hearing last year. “But we hear so much less about what’s going in assisted-living facilities than we do in other facilities, like nursing homes.”

Brian Doherty, the president and CEO of the Massachusetts Assisted Living Association, said his organization supports the state ensuring that all facilities “meet the mandate to have adequate staffing at all times to meet the specific needs of its residents, including in emergency scenarios.”

“State regulations require that ALRs develop individualized service plans for each resident that are revised as a resident’s needs evolve over time following regular review,” he said in a statement.

In Massachusetts, lawmakers last year passed a package of bills aimed at improving long-term care and assisted-living facilities. A commission created by the legislation faces an Aug. 1 deadline to recommend policies to ensure facilities meet health and safety needs. But members said Tuesday that they may seek more time given the fire.

“We need to do a deep dive based on the investigation results with this facility, but also the facilities like this one,” said state Rep. Thomas Stanley, who leads the Joint Committee on Elder Affairs.

In an interview, Stanley said he was concerned because Gabriel House was among the only 20 or so facilities serving a mostly low-income population — what he called affordable assisted-living facilities.

Unlike traditional assisted-living facilities that have any array of amenities and mostly rely on residents to pay around $15,000 a month, three-quarters of the residents at Gabriel House were on MassHealth, the state's Medicaid program. They paid $1,850 to $2,400 monthly for a studio apartment in a facility that was a motel decades ago.

“This fire would not have happened in one of the modern facilities,” said Stanley, adding that one option would be to provide state funding to help lower-cost facilities upgrade or to create more housing options for the populations they serve.

At Gabriel House, a former worker said staffing was always an issue, as was the pay that never rose much higher than the state's minimum wage, even for nursing work, said Wyntter Munroe-Myers, who worked at the home as a certified nursing assistant from 2014 to 2016. At the time, one certified nursing assistant typically handled two of the six wings at the home, with each wing having about 15 residents. Often, there would be three assistants on a shift and a fourth managing them.

“The building is huge. To have four people that are supposed to be managing a whole building is almost irrational," he said.

Jenn Marley, who worked at Gabriel House as a certified nursing assistant from 2018 to January 2020, said she would often bring in food to supplement what residents were served. She said cockroaches, mice and bedbugs were a problem and that resident bathrooms were often filthy.

“God forbid, if they ran out of toilet paper, the boss would complain that we had to give them a roll,” she said. “They would mark it on the paper who came to ask for toilet paper.”

Jarren Oldrid, whose 67-year-old father, Steven, lived at Gabriel House for three years and is still hospitalized, said he often would not see staff members when he went to visit his father's third-floor room. He recalled that the building's elevator was recently out for as long as nine months, a major inconvenience for many residents who, like his father, were not mobile.

"The whole time the elevator was out, he was stuck in his room," Oldrid said. The only other option was carrying him down the stairs. If he did it himself, he would do it a few steps at a time, and it would take ages. So that never really happened."

The night of the fire, Oldrid recalled his father saying he never saw a staffer and that the first person he saw was a firefighter when he was rescued.

“The staff never made it upstairs to him from what he told me,” he said. “No one banged on the door. No one said anything.”

Associated Press writers Holly Ramer in Concord, New Hampshire, and Matt O'Brien in Providence, Rhode Island, contributed to this report.

Boards cover the windows of the Gabriel House assisted living facility, where a fire on Sunday killed several people, Tuesday, July 15, 2025 in Fall River, Mass. (AP Photo/Kimberlee Kruesi)

A unidentified man, right, appears emotional while embracing a resident of the Gabriel House assisted living facility, left, in Fall River, Mass., outside a temporary shelter, Monday, July 14, 2025, in Fall River, following a fire at the Gabriel House that started late Sunday and resulted in multiple fatalities. (AP Photo/Steven Senne)

An investigator takes measurements Monday, July 14, 2025, near an entrance to the Gabriel House assisted living facility following a fire that started late Sunday in Fall River, Mass. (AP Photo/Steven Senne)

Donna Murphy, a resident at the Gabriel House assisted living facility, in Fall River, Mass., speaks with members of the media outside a temporary shelter, Monday, July 14, 2025, in Fall River, Mass., following a fire at the Gabriel House that started late Sunday and resulted in multiple fatalities. (AP Photo/Steven Senne)

Flowers sit at a makeshift memorial in front of the Gabriel House assisted living facility, where a fire on Sunday killed several people, Wednesday, July 16, 2025 in Fall River, Mass. (AP Photo/Rodrique Ngowi)

ORLANDO, Fla. (AP) — The next U.S. census is four years away, but two lawsuits playing out this year could affect how it will be done and who will be counted.

Allies of President Donald Trump are behind the federal lawsuits challenging various aspects of the once-a-decade count by the U.S. Census Bureau, which is used to determine congressional representation and how much federal aid flows to the states.

The challenges align with parts of Trump's agenda even as the Republican administration must defend the agency in court.

A Democratic law firm is representing efforts to intervene in both cases because of concerns over whether the U.S. Justice Department will defend the bureau vigorously. There have been no indications so far that government attorneys are doing otherwise, and department lawyers have asked that one of the cases be dismissed.

As the challenges work their way through the courts, the Census Bureau is pushing ahead with its planning for the 2030 count and intends to conduct practice runs in six locations this year.

America First Legal, co-founded by Stephen Miller, Trump's deputy chief of staff, is leading one of the lawsuits, filed in Florida. It contests methods the bureau has used to protect participants' privacy and to ensure that people in group-living facilities such as dorms and nursing homes will be counted.

The lawsuit's intent is to prevent those methods from being used in the 2030 census and to have 2020 figures revised.

“This case is about stopping illegal methods that undermine equal representation and ensuring the next census complies with the Constitution," Gene Hamilton, president of America First Legal, said in a statement.

The other lawsuit was filed in federal court in Louisiana by four Republican state attorneys general and the Federation for American Immigration Reform, which opposes illegal immigration and supports reduced legal immigration. The lawsuit seeks to exclude people who are in the United States illegally from being counted in the numbers for redrawing congressional districts.

In both cases, outside groups represented by the Democratic-aligned Elias Law Group have sought to intervene over concerns that the Justice Department would reach friendly settlements with the challengers.

In the Florida case, a judge allowed a retirees’ association and two university students to join the defense as intervenors. Justice Department lawyers have asked that the case be dismissed.

In the Louisiana lawsuit, government lawyers said three League of Women Voters chapters and Santa Clara County in California had not shown any proof that department attorneys would do anything other than robustly defend the Census Bureau. A judge has yet to rule on their request to join the case.

A spokesman for the Elias Law Group, Blake McCarren, referred in an email to its motion to dismiss the Florida case, warning of “a needlessly chaotic and disruptive effect upon the electoral process” if the conservative legal group were to prevail and all 50 states had to redraw their political districts.

The goals of the lawsuits, particularly the Louisiana case, align with core parts of Trump's agenda, although the 2030 census will be conducted under a different president because his second term will end in January 2029.

During his first term, for the 2020 census, Trump tried to prevent those who are in the U.S. illegally from being used in the apportionment numbers, which determine how many congressional representatives and Electoral College votes each state receives. He also sought to have citizenship data collected through administrative records.

A Republican redistricting expert had written that using only the citizen voting-age population, rather than the total population, for the purpose of redrawing congressional and state legislative districts could be advantageous to Republicans and non-Hispanic whites.

Both Trump orders were rescinded when Democratic President Joe Biden arrived at the White House in January 2021, before the 2020 census figures were released by the Census Bureau. The first Trump administration also attempted to add a citizenship question to the 2020 census questionnaire, a move that was blocked by the U.S. Supreme Court.

In August, Trump instructed the U.S. Commerce Department to change the way the Census Bureau collects data, seeking to exclude immigrants who are in the U.S. illegally. Neither officials at the White House nor the Commerce Department, which oversees the Census Bureau, explained what actions were being taken in response to the president's social media post.

Congressional Republicans have introduced legislation to exclude noncitizens from the apportionment process. That could shrink the head count in both red and blue states because the states with the most people in the U.S. illegally include California, Texas, Florida and New York, according to the Pew Research Center.

The Constitution's 14th Amendment says “the whole number of persons in each state” should be counted for the numbers used for apportionment. The numbers also guide the distribution of $2.8 trillion in federal dollars to the states for roads, health care and other programs.

The Louisiana lawsuit was filed at the end of the Biden administration and put on hold in March at the request of the Commerce Department. Justice Department lawyers representing the Cabinet agency said they needed time to consider the position of the new leadership in the second Trump administration. The state attorneys general in December asked for that hold to be lifted.

So far, in the court record, there is nothing to suggest that those government attorneys have done anything to undermine the Census Bureau's defense in both cases, despite the intervenors' concerns.

In the Louisiana case, Justice Department lawyers argued against lifting the hold, saying the Census Bureau was in the middle of planning for the 2030 census: “At this stage of such preparations, lifting the stay is not appropriate.”

Follow Mike Schneider on the social platform Bluesky: @mikeysid.bsky.social

FILE - Two young children hold signs through the car window that make reference to the 2020 U.S. Census as they wait in the car with their family at an outreach event in Dallas, June 25, 2020. (AP Photo/Tony Gutierrez, File)

FILE - People walk past posters encouraging participation in the 2020 Census in Seattle's Capitol Hill neighborhood, April 1, 2020. (AP Photo/Ted S. Warren, File)

Immigration activists rally outside the Supreme Court as the justices hear arguments over the Trump administration's plan to ask about citizenship on the 2020 census, in Washington, April 23, 2019. (AP Photo/J. Scott Applewhite, File)