Calls started coming into Maine Family Planning clinics on November 5, and they haven’t stopped. In the wake of Trump’s re-election, Mainers across the state have been making appointments to get IUDs and implants, forms of long-lasting birth control, out of concern that the new administration could limit access to contraceptives. “It’s been non-stop,” says Shasta Newenheim, regional manager for Maine Family Planning, a nonprofit with eighteen clinics across the state. “We're seeing a lot of people who are choosing to either get (implants and IUDs) replaced early. Or, if it was something they thought they wanted in the past, they definitely want it now.”  Maine Family Planning is not the only organization fielding an influx of calls. Providers that have reported increased contraception requests include Planned Parenthood of Northern New England, the Mabel Wadsworth Center, York Hospital and MaineHealth Obstetrics and Gynecology in Biddeford. Among the providers that responded to questions from The Maine Monitor, only Northern Light Health reported no change in contraception requests. But an obstetrics and gynecology provider affiliated with Northern Light Health, who requested anonymity to protect her job, took issue with this characterization and told The Monitor that she has seen requests for long-acting reversible contraception and sterilization increase dramatically since the election.  To Aspen Ruhlin, who works at the nonprofit Mabel Wadsworth Center in Bangor, the impetus behind the increase is clear: “If you're on the pill, there's always the risk that you run out and can't get more. But if you have something in your uterus or arm that lasts for years, it's a lot harder to lose access to that.”  Planned Parenthood of Northern New England, which operates in Maine, New Hampshire, and Vermont, saw its average weekly requests for long-acting reversible contraceptives more than double after the election, according to a November 21 press release. At the organization’s Maine health centers, appointments grew from a weekly average of 26 appointments to 48 in the week after the election.  “Our patients are scared,” Nicole Clegg, interim-CEO of Planned Parenthood of Northern New England, said in an interview eight days after the election. “We’ve already experienced a spike in patients seeking long-acting reversible contraception and emergency contraception.”  “We saw this last time too,” she said.  Maine Family Planning also saw an influx of patient requests following Trump’s 2016 election and after the 2022 Supreme Court ruling that overturned Roe v. Wade — in line with national trends. A 2024 study published in the journal Jama Network Open that analyzed a national data set of medical and prescription claims found downward trends in most contraception services since 2019, but found sharp, temporary increases in all contraception services after the 2022 decision.  “We are in a place that we've already been before; we know what we’re up against,” Newenheim said. “This is just another signal that there's a real movement to take away (reproductive) rights. There’s always the question of, where is it going to end? Our patients feel that too.” Newenheim said many patients are motivated by a fear that the Trump administration could bring changes that influence insurance coverage of birth control.  During his first term, Trump expanded the types of employers that could deny contraception coverage on moral or religious grounds, weakening the federal contraceptive coverage guarantee in the Affordable Care Act, which mandates that most private insurance plans in the U.S. cover contraception without out-of-pocket costs for patients.  Maine is one of 31 states that require private insurers to cover contraception, and one of eighteen states that prohibit cost-sharing, according to data compiled by KFF. MaineCare’s Limited Family Planning Benefit covers contraception — including pills, IUDs, and implants — for individuals at or below an annual income of $31,476. Trump’s administration also enacted policies that stripped funding from reproductive rights organizations that provide contraception and abortion care, including a “gag rule” that prevented clinics receiving Title X funding from referring patients to an abortion provider.  Clegg, of Planned Parenthood, said it’s unclear what will happen to federal funding after Trump takes office on Jan. 20, noting that “the crystal ball is cloudy.” But many Mainers are not waiting to find out.  In addition to requests for IUDs and implants, Dr. Ashley Jennings, a gynecologist at York Hospital, cited increased requests for tubal ligations. Planned Parenthood and Mabel Wadsworth Center described increased requests for vasectomies, and Planned Parenthood and Maine Family Planning described a jump in requests for gender-affirming care. Mabel Wadsworth Center has seen a number of current patients seek gender-affirming surgery sooner than they’d originally planned. “I have spoken to patients currently receiving gender-affirming health care who are in tears because they fear it’s going to be taken away,” said Newenheim. “This isn’t birth control. This is their day-to-day; this is their identity.” Despite widespread concern, providers expressed their commitment to patient care. “We refuse to be fearful,” says Newenheim. “We are dedicated to the mission of not giving up and ensuring these basic human rights are extended to our patients.”

Earlier this month, the independent watchdog monitoring Maine’s child welfare agency went before the legislature’s government oversight committee and admitted frustration. In recent years, she has repeatedly identified the same problems with the agency’s approach to child protection investigations, she said, yet little has changed.   “I don't enjoy, you know, essentially writing the same report every year,” Maine Child Welfare Ombudsman Christine Alberi said on Jan 10, presenting her latest annual report. “The practice issues the department is struggling with continue to be the same.” The problems identified in the report included a cascading list of failures at the Department of Health and Human Services’ child welfare office: failure to conduct sufficient investigations, failure to recognize risks to children, failure to monitor safety plans, failure to identify neglect, failure to interview witnesses, failure to conduct drug screens, failure to file paperwork on time — or at all. It also described problems with the office’s software system, a shortage of attorneys to represent parents and a lack of support services for families. The report highlighted several cases in which allegations were not investigated quickly or thoroughly enough, children remained in unsafe situations after investigations, or children were placed in unsafe environments after removal.  “I’ve sat here on this committee for four years,” said Sen. Jeff Timberlake (R-Androscoggin), the government oversight committee’s ranking Republican senator. “Everything the department has come forward and asked for, we have given, whether it was money or time.”  Timberlake asked Alberi what she thought was preventing the department from improving its training and practices.  “I wish I knew for sure,” Alberi said. “Lack of people to do the training and lack of time.” The discussion at the hearing seemed focused on the idea that Maine needs to grow its child protection system, that it needs more workers and more training to remove more children from unsafe environments. But a new federal report published earlier this month shows Maine is already reporting, investigating and finding abuse and neglect at a higher rate than most states, yet not necessarily keeping them any safer.  The latest child maltreatment report from the federal Department of Health and Human Services, which covers 2023, aligns with previous federal reporting that showed Maine is moving against national trends, investigating more families and removing more children while child protective agencies in nearly all other states are moving in the opposite direction.  The most recent federal foster care data showed that the national foster care population fell 15 percent between 2018 and 2022. In Maine, it rose nearly 40 percent over that same period. Last year, Maine had more children in state custody than at any other time in the last 20 years.  The new federal report bolsters some advocates’ argument that Maine is failing to keep kids safe not because it is investigating too few families but because it is investigating too many, and failing to identify the true threats in the deluge of cases. “I talked to policymakers, and they're like, ‘Okay, we've added 100 case workers, and we've thrown all this money at the agency. Why are kids still dying?’” said Melissa Hackett, policy associate at the Maine Children’s Alliance. “It’s because we’re flooding the system.” “If you're flooding it, you're going to end up with families being involved that maybe didn't need to, and you might miss other families that do need to,” Hackett said. “So it's about getting really laser-focused on the right size role for the agency.”  The concept of taking in fewer cases is often called “narrowing the front door,” including with exemptions that acknowledge poverty is different from neglect. This argument was absent from the hearing at the statehouse, as was the fact that recent data shows Maine is moving in the opposite direction of most states. Alberi told The Monitor reducing the number of investigations makes her “very, very uneasy.” “The more important thing is to just make the correct decisions with the data you have at the time,” Alberi said, “not cut off the fire hose.”  Defining maltreatment A Maine Monitor analysis of the recent federal data found Maine has the second-highest rate of child maltreatment of any state in the nation, second only to Massachusetts. But the report’s authors cautioned against comparing states against each other, as different states define child abuse and neglect in different ways.  Maine parents are not necessarily abusing and neglecting children more than those in other states, but DHHS’s Office of Child and Family Services is finding more of what it considers maltreatment. The department, advocates and parents’ attorneys agree that Maine is more likely than other states to define certain behaviors and situations as abuse and neglect.  “It is OCFS’ understanding from conversations with other states that Maine is in the minority (if not unique) in that findings are made even if harm did not actually occur,” DHHS spokesperson Lindsay Hammes wrote in an email.  Maine allows findings in situations that pose a “threat of” maltreatment, even though the maltreatment has not yet occurred, Hammes wrote. As an example, she described a hypothetical situation in which a parent was driving while intoxicated with a child in a vehicle. Even if the child is not harmed, the department could still make a finding of maltreatment.  In addition, Maine is one of nine states that allows for two levels of findings: “substantiated” and the less severe “indicated,” depending on the level of evidence. Federal data shows that about 40 percent of Maine’s maltreatment findings are indicated. Indicated findings of neglect are “where your poverty cases are brought in, more often than not,” said parent attorney Taylor Kilgore. “I wholeheartedly believe that our definitions of abuse and neglect are just way too broad, and the ability to have an indicated finding kind of plays into how broad that is,” Kilgore said.  Twenty-seven states have exemptions in their laws that acknowledge poverty is not the same as neglect. Maine is not one of them. But Hammes told The Monitor that the department has convened a steering committee to look at the issue. “A goal of this work is to ensure the right families are being referred to the Department based on OCFS’ statutory mandate and for others there are community pathways of support,” Hammes wrote. “Those groups are working on a possible statutory revision to clarify that poverty, in and of itself, is not neglect.” Reporting practices Mainers are more likely to report suspicions about abuse or neglect than many other Americans. Out of 44 states included in this particular data set, Maine had the fifth-highest rate of referrals to child welfare agencies in 2023, with 106.9 per 1,000 children, or more than one report for every 10 children in the state.  Maine also had the third-highest rate of referrals that were deemed to not be worth an investigation.   While many states require that mandated reporters make a report if they are aware of abuse or neglect, Maine also requires reports when there are suspicions that abuse or neglect is likely to happen in the future.  Maine law requires a mandated reporter to “immediately report or cause a report to be made to the department when the person knows or has reasonable cause to suspect that a child has been or is likely to be abused or neglected.” Christine Alberi, Maine’s child welfare ombudsman, has repeatedly raised concerns about inadequate child protective investigations that leave children in jeopardy. Photo by Garrick Hoffman. Even after referrals not worthy of investigations were screened out, Maine still investigated families at a rate higher than every state except Indiana, Arkansas and West Virginia.  Maine is more likely than most states to investigate a report and find abuse or neglect, ranking 39 out of the 50 states.  But after determining a child was victimized, Maine was less likely to offer what the report called “post-response services” than other states. Maine provided those services to 24.2 percent of victims, less than half the national average and higher than only Colorado and Pennsylvania.  Maine’s poor results in that category are likely influenced by the fact that the state’s system does not capture services provided through contracted agencies, Hammes said.  “Maine continues to work with contracted agencies and MaineCare service providers to better capture these services,” she wrote.  Changing policies Instead of looking across state lines, it’s worth looking at the situation before and after states make changes to their own laws defining child abuse and neglect, said Sarah Catherine Williams, a senior research scientist with Child Trends, a nonprofit research group focused on children’s well-being. She pointed to Texas, which recently saw a 40 percent drop in the number of children taken into foster care after the state shrank its definition of neglect. The shift has allowed the state to provide “alternative responses” to families, instead of removing children, The Imprint reported. If a state decides to remove poverty from its definitions of child neglect, it must also provide resources to help alleviate that poverty, said Jill Duerr Berrick, a professor of social welfare at the University of California, Berkeley.  “Telling the public not to report poverty (because it's not maltreatment), or telling social workers not to substantiate only-poverty cases is important, but it's equally important to give the public and — especially — to give social workers the tools they need to help parents whose children are suffering because of poverty,” Berrick wrote in an email.  According to the latest federal data, New Jersey had the lowest rate of child maltreatment of any state. Maine’s rate was ten times higher.  New Jersey rarely finds child abuse or neglect after investigating. In 2023, less than five percent of its screened-in reports resulted in maltreatment findings. In Maine, meanwhile, the figure was 38 percent.  Instead of bemoaning its low rate, New Jersey government officials celebrate it.  “Many of these families had social service needs, but not child protective needs,” a December evaluation of the state’s Division of Child Protection and Permanency noted.  In 2023, New Jersey exited 20 years of federal monitoring of its child protection system. The state has pivoted away from removing children and toward preserving families with the help of services.  “Most children involved with DCP&P received services at home (91% in 2023), and the remaining children resided in foster care (9% or 2,939),” the report's authors wrote. “Children often have better outcomes over time if they safely remain with their families.” New Jersey’s low rates of child abuse and neglect have raised concerns about whether the state is turning a blind eye to maltreatment. But New Jersey argues it is keeping kids safe. And the state’s child fatality rate seems to align with that argument. In 2023, New Jersey had a child fatality from maltreatment rate of 0.7 per 100,000 children.  It’s about a quarter of Maine’s rate of 2.81, which is slightly above the national average. 

Even as a sprawling new multi-town collaboration embarks on a journey to reach consensus around a Machias dike replacement, a federal environmental agency has put up roadblocks to any option other than a bridge. Late last month, the Maine Department of Transportation announced that it would replace the bridge with a longer-term — but still temporary — span intended to last between 15 and 20 years.  MaineDOT then announced it was pausing the federal environmental review process, which had been required because the dike spans Route 1, a federal highway.   Part of the federal review was an Environmental Assessment, a federal document required under national environmental policy rules when significant changes are made to federal roadways. The assessment had been underway for more than a year; it has not yet been published, according to the Federal Highway Administration and MaineDOT.   After seven months of relative silence about the fate of the assessment, the Federal Highway Administration refused to approve MaineDOT’s preferred plan. In a Nov. 19 letter to MaineDOT, federal officials wrote that they anticipated the project would require a full Environmental Impact Statement, a more complex process mandated when a federal agency expects a project could have a “significant adverse impact” on the environment.  NOAA’s critical remark and other conclusions were included in the agency’s June 14 comment letter to the Federal Highway Administration, the lead action agency for the ill-fated draft. The National Marine Fisheries Service, a department of NOAA, determined that the project would have “significant adverse effects.” In particular, NOAA recommended the Department’s proposed plan would negatively impact all stages of winter flounder, including sensitive spawning habitat, spawning habitat of migratory Atlantic salmon, as well as a number of natural resources within the Machias and Middle rivers ecosystem, such as the Schoppee Marsh.   The Machias River is one of eleven rivers in Maine designated as a Habitat Area of Particular Concern — a federally designated, high priority area for conservation, management, or research.  Machias River supports one of the only remaining U.S. populations of naturally spawning Atlantic salmon with historic river-specific characteristics. The National Oceanic and Atmospheric Administration said its determinations were due to “substantial deficiencies” in MaineDOT’s Essential Fish Habitat impact study, a component of the draft environmental assessment. NOAA concluded that, of the proposals put forward by MaineDOT, a full-span, pile-supported bridge should be selected to replace the current structure. The Department’s preferred choice, an in-kind-replacement with a series of box culverts with flap gates, would prevent tides from passing freely under the structure.  Citing federal environmental laws regarding fish passage of diadromous species and climate change, NOAA further wrote that their recommendations “must be given full consideration,” by the transportation agencies. The letters were published in late December on MaineDOT’s website along with a raft of other documents detailing the fifteen year-long-saga.   In a November 26 news release and letter to town officials announcing the failed Environmental Assessment process, MaineDOT Commissioner Bruce Van Note vehemently disagreed with NOAA’s findings, but did not reference the agency’s insistence on a bridge. Van Note addressed that concern in a separate letter to the Federal Highway Administration.  “It appears that the use of ‘significant’ may be designed to cause FHWA to require an Environmental Impact Statement (EIS) in hopes of eventually requiring a bridge alternative,” Commissioner Van Note said in a September 12 letter to Todd Jorgensen, Maine Division Administrator. In response to questions from The Maine Monitor, a NOAA spokesperson said their determinations are ”advisory” and restricted to the agency’s specific federal mandates under conservation law, only one component considered in the National Environmental Protection Act process. “The determination of effects under NEPA should be made by the federal action agency (FHWA) after assessing many factors, including the potential impacts of their proposed actions on natural resources, social and cultural aspects, and economic impacts,” wrote Andrea Gomez, Communication Specialist for the Greater Atlantic Regional Fisheries Office. According to NOAA’s findings, MaineDOT’s Essential Fish Habitat assessment failed to fully account for the operational impacts, even though the assessment indicated the proposed project would permanently eliminate all tidal exchange to the Middle River for the life of the proposed project, 80-100 years. NOAA estimates that at least 232,200 square feet of existing intertidal and subtidal habitat would be impacted under the Department’s preferred plan. Among actions to offset the anticipated harms, the agency said Maine DOT would be required to: conduct a wetland delineation survey, assess and remove contaminants from construction and decomposition of the dike and to mitigate losses to account for both permanent and temporary habitat losses over the 3-4 years of construction. MaineDOT’s latest about-face plan to erect a new, more permanent span to ensure travel along the corridor kicks the decision about a permanent replacement down the road — and avoids dealing with such potentially costly mitigation and a host of other issues inherent in an arduous Environmental Impact Statement process.  But concerns remain about how Machias, other affected communities, and shell fishers will mitigate ongoing flood risks not resolved by the new more durable span, which is expected to be built next year.  On March 10, 2024, Upper Machias Bay experienced the ninth “100-year flood” in six and a half years, and the civil-war era dike remains fragile, according to Tora Johnson, Sustainable Prosperity Initiative director for the Sunrise County Economic Council. Recent storms have caused at least $10 million in damage in the area, according to  Tora Johnson, director of the Sunrise County Economic Council’s Sustainable Prosperity Initiative. Plus another roughly $1.5 million in funding in the form of grants from NOAA and various foundations to pay for studies, reports, and plans. Then there is the $2 million price tag for the new, temporary span, and ever-rising costs for the eventual permanent structure, estimated between $23 and $30 million, depending on which alternative is eventually chosen and inflation, according to MaineDOT estimates. With community input, design, permitting, regulatory issues — and the possibility of legal challenges all around — construction of a more lasting solution will be years away.   Meanwhile, the 150-year-old timber and stone dike foundation gets lashed anew by the sea with every storm.   In the past, MaineDOT, with assistance from FEMA, has made the repairs necessary to keep the dike foundation from washing away completely. Should that happen, the result could be inundation of hundreds of acres of land owned by about 54 Middle River residents upstream of the structure.   “A catastrophic failure of the dike would have significant impacts on downtown businesses and on the community because it would require rerouting Route 1 traffic for an indefinite period of time, breach the Downeast Sunrise Trail, and make a colossal mess,” said Johnson in a later email. The possibility of Middle River properties flooding is a major reason why MaineDOT prefers an in-kind-replacement of the dike, since a bridge would have the same impact, gradually, or not so gradually, returning upstream farmland to wetlands, depending upon the bridge’s design.  Marshfield residents Stephanie and Joey Wood have lived along the Middle River for 30 years. About 1,000 bales of tidal hay are harvested along their property’s shore each year by blueberry farmers, hay that a full-span bridge — or a failed dike — would put underwater.  The worst part, Stephanie Wood said, is being left in the dark.  “This is what's been going on for the past, oh, my God, 15 years or more,” Wood said. We're never notified about meetings…they don't let us know anything.” According to Van Note’s letter to FHWA, the design and installation of the new temporary span “will be done with consideration of adjacent properties and business owners, as well as other nearby resources.”  Johnson said the new span is intended to assure mobility but not to prevent flooding, either to Machias or Middle River properties. That leaves only the rapidly deteriorating and vulnerable dike to hold back flood waters.  The Maine Monitor asked MaineDOT if it will continue to make dike repairs after the new temporary span is erected, given the likelihood of future — possibly devastating — damage to the dike and subsequent flooding. The written response from Communications Director Paul Merrill was unclear. “MaineDOT will continue to make essential repairs to ensure continued mobility along Route 1 through Machias,” said Merrill. With some town structures still not fully restored after last winter’s historic flooding, town officials acknowledge a total dike failure is an ongoing concern. But with the new Upper Machias Bay Master Plan Project firmly established and widely supported, community leaders remain optimistic.   There are about 39 individuals formally signed on as members of the community-led effort, including representatives from: Machias and four other surrounding towns, soon to be named Middle River resident(s), the Sunrise County Economic Council, consultants, four conservation groups, and various federal and state agencies, including NOAA, and MaineDOT. The group, expected to meet for the first time in January, is tasked with reaching consensus on plans for the dike, an issue that has been divisive for nearly fifteen years. “It's not the kind of process that can be rushed,” said interim Machias town manager Sarah Craighead Dedmon. “But I think it's kind of, kind of revolutionary…to drive these regional solutions and with the help of a major state entity.” Correction: This article was updated on Jan. 19 to clarify that the temporary structure would be a bridge, not a dike, and to clarify that damage from recent storms is not necessarily attributable to issues with the dike. It has also been updated to clarify attribution for funding for the structure, the possible effects of a failure of the dike, and recommendations made by NOAA.

In November, the Maine Department of Health and Human Services proposed the first major update to assisted living and residential care facility rules in more than 15 years. The scope of the changes came as a shock to many in the industry, and was met with an outcry from residential care facility operators, who said the associated costs could put them out of business.  This week, the department responded with a new proposal, watering down its staffing requirements and giving facilities two years to phase in the changes, according to documents obtained by The Maine Monitor. “It is apparent that increased staffing, nursing, and documentation requirements are needed to ensure the health and safety of residents, in terms of the increasing acuity of resident needs, and in light of the frequency and severity of complaints related to non-compliance with the rule,” DHHS said in its response to public comments. “However, in light of the concerns regarding financial impact, the department has amended the proposed rule in many sections to address concerns about the burden on providers.” The initial proposed regulations 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. The updated regulations scaled back the staffing ratios, including returning to a standard for memory care units that is lower than in nursing homes.  The scaled back staffing ratios are still higher than current staffing requirements, which require residential care facilities with more than 10 beds to have one direct care worker for every 12 residents during the day; one to 18 in the evening; and one to 30 overnight. Rather than increase the ratios for these facilities to one direct care worker per eight residents during the day and evening shifts, and one direct care worker per 15 residents overnight, as initially proposed, the new proposal sets a final standard of one direct care worker for every 10 residents from 7 a.m. to 11 p.m. and one direct care worker for every 20 residents from 11 p.m. to 7 a.m. In memory care units, the final staffing requirement for these facilities would be one direct care worker for every eight residents during the day and one direct care worker for every 15 residents overnight. In nursing homes, state regulations require a ratio of one worker to five residents during the day, one to 10 in the evening and one to 15 overnight. DHHS had initially proposed a new requirement for memory care units to have an employee whose sole responsibility was to observe residents, but removed it in the updated rule. The new regulations follow 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, including abuse and neglect incidents, more than a hundred cases where residents wandered away from their facilities and hundreds of medication and treatment violations. Experts, advocates and providers said requiring higher staffing levels, better training and more nursing care would help address these problems. Mixed reactions Advocates who applauded the initial proposal said the changes this week still contained “many improvements” around staffing levels, training requirements, transparency and accountability. “The rule does not include everything we hoped for. But it is a significant improvement and will provide comfort and protection for many residents and their families,” said John Brautigam, an advocate for Legal Services for Maine Elders. “Many assisted housing facilities in Maine already meet most of the rule’s requirements, and all of them should welcome a strong new, uniform standard.” Angela Cole Westhoff, president and CEO of the Maine Health Care Association, which represents the state’s assisted living and residential care facilities and had previously warned that the initial proposal could have “catastrophic outcomes,” said this week that Maine is still grappling with historic workforce shortages and these updated regulations won’t create more workers. “While the updates to the rule have made a bit of progress, we still have major concerns with the draft regulations,” she told The Monitor. “Simply put, raising staffing requirements without meaningful investment will lead to the closure of homes across the state.” Michael Tyler, managing partner of Sandy River Company — a real estate firm that owns and operates assisted living facilities in the state — said the updated rules have not assuaged his initial concerns. “As drafted, these rules are a recipe for more closures and reduced access to long-term care in Maine,” he said. “Providers were not consulted in the development of these rules and over 100 individuals testified against these increased regulations and unfunded staffing mandates.” DHHS received and responded to 110 public comments on the proposed updates to assisted living and residential care facility regulations, most of which relayed opposition to the proposal. The department said the most prevalent concerns were the fiscal impact of the staffing ratios, the availability of nursing staff, increased administrative costs related to documentation and the lack of increased rates to offset the costs. The department said it heard from many facilities that the staffing ratios would likely prevent them from operating and that it revised the staffing requirements in response to the public comments, but said that “increased staffing is still needed for all licenses and will improve resident care.” “Overall, the department aims to adopt a rule that promotes resident health and safety without overburdening providers in a way that will result in closures and further reduction in services,” DHHS said in a statement that accompanied the updated rules. “The department also determined that, for many facilities, resident health and safety would still be greatly improved even if the staffing ratios from the proposed rule were slightly reduced.” Increasing needs Assisted living and residential care facilities offer less medical care than nursing homes but have expanded in recent years as people opt to live in more home-like and independent settings. At the same time, the needs of residents in these facilities have increased. A report released last year by 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. Brenda Gallant, Maine’s advocate for long-term care residents and their families, said assessment data indicates a “steep rise” in resident care needs between 2021 and 2023, and that the most frequent complaints she sees have to do with inadequate care and staffing. “Direct care staff tell us how discouraging and difficult it is when staffing levels are inadequate,” Gallant said. “There is no question that inadequate staffing levels not only impacts the quality of care, it also impacts staff turnover.” Brautigam, with Legal Services for Maine Elders, said he welcomed the “long-awaited” updated rules because current residents of these facilities have greater health needs than ever before. “We have seen accounts of residents wandering off premises, individuals languishing in neglected and unsafe conditions, and failures to provide for residents’ medical needs,” he said.  “The stakes here are high,” he added. “Strong rules will prevent neglect, improve health outcomes, and foster environments where residents feel valued and safe. We owe it to them to ensure these protections are as strong as possible.” Expected costs Initially, DHHS asserted the rule changes were expected to have “minimal fiscal impact on licensed providers.” In an updated economic impact statement this week, DHHS estimated additional costs to providers for increased staffing overnight, nurse consulting policy development and management, medication management, compliance paperwork and administrator oversight. In total, the department estimated annual costs would increase by between $178,000 and $262,200 for assisted living programs and between $68,800 and $134,800 for residential care facilities. “The department acknowledges this is a significant increase in operating expenses, and also the licensing rules do not address reimbursement,” DHHS said in the economic impact statement. It added that these proposed regulations will go to the Legislature, which is the “appropriate forum” to discuss increased reimbursement. DHHS was expected to submit final proposed regulations to the Legislature by Jan. 10, but facility owners and operators had asked the department to pause the process in order to have more discussion. In its response this week, DHHS said it had carefully considered public testimony and changed the rules in response, and therefore it “will not delay submission of the rule to engage in further collaboration on the rule, and will await the Legislature’s determination on next steps, including whether to hold a public hearing.”

Editor’s Note: The following first appeared in The Maine Monitor’s free environmental newsletter, Climate Monitor, that is delivered to inboxes every Friday morning. Sign up for the free newsletter to stay informed of Maine environmental news. As the Portland Fire Department transitions away from firefighting foam laden with ‘forever chemicals’ at the Portland International Jetport, a state lawmaker is pushing for the rest of Maine to follow. State Rep. Dan Ankeles (D-Brunswick) teased a bill in Augusta on Tuesday that would create a statewide collection and disposal process for the toxic foam, called aqueous film-forming foam (AFFF), which contains high levels of a persistent, harmful class of compounds known as PFAS. The foam is common in fire departments across Maine. The Portland Fire Department is in the midst of that transition, having swapped AFFF in two of three fire trucks stationed at the Jetport for a PFAS-free foam while the final truck undergoes maintenance before completing the switch, officials told The Maine Monitor. Both measures follow the calamitous spill of the toxic firefighting foam at the Brunswick Executive Airport last August. After months of deferred maintenance by the airport’s governing authority, an equipment malfunction caused the discharge of a more than 50,000-gallon slurry of foam and water into nearby stormwater ponds, leaking into the Androscoggin River and its tributaries. Brunswick residents and elected officials have grilled the Midcoast Regional Redevelopment Authority, which runs the airport, and the Maine Department of Environmental Protection in the spill’s aftermath, spreading attention to the use of AFFF at airports, fire departments, military bases and industrial facilities across Maine.  Though the planned AFFF bill hasn’t yet been introduced to the state legislature, Ankeles described its potential provisions at a presentation to legislators in Augusta on Tuesday, alongside advocates with Maine’s Environmental Priorities Coalition, which hosted the event. Ankeles said the bill could create a takeback program that takes inventory of AFFF across the state and establishes collection points where municipalities and quasi-government agencies like MRRA can send it for storage.  Citing reporting from the Portland Press Herald that traced the disposal of the Brunswick airport’s AFFF to low-income communities in Canada and Arkansas, Ankeles specified that the program would provide safe long-term storage for the foam until a destruction process that is less environmentally impactful than current incineration methods are established. “This program will protect our land and waterways and safeguard the public health of everyone from those who rely on well water to firefighters who deserve to be safe when they do their job,” Ankeles said. In a December interview, Division Chief Sean Donaghue and Portland Deputy Fire Chief John Cenate, who is overseeing the transition, took pride in the city’s proactive initiative, emphasizing that U.S. officials only recently released AFFF disposal guidelines for fire departments at federally certified airports to follow.  “We’re way ahead of this,” said Donaghue, explaining that the 517 federally certified airports were required to have AFFF on-hand until recently. The transition is “well managed and well organized. I'm really proud of the fact that we're… out in front.” The federal guidelines include precautionary measures that Portland firefighters followed when handling the foam, which included suiting up in protective outerwear and donning masks, goggles and gloves, according to Cenate. The effects of PFAS on human health are still being discovered, but the U.S. Centers for Disease Control and Prevention has linked the chemicals to weakened immune responses, kidney and testicular cancer, and pregnancy-induced blood pressure disorders. To ensure that the toxic foam didn’t escape into the nearby Fore River and accumulate in aquatic species like it has by the Androscoggin in Brunswick, Portland firefighters carefully opened valves on the trucks’ tanks and released the AFFF into special chemical-grade totes, with a back-up catchment underneath.  Firefighters then rinsed the trucks twice, driving them around with water sloshing in the tanks, and emptied the byproducts into the same totes as the foam. The department replaced the AFFF with roughly 1,800 gallons of a new foam that lacks fluorine, the element that bonds with carbon in PFAS molecules to form one of the strongest known chains of atoms. The AFFF and byproducts are currently being stored at the Portland Jetport until the environmental waste company contracted by the city collects the totes and disposes of them, Cenate said.  Whereas disposal of the foam is under the oversight of the waste company contracted by Portland, MXI Environmental, Ankeles, the Brunswick legislator, intends for his legislation to mandate the storage of such foam until safer disposal techniques are developed, namely ones that don’t involve the release of potentially hazardous byproducts through incineration. “It's important that we be able to stand up this program as the technology continues to develop, and make sure that we dispose of this” foam, Ankeles said, and “get it out of Maine's communities in an environmentally safe and an environmentally just way.”