The future of long-term care in Maine Part 1

Published: Nov. 1, 2018 at 5:27 PM EDT
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Maine has the oldest population in the nation.

For those no longer able to stay at home and care for themselves, it can be difficult to move into a nursing home or assisted living facility, especially when many of those facilities are economically hurting.

In the next ten years, the population of Mainers 65 and older is expected to grow by more than 110,000 people, a 45% increase.

In contrast, Maine's population under 65 is expected to decrease, meaning the workforce here is shrinking, which could ultimately lead to having less workers available to care for those who need it the most.

"We couldn't continue to absorb the losses which were well over $100,000 a year, and in the past few years closer to $200,000. Those are just operational losses. The facility itself could easily use about $250,000 in repairs," explained Dennis Welsh, CEO of the Down East Community Hospital.

The former Sunrise Care facility in Washington County is just one of many nursing homes that have closed its doors in the last few years due to long time losses and low census.

In August, officials there were forced to relocate 21 residents, while finding help for more than 40 staff members.

Rick Erb is the President and CEO of the Maine Health Care Association who represents long-term care providers across the state.

He says they have a number of growing concerns as many facilities are being forced to shut down.

"We know that over the years as nursing homes close, they do not reopen, and we are concerned about what we see as the ongoing need and the growing need that's going to come as demographics shift," said Erb.

According to the Muskie School of Public Service, over half of the residents in nursing homes here have some type of dementia.

That means those facilities that house residents with higher needs need staffing at higher levels, which is a challenge since the workforce in Maine is only getting smaller.

"The shortage of available workers has been a real issue for us," explained Erb. "We are very heavily staffing dependent. More than 70% of a nursing home's operating cost are workforce related. There is not a large enough pool of younger workers at the very time that the people we care for, at the other end of the age spectrum, is increasing. So, we expect that situation to get more difficult before it gets better."

Many facilities are also feeling a financial burden.

In Maine, they receive payment three ways: MaineCare, Medicare, and private pay.

According to the Department of Health and Human Services, 77% are MaineCare beneficiaries. The higher the MaineCare percentage, the harder it is for many to operate.

"The MaineCare rate becomes very important," said Erb. "There have been some rate increases in the past years, and that has helped the situation from becoming worse than it is. But, we are closing facilities. Often times they are small facilities in rural areas, and I think the state is going to have to make some policy decisions that make certain that access continues to be available in all parts of the state of Maine."

The intensity of nursing care required by a patient has also increased by 30% since 1998, with Maine having one of the highest rates.

While those residents qualify to live in nursing homes, others do not meet the requirement, which gives them other options like assisted living facilities that rely heavily on private pay.

While their staffing requirements are not as high, Erb says they too face challenges.

"As people do age in place, they are serving a population that really had been anticipated to be, would be a nursing home level of care, and so it's obviously a challenge using assisted living facilities and staffing levels to meet peoples' needs that really are nursing home eligible."

Officials say the topic of funding for nursing homes at a higher level has been a priority in the legislature, and they hope that continues into next session.