State must craft plan to care for seniors

Posted Dec. 16, 2008, at 6:05 p.m.

In the article “Budget Cuts Imperil Assisted Living Homes” (BDN, Dec. 9), Meg Haskell wrote about the serious issues facing elderly persons needing residential care in Maine. She described very well the dilemma facing private nonmedical institutions, or PNMIs, and the resultant crisis awaiting elderly Maine residents who need housing and services.

There are more than 3,500 beds in facilities variously called boarding homes, residential care, assisted living, assisted housing with services, and PNMI. In addition, 215 seniors are served in apartment-style affordable assisting living projects (such as Freese’s in Bangor). The common denominator for the elderly residents who live in these locations is the inability to continue to live alone in houses or apartments where there is no 24-hour assistance with the activities of daily living.

The “bed hold” issue described in the article is just the tip of the iceberg. MaineCare funding, Maine’s plan for allocating Medicaid funds, does not meet the cost of delivering services to those in need, and providers are facing difficult decisions regarding their ability to continue serving a clientele in need of care. This situation is exacerbated by the recent knowledge that the entire residential care funding system and the affordable assisted living projects currently in place do not meet federal Medicaid standards, and Maine is in jeopardy of losing the major source of support for both of these categories of elder care if a new plan is not approved.

Providers of these residential care facilities and assisted living programs are licensed by the state, subject to surveillance by the Department of Health and Human Services. Surveyors visit the homes periodically to determine if the providers are meeting strict rules regarding medications management, residents’ rights, staff credentialing, dining services, nutrition, building safety and myriad performance criteria mandated by rules promulgated by the Department of Health and Human Services, or DHHS.

Some of the residents are private paying, and are charged monthly rates that are determined by the cost of service and housing. However, a majority of residents are unable to provide private funding, and in order to qualify for housing and services must be approved for Medicaid funding through the MaineCare system managed by the Maine DHHS. These MaineCare eligible residents are required to pay the provider a cost of care determined by the state, and supplemented by MaineCare. With the exception of those living in the affordable assisted living model, this formula leaves the resident with virtually no disposable income, and does not provide adequate funds to meet the provider’s expenses. Affordable assisted living residents are responsible for paying the rent and have more disposable income for independent living.

Now we have learned that the whole funding plan requires immediate attention if the state is to qualify for continued Medicaid funding in this critical area. Each provider of housing and services must depend on significant nonoperating funds to meet the total cost of the program, and in a recessionary period, those funds are becoming increasingly scarce.

In study released in September by the Office of Elder Services, a division of DHHS, it was revealed that the current and projected demographics for the state show a growing population of elders with a known requirement for increased residential care beds. The statistics looked at every sector of Maine, and presented a conclusion that the growth of an already older population would affect the state as soon as 2010. This statistic confronts another recent state study that estimates a slowing of revenue and a reduction of available funds in the next biennium.

Maine’s elderly residents have worked, raised their families and contributed to the general life of the state for many years. Many have exhausted their resources, and now, when they are the most vulnerable, they are being put on hold while policymakers scurry to find acceptable answers to the complex problems facing the state of Maine.

Service providers are trying to find strategies to continue to meet the essential needs of residents served, hold on and survive the difficult months ahead. For example, as you read in the Dec. 10 Bangor Daily News, the affordable assisted living projects in Bangor and Camden will be eliminating breakfast in their dining rooms as of Jan. 1. Fortunately, the seniors affected in these apartment dwellings have the ability to prepare breakfast in their kitchenettes and still will have the help of staff for this activity.

Issues regarding work force retention, energy costs, capital costs and adequate funding of direct care and routine services require innovative solutions and complete cooperation among the players. Maine’s 124th Legislature will be faced with the daunting task of crafting a budget that meets constitutional requirements while providing a safety net for those most in need. Maine’s elderly population needs to know that their health, safety and well-being will be protected, and that we, as residents of Maine will not let the system fail.

Nelson E. Durgin is executive director of Phillips-Strickland House in Bangor. Noelle L. Merrill is executive director of the Eastern Agency on Aging in Bangor.

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