"Do not regulate us into a deeper crisis." That was the near-unanimous plea at a hearing on Nov. 13 in Augusta. About 175 people who work to keep Maine's struggling eldercare network from collapsing participated - some testifying emotionally that new rules proposed by the state will have a devastating impact.

"Mass closures," predicted several witnesses. "You'll just make things worse," predicted another.

ABOUT THE AUTHOR

Susan Q. Stranahan is a journalist and author who is president of the board of the Island Commons, an assisted living home on Chebeague Island.

Worse, in a rapidly aging state already reeling with health care shortages at all levels.

Last month, Maine's Department of Health and Human Services (DHHS) issued proposed regulations governing the state's nearly 1,200 assisted living and residential care facilities. These facilities, which are licensed and inspected by the state, represent the entry level of care for those no longer able to live independently but who do not require the higher skilled care delivered in nursing homes, memory care units or hospitals.

From a purely financial perspective, residential care and assisted living services represent a bargain for the state, offering care at lower daily fees than what is provided in nursing homes or hospitals. Logically, this is the segment of the eldercare continuum that the state should be fostering.

The proposed regulations, however, take the state in exactly the opposite direction, imposing a raft of strict new standards, more appropriate for nursing homes than for assisted living homes, which are not, by virtue of their clientele, medical facilities.

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Many, in fact, are designated by the state as private non-medical institutions - providers of social services, such as meals, companionship and shelter. Caregivers are licensed to administer medications with guidance from medical professionals.

If enacted, the facilities most in danger of closing are small assisted living and residential care homes serving rural communities, where there are few options if doors close.

What population group will be hardest hit? The thousands of elder Mainers of modest means who are reliant on MaineCare (Medicaid). Currently MaineCare reimbursement rates don't cover the cost of care, often by as much as several thousand dollars a month per resident. As a result, many facilities now refuse to admit those on MaineCare or limit the number of beds available.

If the new rules go into effect, "MaineCare beds will just disappear," warned several at the hearing.

Under the new rules, the disparity between costs and reimbursement rates will balloon. The rules come with no guarantee of additional funding. That would be up to the Legislature, which historically has been reluctant to address funding shortfalls in any meaningful way.

The new rules double certain staffing levels, add significant new administrative and record-keeping responsibilities, impose new license requirements and mandate costly capital investments far above the standards the state now imposes.

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The burden of the new staffing requirements drew the most criticism at the Nov. 13 hearing and in written comments.

"Where do they think all these new workers are going to come from?" one provider wrote to colleagues. The new requirement doubling the number of on-duty staff is unattainable in today's job market, where there are two vacancies for every one worker.

At Portland's 75 State Street, a nonprofit residential care facility, the new staffing rules will increase operating costs by at least $500,000 a year, an administrator testified. A seven-bed nonprofit facility on Chebeague Island, already operating at a significant deficit, estimates additional costs of more than $190,000 annually.

Particularly upsetting to many providers was the official finding by the state that the new regulations are "expected to have minimal fiscal impact on licensed providers and no fiscal impact to DHHS." The 107 pages of new regulations caught many by surprise. "There was no collaboration on this, and that is disappointing," said Michael Tyler of the Maine Health Care Association.

DHHS is accepting written comments on the rules until 5 p.m. Nov. 25 and will review the public response before submitting them to the Legislature after the first of the year. There, additional hearings are almost a certainty. Providers plan to voice their objections.

"You are about to destroy a system that, somehow, still manages to serve the most vulnerable of our citizens," warned one administrator. "What exactly is the state thinking?"

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