Journal of Science Policy & Governance
Volume 26, Issue 01 | June 16, 2026

Policy Memo
Partial or Limited Frail Elder Waivers in Massachusetts—Minimizing Costs and Need for Institutional Care in Later Life

​Elaine M. Eliopoulos1, Christine Carter2, Chris Gilleard1, Paul Higgs1
  1. University College London, Faculty of Brain Sciences, Division of Psychiatry, London, UK
  2. Queen Mary University, Wolfson Institute of Population Health, London, UK
​​
​Corresponding author:  [email protected] ​​​
Keywords: Frail Elder Waiver; advanced old age; home and community-based services; institutional care ​
https://doi.org/10.38126/JSPG260101 ​​

Executive Summary

Massachusetts will experience an exponential increase in adults living into advanced old age over the next several decades. Medicare and Medicaid costs to fund institutional care continue to rise. The Frail Elder Waiver program presents an opportunity to reduce institutional costs by providing essential support at home to older people who would otherwise require institutional care. These supports would allow the individual to remain at home longer and avoid or delay the need for institutional care. Eligibility for the waiver requires that individuals over 65 meet specific clinical requirements that may be safely managed at home with specific services. These services may include such essentials as environmental accessibility adaptation, medication assistance, supportive day programming, and home-delivered meals. Revising the waiver program to allow limited or partial services prior to the onset of substantial limitations would result in economic and quality of life gains.

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Background header image courtesy of Modern Primary Healthcare
Elaine Eliopoulos recently received her PhD at University College London in gerontology. Elaine is a public defender attorney representing older people and psychiatric patients in judicial proceedings designed to substitute a decision-maker, involuntarily place them in a nursing home or other institutional setting. Elaine pursued a PhD to transition to a policy career to ensure equitable and inclusive treatment of marginalized populations. 

Christine Carter is a nurse, post-doctoral research associate at Queen Mary University in the Wolfson Centre for Population Health. She is working on a research project which examines the practices and experiences of minority ethnic groups in East London who experience dementia. Her doctoral research explored how active aging policy reconfigured experiences of those with mild cognitive impairment. 

Chris Gilleard is an Honorary Associate Professor in the Faculty of Brain Sciences, Division of Psychiatry at University College London. He has published extensively on advanced old age, the “fourth age” and the theoretical limitations of current depictions of aging. His most recent publication, co-authored with Paul Higgs, suggests a reorienting of later life whilst considering Beck’s theory of cosmopolitanization. 
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Paul Higgs is a Professor of the Sociology of Aging in the Faculty of Brain Sciences, Division of Psychiatry at University College London. He has published extensively on the theoretical considerations in aging policy. He was elected a Fellow of the Academy of Social Sciences in 2012 and a fellow of the Gerontological Society of America in 2013. In 2021, he received a 50th Anniversary Outstanding Achievement Award from the British Society of Gerontology.

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