February 3, 2013

Chronic underfunding means long hours, short staffing for Maine nursing homes

By Susan M. Cover scover@mainetoday.com
State House Bureau

The Oak Grove Center nursing home in Waterville swirled with activity last week, with a beano game in one room, two women chatting over coffee in another, and an ambulance crew wheeling in a new resident on a gurney.

click image to enlarge

Sara Sylvester, right, administrator at the Oak Grove Center in Waterville, speaks with employee Betty Bayley in a rehabilitation unit on Thursday. Sylvester said that the facility is concerned about funding shortfalls that could impact staffing.

Staff photo by David Leaming

click image to enlarge

Betsy Stevens reads a book in the dining room on Friday at Heritage Rehabilitation & Nursing Center in Winthrop.

Staff photo by Joe Phelan

A nurse typed on a wall-mounted computer in the hall, and administrator Sara Sylvester took a turn answering the phone in the front lobby so one of her employees could go to lunch.

The staff of 130 full- and part-time workers often do double duty, but they don't get paid overtime.

The facility provides care 24 hours a day, seven days a week for 90 people. It is one of 107 nursing homes statewide that are continuing to deal with chronic underfunding from the state. Over the past five years, the nursing homes have been underfunded by $122 million in state and federal funds, and places such as Oak Grove run an average of $340,000 short every year, according to the Maine Health Care Association, a trade group that represents most nursing homes in Maine.

The payments fall short because they are based on a 2005 formula, so even as utility and other costs have gone up, the payments have not.

"I've had to cut back on the night shift," Sylvester said. "I don't have an afternoon-evening receptionist. We don't do any overtime."

In Winthrop, at Heritage Rehabilitation & Nursing Center, MaineCare funding fell short of expenses by $99,250 in 2011, administrator Matthew Lessard said.

He, too, struggles with staffing, particularly because he can't pay competitive wages.

"We still push to provide the best quality care, but we can't keep up with wages offered in other industries," he said. "We have a set rate based on 2005 data to pay people in 2013."

The center employs 86 to 100 people, either full-time, part-time or on a per-day basis. There are 28 nursing home beds and 24 people who live in the residential care unit.

Another factor to consider is that Maine has stringent standards when it comes to allowing people to live in nursing homes, which means those who live in the facilities suffer from multiple health problems, Lessard said. Also, Maine has a large population of older residents, putting more strain on the system.

"It's almost like they could get hidden," Lessard said. "It's our job as advocates to ensure that doesn't continue to happen."

To that end, the health association recently launched a renewed effort to get the funding necessary to keep the homes open and safe. In the coming weeks and months, the association will push for a bill before the Legislature that seeks to increase MaineCare rates paid to nursing homes, give more money to facilities where more than 70 percent of residents rely on MaineCare, and set up a system that rewards nursing homes based on performance.

Those changes are estimated to cost $6.5 million over two years, which would come from the state budget.

Richard Erb, the association's president, said he doesn't think it's unrealistic to ask for $6.5 million out of a $6.2 billion state budget.

He said $6.5 million "is a lot of money for us, but within the entire state budget, I don't think that's unachievable," he said.

Nursing homes will have to compete for funds against other social service programs in the budget, including a prescription drug program for the elderly and disabled, which is proposed for elimination; and substance-abuse prevention and community mental health services, both of which are expecting funding cuts. Also, municipalities have vowed to fight the proposed loss of all of their state funding for the next two years.

(Continued on page 2)

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