Testimony reveals nursing home bed removal hardships

Well over 100 people attended the April 5 Department of Health and Human Services' (DHHS) reconsideration hearing of the certificate of need (CON) granted to First Atlantic Healthcare for the removal of 52 nursing home beds from the Calais‑based Atlantic Rehabilitation and Nursing Home to Hancock County.
United Methodist Pastor Ron Chaffee was one of a number of those who testified in support of reversing the CON. He stated, "My purpose right now is to keep the other party, the residents, our loved ones, who are already at our mercy" in the minds of those making the decision about whether to retain the beds and keep the Calais nursing home open.
Chaffee's mother is a resident at the nursing home. "I'm speaking from a biased perspective because my mom is valuable to me." And his mother is valuable to his sister and his father, both living in Calais. "I will go wherever my mother goes." Chaffee's voice broke as he added, "But my dad can't. ... He'll get lost 15 miles out of town."
Those who testified against the granting of the CON discussed the emotional and financial hardships on family and the physical and emotional tolls that such a closure would mean for nursing home residents moved far from familiar faces. Long driving distances to alternative nursing homes and the lack of any nursing home to serve northern Washington County were also given as reasons not to close the facility.
All those present, said Dr. Peter Wilkinson, "are the future residents of nursing homes. ... If you take the time to transpose yourself to that Atlantic Rehab bed, you'll know the right thing to do." He added that the credo first taught in medical school was one relevant to the situation. "First, do no harm."
Sunrise County Economic Council Director Harold Clossey listed Atlantic Rehab’s approximate value to the local economy. He explained that there are three ways to measure the loss of jobs: direct, indirect and induced. If the facility employs 92 staff, the payroll loss would be about $3.5 million, with an economic impact on an additional 141 jobs to the area for a total loss of over $13 million.
At 31 staff, the payroll loss would be about $3.3 million, with an impact on an additional 93 jobs being affected for a total loss of about $8.6 million.
Karen Raye, wife of Senate President Kevin Raye, read his testimony in his absence. "The loss of nursing home beds in the Calais area will have a long-term deleterious impact on the well‑being of residents of the Calais nursing home and their families, as well as those who may require nursing home care in the future." Raye cited 2010 U.S. Census and Maine State Planning Office statistics that differed from those from the Muskie School of Public Service used by First Atlantic in its CON application. Raye's citations suggest that the county's population of those 65 and older will increase with time, putting additional pressures on assisted living and nursing home needs in the county.
A number of those presenting testimony cited similar information as Raye, including Calais Regional Hospital CEO Michael Lally, Calais Mayor Joseph Cassidy, Calais City Manager Diane Barnes, Baileyville Town Manager Linda Pagels‑Wentworth, Teamsters Union Local 340 Business Agent Traci Place and Eastport Memorial Nursing Home board President Gwen Jones.
Calais resident Jane Marino described herself as an example of the county's aging population. She explained, "I'm following my mother's path." She bought her home in Calais for retirement and expects that as she ages she will transition to an apartment, then to assisted living and finally to a nursing home. "But where?" she asked about her final home.
Calais United Methodist Pastor David Granger noted, "Families have deliberately chosen the placement of residents in area assisted living facilities because of the proximity to the nursing home."

Finding a model that will work
The DHHS commissioner has 60 days from the April 5 hearing to make a decision about the CON granted to First Atlantic. But her decision does not necessarily mean that Atlantic Rehab will stay open.
First Atlantic CEO Kenneth Bowden testified that the situation was compounded by policy decisions made over the years by the state that have had significant bearing on the ability of for‑profit nursing homes to stay financially healthy. He said that when he started his career about 30 years ago, he never thought he would be in the position of having to close a nursing home. He acknowledged, "It's hard to have someone like me stand here talking numbers." He added, "Our company is unable to pay all the expenses at the facility" because of principles of reimbursement for direct care, administrative allowances, among other factors.
In response to a comment that a percentage of monies collected from nursing home residents and mandated by law to be used for facility upgrades and maintenance had not been used for that purpose, Bowden stated that between the nursing home and Washington Place the company had spent over $2 million during its ownership. Bowden also explained that the state's placement of the nursing home on a list to "replace" rather than "renovate" created additional difficulties, but if "significant" renovations were to occur, they would be well over $1 million. The home's load‑bearing wall placement makes it difficult to expand or reconfigure room sizes, which do not conform to current nursing home requirements. Bowden said, "It would be very difficult to do anything with the structure other than to start over."
Dr. Charles McHugh's statement that First Atlantic does not "own" the 52 beds it is seeking to move to Hancock County was addressed later by Bowden when he explained that with current law the amount of nursing home beds in the state is a fixed number, thus requiring that a facility be closed or downsized if another is built or expanded.
Gwen Jones testified, "We may not need all the beds that are leaving us, but we do need additional long‑term nursing home beds to stay in the Calais area. ... I urge the state to consider designating additional nursing home beds to this area."
The hearing was not the forum to discuss the nursing home's future options, but Bowden commented that the City of Calais could own the facility profitably because the law allows a higher rate of Mainecare and Medicare reimbursement than the rate given to a for‑profit. Another option he suggested was to transfer 15 beds to Washington Place and "put 15 beds back on line" at First Atlantic's facility in Machias.
Bowden presented additional information about the unique status of the Eastport Memorial Nursing Home. "It's one of the only ones that departs from the norm." He explained that the rule governing Eastport's nursing home applies only to those on an island with less than a certain number of beds. It is subsidized at a similar level to municipally‑owned nursing homes. "The Eastport example is what we should be looking at," he suggested as the possible model for the Calais facility.
The hearing testimony will be reviewed by the DHHS commissioner to determine if there was significant relevant information of the effect of the closure on Calais and the surrounding areas that was not known at the original granting of the CON.

Bill amends notification process
In response to the process that was followed by DHHS concerning the Calais nursing home, Senate President Kevin Raye has sponsored LD 1848, "An act to require notification of health care facilities that may be negatively affected by a CON application." The bill "expands the notification requirements" of the CON Act of 2002 to "specify that if an existing health care facility may close or lose bed capacity as a result of a proposal for which a CON application has been filed, DHHS must notify municipal officers of the municipality in which that health care facility is located and the members of the state House of Representatives and state Senate representing any part of that municipality." The bill requires the published notice to identify the name and location of any health care facility that may close or lose bed capacity.
The legislation had originally called for notice to be given in a newspaper published in the service area of the affected health care facility, but that requirement was taken out by the legislature's Health and Human Services Committee. The amended bill passed in the House on March 30 and in the Senate on April 2.
Washington County residents were caught by surprise by the nursing home news because there was no requirement in the previous law to publish a notice in a Washington County newspaper or to hold a public hearing in Calais because the county and the city did not fall into the expenditure location of Atlantic Healthcare's projects.