January 3, 2012

LePage proposal puts senior facilities at risk

About half of residents suffer from some form of dementia

By Susan M. Cover scover@mainetoday.com
State House Bureau

WINTHROP -- In an old farmhouse on a rural road, 24 elderly Mainers live in a residential care facility that would run out of money July 1 under a proposal put forward by Gov. Paul LePage.

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ABOUT THE FACILITIES

What are private non-medical institutions?
• Residential treatment services funded by MaineCare
• Operated by agencies or facilities
• Licensed by Maine DHHS
• Provide rehabilitative treatment to four or more residents
• Provide food, shelter and personal care
• Give treatment that is medically necessary

How many are served?
• Substance abuse facilities: 302
• Elder services: 4,291
• Infant mental health, foster care, residential: 696
• Adults with mental illness: 608
• Brain injury, elder services, intellectual disability: 379
• Total: 6,276

How many sites are there?
• About 470

Source: Maine Department of Health and Human Services

The Heritage Rehabilitation and Living Center is one of about 470 private non-medical institutions scattered around the state that are supported mostly by state and federal Medicaid dollars. They are home to people like Errie Hasty, 89, who moved in almost five years ago when she could no longer manage her medications by herself.

"I wasn't giving myself the right stuff," she said as she stood in the dining hall, using a walker to steady herself.

Hasty is one of the 4,291 elderly people in the state who would need to find somewhere else to live if the facilities close. Many of them would be eligible to live in nursing homes, but there are only about 400 available beds statewide, advocates for the elderly say. The facilities also provide residential care to those with mental illness or substance abuse problems, so the total number of people affected by the loss of funding is about 6,000.

Closing the facilities will save the state $60 million and reduce federal matching funds the state receives by more than $100 million.

When it comes to controversial parts of LePage's proposal to close a $221 million budget shortfall at the Department of Health and Human Services, this is at the top of many lawmakers' lists.

"Assuming 10 is most important, I would put it at 10," said Rep. Meredith Strang Burgess, R-Cumberland, House chairwoman of the Health and Human Services Committee.

That committee and members of the Legislature's Appropriations Committee will meet today to continue deliberations on the budget, which proposes to end Medicaid coverage for 65,000 Mainers.

The LePage administration says the residential care program is no longer sustainable as it is currently structured because the federal government is raising questions about the way Maine has billed for services. LePage spokeswoman Adrienne Bennett says there is money in the budget to help transition away from the system, but the budget does not spell out an alternative.

That's up to lawmakers.

Sen. Roger Katz, R-Augusta, a member of the Appropriations Committee, said he's confident lawmakers will find a way to answer the federal government's questions and maintain the state's eligibility for reimbursement for the residential care services. But they will then have to find other ways to save the $60 million. Overall, the state does need to reduce the number of people enrolled in MaineCare, the state's Medicaid program, he said.

"We've got to come back to fiscal sanity and still protect the most vulnerable," he said.

Rep. John Martin, D-Eagle Lake, also a member of the Appropriations Committee, said there's little chance the proposal to close the facilities will have any traction at the State House.

"I don't know of any legislator that would ever vote for that," he said, noting that it's the part of the budget that has the most immediate impact on people.

These types of assisted living facilities began to open in the mid-to-late 1990s, when the state decided it wanted to reduce the number of people living in nursing homes to cut costs, said Rick Erb, president of the Maine Health Care Association. Nursing homes are a more expensive way to provide care, and in today's dollars, cost Medicaid about $178 per day, while assisted living facilities cost about $98.

Back in the 1990s, the state changed its standards so people had to be sicker to get into nursing homes, which drove demand for home care or assisted living facilities. The state reduced the number of nursing home beds from 11,000 to fewer than 7,000, with most of those beds being converted to the less-costly option of a private non-medical institution, Erb said.

(Continued on page 2)

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