Hank Homer outside the state-run temporary “crisis” home in Monmouth where he is staying. Homer, 46, had a frontal lobectomy after an accident in his childhood and is considered intellectually disabled. He was nearly shipped out-of-state twice beginning in 2015 because of a shortage of housing in community-based group homes in Maine. (Brianna Soukup/Portland Press Herald)
Hank Homer’s family for years has fought for the 46-year-old to live in Maine, scrambling for suitable housing at a time when group homes for adults with intellectual disabilities like Hank are in critically short supply.
He nearly was shipped to facilities in Illinois or Virginia in 2015. This year, the Maine Department of Health and Human Services wanted to send him to Florida, after he lost his placement at a group home in Portland where he was having trouble getting along with the staff, family members said.
“We said no, absolutely not,” said Denise Beavers, Homer’s sister, who advocates for him with Maine DHHS.
Homer underwent brain surgery for a head injury he suffered as a child and now has a low IQ. He lives – for now – in a small yellow house in rural Monmouth, surrounded by fields and towering pine trees. His social worker cooks him meals and helps him with daily living tasks. The home, operated by Maine DHHS, is supposed to be a temporary crisis placement for people who must live in supported housing but can’t get into community-based group homes because of the housing shortage.
Homer’s family said they don’t know how long he will live in the temporary crisis home – with the housing shortage, it could be several months.
The family’s struggle reflects the critical shortage in group home housing for adults with intellectual disabilities, heightened by a lack of workers. The waiting list for housing for adults with intellectual disabilities in a certain part of the Medicaid program – Section 21 – has more than 1,500 people on it, and it can take years to get off the list.
Homer, of Harpswell, has lived in institutions in New Hampshire, Tennessee and Virginia, but returned to Maine in 2015 when Lakeview Neurorehabilitation Center in Effingham, New Hampshire, closed while under scrutiny for reports of abuse and neglect.
Homer’s current arrangement is acceptable, he and his family say, but he was nearly shipped out of Maine three times after Lakeview closed, because of the lack of housing options.
He ended up being placed at a group home in Portland, but after living there about two years, disputes arose after a revolving door of workers at the group home provided inconsistent care, said Beavers, of Rhode Island.
This spring, Homer was told he had to leave the Portland group home or be evicted. Beavers said DHHS officials told her there was no capacity in nearby New England states, and he was nearly sent to Florida before being placed in the crisis home.
“It kept getting worse and worse and I really wanted to be out of there. If they didn’t find this place, I would be out in Florida or Oklahoma or Illinois in a lockdown unit,” Homer said.
At the temporary home, Homer receives one-on-one care, goes to counseling once per week and goes on outings, such as to coffee shops and Bull Moose.
His father, George Homer, said he and his daughter, Beavers, had to “fight like hell” with Maine DHHS to keep his son in Maine.
“If he had been in Illinois, I would have hardly been able to see Hank,” said Homer, of Durham, who frequently visits his son. All of Hank Homer’s extended family lives in New England.
‘A WORKFORCE CRISIS’
The root of the problem, advocates say, is a chronic workforce shortage caused by low reimbursement rates at the same time the minimum wage is increasing.
Those financial conditions constrict the supply of group homes, straining the system for the intellectually disabled, which includes those with autism, low IQs and Down syndrome.
The waiting list for group homes for adults with similar conditions as Homer is 1,580 people deep, and nonprofits are struggling to find workers to staff the homes. Some families have spent years on the waiting list.
Proposals to increase reimbursement rates are currently stalled, although Maine DHHS is planning to analyze the rates and report back to the Legislature in January. In 2008, the waiting list stood at 110, as the reimbursement rates then allowed nonprofits to pay significantly more than the minimum wage.
The group homes are paid for through Medicaid, a federal program operated by the states funded with a blend of federal and state tax dollars. States have wide latitude to set reimbursement rates.
Jackie Farwell, spokeswoman for Maine DHHS, said in an email response to questions that “the number of people needing these critical services has exceeded the available funding for many years.”
She said DHHS is working to remove 167 people from the waiting list and has set up a crisis phone line for adults with intellectual disabilities.
“We are also studying the adequacy of MaineCare (Medicaid) reimbursement rates to providers who serve adults with intellectual or developmental disabilities, autism and/or brain injury, and will report our findings to the Legislature,” Farwell said.
Community-based services, such as group homes and in-home services, were designed to replace institutions like the state-run Pineland Center, which closed in 1996 after decades of reports of abuse and neglect.
For about 15 years, they did, and Maine was considered one of the leaders in replacing institutions with community services. But now the services are increasingly hard to access.
About 3,100 Mainers live in group homes for the intellectually disabled through the Medicaid program, under Section 21, and an additional 2,200 people get in-home help through Section 29, according to state statistics.
Hank Homer’s services are currently funded through another program for those who suffered brain injuries, Beavers said, but it doesn’t cover the cost to take care of her brother, and the state is considering switching him to Section 21.
The $350 million system has struggled with capacity over the last several years.
The direct-care jobs working with people who need help with daily living are stressful and require lots of training, while easier jobs pay the same.
“We have a workforce crisis,” said Lydia Dawson, executive director of the Maine Association for Community Service Providers. “People can be paid the same for working at fast food restaurants or convenience stores.”
The reimbursement rate pays agencies the equivalent of a worker earning $11 an hour, the current minimum wage. But the Maine minimum wage will jump to $12 per hour in January.
Ray Nagel, executive director of the Brunswick-based nonprofit Independence Association, which runs group homes and other services for the intellectually disabled, said his agency pays above minimum wage in order to attract workers. But Nagel said he’s had to close three group homes in the last 18 months for financial reasons.
“We have 11 group homes, and 10 of them lose money,” Nagel said. “I’m at a loss about what to do. We can’t keep losing money year after year.”
BRAIN INJURY
Surgeons removed the frontal lobe of Hank Homer’s brain after he fell out of his high chair at age 2, and had numerous seizures. He now has the equivalent of about a 70 IQ.
George Homer said his son struggles with impulse control, anger and has difficulty in some social situations, and needs a stable living situation.
“He has lived in New Hampshire, Tennessee, Virginia, and has bounced around, and the state wonders why he has had a difficult time,” Homer said. “The state would rather send him out of state, out of sight, out of mind, just write a check and forget about him.”
When in a supported living situation, Hank can thrive, and he enjoys saltwater fishing, war and spy movies, Denzel Washington films, playing cards and Southern rock bands. He also likes watching football, hockey and basketball.
The rates increased slightly in 2018, after a long battle in the Legislature, but Dawson said the rate hike sidestepped the deeper crisis and did not solve the underlying problem.
“It was a Band-Aid,” Nagel said.
Beavers said she hopes the state will work on wide-scale changes to improve the system, not only for Homer but for the thousands of people who need help.
“It’s been very frustrating,” Beavers said. “I just don’t feel there’s enough urgency to take care of these concerns. The state of Maine can do better for the clients it’s supposed to serve.”
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