Closure is not imminent at Atlantic Rehab

Calais and neighboring communities in Washington County were caught by surprise when rumors began to circulate on Monday, January 23, that Atlantic Rehabilitation and Nursing Center might be closed by its corporate owner, First Atlantic Healthcare of Portland. Atlantic Rehab Administrator John Wood issued a press release on January 24 stating that "no closing is imminent." First Atlantic CEO Kenneth Bowden stresses that if the facility is to close, it would be "in a couple of years."
In early 2011 First Atlantic submitted a proposal with the Department of Health and Human Services (DHHS) Division of Regulation and Licensing Services (DRLS) to expand its Ellsworth facility, Collier's Rehabilitation and Nursing Center, which would be partially predicated on the transfer of bed rights from the Calais facility to Ellsworth. On January 9 First Atlantic was granted its "certificate of need" (CON) by DRLS.
Part of the surprise felt by the Calais community may be attributable to the lack of public notice or public informational meetings held about the Ellsworth project. CON regulations specify that public notice be published in Kennebec County and a newspaper published within the service area in which the proposed expenditure occurs, in this case Ellsworth. A public information meeting was held in Ellsworth in August 2011. Notices were published in the Bangor Daily News on August 1, 2011, and the Kennebec Journal on July 30, 2011. Public comments were accepted from July 27 through September 3 and November 17 through December 8. Because Calais is not where the project's expenditures lie, there is no regulatory requirement to notify the community of the proposal.

Transfer of "bed rights"
The number of beds is a critical component to the CON regulatory process that governs the expansion or building of a healthcare facility. According to the National Conference of State Legislatures, Maine is one of about 36 states that has CON regulations, which are meant to restrain health care facility costs and allow for coordinated planning of new services and construction. CON programs originated to regulate the number of beds in hospitals and nursing homes in order to prevent excess capacity and thus the inflation of health care prices.
Atlantic Rehab was originally licensed for 100 beds, but is now licensed for 52 and has 41 clients. First Atlantic's Ellsworth expansion proposal states that while Hancock County's number of beds is below the state average and the county's need is expected to grow, Washington County's population is declining and it has over the state average for number of beds available.
Bowden's company has been tracking the number of beds available in the county that are defined as within 60 miles of Calais by DHHS. "There are 20 to 29 available beds" on average at any given time, he notes. If Atlantic Rehab were to close, Bowden is confident that a majority of its residents could find a place in one of the nursing homes within a 60‑mile distance of Calais, whether Eastport, Lubec or Machias. The facility in Machias has the capacity to expand by 10 to 15 beds, he notes. Residents also would have the option of transferring to the expanded Ellsworth facility.
DHHS Director of Communications John Martins explains that the CON analysis process notifies the Office of Elder Services (OES) about the proposal and provides the office with copies of the application. In the case of First Atlantic's proposal, OES reviewed the application and determined that the project met OES criteria for consistency with their expected demands for nursing care beds for the area served by the facility. He notes that the CON analysis further states, "there will continue to be a need for nursing facility beds in Calais and Washington County."

Washington County delegation expresses concern
Senate President Kevin Raye and members of the Washington County delegation met for three hours with Bowden on January 23 to express their concern over the possible loss of the Calais facility. Raye says, "We impressed upon him in passionate terms how critically important their Calais facility is to its residents, their families and the dedicated employees who provide their care. We appealed to him to allow time for options to be fully explored in an effort to ensure that this vital care continues to be offered in Calais over the long term."
First Atlantic's proposal states that Atlantic Rehab's facility has been deemed "need to replace" by DHHS DRLS. Martins explains, "The department maintains a list of facilities needing replacement. It considers a number of factors including code compliance, age of building, access and other factors." Bowden suggests, "It's not so much replacement, but underlying is if the institution can remain financially viable.... The way replacement facility regulations exist, it's virtually required to close two facilities to create one." He adds, "We also have an issue where MaineCare rates aren't sufficient to meet costs in facilities that have very high MaineCare populations."
Raye says, "Mr. Bowden indicated that the declining number of patients, which once numbered 100, but now are less than 40, has severely challenged the economics of the nursing home." He adds, "Today, more elderly residents receive in‑home services that allow them to stay in their own homes, and others live in assisted‑living facilities that do not offer the level of medical care provided in nursing homes, and Medicare‑reimbursed rehabilitative services are available in hospital settings. Together with low Medicaid reimbursements, these factors are challenging nursing homes, particularly those in areas with a high percentage of MaineCare‑eligible patients."
Atlantic Rehab has served the community since it was built in the 1960s, but people's expectations have changed, says Wood. "It's competitive out there," he adds. "I know of a number of people who are deciding to go to Bangor for rehab. That's where their physician is and they just decide to stay there." He notes, "It's an old building. We've tried to keep it up as best we could. It does have some problems.... At the time it was built it was considered fine." Now when potential clients look at facilities, they "want something nicer.... When people go out to look, this might not seem quite as nice."
About 90 employees work at the facility. Bowden notes that while the closure would not occur for a couple of years, when and if it happened, "We certainly would welcome any Calais employees C they've done a great job. We'd be interested in having them apply to our other facilities." In addition, his company would hold job fairs and track the inventory of openings within their own organization and others. He also believes that if one local facility closes, it "financially strengthens other facilities [in the county] because it increases their census."
If Atlantic Rehab were to close, Martins explains that the facility would have to notify DRLS 30 days in advance of intent to close. It would also need to produce a plan "to assure that those who are currently served are transitioned to care in the most safe and efficient way possible."
Raye comments, "The residents of the home are foremost in our minds. It would be tragic for them, and for the loved ones who spend time with them, if anyone were to be displaced. The entire delegation wants to be sure we leave no stone unturned to prevent that from happening." He adds, "At the conclusion of our meeting, Mr. Bowden assured us that a closure is not imminent, and that he will work with us to explore options to keep that from happening."