It's no secret that Maine's more than 100 nursing homes have been chronically underfunded. MaineCare pays the bills for about 70 percent of nursing home patients. But MaineCare rates don't cover the full cost of nursing care. And at some nursing homes, the shortage has become so serious that several have warned that they may have to close. Gov. Paul LePage and lawmakers can't agree on how to address the $12 million problem. In the meantime, nursing homes are struggling to provide shelter, food, and treatment for Maine's oldest citizens.
The day is just getting started at this facility in Caribou. Some people are sitting in wheelchairs watching TV, others are in their rooms seated behind tray tables, as nurses bustle about to see how residents have fared during the night.
"This is the time of day where people are getting bathed and dressed," says administrator Phil Cyr, who starts each morning like this.
Phil Cyr: "You're looking sharp today!"
Junior: (Inaudible)
Phil Cyr: "Oh you are? You are? OK. Junior is a resident here. Has been for how long?"
Junior: "Eleven and a half."
Phil Cyr: "Eleven and a half years you've been here? Yup. Junior had a stroke."
The residents of nursing facilities such as this one will need six or seven hours of professional care each day. They need help eating their meals, walking to the day room, going to the toilet, and taking sometimes complicated regimens of medication.
And they may also die here. They're too frail to care for themselves, says Cyr, and need more care than many working families are able to provide - or afford themselves.
"We're losing about $6,000 a year, per Medicaid client," he says.
And of Cyr's 60 residents, about 50 are on the state's Medicaid program, known as MaineCare. "So that's $300,000 a year that MaineCare - Medicaid - is not paying us."
Cyr says there's no way that his business, which has been around since 1972, can sustain those kinds of losses forever. Facilities like the Caribou nursing home are currently held aloft by payments they receive from Medicare for clients who need some skilled nursing and rehabilitation.
"And that's not looking nearly as promising as it was in the past," says Rick Erb, executive director of the Maine Health Care Association.
He says, although some relief has been promised in the form of a bill that recently was approved by the Maine Legislature, it won't come right away, and it won't cover the entire outstanding amount. And things are changing at the federal level too.
"Medicare rates have already been cut, and future increases through the Medicare program are far less certain," Erb says.
Facilities that have very few private-pay clients, says Erb, are running out of ways to bolster their bottom lines - and nothing will happen fast enough to provide immediate relief.
Manager Nathan Brown's facility is four hours south of Caribou, in the Washington County town of Lubec.
"Security, plumber, replacing light bulbs." Brown says he takes on as much extra work as necessary to keep his nursing home above water. It's one of just a few serving the Downeast area, following the closure of the Calais nursing home two years ago.
Still, Oceanview Nursing Home is stuggling to keep its 39 beds full. Currently, 10 beds are empty, and of his 29 clients, 26 are on MaineCare.
While the Caribou facility is hanging on - for now - thanks to Medicare, homes in places like Lubec, are not. This is partly because elders who wind up in the hospital are often shipped to Maine Coast Memorial in Ellsworth or Eastern Maine Medical Center in Bangor.
"The skilled nursing facility referrals that would be coming from hospitals in urban areas, don't get out of urban areas," Brown says. "They stay close to within that hub." So, Brown says remote towns like Lubec often don't get their residents back after a hospital stay in the city.
Rick Erb with the Maine Health Care Association says rural nursing homes aren't the only ones facing difficulties. But Brown finds that it is a factor, especially when it comes to recruiting staff. He says it's hard to convince a young person to invest their time at a facility like his, where even the boss is called upon to make toast or wield a plunger.
