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Maine Panel: Costs Threaten Elderly's Access to Long-Term Care
10/11/2013   Reported By: A.J. Higgins

A disparity in access to nursing home beds and the rising cost of long-term health care in Maine are two of the themes under consideration by a special legislative commission that began its work today. Several panelists say the state must pick up more of the costs for nursing home care at a time of declining federal reimbursement. And as A.J. Higgins reports, those rising costs are having a greater impact in rural areas where some facilities have already closed their doors.

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Imagine spending most of your working life trying to save enough money to cover health care needs in old age, only to find that your plans don't come close to paying the bills. That's a reality that's hitting home for many Mainers who thought they could afford the costs of a private pay nursing facility in their advancing years.

State Sen. Margaret Craven, a Lewiston Democrat, says this select group of senior citizens is actually paying twice - once for themselves and again for thousands of Mainers on Medicaid, also known as MaineCare - whose costs are not adequately covered by the federal or state governments.

"Which is something that aggravates me, by the way, as well, as having private pay individuals who have worked so hard and worked to make savings for themselves and now they are paying for the care of the general population," Craven says.

Craven is the Senate chair of the Commission to Study Long-term Care Facilities. The panel was created by the Legislature to review the accessibility, costs, staffing and reimbursement of the nearly 130 nursing homes in the state.

Craven says her commission, consisting of lawmakers and those in the long-term care business in Maine, must reach consensus on what needs to be done to address the needs of aging Mainers now and in the near future. And the panel only has about four meetings left to accomplish its goals.

"I really hope that we'll be able to get a bill through the Legislature that would raise funds to adequately pay for MaineCare recipients," Craven says.

Rick Erb, of the Maine Health Care Association and a commission member, represents Maine nursing homes and assisted living and residential care facilities. He says in recent years, nursing home care providers who lost money on their MaineCare clients could expect to make up the difference by what they received from Medicare and private paying customers. But that formula isn't working anymore.

"Over the last five years we've seen, actually, reductions in Medicare rates - at the federal government level they've said, 'We think we can afford to cut back on that,'" Erb says. "Well, maybe they could, but the problem is that it was always subsidizing Medicaid, so unless there is a state increase in the Medicaid level, we really need to keep those Medicare rates intact."

The problem presented by declining federal reimbursement and a state budget that - for the moment - does not include a way to increase its share of Medicaid reimbursement, holds even greater challenges for nursing homes in rural areas that could be hours away from a major medical facility.

Last year, the Atlantic Rehabilitation and Nursing Center in Calais closed its 52-bed facility. About 90 percent of its residents were MaineCare clients, and the hospital administration cited insurmountable financial challenges as the reason for its closure. Calais City Manager Diane Barnes says the loss of the facility triggered a ripple effect through the region's long-term care options.

"When the Calais nursing home closed, we have Eastport, Machias and Lubec to pick from, and when they're full we have to go to Ellsworth or Bangor, and that's a two-hour drive from Calais," Barnes says. "And if Lubec closes, it's just going to make it worse."

Another commission member, Philip Cyr, the administrator at the Caribou Rehab and Nursing Center, says urban nursing care facilities tend to fare better than their rural counterparts because of two essential distinctions:

"There's more wealth in urban areas of Maine than in rural areas, so you have more self-paying clients," Cyr says. "Number Two, your major hospitals are in your urban areas, and so when it comes to your Medicare-funded clients, they're more apt to go to a rehab facility closer to the hospital within the urban area."

The commission is charged with reporting its recommendations to the full Legislature by Dec. 4.


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