The expected closure of the nursing home at Seaport Village Healthcare in Ellsworth has been tough on Samantha Jones of Blue Hill and her father, Ronald Stanko, who was a resident there.
Seaport Village is the only remaining facility delivering nursing care in Hancock County. And while Jones was finally able to move Stanko on Friday to another nursing facility, Narraguagus Bay Health Care in Milbridge, it’s been a “very emotional and very stressful” month, Jones said. Now, she and her husband must drive over an hour to see Stanko, 81, who has difficulty communicating and needs round-the-clock assistance.
It’s a story that’s played out many times across Maine in recent years, as numerous nursing homes have shut their doors or been converted to a lower level of care.
Over the past three decades, 51 nursing homes in Maine — nearly 40 percent — have closed, forcing residents and their families to search for other places to get round-the-clock care. The pace has accelerated in the past decade, with nearly two dozen nursing homes shutting down, including nine in the past four years.
So, how has it gotten so hard for companies to deliver a service as vital as nursing care in an aging state like Maine where it’s so needed?
It’s largely driven by reimbursement rates that haven’t kept up with the cost of delivering services. And given larger changes to the health care sector and economy during the COVID pandemic, it’s also become increasingly hard to hold onto staff with the limited salaries that nursing homes can afford to pay.
According to industry officials, the biggest challenge is that MaineCare, the state’s version of Medicaid, does not cover the full expense of providing round-the-clock skilled nursing care to residents. The shortfall makes it difficult to make ends meet and keep their doors open, said Ben Hawkins of the Maine Health Care Association, a group that represents long-term care facilities.
“Each nursing home is losing about $36, $37 a day” for each MaineCare patient at their facility, he said. “The numbers aren’t adding up.”
When news broke earlier this month that Seaport Village planned to shut down its skilled nursing care wing, Hawkins’ association and other industry officials urged state legislators to take action. North Country Associates, which runs several nursing homes in Maine, health care provider MaineHealth, and the state’s Long Term Care Ombudsman Program joined the association in calling for greater funding for MaineCare.
“From 2012 to 2022, MaineCare’s reimbursement shortfall increased from approximately $28 million to $43 million per year,” the groups said in a joint statement. “Nursing homes will continue to close until this is resolved.”
As recently as a decade ago, Hancock County had licensed nursing homes in Bar Harbor, Deer Isle, Ellsworth and Penobscot.
Penobscot Nursing Home was the first among them to shut down, after federal regulators revoked its Medicare and Medicaid certifications over substandard conditions and practices. Then in 2019, Sonogee Rehabilitation and Living Center in Bar Harbor closed, with its owner citing declining occupancy and increasing labor costs as the reason. Last summer, Courtland Rehabilitation and Living Center in Ellsworth told residents and families that it was closing its nursing wing and would offer only residential care, according to local media reports.
When the nursing home wing shuts down at Seaport Village, pending authorization by state regulators, the nearest nursing homes for the county’s residents will be in Belfast, Brewer and Milbridge.
For residents of Deer Isle and Stonington, which lost their local nursing home in 2021, those destinations are roughly an hour and a half away. Making those drives takes less time from other parts of the county, but still may put long distances between patients and their loved ones — and that’s if those other nursing homes have available beds.
When Jones first heard about the changes at Seaport Village, she hoped her father would be able to stay on under the less-intensive residential care services that will continue to be offered there. But her outlook changed after talking to officials from the new ownership group, Camden-based DLTC Healthcare & Bella Point.
“It would have been very bad for us financially and for dad’s care if we had stayed” with Seaport, Jones said. “Thankfully we were able to find a place for him.”
While the last month has been difficult, she feels good about Narraguagus Bay, which got a lot of community support when its roof membrane blew off in a storm two years ago. It has more of a homey feel than Seaport did, she said.
Jones added that she and her husband hired a lawyer to help them navigate the situation for her father — something not everyone can do. They live in a house they built on her father’s land and did not have a mortgage on the property, but they took out a mortgage loan so they could pay to move her father into Seaport.
With the change in ownership at Seaport, and with the uncertainty of trying to enroll her father in a different type of care, she is not sure how things would have turned out if they had tried to keep him there.
“We’re just trying to survive,” she said. “I feel like there are so many families right on the edge of what they can afford.”
Brenda Gallant, the state ombudsman for long-term care, said that even if families can find a spot for a loved one at another nursing home, moving further away can harm patients. A loss of familiarity between a patient and nursing staff can make it hard to note changes in a patient’s health, she said, and fewer visits from friends and family can lead to depression.
“There are many challenges with a closure,” Gallant said. “It’s a very stressful situation.”
Staffing for nursing homes — a key factor cited by Deer Isle officials as they tried to keep Island Nursing Home functioning — is a problem statewide and is related to nursing home financial challenges, Gallant said. Many health care facilities have come to rely on temporary staffing agencies to fill nursing shifts, but those services tend to be much more expensive than hiring nurses directly, which exacerbates the inadequate reimbursements from MaineCare, she said.
“Consistent staffing is very important in terms of quality of care,” Gallant said. “We need to reduce our reliance on agency staffing.”
Hawkins agreed, saying the nationwide labor shortage is part of the problem. Nursing homes have difficulty offering higher wages to workers, who often take competitive-paying jobs in other sectors such as retail that have better hours.
“We haven’t had a labor shortage like this in this country in 40 to 50 years,” Hawkins said, adding that he does not see any short-term solutions to the problem.
“I’m not optimistic at this point,” he said.