The recent closing of long-term care facilities in the Pine Tree State has highlighted concerns about what's happening to the industry. If you or a loved one need care now or later, you may wonder what to do and where to go. Knowing what's in-store for long-term care in Maine and nationwide can help you explore your options.
Where Things Stand Now
Rising costs continue to be an issue. Genworth's Annual Cost of Care survey reports that in Maine, the average price of one year of care for a private room in an assisted living facility is $71,298, a 15 percent increase since 2019. Nursing home care averages $115,705 for one year. Among all the forms of long-term care, the figures place Maine among the top 20 states with the highest costs.
Regardless, several facilities have closed in Maine, and more may follow. The COVID-19 pandemic has worsened several existing long-term care issues in Maine and nationwide, which include:
• An aging population: Mainers are the oldest Americans by median age (45) during a period of increased need for care. "As Maine goes, so goes the nation" doesn't apply just to politics. According to The Washington Post, "The disconnect between Maine's aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade."
• Staffing shortages: Low wages and anxiety about catching the coronavirus or burnout from its effects on patients have caused some workers to quit or retire early. The results of a Maine Health Care Association (MEHCA) survey of 122 provider members showed that 94 percent of them were experiencing staffing shortages. Nearly 50 percent said they were at crisis levels. The recent COVID-19 vaccine mandate for healthcare workers may have led more to quit, further depleting the workforce.
• Expenses: There are many regulatory, licensing, and employee certification costs.
• Increased employment costs: According to the Genworth study, higher mandated minimum wages and recruiting and retention costs, including higher hazard pay, and added benefits such as free childcare have exacerbated staffing challenges.
• Lack of funding: State and federal funding doesn't cover all of the costs of running long-term care facilities. Some of them haven't received enough money from Medicaid, which bases its reimbursement rates on an outdated payment structure.
• COVID-19: The need for new safety procedures, testing, personal protective equipment, and cleaning supplies has also increased costs for facilities.
The effects of these multiple contributing factors have led not just to closures of facilities, but to reduced hours and services in existing centers. Many of them have long waitlists for care or end up leaving patients in hospitals. With fewer options, some families need to travel long distances to visit their loved ones. As a result of these and other problems, some solutions are emerging and are being put into place.
What's On the Horizon
The top response from the providers in the MEHCA survey in addressing workforce challenges was to increase wages (86 percent of respondents). Many of them also wanted to offer bonuses to staff who work overtime or double shifts (83 percent). Sign-on bonuses, using contract/agency staffing, and hiring campaigns were among the other ideas.
To improve the staffing issues, some experts suggest using temporary nurse aid programs to reduce training requirements for nursing home workers. The Centers for Medicare & Medicaid Services (CMS) has already implemented some of them in other states.
State and federal government officials know that care costs are a burden, and they are seeking ways to increase funding. According to NewsCenter, in January 2020, the state government held a Commission to Study Long-Term Care Workforce Issues. Among the recommendations they made were to pay direct care workers more -- at least 125 percent of the minimum wage -- and to increase training and support. Maine's legislature has also passed bills to increase MaineCare reimbursements and wages to direct caregivers.
On the federal level, Maine Senator Susan Collins and New Hampshire Senator Jeanne Shaheen led a group of 50 senators in a bipartisan push urging Health and Human Services to release $25.5 billion to direct care facilities. Other state and federal efforts include:
• The American Rescue Plan Act of 2021 (ARPA), which included a ten percent federal medical assistance percentage increase for Medicaid home- and community-based services. States can use it for direct care worker recruitment, retention, and training initiatives. The ARPA also includes $360 billion in aid to state and local governments to offer premium pay for essential eligible workers. The Maine Dept. of Health and Human Services has outlined its plans for its share, which include increasing wages and easing the certification process.
• The proposed historic Build Back Better Act contains funding to increase support for aging services and direct care workers.
• Grants aimed at supporting long-term care workers, such as the $425 million Health Profession Opportunity Grants program, which provides grants for support services (childcare and transportation) and direct care worker training.
• The Older Americans Act offered $1.2 billion in funding for the aging services network and infrastructure, including $650 million to support home and community-based services. The state's plans for the funds include developing and expanding in-home services, improving the quality of community services, and strengthening elder rights programs.
Industry experts have discussed changing the traditional long-term care model to more flexible options, such as small-home settings and communities of houses accessible for people with disabilities. Among the potential benefits of these structures are a decrease in the spread of infectious diseases and more personal care. The future of long-term care may look bleak, but with these and other innovations, it's starting to look brighter.
Based on these trends, it makes sense to think now about the future for you and your loved ones. Long-term care can be a complex issue. We're here to help you understand it and plan for it. Contact us online or call us today at (207) 377-6966.
