September 1, 2013

MaineCare underfunding hurts long-term care

The crisis at nursing homes and assisted-living centers is getting some lawmakers' attention.

By Kelley Bouchard
Staff Writer

Maine's long-term care system is in trouble and state lawmakers are starting to notice.

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St. Joseph's Manor in Portland

Press Herald file photo/Gordon Chibroski

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St. Joseph's Rehabilitation & Residence in Portland is discharging 34 residents to make way for a major renovation intended to attract more private-pay residents and help offset the underfunded cost of MaineCare recipients.

Houlton Regional Hospital will close its nursing home wing later this month, eliminating 28 long-term care beds and putting additional strain on a 90 percent occupancy rate among Maine's nursing homes.

The Penobscot Nursing Home and Northern Bay Residential Care in the Hancock County town of Penobscot are financially solvent again after being placed in receivership in 2008. However, they still face the challenges of underfunded MaineCare reimbursements and a rapidly growing senior population that has more acute physical and mental health needs.

"We're paying our bills," said Irving Faunce, the administrator who was appointed to steer the Penobscot facilities out of the red.

"But MaineCare reimbursements haven't increased for several years, which means it's very difficult to generate a positive bottom line," Faunce said.

Meanwhile, the spectrum of geriatric health issues that assisted-living facilities and nursing homes are dealing with is larger than ever, Faunce said. Many long-term care residents have several illnesses, such as heart disease, kidney failure, diabetes and dementia, while the number of seniors with mental illness is growing, too.

Faunce said about 40 of the 87 residents at the Penobscot facilities have mental health issues ranging from chronic depression to schizophrenia. He said the number has grown since the state started closing institutions that cared for mentally ill and disabled adults in the 1990s.

"It's our job to care for people," Faunce said. "But it's important for consumers, politicians and taxpayers to understand the growing complexity of what we do."

The Penobscot facilities are among several that the Maine Department of Health and Human Services placed in receivership five years ago, Faunce said. The others are Gray Manor, Rocky Hill Manor and Dolley Farm Residential Care in Westbrook, Snow Pond Residential Care in Sidney and Somerset Residential Care in Madison.

A significant funding challenge for most long-term care facilities is MaineCare, the state's version of Medicaid. It covers about 80 percent of assisted-living residents and 66 percent of nursing home residents statewide, according to the Office of MaineCare Services at the DHHS.

But while assisted-living facilities charge private-pay residents $6,500 per month or more, MaineCare reimbursements for assisted living average about $3,000 per month, according to the Maine Health Care Association.

The gap forces many assisted-living facilities to shift the underfunded cost of Maine- Care recipients to private-pay residents, which causes them to spend down their personal assets and wind up on Maine- Care more quickly, said association spokesman Rick Erb.

Despite this cost-shifting, Maine lawmakers have increased MaineCare reimbursement rates for assisted living only once in the last eight years -- a 1 percent increase for fiscal year 2012, Erb said.

Front-line concerns about long-term care and other aging issues are starting to reach the State House, and some lawmakers are responding.

The Legislature agreed last spring to form a commission to study long-term care issues, starting in October. Sen. David Burns, R-Whiting, sought the study after the Atlantic Rehabilitation and Nursing Center closed in 2012, leaving Calais without a long-term care facility.

Burns said the commission will review MaineCare reimbursements, staffing regulations, resource sharing and other ways to ensure the viability of long-term care facilities in rural areas.

"Rural communities have fewer long-term care options, more MaineCare recipients and fewer private-pay residents," Burns said. "That drives their revenues way down and makes it difficult for them to survive."

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