“Don’t settle us into a deeper crisis. » This was the almost unanimous plea during a hearing on November 13 in Augusta. About 175 people who are working to prevent the collapse of Maine’s elder care network participated – some testifying emotionally that the state’s proposed new rules will have a devastating impact.

“Massive closures”, predict several witnesses. “You will only make things worse,” predicted another.

Worse still, in a rapidly aging state already struggling with health care shortages at all levels.

Last month, the Maine Department of Health and Human Services (DHHS) released proposed regulation governing the state’s nearly 1,200 assisted living and residential care facilities. These facilities, licensed and inspected by the state, represent the entry level of care for those who are no longer able to live independently but do not need more skilled care provided in nursing homes, memory care units or hospitals.

From a purely financial perspective, residential care and assisted living services represent a boon to the state, providing care at lower per diem rates than those provided in nursing homes or hospitals. Logically, it is this segment of the continuum of care for the elderly that the State should favor.

The proposed regulations, however, go in the exact opposite direction for the state, imposing a series of strict new standards more suited to nursing homes than assisted living facilities, which are not, by virtue of their clientele, medical establishments.

Many, in fact, are designated by the state as private, non-medical institutions – providers of social services, such as meals, companionship, and shelter. Caregivers are allowed to administer medications with the guidance of healthcare professionals.

If passed, the facilities most at risk of closure are small assisted living and nursing homes serving rural communities, where there are few options if the doors close.

Which population group will be hardest hit? The thousands of elderly Mainers of modest means who rely on MaineCare (Medicaid). Currently, MaineCare reimbursement rates do not cover the cost of care, often up to several thousand dollars per month per resident. As a result, many facilities now refuse to admit people receiving MaineCare or limit the number of beds available.

If the new rules take effect, “MaineCare beds will simply disappear,” several people warned at the hearing.

With the new rules, the gap between costs and reimbursement rates will widen. The rules do not include any guarantee of additional funding. That would depend on Parliament, which has historically been reluctant to meaningfully address funding shortfalls.

The new rules double some staffing levels, add new administrative and recordkeeping responsibilities, impose new licensing requirements and impose costly capital investments well above the standards now mandated by the state.

The burden of the new personnel requirements drew the most criticism at the Nov. 13 hearing and in written comments.

“Where do they think all these new workers will come from? a provider wrote to colleagues. The new requirement to double the number of employees on duty is unachievable in today’s job market, where there are two vacancies for every worker.

At Portland’s 75 State Street, a nonprofit residential care facility, the new staffing rules will increase operating costs by at least $500,000 a year, an administrator testified. A seven-bed nonprofit facility on Chebeague Island, already operating at a significant deficit, estimates additional costs at more than $190,000 a year.

The state’s official conclusion that the new regulations “should have minimal tax impact on licensed providers and no tax impact on DHHS” was particularly upsetting to many providers. The 107 pages of the new regulations surprised more than one. “There has been no collaboration on this, and that’s disappointing,” said Michael Tyler of the Maine Health Care Association.

DHHS is accepting written comments on the rules until 5 p.m. on Nov. 25 and will review the public response before submitting them to the Legislature after the first of the year. There, additional hearings are almost a certainty. The providers plan to express their objections.

“You are about to destroy a system that somehow still manages to serve the most vulnerable of our citizens,” one administrator warned. “What exactly does the state think?

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