A deadly fire at Gabriel House, an assisted living facility in Fall River, Massachusetts, claimed 10 lives this July.

In the aftermath, horrific scenes emerged of elderly residents trapped inside smoke-filled rooms and hanging out of windows, desperate for rescue. Victims ranged in age from 61 to 86.

Over the years, Gabriel House owner Dennis Etzkorn has faced several charges over sexual harassment and kickbacks, but was not indicted. Regulators cited the facility for violations around staffing and emergency preparedness but never followed up. Former staffer Debbie Johnson told CBS Boston that the facility was “horrible,” dirty, and understaffed.

Etzkorn reportedly owns several care facilities for elders in Massachusetts. This sort of consolidation in ownership of assisted living and other senior-centered facilities is increasingly common across the country.

And that, says author Judy Karofsky, is a serious problem — even when the owners are nonprofit corporations. “There really is no difference in the performance [whether they are nonprofit or for-profit],” Karofsky told me.

Her book, DisElderly Conduct: The Flawed Business of Assisted Living and Hospice explores her personal experience navigating the system to care for her mother. “My mother was injured, my mother was sexually assaulted. My mother had many, many falls because there just wasn’t enough staffing,” said Karofsky.

The assisted living industry relies heavily on immigrant laborers who are overworked and underpaid. According to Karofsky, “We need to honor them, understand who they are, what they’re willing to do.”

Karofsky’s mother loved many of the people who cared for her, but “some of them …were so unhappy or frustrated in their situation, they really couldn’t give the kind of care that she needed.” Many held multiple jobs, moved from one facility to another, and were offered only temporary positions.

The crisis of care in assisted living boils down to funding — or lack thereof.

Because these are a relatively new sort of institution — different from nursing homes or hospice care facilities — assisted living facilities are ruthlessly frugal and notorious for cutting corners. There’s little federal regulation, and not enough funding for staff training or the sort of memory care that elderly people increasingly need.

“Yes, we are living longer — good for us,” said Karofsky. “Now we have an obligation to provide health facilities, care facilities till the end of our days and not cut back on the sources of funds that would ease our passage.”

There’s a powerful analogy with childcare. Most parents rely on the childcare industry, and yet it’s increasingly unaffordable, even though most childcare workers are underpaid. Yet the well-being of children is at stake.

“It’s profiteering. It’s exploitation,” said Karofsky of the assisted living industry, whose facilities are growing more expensive each year even as workers struggle for fair pay.

How is it that industries like these are simultaneously in high demand, exploitative to workers, and unaffordable?

It takes an enormous amount of work for humans to take care of other humans. That’s one of the best reasons for public taxation — to consolidate resources so we can pay people like us fair wages to care for people like us.

Instead of using our tax dollars for things like eldercare (and childcare), politicians are increasingly cutting funds from programs like Medicaid, as President Donald Trump and the GOP’s so-called “Big, Beautiful Bill” recently did.

Wealthy elders will get the luxury care they need. The rest of us — if we’re lucky enough to live into our 70s and 80s — may find ourselves living in assisted living facilities in our golden years.

Don’t we deserve well-regulated, well-funded institutions where we can enjoy independence, safety, and robust care — rather than abuse, accidents, and tragic deaths like the ones at Gabriel House.

“We need to be more concerned about our elders,” said Karofsky. “We can offer better care and more… compassionate care.”

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