Friday, December 13, 2013
BY KELLEY BOUCHARD
Michaud is one of 34 residents of St. Joseph's assisted-living unit who were notified last week that they will be discharged to make way for a major renovation. They have until Oct. 1 to find another place to live, which may be tough given the high demand for assisted-living facilities.
"Every day she wakes up thinking she has to move out today," said Michaud's daughter, Audrey Rolfe, of Portland. "The anxiety this is creating for her is excruciating."
Rolfe is one of several family members of St. Joseph's residents who contacted the Portland Press Herald to express disappointment and anger about the way the facility is handling the discharge of their loved ones.
State officials and others are overseeing the discharge process to ensure that residents find safe and appropriate accommodations, especially for MaineCare recipients who face the challenge of finding a bed when many facilities are underfunded and have long waiting lists.
Family members say they're most upset about the lack of respect being shown for residents and family members, and the lack of clear information they're getting about the discharge process and the futures of their loved ones.
"For us now to be treated this way by a facility we trusted to take care of her is devastating for all of us," Rolfe said.
They're also upset that the Roman Catholic Diocese of Portland, which owns St. Joseph's, hasn't intervened or responded publicly to concerns about discharges from the facility at 1133 Washington Ave.
Louis Philippe, another family member of St. Joseph's residents, said he called the chancery in Portland "to let them know just how un-Catholic-like they are treating elderly residents."
The diocese hasn't responded to repeated request for comment from the Press Herald.
The situation at St. Joseph's is emblematic of the struggle that long-term care facilities, their residents and their families are facing across Maine, said Rick Erb, spokesman for the Maine Health Care Association.
The association represents about 100 nursing homes and 100 assisted-living facilities.
The crisis in long-term care arises, in part, from Maine's status as 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 U.S. Census. The state's proportion 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.
"I see a whole system that's under stress," Erb continued. He referred to several long-term care facilities across Maine that are either up for sale, in receivership, eliminating beds or shutting down altogether.
"And it's not as though MaineCare beds were plentiful before St. Joseph's announced its plans," Erb continued. He said there's a 92 percent occupancy rate for the 4,232 beds in assisted-living facilities that accept MaineCare, the state's form of Medicaid.
St. Joseph's circumstance also highlights a MaineCare funding gap that pushes the unreimbursed cost of MaineCare recipients -- who make up 80 percent of assisted-living residents -- onto the few residents who are paying their own way.
Twenty-eight of the 34 residents (82 percent) who are being discharged from St. Joseph's are MaineCare recipients, according to the Office of MaineCare Services at the Maine Department of Health and Human Services.
The MaineCare funding gap also has forced many facilities to put off much needed renovations for years, Erb said. It's no surprise that St. Joseph's board of directors decided to renovate the assisted-living unit in the 40-year-old facility, he said. Forty-one percent of MaineCare-dependent assisted-living facilities need to be renovated or replaced, according to the Muskie School of Public Service.
Even so, Maine lawmakers have increased MaineCare reimbursement rates for assisted living only once in the last eight years -- a 1 percent increase for fiscal 2012, Erb said.
MaineCare pays an average of $100 per day, or $3,000 per month, for eligible residents of assisted-living facilities, Erb said. These residents also contribute most of their Social Security benefits, which is about $500 to $1,000 a month.
Meanwhile, assisted-living facilities charge private-pay residents $6,500 or more per month, depending on services and amenities.
St. Joseph's current MaineCare reimbursement rate is $86 per day, Erb said, or about $2,580 a month. Rita Michaud, one of only six private-pay residents at St. Joseph's, has been paying $6,444 a month, her daughter said.
"They have to charge private-pay residents more to cover costs," Erb said.
Underfunding MaineCare's long-term care services is shortsighted, Erb said, because
This "cost shifting" has the unintended consequence of driving up the number of people on MaineCare, Erb said, and shows how underfunding MaineCare is shortsighted public policy.
"When assisted-living facilities charge private-pay residents more, it causes people to spend down their assets more quickly, and then they end up on MaineCare, too," Erb said.
Like many seniors, that's where Rita Michaud is heading.
Michaud has been at St. Joseph's for nearly two years, said her daughter, Audrey Rolfe. She entered the facility after she and her husband, Albert Michaud, 84, were hit by a car several years ago while crossing a street in Old Town, where they had lived for decades. The teenage driver was talking on a cellphone.
Their injuries were severe, causing them to spend months in rehab and accelerating their need for long-term care, Rolfe said. Albert Michaud's health problems are more intense, so he's in the skilled-nursing unit at the Barron Center in Portland, where he's covered by MaineCare.
Rita Michaud has spent about $130,000 of her own money on the only private, recently renovated room at St. Joseph's, Rolfe said. She shares a bathroom with other residents. Most rooms have two beds, and two rooms share a bathroom.
Now, with about $60,000 left, Michaud must try to find another facility that will accept her as a person who has dwindling personal resources and soon will be dependent on MaineCare.
"To go to another (assisted-living facility) will be difficult because she doesn't have the upfront cash she once had," Rolfe said. "It really narrows our options tremendously. We don't have the resources to start all over again."
Rolfe said her mother, who has Parkinson's disease, has increasing medical needs and may now qualify for long-term care at the Barron Center, where her parents would be reunited.
Rolfe said she's frustrated, however, that St. Joseph's has disregarded all of the money that her mother has paid them and refused to guarantee her a spot in the renovated assisted-living unit.
Rolfe disputes claims made by Gail Winchell, St. Joseph's administrator, who said she doesn't know how the unit will be reconfigured, how many rooms it will have or how future residents will be selected. Winchell didn't respond to a Press Herald request for comment on Wednesday.
Rolfe said she spoke recently with a representative of Catholic Health East and Trinity Health, the recently merged national nonprofit that operates St. Joseph's for the diocese. The consultant told her that the unit will be renovated into private rooms with private baths and that current residents will have to re-apply if they want to return.
"Why wouldn't my mother's investment be honored?" Rolfe asked rhetorically. "I think they know exactly what they're doing. Once renovations are complete, they have a lot of motivation to fill those beds with private-pay residents."
A regional representative of the Maine Long-Term Care Ombudsman Program visited St. Joseph's on Wednesday to talk with residents and family members, said Brenda Gallant, executive director of the program.
Gallant said her staff will visit St. Joseph's weekly and be available to assist residents and family members with the search for alternative accommodations.
The ombudsman program and the licensing division of the Maine Department of Health and Human Services also will make sure St. Joseph's follows state laws in discharging residents, Gallant said.
That includes notifying assisted-living residents 15 days before discharge and making sure they have a safe and appropriate place to live, she said.
Regardless of statutory requirements, Rolfe said, St. Joseph's is falling short.
"It's not a good plan to begin with," she said, "and it's not being well executed."