I’d like to tell you about Sue and Ivan, two long-stay patients at Maine Medical Center in Portland whose names and certain personal details have been changed to protect their privacy. Their stories are the result of our collective failure to invest in tailored residential services for our neighbors.
Sue is an adolescent who has lived in residential treatment homes for years. Her parents say they are unable to care for her. Last year, Sue got angry and assaulted a staff person.
The facility was short-staffed, and rather than jeopardize the safety of others, Sue was dropped off at the Maine Medical Center’s emergency department. The emergency department staff performed physical and psychiatric assessments on Sue, and it was determined that an inpatient bed would be of no benefit to her. An inpatient stay simply wouldn’t address the need for ongoing supervision and care.
A few hours after arriving, Sue was cleared for discharge. Yet when staff called the residential home, they were told she could not safely return to the facility, so they refused to pick her up. Sue “lived” in a bare, windowless room in the emergency department for months before a residential facility that would accept her was found in another state.
Ivan is a 62-year-old man who has diabetes and is on hemodialysis three times per week. He is in generally poor health. His most recent admission to the hospital was for a diabetes-related infection. His infection improved, and he was medically ready for discharge on day four.
His care team identified food insecurity, impaired mobility and an inability to care for himself as serious risks for a successful discharge to home. He lives alone in a walkup that has stairs, and he does not have family or others to help him. Ivan uses MaineCare transportation to get to and from dialysis treatments.
Ivan’s care team has recommended that he move to long-term care. The challenge is that few nursing facilities are accepting new residents in Maine. This is complicated because transportation is not covered by MaineCare for patients in residential facilities, so very few will take patients on dialysis. Ivan has now been at Maine Medical Center for 120 days with no discharge plan in the foreseeable future.
Ivan has been one of about 40 patients who, on any given day, no longer need hospital-level care, but are stuck at Maine Medical Center awaiting access to an appropriate level of care.
These vulnerable patients are not benefiting from the support they would receive in the right settings, such as social activities, community outings or simply going outside.
It is just as concerning that Maine Medical Center is boarding 40 or more patients who do not need the services of an acute care hospital at a time when it has insufficient capacity to meet the state’s needs. It is a tragic situation, one that has the potential to affect anyone who needs acute care at Maine’s leading medical center.
There are no easy answers to the insufficient residential capacity for vulnerable populations in Maine. We made policy decisions to close residential beds in institutions for children and adults with disabilities (including nursing homes), but the community systems meant to replace them are not sufficient to meet the need.
In spite of having the highest median age in the country, Maine has the sixth-lowest number of long-term-care beds in the country. The math doesn’t add up. And we have a waitlist of Maine children awaiting placement in out-of-state facilities – far from their homes and families.
While I do not have all of the answers, I do know that hospitals are not it. Neither emergency departments nor inpatient units are designed to provide ongoing treatment or long-term care. Patients who do not belong in the hospital frequently decompensate rather than recover in that environment. We need to maintain our hospital capacity to meet the acute care and emergency needs of our communities. Furthermore, the inability to move patients to appropriate settings places an additional stress on a care team that is already stretched thin.
This Legislature will address bills identifying solutions to some of these issues. Just as the Legislature and administration have appropriately prioritized housing this session, I ask that they prioritize those populations who need specialized housing and supports to live safely in our communities. Ivan, Sue and the hundreds of other vulnerable Mainers deserve it. And as a society, we cannot afford to do without it.
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