May 22, 2018
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Rural nursing homes face closure without plan

By Richard Erb, Special to the BDN

While it’s hard to imagine needing nursing home care, the fact is that at least 70 percent of people over age 65 will require some kind of long-term care and the odds are even higher for people who are 85 or older. Today, some 7,000 Maine residents and their families rely on their local nursing home and it may surprise readers to know that they are overwhelmingly satisfied with this choice.

According to My Innerview, an independent national long-term care benchmarking company, 93 percent of families gave their Maine nursing home an overall “excellent” or “good” rating, with the same percentage indicating a strong willingness to recommend to others the home where their loved one receives care and services. Maine consistently outscores neighboring states and the country in these rankings.

Given this information, the Calais community’s response to the prospect of losing its local nursing home is not at all surprising. The concern is understandable and underscores the important role of a nursing home as both an employer and health care provider in rural Maine. But what’s happening in Calais should serve as a wakeup call for communities and lawmakers around the state, as it foreshadows what’s to come for many rural facilities if state health policy remain status quo.

There are specific, identifiable contributing factors in the demise of a rural nursing home in Maine. And I believe they are also preventable. First and perhaps the most obvious is a nursing home’s disproportionate reliance on public funding to survive. While many think of MaineCare as a health program for the poor, the state’s Medicaid program funds nearly 75 percent of the care for our nursing home residents. Today, the funding gap between the cost of care and the state’s payment for that care has increased to $21 per day, or $32 million statewide per year.

Historically, these losses have been offset by Medicare and those who pay privately for their care. However, some rural nursing homes are affected by a Maine policy that allows critical access hospitals to directly compete for these Medicare funds through use of “swing beds.”

Maine’s critical access hospitals are located in rural locations and some very near to their community’s nursing home. Swing beds allow the hospital to use the beds for acute care or short-term rehab care. It is a policy that has helped preserve access to acute care services in rural areas but unintentionally has created a disadvantage for nursing homes in the same area.

This underscores the necessity of sufficient MaineCare funding for nursing homes.

The last factor that must be addressed is the fact that Maine has an aging stock of nursing homes, particularly in rural areas. The average nursing home is more than 30 years old and there have been only three new facilities constructed in the past 12 years. Despite recent regulatory changes that encourage renovations and improvements, Maine lags behind much of the nation in building modern facilities that are truly designed to support a patient-centered care model that did not exist 30 years ago.

If we are to meet future demand and retain high levels of customer satisfaction, we must be prepared to provide a care environment that includes larger, private rooms, built-in technology, private bathrooms/showers, more windows and in-room services. Today’s facilities are not built to support these preferences.

Maine’s long-term care providers have a long tradition of caring for Maine’s elderly and disabled residents. They are honored to care for a group of people that society largely ignores — until reality hits home. The consequences of underfunding, conflicting policy and an overall state of indifference toward long term care are coming home to roost.

We do not have a sustainable model of long-term care, precisely at the time when our demographics show we need one. This issue goes far beyond the borders of Calais. Without change, many rural nursing homes could find themselves in the same position in the future.

Richard Erb is president and CEO of Maine Health Care Association in Augusta.

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