This article was written by Main Monitor, who was a member of ProPublica’s Local Reporting Network from 2022 to 2023. Sign up for Dispatchs to get articles like this as soon as they’re published.
The Maine Department of Health and Human Services has proposed significant increases in staffing requirements, among other changes, in the first major update to assisted living and residential care regulations in more than 15 years.
The proposed updates are based on a survey of the state’s largest residential care facilities by Maine Monitor and ProPublica. The investigation found dozens of cases of abuse and neglect and other violations of residents’ rights, more than 100 cases of residents wandering from the facility, and hundreds of violations of medication and treatment procedures.
As part of a media investigation, one facility owner said current staffing requirements were “horrendous,” “dangerous” and “completely inadequate.” Experts, advocates and health care providers said requiring higher levels of staffing, better training and more care would help solve these problems.
At a public hearing this month, the department proposed doubling the number of overnight direct care workers in residential care facilities and establishing stricter rules for memory care units that exceed state and federal staffing requirements for nursing homes. did. DHHS has until January 10 to present the proposed regulations to lawmakers for consideration in the next Congress.
Assisted Living programs serve older Maine adults, adults with intellectual and developmental disabilities, and people with mental illness. These facilities provide less medical care than nursing homes, but have expanded in recent years after states placed limits on the number of beds in nursing homes in the 1990s. At least 26 nursing homes have closed in Maine over the past decade.
The changes mean the needs of residents in these facilities have “significantly increased,” said Brenda Gallant, an advocate for residents and their families at Maine’s long-term care ombudsman. Ta. “Current regulations for assisted living facilities have not kept pace with the growing needs of residents,” Gallant said, adding that up to one-third of residents in these facilities are not eligible for nursing home care. He cited a recent state assessment that there is a possibility.
Currently, in residential care facilities with more than 10 beds, one person for every 12 residents during the day, one person for every 18 residents at night, and one person for every 30 residents at night. One direct care worker is required. Under the proposed regulations, those ratios would increase to one direct care worker for every eight residents on day and night shifts and one direct care worker for every 15 residents during the night.
Currently, facilities with 10 or fewer beds must have at least one responsible adult present at all times. The number of full-time employees will increase to two.
For memory care units, the proposed staffing requirements are even more stringent and higher than those currently required for nursing homes. One direct care worker is required for every five residents during the day and at night, and one care worker is required for every 10 residents on night shifts.
Experts and advocates told the Monitor that residents with Alzheimer’s disease and other dementias are the most vulnerable because they tend to wander. The proposed regulations would also require residents to be assessed for the risk of elopement, defined as “leaving a secure facility without authorization or supervision.” The Monitor and ProPublica found that at least 115 elopements were reported at residential care facilities in Maine from 2020 to 2022, according to a database of state inspection records and incidents reported to the health department.
“New significant costs”
The proposed changes were “quite shocking,” said Angela Cole Westhoff, president and CEO of the Maine Health Care Association, which represents nursing homes and assisted living facilities in the state. Ta.
Westhoff and facility managers repeatedly asked the state during a public hearing this month to pause the process to get more input from the industry. A DHHS spokesperson did not respond to questions about what would happen if the agency misses the Jan. 10 deadline to submit a proposal to Congress in favor of further discussion.
The staffing requirements would mean adding about 2,000 additional direct care workers, according to MHCA estimates.
“The industry will incur significant new costs without a corresponding increase in Maine care spending and private payroll pricing,” he said, referring to Maine’s version of Medicaid. We’re not in that financial position,” Westhoff said. Providers strongly disputed DHHS’ assertion that the rule is expected to have “minimal financial impact on licensed providers.”
DLTC Healthcare & Vera Point, a company that owns and operates 17 residential care facilities, estimates the changes will cost each 30-bed facility an additional $108,000 per year.
The directors of finance and human resources for Schooner Estates, Schooner Memory Care and Fallbrook Woods estimate that the three facilities will need to add 68 full-time equivalent employees, totaling $4.5 million annually. Ta.
The Woodlands Senior Living, which operates 16 facilities in Maine, said it needs to hire more than 300 staff across all its facilities, totaling nearly $13 million a year.
Many health care providers said they will likely have to pass these costs on to residents unless regulations come from the state that increase MaineCare reimbursement.
Facility owners and managers also warned that increased staffing requirements will be difficult to meet due to labor shortages. During the hearing, one resident services director in Saco said he had been trying to hire a nurse for more than two years. Another administrator said that her facility’s last recruitment took two months to fill, but when it was finally hired, the candidates were “unqualified” and required months of training. He said it was necessary.
DHHS spokeswoman Lindsay Hames said the department could not comment on the proposal while it was in the rulemaking process and that the proposal was subject to change based on public comments, which were accepted through Nov. 25. .
“The stakes are high here.”
At recent public hearings, facility representatives voiced their vocal opposition, but others also testified in support.
Nicole Marchesi, who works at the Ombudsman’s office, cited a recent study of direct care workers that said increasing staffing ratios could help prevent burnout and turnover.
Maine Department of Health rarely investigates residents when they wander from nursing homes
“Staff continue to express dissatisfaction with the care of residents receiving nursing-level care in nursing homes,” Marchesi said. “Lack of staff threatens the safety of residents.”
Long-term care ombudsman Gallant and Maine Elderly Legal Services also advocated for license renewals and inspections to be completed annually instead of every two years, and standards for following up with remediation plans when facilities are flagged as having deficiencies. It was recommended to create a standard practice. . In an investigation into elopements, the Monitor and ProPublica found that in most cases, DHHS never inspects the facilities and rarely imposes sanctions.
“The stakes here are high,” wrote John Brautigam on behalf of the Maine Office of Elder Justice. “These rules have the potential to prevent neglect, improve health outcomes, and foster an environment where residents feel valued and safe. We want these protections to be as strong as possible. We owe it to them to ensure that.”
