Gov. Janet Mills and state legislators pose with staff from the Maine Veterans' Homes facility in Caribou following a ceremonial signing of the bill that preserved the organization's Caribou and Machias homes. A work group tasked with digging into the homes' problems held its first meeting this week. Credit: Courtesy of Sen. Troy Jackson’s Office

A political solution kept two Maine Veterans’ Homes locations alive this year. But it is a systemic problem several stakeholders began to confront this week that stands in the way of the facilities’ long-term survival.

News that the Maine Veterans’ Homes locations in Caribou and Machias would close this spring after long-standing financial troubles sparked an outcry from residents and lawmakers alike. Their closure would have meant losing a combined 70 nursing home beds in rural Maine, where access to health care is already limited, and would have sent some residents hours away from their loved ones.

Although a handful of other nursing homes shut down last year due to financial and staffing problems, Maine Veterans’ Homes’ status as one of the few organizations devoted specifically to veterans’ care seemed to mobilize lawmakers in a different way.

A $3.5 million bill sponsored by Senate President Troy Jackson, D-Allagash, eliminated the Caribou and Machias homes’ back debt and required the organization to seek legislative approval before it could close one of its homes.

In addition to Machias and Caribou, Maine Veterans’ Homes runs facilities in Augusta, Bangor, Scarborough and South Paris.

The legislation also required the homes to seek additional funding and established a work group — one of Augusta’s preferred ways to handle problems with tough solutions — to understand why the homes were targeted for closure. The bill easily passed both chambers in March and was signed by Gov. Janet Mills despite the operators saying it would not fix their financial problems.

The work group has until February 2023 to report back to the Legislature on how to keep the homes viable for the long term. But what members really faced during their first meeting Wednesday afternoon were the financial and staffing problems facing all nursing homes — a problem participants acknowledged would be difficult to solve.

“I really want to thank all the folks that are part of this group for stepping forward because we know that this is tough business,” said Maj. Gen. Doug Farnham, the adjutant general of the Maine National Guard and the state’s top military official. “I don’t even begin to pretend that I understand the ins and outs of veterans homes or nursing care and that type of thing.”

Part of the challenge is staffing, a problem that has plagued the industry for years and was made worse by the coronavirus pandemic. The Maine Health Care Association, a lobbying group representing nursing homes, found in the spring that nearly 45 percent of its members faced crisis-level staffing shortages.

Staffing levels can in turn affect occupancy levels, as state law requires a certain employee-to-resident ratio. The Maine Health Care Association also found that occupancy rates for nursing homes dropped from 90 percent in 2019 to just under 75 percent at the end of 2021. When there are fewer residents, homes have less money.

Despite the state putting millions  toward  long-term care facilities to help them weather the pandemic, the homes’ challenges have not waned. A Department of Labor report found employment at nursing homes hasn’t rebounded even as employment in other sectors has recovered to pre-pandemic levels.

Nursing homes have often pointed to low Medicaid reimbursement rates as the culprit. Most nursing home residents rely on Medicaid, a combination of federal and state funds, to pay for their care.

The Legislature established the Maine Veterans’ Homes in 1977 as a quasi-state entity, but the homes typically only get their funding from Medicare, Medicaid, private insurance and charitable donations.

How much home administrators think the group will be able to do is unclear. Kelley Kash, the CEO of the homes, said little during the work group’s meeting and did not respond to a request for comment.

Christine Henson, a spokesperson for the homes, said the organization looks forward to “all progress that may be realized by mutual communication with the stakeholders’ group.”

The Legislature’s action may have given the homes a boost for now, but the Legislature did not explicitly task the group with looking at their financial challenges. Much of the work will consist of focus groups studying unmet needs and workforce projections. A comparative study of how other states pay their nursing homes will also be done.

It is a problem Donald Lagace, a member of the homes’ board of trustees and a former assistant adjutant general in the Maine National Guard, said they would have to face.

“I think it has to come into play,” he said. “And I throw that out as well, because finances are clearly going to be an issue with the operation of the Veterans’ Homes.”