July typically is a time Mainers look forward to. However, this year, July 1, is a date to be dreaded by about 215 frail elders. July 1, the essential services they new are provided in seven affordable subsidized assisted living projects statewide will end.
MaineCare will no longer pay to provide these elderly residents meals, medicine administration, 24-hour 7-day-a-week staffing, to name a few of the services in danger.
The Department of Health and Human Services has stated that it will assess the residents of these facilities to determine what, if any, services they might qualify for. It is important to note that the MaineCare on which these residents now rely on is not traditional MaineCare, but an expanded version of coverage unique to these assisted living projects.
When DHHS assesses these 215 elders, it will be determined if they will qualify for traditional MaineCare. Some will, some won’t. Those that do qualify are not out of the woods as traditional MaineCare does not cover meals, medicine administration and 24-hour staffing. Essentially, the state is proposing that these residents be put on a home-based care system along with suggesting that Eastern Area Agency on Aging become a home-based care service provider in order to keep our current services intact.
This means that the residents probably will have a person come in to their apartments for a few hours a week. No meals, no meds, no help in the middle of the night. Those that need help dressing will most likely spend most of their days in their pajamas until their worker comes to dress them. Plan of care is far less than EAAA is currently providing.
Many of our residents won’t qualify for traditional MaineCare because their low incomes are slightly too high. Many won’t qualify because they only need help with a few things such as medication administration, a life-saving, but uncovered service.
In 1994, nursing home criteria changed drastically and many elders no longer qualified to be institutionalized even though they could no longer stay at home. Nursing home beds became only for those close to the end of life. Assisted living communities were becoming available where people with higher incomes could enjoy a private apartment with personal care service and meals as needed, but someone making under $20,000 a year was not going to be able to pay the $3,000-plus a month price tag.
During those same ’90s, three Maine Legislatures voted to fund demonstration projects that would provide a service similar to the private pay models of assisted living. Eastern Area Agency on Aging, along with others, responded because we all could picture the vision of a cost-effective way to provide a new type of home care to the growing number older Mainers, who had outlived the ability to stay in their homes and needed round-the-clock personal care services. The funding at that time was strictly from the state General Fund.
The proposals submitted for the projects were creative because they inspired the unusual partnership of private investors, developers and nonprofit service providers such as Eastern Area Agency on Aging and brought in excess of $24 million into the state. These projects revitalized community landmark buildings, such as the Inn at City Hall in Augusta and the old Stearns High School in Millinocket and the former Freeses Department Store in Bangor.
In 2003, DHHS said there was no longer enough state money to fund the projects from the General Fund and the assisted living costs needed to be shared by using the federal Medicaid match. None of the providers, including EAAA, wanted to participate in MaineCare, but because this was the only option, we all did what was necessary to keep the service intact for the residents.
These assisted living projects successfully demonstrated that there is a low-cost alternative to institutional care. Residents maintain their independence and dignity. Sometimes they become healthier because they are eating well, taking their medications on time and are surrounded by community. In a perfect world, my agency and others would be working to create more of these instead of fighting and struggling to save the few we have. And affordable is the key word. The average cost among all the sites is less than $60 a day.
So, July 1, brings an end to the MaineCare service benefit. DHHS says that the MaineCare service model was never approved by the federal Centers for Medicare and Medicaid Services and that these special services must end.
Help us by asking that these residents be given the care they were promised when they moved in. Help us advocate for more community-based assistive housing settings for our seniors. Lastly, demand legislators implement a good plan for long-term care choices for the elderly and disabled residents of our great state. Without an array of service options, residents will end up in the very costly settings of our hospitals and nursing homes.
Noelle Merrill is executive director of the Eastern Area Agency on Aging in Bangor.