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 kbouchard@pressherald.com
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."

House Speaker Mark Eves, D-North Berwick, also plans to hold a series of round-table talks this fall, bringing together experts and others interested in addressing a wide variety of aging issues facing Maine, including long-term care. Eves said he hopes the talks produce legislation in 2014 that would bring substantial policy changes to everything from geriatric health care to senior housing to elder transportation.

"The crisis is not coming, it's here," Eves said. "St. Joseph's is just another example of what's happening across the state."

Eves noted that Maine faces significant challenges because it's the oldest state in the nation. Maine's median age -- 43.5 years -- is the highest in the United States, in part because the state also has a dwindling younger population, according to the Census. The state's percentage of people age 65 and older -- 17 percent -- is second only to Florida's 18.2 percent.

By 2030, more than 25 percent of Mainers will be age 65 or older, putting greater demand on long-term care facilities that are already overburdened.

Eves said the human and economic impact of Maine's aging population can be felt in every family and community, and all the way to the Legislature. He admitted that leadership has been lacking in dealing with mounting aging issues, in part because the state has limited resources.

"It's an enormous policy imperative that we must address," Eves said. "We'll be putting the spotlight on aging issues and hoping to build the political will to do things differently."

Faunce, administrator of the long-term care facilities in Penobscot, hopes to participate in both the study commission and the round-table discussions. He's ready to start now.

"For the short term, we need to address the funding issue," Faunce said. "Just because we don't fund it, doesn't mean the problem goes away. For the long term, we need to do some strategic planning, because there isn't enough money to go around now and that probably won't change." 

Kelley Bouchard can be contacted at 791-6328 or

kbouchard@mainetoday.com

Twitter: @KelleyBouchard

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