Assisted living services pondered Panel sought to study increasing demand

AUGUSTA – Maine has received a $156,000 grant from the Robert Wood Johnson Foundation to plan how to handle the growing demand for assisted living, a level of care proving very popular across the country and in Maine. But some lawmakers and advocates say the study is not enough, and they want a commission with public members to explore the issue.

“I had not even heard of the grant until you just told me,” said Rep. Tom Kane, D-Saco, sponsor of a measure that would set up a commission to study the growing need for assisted-living facilities in Maine. “The preference of most, who can no longer stay in their own home, is a home-like setting. They may not need a high level of nursing services, but they need some supportive services. We need to study how best to provide these services in a legislatively directed study.”

Kane said he is pleased the Department of Human Services has received the grant, but added setting public policy is the role of the Legislature, not the department. He said the study would be very helpful but is not a substitute for a commission with consumer representation.

“We have heard plenty of complaints today about policies and programs developed without public input and support,” he said.

As co-chairman of the Legislature’s Health and Human Services Committee, Kane was presiding over a public hearing on more than a dozen bills dealing with long-term care issues. Much of the public testimony was critical of agencies the state has contracted with for a wide range of services to the elderly.

“We need a study of long-term care issues free from the influence of the state,” said David Hall of Bath. “We need greater consumer participation.”

Part of the commission study, Kane said, would define the different levels of care for the elderly and how to plan to make sure services are available and affordable.

“I think assisted living fits a need for people who no longer can be at home or don’t want to be at home and don’t need the intensive medical care provided in a nursing home,” said Chris Gianopolis, director of the Bureau of Adult and Elder Services. “I think it is an important part of the picture, and we hope this grant will help us find out how to project the need for assisted living and look at ways to finance it and make it more affordable.”

Gianopolis said she had planned to oppose Kane’s legislation because it originally would have appropriated $2.7 million dollars over the next two years to expand assisted-living options in six areas of the state. She said the state could not afford the measure and she believes the foundation-funded study should be completed to help determine state policy before additional state dollars are spent. Kane abandoned the request for funds because of the state’s current financial problems. The second part of the bill to create a commission to study assisted living was left intact and was among those discussed at Monday’s public hearing.

“We are facing a real affordability challenge, particularly in the rural areas,” Gianopolis said.

Providing care for Maine’s graying population is expensive. Nursing home care costs more than $4,000 a month, while assisted living costs about half that amount. But residents in assisted-living facilities often are paying hundreds of dollars more a month out of pocket for medical care that is included in nursing home care.

Home-based care services have price tags as varied as the services provided. Some Mainers are receiving many services, including relatively expensive regular visits from nurses. Some are getting services costing more than $1,000 a month. Others are receiving only a few services like personal care assistants or homemaker services that cost a few hundred dollars a month.

About 8,000 Mainers reside in nursing homes, and about half of them are getting some level of home-based care services. Currently, however, there are fewer than 100 tax-subsidized assisted-living facilities in the state.

“The reality is these alternatives to nursing home care are saving the taxpayers a lot of money,” said Deborah Poulton, director of residential programs at the Eastern Agency on Aging, referring to both home-based care programs and assisted living. “And they really are better for the individuals.”

Poulton said there is a real shortage of assisted-living units for middle- and low-income Mainers. Currently there are 99 units statewide with another 55 apartments becoming available in the next few months. Only 30 additional units are in the planning stage, all in Augusta.

Several thousand assisted-living apartments have been built and are in use by those Mainers with a retirement income sufficient to pay the monthly bill without any public assistance. Some “retirement centers” can be quite expensive and offer amenities usually found at resorts, not apartment complexes.

“We are very concerned about what happens when those people run out of money and can no longer afford some sort of assisted living,” said Brenda Gallant, Maine’s long-term care ombudsman.

She said every month there are Mainers in nursing homes who have been paying for their own care who run out of cash. Gallant said she expects that also will be a problem in assisted-living apartments.

A committee work session on the bill, LD 853, to study assisted-living options will be scheduled later.