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Higher staffing requirements removed from assisted living bill
Lawmakers have scrapped proposed increased staffing ratios for assisted living and residential care facilities, replacing the measure instead with reporting requirements and a stakeholder study group.
Members of the Health and Human Services committee on May 16 voted unanimously in support of a version of the bill that removed changes to staffing ratios and added in the requirement that facility administrators report quarterly information on the number of direct care workers per shift, including the number of temporary staff and turnover rates. This information will be public and be made accessible in some form of a dashboard.
Bill Montejo, director of the DHHS Division of Licensing and Certification, said there currently isn’t solid data on baseline staffing levels, which can vary across facilities based on resident needs. Collecting this information will help the department assess the situation and then consider staffing increases based on current levels, as well as findings from inspections and national standards and studies, he said.
“The intent of the staffing data really was to get solid data to use to go forward as we look at staffing needs in facilities,” Montejo said.
The initial proposed regulations, which are the first update in 17 years, would have doubled the number of direct care workers at residential care facilities overnight and set stricter rules in memory care units that went beyond the state and federal staffing requirements at nursing homes.
Those changes were supported by advocates, who say they are needed to protect residents and support overwhelmed staff, but opposed by assisted living and residential care facility operators, who argued that the associated costs of hiring more workers at a time of severe workforce shortages could put them out of business.
Now that those staffing changes were dropped from the proposal, staffing requirements will stay at the current level: Residential care facilities with more than 10 beds are required to have one direct care worker for every 12 residents during the day; one to 18 in the evening; and one to 30 overnight.
Lawmakers also added an amendment to the bill establishing a study group that includes representatives from the state, the assisted living industry group, facility providers, family members of a resident, two workers and advocates including the Long Term Care Ombudsman, Legal Services for Maine Elders, the Alzheimer’s Association and AARP. The group would come back with a preliminary report in January 2026 and a final report in January 2027.
The bill also establishes that all memory care units have to be licensed as residential care facilities. Montejo said this was because residential care facilities have higher requirements than assisted living facilities around assessment, safety and service planning for residents with Alzheimer’s and other dementias. Assisted living facilities are intended for people with more independence, he said.
The legislation also sets a limit on how many residents an administrator can be responsible for: One administrator for a facility up to 160 beds or up to three facilities of no more than 50 beds. However, Montejo said the department would be open to issuing waivers for reasonable compromises as long as the intent of the rule is followed.
The bill will now move to the full Legislature for consideration.
Changes to the legislation are the result of months of negotiation over staffing proposals. The Department of Health and Human Services in November unveiled its first update to rules governing assisted living and residential care facilities since 2008. The update was intended to simplify the rule structure and align regulations with current best practices, which included significantly higher staffing ratios, especially for facilities with memory care units.
The proposal followed an 18-month investigation by The Maine Monitor and ProPublica into the state’s largest residential care facilities, which found dozens of resident rights violations, more than a hundred cases where residents wandered away from their facilities and hundreds of medication and treatment violations. And a report from the Catherine Cutler Institute at the University of Southern Maine found that Mainers in residential care facilities are on average older and more likely to have dementia than those in nursing home facilities.
During a public hearing in April, the department argued that these stricter requirements are necessary because the need in these facilities is higher than what they were intended to serve under a “social model” of care, rather than a medical model. The department said the need has risen as nursing homes have closed, pushing residents with more needs into these lower levels of care, and they have seen through investigations that higher standards are necessary.
After pushback from assisted living and residential care facility operators, the department responded with a new proposal that watered down staffing requirements and gave facilities two years to phase in the changes. The scaled back staffing ratios, which would have still been higher than current staffing requirements, set a standard of one direct care worker for every 10 residents during the day and one direct care worker for every 20 residents overnight. In memory care units, the staffing requirement would be one direct care worker for every eight residents during the day and one direct care worker for every 15 residents overnight.
Advocates had supported the measure, saying it is a necessary update to protect residents and that the updated proposal represents a compromise. The ombudsman program said it received 482 complaints last year from residents and their family members about quality of care, including serious cases where medication was mismanaged, staff did not respond to calls for help from an injured resident, and residents going more than a week without showers.
Numerous providers testified against the measure, saying they were not meaningfully involved in the process and that the increased costs of hiring more staff, without additional funding, would be devastating.
The industry group representing these facilities estimated the watered down staffing proposal still would have required an additional 623 full-time equivalents and would cost residential care facility owners about $30 to $40 million annually. The group also commissioned its own study of resident need in these facilities, and found that it had only increased 4 percent since 2018.
Representatives from both the assisted living industry group, which opposed the increased staffing requirements, and the long-term care ombudsman, which supported the increase, voiced measured support for the final outcome after the vote.
Angela Cole Westhoff, president and CEO of Maine Health Care Association, which represents assisted living and residential care facilities across the state, told The Maine Monitor that the final outcome was “overall a good improvement.”
“Certainly, the removal of the staffing ratios is appreciated,” she said. “We respect the opportunity to collect data. I think it’s really important that public policy be grounded in data.”
She was still worried about removing memory care beds from assisted living and licensing them solely under residential care facilities.
Brenda Gallant, Maine’s long-term care ombudsman who advocates on behalf of residents and their families, said it was disappointing that the staffing requirements were scrapped but said that creating the stakeholder group will keep staffing issues at the forefront of discussions and it’s an opportunity to study the problem and come up with the best solution going forward. She added that it gives the department time to look at possible higher reimbursement rates for facilities if they increase staffing at a later date.
ICYMI: If you weren't able to make our Long Trek to Care Event last week at Colby College, you can read takeaways from the discussion and watch the full video here. Thanks to Colby and everyone who joined us!
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