Maine Assisted Living
The typical resident population in Maine's assisted living communities is 68% female. Overall, 79% of residents are ages 75 and older, with 30% of residents ages 75 to 84 and 49% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Licensing and Regulatory Services division of the Maine Department of Health and Human Services licenses nine different types of facilities that provide assisted living services. These types include assisted living programs (ALPs), four levels of residential care facilities (RCFs), and private non-medical institutions (PNMIs). PNMIs are very similar to ALPs except that they provide bedrooms instead of apartment units.
The rules governing PNMIs are the same as those governing RCFs, except that they receive Medicaid funding to provide personal care services to the residents and must comply with an additional set of requirements.
An adult family care home (AFCH) is a residential-style home for eight or fewer residents.
Assisted living services are provided in four different settings: ALPs, independent housing with services programs (IHSPs), RCFs, and PNMIs. All services are provided directly by the facility or through a third-party contract. Assisted living services include one of the following:
- Assisted Housing Services: Personal supervision and protection from environmental hazards, assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), recreational activities, dietary services, and care management services.
- Assisted housing services with medication administration.
- Assisted housing services with medication administration and nursing services, which licensed professional nurses provide.
An ALP is a facility that provides the aforementioned services in private apartments in buildings that includes a common dining area. There are two types of ALP:
Type 1 - Assisted housing services with medication administration.
Type 2 - Assisted housing services with medication administration and professional nursing services.
An independent housing with services program (IHSP) is a facility that provides assisted housing services to residents in private apartments with a common dining area. IHSPs assist residents with both ADLs and IADLs. The difference between IHSPs and ALPs is that the IHSP does not provide medication administration services.
A residential care facility is a house that provides residents with assisted living services. RCFs provide housing and services to residents in private or semi-private bedrooms with common living areas and dining areas. There are four levels of RCF based on the number of residents and employees. The types are:
Type 1 - Licensed capacity of one or two residents, and licensing is voluntary.
Type 2 - Licensed capacity of three to six residents.
Type 3 - Licensed capacity of three to six residents and employs three or more persons who are not owners.
Type 4 - Licensed capacity of more than six residents.
Private non-medical institutions (PNMIs) are houses that provide residents with assisted living services. PNMIs are RFCs that receive funds from Medicaid and have the same types of homes as RCFs.
Resident Agreements and Disclosures
All resident agreements must describe the services and accommodations that will be provided to residents, along with the rates and charges for those services. The agreement also must stipulate charges that are not covered by the facility's base rate. All residents or their representatives must sign the agreement.
All residents must receive an information packet from the facility (or program) that includes information regarding advance directives, the type of facility, the licensing status, staff qualifications, and admission, transfer, and discharge policies and procedures.
If the assisted housing program operates a special care unit for residents with Alzheimer’s or another form of dementia, additional disclosures must be provided. The following must be disclosed:
- A statement regarding the provider’s service philosophy.
- The process for resident assessment and the establishment of the residents’ service plan.
- The frequency and types of group activities provided by the program.
- A description of family involvement and the availability of family support programs.
- A description of the facility’s security measures.
- A description of training provided for the staff.
- Admission and discharge policies and procedures.
Assisted Living Admission and Retention
Admission and retention rules are flexible in order to encourage aging in place. A resident may be discharged if the facility cannot provide for their needs, if the resident has behavioral issues that cause substantial physical damage to the facility, or if the resident becomes a direct threat to the health or safety of others.
Within 30 days of admission to a special care unit, a physician must document the resident’s Alzheimer’s disease or dementia diagnosis. The representative authority of the resident must also be documented in the resident’s record.
Assisted Living Services and Service Planning
ALPs must offer residents service coordination, housekeeping services, assistance with ADLs and IADLs, chore services, and other services as outlined in their service plans. Residents in ALPs need to be assessed within 30 days of admission and assessed every six months in order to develop and maintain their service care plan.
RCFs and PNMIs that are levels 1, 2, and 3 must coordinate health care services for their residents and assist them in accessing these services by providing or arranging transportation to medical and other appointments. Professional nurses must provide all nursing services, including coordinating assisted living services provided by unlicensed personnel.
Residents in Level 4 facilities are able to receive individualized services that enable them to age in place. In some cases, supplementary services can be brought into the facility to facilitate this, except in cases where it imposes a financial burden or a fundamental change in the program.
Medicaid covers services provided by PNMIs for personal care, housekeeping, laundry, dietary services, clinical consulting services, licensed practical nursing services, social workers, and other qualified and remedial services.
Assisted Living Food and Dietary Provisions
ALPs must provide residents with at least one nutritious daily meal. Menus must be planned in accordance with the needs and preferences of the residents and must be approved annually by a registered dietitian. Therapeutic diets are considered treatments and must be ordered in writing by a licensed practitioner and approved by a registered dietician.
RCFs and PNMIs must provide a well-balanced nourishing diet that meets all of the dietary needs of the residents. Level 4 facilities must provide a meal plan that provides three meals in a 24-hour period and must have a dietary coordinator trained or experienced in food service for the size of the facility.
Assisted Living Staffing Requirements
All ALPs must have an administrator with a current license related to residential care, ALPs, or health care. There are no staff ratios or minimum requirements.
The providers of Types 1, 2, and 3 RCFs and PNMIs are responsible for running the facility and must either be present or provide supervision when they are absent. The provider coordinates health care services and assists residents in accessing these services.
Level 4 RCFs and PNMIs require an on-site administrator licensed as a multilevel or resident facility administrator. Each facility must retain a registered nurse to observe residents' records and medication records, review medication administration practices and procedures, review therapeutic diets, and recommend staff training. All facilities with more than ten beds must retain the services of a consultant pharmacist at least quarterly.
Staffing levels in RCF/PNMI facilities must be adequate to provide for a safe setting and the residents' needs according to their care plans. Level 4 facilities with ten or fewer beds must have one authorized adult on-site at all times when a resident is present. Level 4 facilities with more than ten beds must have a minimum of two awake adults on duty and be available at all times.
Level 4 facilities must maintain the following resident care staffing ratios:
- 1 per 12 residents between 7 a.m. and 3 p.m.
- 1 per 18 residents between 3 p.m. and 11 p.m.
- 1 per 30 residents between 11 p.m. and 7 a.m.
Assisted Living Housing Requirements
ALPs are multi-unit residential buildings that provide apartments. Each apartment includes a bathroom, bedroom, and food preparation area.
RCFs and PNMIs provide housing and services in private or semi-private bedrooms in buildings with common living and dining areas. Up to two residents are permitted in each unit.
Levels 1, 2, and 3, licensed after 2004, must provide a bathroom and hand-washing facilities for every six users, including residents and staff. Level 4 facilities must provide one toilet and sink for every six users. Facilities licensed after May 2002 must have at least one bathroom with a toilet and hand-washing sink for each floor with residents.
Level 4 facilities also have bathing facility requirements. Facilities licensed after May 2002 must have one bathing facility for every ten users. Facilities licensed after May 1998 must have at least one tub or shower for each floor with resident bathrooms.
What Is Included With Assisted Living Care In Maine?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In Maine, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 57% of communities providing skilled nursing. Many have health care specialists and on-site services, with 65% of communities offering dental care. In addition, 70% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Maine, 89% of communities conduct depression screenings and 62% offer mental health counseling. Social work programs are also found in 62% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all necessary resources.
Some assisted living residents live with various medical conditions. In Maine, 53% have Alzheimer's disease or another form of dementia. In addition, 55% have high blood pressure, 43% have heart disease, 40% have depression, and 22% have diabetes.
State Mental Health Resources
The State of Maine Department of Health and Human Services, Office of Behavioral Health, manages several programs to support mental health. Anyone experiencing a mental health emergency can call the Maine Crisis Line. Individuals may also contact 211 Maine for free, confidential information about supportive services; the line is staffed 24/7. The nonprofit National Alliance of Mental Health (NAMI) has a branch in Hallowell, providing additional support to any Maine resident facing mental health challenges. The toll-free Intentional Peer Support Warmline offers support any time of the day or night. For veterans, support and counseling are available via the VA Maine Healthcare System or by calling the national Veterans Crisis Line, which is available 24/7. The Bureau of Veterans’ Services also maintains an up-to-date list of mental health resources.
Medication Services
When residents are admitted to any facilities covered by these regulations, they must be assessed for their ability to self-administer medications and their need for assistance. Unlicensed staff is permitted to administer medication and/or treatments as long as they have completed an approved training program. Medication administration includes reading the medication label for the resident, observing the resident taking their medication, checking the dosage, removing the prescribed dosage, filling a syringe and administering insult, and maintaining medication records for each resident. No other injectable medications are to be administered by an unlicensed person.
In ALPs and Level 3 and 4 RCFs and PNMIs, a qualified person must be on site when a resident has medications prescribed as ‘as-needed’ if the resident is not self-administering medications.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in Maine’s assisted living facilities often receive help with their ADLs. In Maine, 26% of residents need help eating. Other commonly used services include bed transfer (29%), toileting (36%), and walking (46%). Caregivers in ALFs help 49% of residents dress, and 67% need help bathing.
Cost Of Assisted Living Care In Maine
The average cost of assisted living care in Maine is $5,865. This is $1,365 higher than the monthly national average of $4,500. The cost of living in Maine is more than the national average by 15.0%, with health care costs more than the national average by 12.8% and housing costs more than the national average by 36.6%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $4,750 in the Bangor area to a high of $8,061 per month in the Manchester area of Maine.
How Costs Compare In Nearby States
Maine only borders one state but is close enough to Massachusetts that it should also be considered an option. The cost of Assisted Living in New Hampshire averages $6,053 per month and $6,500 in Massachusetts. Both states have a higher average cost than Maine, but you may be able to find something affordable outside the state.
Maine Assisted Living Oversight
The Division of Licensing and Certification of the State of Maine Department of Health and Human Services oversees assisted living communities' legal and regulatory compliance in Maine. The Maine Long-Term Care Ombudsman Program investigates complaints against senior residential care facilities, such as assisted living communities and nursing homes. It helps individuals resolve issues related to standards and quality of care. Individuals can contact the Office of Aging and Disability Services for help accessing medical support, funding, or social services.
Quality and Safety of Assisted Living Facilities in Maine
Under Chapter 113 of the Code of Maine Rules, assisted living facilities that house two or more residents must obtain a Department of Health and Human Services license. Communities must meet minimum standards related to safety, health, and quality. Facilities comply with this by having documented procedures for disasters and emergencies, meeting staffing requirements, and adhering to local fire safety regulations. The Department of Health and Human Services periodically inspects assisted living communities and investigates complaints from residents and their family members.
All potential employees must pass a background check from the Maine Background Check Center before being hired. Communities cannot employ anyone convicted for a disqualifying offense, such as exploitation, abuse, and neglect. Staff members of a Level 4 facility must complete a minimum of 50 hours of training related to personal support and a 40-hour course on medication administration. Any employee who administers medication must complete a Board of Nursing-approved training course. Community administrators must have a professional license in the field of residential care or a minimum of five years of experience working in healthcare.
While no prescribed staffing ratios exist for Level 1, 2, or 3 facilities, adequate staff members must be on duty to care for residents appropriately. Level 4 communities with more than ten beds must always have at least two staff members on duty. For Level 4 communities with a capacity of 10 or under, at least one staff member must always be present.
Legal Resources
The term "elder law" is often associated with estate planning, trusts, and help to obtain benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues.
In Maine, Adult Protective Services operates a 24/7 phone line for individuals to report neglect, abuse, and exploitation of seniors and other dependent adults. People can also use the online report form. Maine’s network of Area Agencies on Aging and Aging and Disability Resource Centers can connect seniors with free or low-cost legal services. Maine Senior Medicare Patrol provides assistance in cases of Medicare fraud and misuse.
Legal Services for the Elderly provides free civil legal advice, assistance, and advocacy for seniors 60 and older. Topics include public benefits, debts, health insurance, pensions, long-term care, consumer affairs, powers of attorney, wills, advanced healthcare directives, and elder abuse. The statewide helpline is staffed during business hours. Low-income people can also obtain assistance from the Maine Volunteer Lawyers Project.