nursing homes – COMMUNIST PARTY OF MAINE

_{^{Gov. Janet Mills, a Democrat, released her $71 million spending addition to last year’s biennial budget earlier this month. (Jim Neuger/Maine Morning Star)}}

The Mills administration defended its proposal as striking the balance ‘between making timely investments to address urgent needs…and saving money to ensure that our state continues to stand on strong financial fiscal footing.’

_{Reposted from Maine Morning Star}

Advocates and some lawmakers on Monday sharply criticized aspects of Gov. Janet Mills’ supplemental budget plan that would delay or cut health expansion initiatives, child care subsidies and social service programs.

Mills, a Democrat, released her $71 million spending addition to last year’s biennial budget earlier this month. The plan includes investments in public safety, health care, housing, and child welfare, but also proposes stashing $107 million in a new reserve for the next biennium — a provision both progressives and conservatives have criticized.

The budget is now in the hands of the Legislature’s Appropriations and Financial Affairs Committee, which on Monday held a joint hearing with the Health and Human Services Committee on health care-related spending within the plan.

Department of Health and Human Services Commissioner Jeanne Lambrew, who represented the Mills administration at the hearing, told lawmakers that the budget proposal appropriately weighs current needs with fiscal caution.

“The supplemental budget is balanced, prudent and responsible, and it advances the governor’s long-held belief that we must continue to invest in the people of Maine — our greatest asset,” Lambrew said. “That is why the governor’s proposal strikes the balance between making timely investments to address urgent needs — like public safety, mental health, housing, education and health care — and saving money to ensure that our state continues to stand on strong financial fiscal footing.”

However, many of those testifying at Monday’s hearing were not convinced, arguing that while the budget contains many admirable investments, several provisions would be detrimental to vulnerable Mainers.

Medicare Savings expansion rollback

One frequent target of those testifying was Mills’ proposal to rollback an expansion of the Medicare Savings Program that was approved as part of last year’s biennial budget. The expansion aims to help low-income retirees by raising the threshold for income eligibility and eliminating an asset test. It was supposed to be implemented by March 1, opening the program up to 19,000 additional people.

Lambrew said the administration believes with state revenues slowing — along with high drug costs and an aging population — the expansion would not be sustainable.

Many testifying blasted the proposed reversal, though. Fran Seeley of Portland said the program would lead to thousands of dollars in savings for older Mainers. In her case, Seeley said it would provide her with sufficient funds to pay her electricity and heating bill.

Seeley argued that Mills’ proposal to halt the expansion and save the state $14 million would create those savings “on the backs of financially-vulnerable, lower-income Mainers.”

“This is a social injustice we must not allow,” she said.

Jess Maurer of the Maine Council on Aging added that older residents are struggling with the rising costs of food, housing, health care and other basic necessities and that providers are seeing an increase in evictions of such people. Rolling back the Medicare Savings Program expansion is the last thing older Mainers need, she said. She also noted that although Maine would save $14 million by nixing the expansion, it would also forfeit $38 million in matching federal dollars.

Child care program delays

Proposed delays in state funding meant to stabilize the child care workforce also came under heavy criticism.

Providers have repeatedly told lawmakers that the state’s child care industry is in crisis, with facilities operating on extremely tight margins that makes it difficult to adequately pay workers, leading to staffing shortages that create a lack of available slots for families.

To help address the issue, lawmakers and Mills in last year’s biennial budget doubled stipends for child care workers and also provided an ongoing stipend to child care workers with young children in the subsidy program in an effort to recruit and retain staff.

After telling providers that the doubled stipend would be available this spring, Mills has proposed delaying implementation until July 1 and also asked the Legislature to turn the child care worker subsidy program into a limited two-year initiative.

“I hear a lot about how Maine won’t wait, but it seems like on this issue, Maine is definitely waiting. The situation in Maine regarding childcare is dire. … The last thing that we should be doing is going back on our commitments or scaling back our relief” – Senate President Troy Jackson

Lambrew emphasized that the state is not doing away with either of those programs but simply needs more time to implement them.

But that didn’t go over well with providers.

“It’s little wonder folks lose faith in state government,” said Chrissie Davis, a child care provider in Skowhegan, in testimony read by another person. “Child care providers are real people, serving real people’s children on a daily basis [and] trying to pay our ever increasing bills each week. We don’t have the luxury of pushing our financial obligations off for months or a year.”

Senate President Troy Jackson (D-Aroostook), who sponsored the initial bill to double worker stipends, also blasted Mills’ proposal.

“I hear a lot about how Maine won’t wait, but it seems like on this issue, Maine is definitely waiting. The situation in Maine regarding childcare is dire. … The last thing that we should be doing is going back on our commitments or scaling back our relief,” Jackson said.

Change in food stamps eligibility

Mills’ proposed budget also removes a provision within the Supplemental Nutrition Assistance Program (SNAP) that allows asylum seekers to receive benefits while they are looking for employment after receiving their work authorization.

Mills’ budget does include $5.4 million in SNAP funding due to increased enrollment in the program. But the proposal to eliminate the hardship exemption — the initiative that allows people to receive benefits after getting work authorization — sparked significant pushback.

DHHS said the proposal is to help control costs while ensuring others can continue to access the program.

But Simane Ibrahim of Maine Access Immigrant Network said the change would cause significant problems. She noted that there is often a significant delay between when immigrants receive work authorization and when they get a job. The SNAP program is a crucial bridge that helps people survive during that time, she said.

“We have people who come to us who are starving,” Ibrahim said.

“This is a retraumatization, it’s inhumane,” she added of Mills’ proposal.

Kathy Kilrain del Rio of Maine Equal Justice also criticized the plan, calling the elimination of the hardship exemption egregious given the frequent delays in people finding jobs. And along with rejecting that proposal, she called for lawmakers to ensure all immigrants can access MaineCare benefits, a long-time goal of health care advocates that was not included in Mills’ budget plan.

General Assistance program adjustments

Mills’ budget proposed adding $5 million to reimburse municipalities for general assistance program costs, which is meant to be a program of last resort to help people meet basic needs such as food, housing and utilities.

Municipalities and advocates said those funds are needed. But they asked lawmakers to strike another part of the governor’s budget that would prevent municipalities from exceeding the maximum amount of assistance to any applicant for more than one month within a year-long period.

Portland Mayor Mark Dion spoke against the proposed change. While he said he agrees with one of the Mills administration’s stated reasons for the reform — to move away from putting unhoused people up in hotels because of the expense of that solution — he argued municipalities need the ability to stay flexible enough to help those struggling with housing insecurity.

“This cap [on GA assistance levels], by its very nature, threatens our ability to respond to those needs,” Dion said.

Nursing homes and residential care challenges

In her budget, Mills also proposed a $10 million allocation to support rate reimbursement reform for nursing facilities — a sector that has faced many of the same challenges as the child care industry — in an attempt to incentivize staff retention and spur high quality service.

Maine Health Care Association President Angela Westhoff said while she appreciates that proposed investment, it’s not enough to support the needs of the nursing home workforce. Westhoff said inflation, a labor shortage and an aging population mean the cost of providing nursing and residential care has skyrocketed and that MaineCare reimbursement rates continue to lag behind. That’s a significant reason why she said nine nursing homes have closed in the last three years alone.

Although reforms to reimbursement rates are slated to begin in 2025, Westhoff said nursing and residential care facilities need help now, telling lawmakers that a $31 million allocation would provide a meaningful start toward addressing the issues such centers face.

“If the budget advances as drafted, Maine will continue to lose access to nursing homes and residential care facilities,” she warned.

_{Evan Popp studied journalism at Ithaca College. He joins Maine Morning Star following three years at Maine Beacon writing about statewide politics. Before that, he worked for the Santa Fe New Mexican newspaper and interned at the Progressive magazine, ThinkProgress and the Reporters Committee for Freedom of the Press.}

_^AP

_{Reposted from the People’s World}

Nursing home trade unions and residents have successfully mobilized to demand the Biden administration use its broad rule-making authority to regulate private equity. These new rules will crack down on the large corporate landlords that have started buying nursing homes. The rules will require unprecedented transparency of nursing home ownership and also increase staffing levels.

Unfortunately, the Supreme Court is being asked by the far-right to destroy the government’s flexible rule-making power. If the far-right prevails in their bid, the result may make the government even more rigid and less responsive to mass action.

Healthcare in nursing homes requires beds and caregivers. The chronic lack of beds and the standing war on healthcare workers is the result of profit-driven healthcare. In recent years, nursing homes have been targeted by waves of aggressive profit seeking. Profiteering oppresses nursing home workers and harms elderly and disabled residents.

Traditionally, nursing homes have been run by either small companies or by non-profits or the government as a public service. Profit seeking in this area used to be the exception. But, aggressive profit seekers are buying nursing homes at alarming rates. As they do so, quality of care is declining and already difficult working conditions are becoming unbearable.

Residents of nursing homes, already some of the most vulnerable members of our society, are not having their needs met in facilities purchased by private equity firms. Horrifically, these firms quietly extract great public wealth from our Medicaid and Medicare programs by requiring workers to cut corners meant to safeguard residents.

For example, one recent study relied on by the federal government found that when private equity firms acquired nursing homes, the rates of premature resident death increased 10% and the rates of pacifying drug treatments increased 50%, while the actual number of workers providing hands-on care fell and the cost of care increased.

In another recent study it was revealed that nursing homes acquired by private equity firms experience increased levels of mistreatment and neglect among residents.

Turning residents into commodities

In other words, as a matter of policy, private equity firms have sought to turn residents with diverse human needs requiring equally diverse levels of hands-on care into immobilized commodities tied quietly to assembly lines. This is being done to increase rates of profit.

The increased level of mistreatment is a result of profit seekers, as a matter of policy, requiring their workers to give less hands-on levels of care. Profit seekers impose these harmful policies on workers and residents in order to collect the highest rates of profit possible.

In response to these troubling trends, unions and residents have mobilized to demand human dignity in healthcare. Today’s organizing builds off the material gains acquired over previous decades of mass struggle: The Social Security Act of 1935, the Older Americans Act of 1965, the Nursing Home Reform Act of 1987, and the Affordable Care Act of 2010.

Using these laws, the first demand is for the federal government to increase the minimum levels of hands-on care per resident, dignified staffing levels, and living wages. In response to this demand, the large institutional profit seekers cry poverty and hide behind a propaganda that “mom and pop” nursing homes (long since crushed by corporate healthcare) cannot bear the burden of providing the care they agreed to provide as a condition of receiving Medicaid and Medicare funds.

To combat this lie, the second demand is for increased levels of transparency in nursing home ownership so the public can finally see exactly where their money is going. Profit seekers are making incredible profits, but they conceal these profits from the public by deploying shady legal tricks to hide profits from the public through layers and layers of hidden shell companies and undisclosed agreements.

This November, the federal government imposed transparency requirements that would, for the first time, require private equity firms and real estate investment trusts to publicly disclose the identities of companies and individuals in their web of profit. In addition, the federal government will soon increase levels of hands-on care.

These rules are the result of boots-on-the-ground pressure from trade unions, resident councils, and other mass organizations.

Just as the struggle for human dignity for workers and residents in nursing homes is inextricably tied to the struggle for housing as a human right, the struggle is also linked to other issues such as environmental protection. The federal government’s ability to respond to collective action is reflected in its adoption and amendment of federal regulations.

The federal government’s ability to implement environment-protecting regulations is being challenged before the Supreme Court in January, 2024. In two cases brought by the fishing industry (Relentless, Inc. v. Department of Commerce and Loper Bright Enterprises v. Raimondo), large corporate interests are calling into question whether federal agencies can issue progressive regulations if Congress was silent on a specific issue when crafting the law decades earlier. These corporate interests want federal agencies to respond narrowly to the interests of mass struggle, overturn over 40 years of policy, and defer to an increasingly bogged-down and dysfunctional Congress, held hostage by an emboldened clique of far-right representatives.

If corporations can use the Supreme Court to cut off the federal government’s ability to respond to mass struggle, the ability of the federal government to respond to the needs of the people will be increasingly hampered. And, if the federal government becomes rigid and if every decision must be approved by Congress, the result will be crisis.

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_{C.D. Carlson writes from Connecticut.}