BELFAST, Maine — On a quiet residential corner in the coastal town of Belfast stands a spacious, Victorian-era home. A small, gilded sign near the door identifies it simply as the Deborah Lincoln House.
Founded in 1903 as the Belfast Home for Aged Women, the nonprofit Deborah Lincoln House is now a state-licensed, private-pay, assisted-living facility with a six-bed limit. Currently, because there’s a rare vacancy, five independent-minded women live here, ranging in age from 72 to 103. Each has her own bedroom and a private bath. Some have a separate sitting room as well. The rooms are clean and modern, furnished by the resident, with big windows overlooking the neighborhood and admitting lots of natural light. The sweeping central staircase boasts a chair-style lift in addition to its massive oak handrail.
The “ladies” — as they’re affectionately called by the staff — come together in the high-ceilinged dining room for family-style meals and in the spacious living room for yoga classes, birthday parties, afternoon jigsaw puzzles and other activities. They’re provided with transportation for medical appointments, church services, community events, shopping and other outings.
“It’s a really homey atmosphere we have here,” said administrator Diane Martin, a registered nurse who has managed operations for more than seven years. “The food’s great and the staff is friendly.”
But the Deborah Lincoln House is not for everyone. Whereas most nonprofit assisted living facilities accept Medicaid as part of their funding stream, the Deborah Lincoln House does not. Its unusual funding mechanism, a holdover from earlier times, requires each resident to sign all her financial assets over to the organization when she is admitted. These assets, including retirement pensions, Social Security payments or other income, are deposited to an interest-earning investment account that funds all elements of the program, including building maintenance, staff salaries and resident services.
In exchange, each resident is assured, for the rest of her life, of a room and meals, housekeeping services, assistance with bathing, dressing and medications, transportation and a $225 monthly allowance for personal expenses. In addition, any medical expenses not covered by Medicare — including dental work, eyeglasses, hearing aids, medications, and even nursing home care, if it’s needed — are paid by the pooled assets of the Deborah Lincoln House.
In the rare event that a resident is unhappy or doesn’t fit in, she may leave and be issued a pro-rated refund.
“This is unique. We don’t know of anything else like it,” Martin said. “There is no Medicaid, no state funding at all.”
While a committee of the board of directors reviews prospective residents to ensure “a good fit” with the culture of the home, Martin emphasized that there is no financial test for who can or cannot qualify for admission. She said the ladies at Deborah Lincoln House are not rich, though they do need to have enough in assets to “make it work.”
“Most are financially comfortable, and most are college-educated,” she said. “But I can’t think of anyone I’d really call wealthy.”
A home for aged women
Deborah Lincoln, the original benefactor of the house, is believed to be the daughter of a successful farmer in the nearby town of Searsmont, who married a shipyard worker and moved into Belfast. Widowed with no children, she lived alone for several years before dying in 1903, leaving the bulk of her estate — her private home, which was to be sold, and about $9,000 — to the local chapter of the Women’s Christian Temperance Union to create “a home for aged women” in Belfast. If such a facility was not established within three years, her will stipulated, the money was to go to an existing home in Bangor.
Before the year was out, the Women’s Christian Temperance Union had purchased the expansive private house on Cedar Street for $3,000 and established the Belfast Home for Aged Women. The home has been in continuous service since, providing housing and care to women 60 and older from Belfast and surrounding communities. With changes in life expectancy, Martin said, the average age of applicants has moved up to between 70 and 80 years.
For 103-year-old Georgia Randall, who has lived here for about 16 years, the Deborah Lincoln House is much more than a care facility. The former Army nurse, who served in the Pacific theater in WWII, grew up in Belfast.
“I lived in this neighborhood and I used to go by the ‘old ladies’ home’ every day,” she said, taking a break from a complicated jigsaw puzzle set up on a table in the living room. “Now, I like living here very much. Everything we need or want to do is available. It’s just like being home.”
She paused and corrected herself. “It is home.”
Randall’s son, former U.S. Rep. David Emery of Tenants Harbor, said his mother benefits from the emotional warmth and social interactions that characterize the Deborah Lincoln House. He remains unperturbed by her decision to turn her assets over to the facility in exchange for her care.
“It was entirely her decision,” he said. “She certainly has gotten her money’s worth from them.”
The Deborah Lincoln House has been part of Priscilla Withee’s life for more than 20 years. After retiring in 1993 from her job as a floor nurse at nearby Waldo County Hospital, she worked part-time here for almost 20 years.
“Then I got sick, and in 2013 I moved in,” the 87-year-old said, knitting vigorously in her sunny second-floor room. “I knew it very well by then. I knew I wanted to end my life here, so I gave up everything I owned and here I am.”
Administrator Martin conceded that a resident’s decision to direct all her financial assets to the organization instead of to adult children or other family members can be contentious. But many of the women who choose to live here have no children, she said, and those who do typically work things out with them over time. It’s rare, she said, for there to be ongoing ill will over the disposition of the estate.
“I can tell you that for every woman who has lived here, we have paid out way, way more [in care] than they have brought in,” Martin said.
Is it sustainable?
According to Richard Erb of the Maine Health Care Association, which represents Maine’s long-term care and assisted living facilities, there are just a handful of homes for seniors as small as the Deborah Lincoln House.
“There is a lot to be said for these small facilities,” he said. “They are generally more comfortable, more homelike.”
Almost all accept a combination of private-pay and Medicaid residents, he said. In fact, the Deborah Lincoln House may be the only one that eschews public funding altogether and requires residents to pay in advance with their estates.
“It does seem like a vestige of an earlier time,” he said.
The Deborah Lincoln House is not a nursing home. The building is not fully handicapped accessible. Staff members — which include nurses, aides, a cook and a 24-hour on-site “matron” — are trained and allowed to provide only a low level of personal support.
“The ladies really take care of themselves,” Diane Martin said, with assistance and supervision available for bathing and dressing if it’s needed. “We keep them here as long as we can,” she said, adding, “Most residents are able to die right here.”
But if loss of mobility and cognition become a matter of personal safety, bylaws require the organization to transfer a resident to a nursing home for more comprehensive care. Right now, two former residents are living at a nearby nursing home. The Deborah Lincoln House pays for their care.
Although the private-pay-only system has worked well for over a century, board president Ed Varney said, trends toward longer life expectancy make it likely that more Deborah Lincoln House residents will eventually need nursing home care. With an average annual price tag of about $100,000 and rising every year, Varney said paying for nursing home care has the potential to destabilize the finances of the Deborah Lincoln House.
Generally, the Medicaid program picks up the nursing home tab for low-income individuals, but most Deborah Lincoln House residents do not qualify for Medicaid due to the value of their pre-admission assets. The board is in early discussions now with state Medicaid officials, Varney said, to see if a compromise can be reached, perhaps by sharing the cost of residents’ nursing home care.
He said the Deborah Lincoln House is not in financial trouble.
“As things are now, we’re fine,” he said. “But you never know what the future will hold. The Deborah Lincoln House has been around for more than 100 years and we want it to last for another hundred.”
