Pop goes the initiative

After five years of pumping up Maine’s potential as a relocation destination for affluent retirees, state officials must have found the medical panel discussion at the Governor’s Conference on Retirement and Aging this week to be about as welcome as a needle in a balloon factory. Nothing deflates an economic-development initiative quicker than a sharp dose of reality.

From the time this initiative was introduced in Gov. King’s Economic Development Strategy of 1996, and through two State Planning Office reports (Golden Opportunity in 1997 and Golden Opportunity II two years later), it has been clear that the success of pitching Maine’s scenery, safety and relaxed lifestyle to retirees depended, above all, on having a health-care system that meets the needs of seniors.

Yet the panel of professionals from across the spectrum of health care was unanimous in agreeing that Maine does not have such a system. Worse still, despite persistent warnings, it continues to move in the wrong direction.

The deficiencies are well known to those involved in elder care: an inadequate number of physicians and nurses trained in geriatric specialties; state regulations that make such training difficult to obtain; paperwork that swamps providers, especially nurses, which reduces contact with patients and greatly increases job frustration; and disjointed services and reimbursement sources. This is a lot to fix at once, but five years should have been enough time to make a start.

A good place to start now would be with those who have, or should have, the most direct contact with patients – the nurses. Maine is hardly alone in having a severe shortage of nurses and rampant nursing burnout; it is a worldwide problem. But Maine cannot, for the sake of immigrant retirees and current residents alike, allow it to persist.

One especially telling measure of burnout is that Maine, according to a national study, has the highest percentage in New England of registered nurses who have left their profession to work in other occupations, a dreadful waste of education, expertise and caring. A bill to address this problem – L.D. 1085, An Act to Improve Staffing in Health Care Settings – was introduced last session but held over. The amended version lawmakers will take up in January is a distinct improvement on an already good idea.

The original version, sponsored by Sen. Peggy Pendleton, a nurse education consultant, would have based licensing of health-care facilities on nurse staffing levels based upon acuity – how sick a patient is – a standard that experience elsewhere has revealed as flawed. An amended version Sen. Pendleton will propose this coming session will base minimum staffing requirements on a specific nurse-patient ratio. This method is being embraced in other states; in Australia, it is credited with the return of some 2,300 nurses to the profession within the first six months of its adoption.

The shortage of slots in nursing schools is another issue that has been neglected too long and about which lawmakers can do something. The decline began in 1994 with a freeze on nurse hiring across the state. With nursing thus identified as a no-growth field, nursing school enrollments declined which led state universities and colleges to scale back their programs, a situation that continues today. Recent legislatures, even in years of robust surpluses, have ignored this problem and rejected numerous proposals to provide additional funding for nurse education, such as loan forgiveness program last session. This Legislature will have no such surpluses, but it will have the same problem and some difficult choices to make.

It is unfortunate that this retiree-attraction initiative was touted as a boon to Maine’s struggling economy for so long while such a fatal flaw went unaddressed. That flaw, exposed with such a loud pop at such a visible forum, should now be impossible to ignore.