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ALR Level I vs. Level II/SCU: How Massachusetts Memory Care Certification Works

Massachusetts doesn't license 'assisted living' or 'memory care' as separate categories — it certifies Assisted Living Residences at Level I or Level II/SCU instead. Here's what Boston families need to know before choosing a secured memory care community.

HomeBlogALR Level I vs. Level II/SCU: How Massachusetts

By Linda Alvarez, CDP · March 25, 2026

Massachusetts certifies senior care as Level I or Level II/SCU

Unlike some states, Massachusetts does not issue a separate 'assisted living' license in the way it licenses nursing homes. Instead, an Assisted Living Residence (ALR) is certified by the Massachusetts Executive Office of Elder Affairs (EOEA) under M.G.L. Chapter 19D and 651 CMR 12.00. ALRs are certified at either Level I, standard residential services for generally independent seniors who need some support, or Level II, an enhanced certification that includes Special Care Units (SCUs) designed for residents with Alzheimer's disease or other dementias. Nursing homes and rest homes, by contrast, are licensed separately by the Massachusetts Department of Public Health (DPH) under M.G.L. Chapter 111, Section 71.

As a Certified Dementia Practitioner, I tell Boston families that this structure means the 'memory care' label on a brochure isn't itself a certification level — it's a description of a program that, in a properly certified community, sits within a Level II/SCU designation. Two communities can both market memory care and hold meaningfully different certification levels, staffing, and disclosures underneath.

What Special Care Unit disclosure actually means in Massachusetts

Under 651 CMR 12.00, an ALR operating a Special Care Unit must meet specific Alzheimer's Special Care Disclosure requirements — a written description of the unit's programming, staffing, physical environment, and admission and discharge criteria for residents with dementia. A locked or monitored unit alone is not the same as a genuinely disclosed, adequately staffed Level II/SCU program.

For dementia-specific care, families should ask to see the community's written Special Care Unit disclosure, what dementia training staff have completed, how the secured unit prevents elopement, and what the overnight staffing ratio is in that specific unit — a number that often differs from the community's overall Level I staffing. Some larger Back Bay or Newton communities operate dedicated Level II/SCU wings alongside Level I units, while smaller residences may offer a more intimate, home-like dementia-care setting — both can be appropriate depending on a resident's needs and personality.

What to verify before you sign in Boston

Before touring, ask whether the community is EOEA-certified at Level I or Level II/SCU, and request to see its written Alzheimer's Special Care Disclosure for the specific unit — not just the parent community's general marketing materials. Ask what dementia training staff have completed and how recently. Ask about the overnight staff-to-resident ratio in the memory care unit specifically.

Verify the facility's EOEA certification status on the Mass.gov EOEA certified Assisted Living Residence list, and cross-check any DPH-licensed nursing-home component on Medicare's Care Compare, before you commit. Memory care in Greater Boston runs $7,200 to $10,000 a month in 2026 — above the $5,800 to $8,200 range for standard Level I assisted living — and the price should reflect the additional staffing and dementia-care programming, not just a locked door. A free advisor familiar with Suffolk, Middlesex, Norfolk, and Essex county memory care options can help match a family's needs to the right setting and verify the record before a tour is scheduled.

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Common questions

Does Massachusetts have a separate memory care license?
No. Massachusetts certifies Assisted Living Residences at Level I (standard) or Level II, which includes Special Care Units (SCUs) for residents with Alzheimer's disease or other dementias, through the Executive Office of Elder Affairs (EOEA). Memory care is a program delivered within a Level II/SCU certification, distinguished by dementia-trained staff, a secured unit, and a written disclosure rather than a standalone license.
What is the difference between ALR Level I and Level II/SCU in Massachusetts?
Level I is standard EOEA certification for residents who need housing, meals, and general support. Level II includes Special Care Units built for residents with Alzheimer's disease or other dementias, with additional staffing, training, and disclosure requirements under 651 CMR 12.00.
How much does memory care cost in Boston?
Memory care (Level II/SCU) in Greater Boston runs $7,200 to $10,000 a month, above the $5,800 to $8,200 range for standard Level I assisted living. The higher price should reflect dementia-specific staffing, training, and a secured environment.

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