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If provider punishments in Maine ramp up in the near future, operators won’t need to look far for the catalyst.

A ProPublica investigation into what it calls the failures of the state’s oversight agencies is creating a lot of heat in and around the sector.

The 2021 death of an assisted living resident from a severe allergic reaction highlights the lack of “meaningful” penalties against Maine’s long-term care facilities for “serious” violations, the ProPublica project reported.

In partnership with The Maine Monitor, ProPublica’s Local Reporting Network shined a spotlight on the state’s health department for citing dozens of resident rights violations and hundreds of other deficiencies between 2020 and 2022 but imposing only the “lowest intervention possible, even for some of the most serious abuse and neglect incidents.”

It’s not the only recent report targeting the assisted living industry.

The cost of long-term care came under scrutiny in a recent “Dying Broke” series from KFF Health News and the New York Times. The second story in the series focused on the cost of fees driving assisted living profits, saying they they are pricing services and care out of reach for most Americans.

No consequences?

Maine’s state health department issued “statements of deficiencies” against the state’s 190 largest residential care facilities for 59 resident rights violations and 650 additional violations, according to the ProPublica report. Those violations included everything from medication and record-keeping errors to unsanitary conditions and missed mandatory training.

Yet the agency imposed only one fine: a $265 penalty against a community for failing to comply with background check requirements for employee hires. The agency also issued four conditional licenses for administrative or technical violations and a violation of a resident’s privacy rights, the news outlet reported.

In comparison, during the same two-year period, Maine fined more than half of the nursing homes in the state — 98 penalties totaling almost $700,000 — for violations ranging from not following COVID-19 infection prevention protocol to medication errors to not reporting unexpected deaths and failing to protect residents from harm.

The investigation compared Maine’s lack of action with Massachusetts during the same two-year time period — 2020 to 2022 — which suspended eight of its 269 assisted living communities’ operations for regulatory violations. 

The article highlighted that Maine’s decision in the mid-1990s to tighten nursing home placement requirements led to thousands of older adults moving to residential care facilities. Assisted living communities are regulated by states and have lower minimum staffing, nursing and physicians requirements than do nursing homes.

The state responded that plans of correction often were “sufficient” for improving conditions at communities but added that it was considering rule changes to impose fines and sanctions as “more meaningful deterrents.”

Long-term care advocates said that a lack of regulatory enforcement essentially encourages bad behavior. Industry representatives called for increasing nursing hours and requiring on-site medical directors in assisted living rather than imposing sanctions.