Nursing Homes in Maine
As retirees age, increasing frailty, chronic medical conditions and disabilities can make living with limited support unsafe. When living alone becomes unsafe and seniors require access to more regular medical care, it may be time to look into a nursing home. In Maine, 21.7% of the state's 1,385,340 residents are aged 65 or older. Of the nearly 301,000 seniors in the state, 4,823 are nursing home residents at one of the 90 communities available statewide.
Nursing homes offer skilled nursing services round-the-clock, making them ideal for seniors who need more intensive management for chronic health conditions or for those who struggle with daily tasks. Nursing homes combine meal preparation, medical services and recreational activities under one roof. The rate for a semiprivate nursing home room averages $7,908 monthly in Maine, according to the Genworth Cost of Care Survey.
The information provided below includes an overview of the average cost of nursing home care in different parts of Maine, along with information about Medicaid benefits that may be available to help pay for some of the associated costs. This guide also includes resources that seniors and their loved ones may find helpful when navigating the benefit options and enrollment processes.
Popular Cities in Maine
Cost of Maine Nursing Homes
The average cost of nursing homes in Maine is $275 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Maine?
Medicaid is administered by the Office of MaineCare Services in Maine and currently has enrolled approximately 366,526 residents. Seniors who meet functional and financial eligibility guidelines may qualify for partial or full coverage for stays in a nursing home, but not all facilities may accept Medicaid as a payment method. The functional eligibility requirements apply to all seniors, regardless of the source of funds for their long-term nursing home stay.
For seniors who may not yet need the level of care provided in a nursing home, Maine has alternative Home and Community Based Services Waivers that provide in-home assistance. These waivers also assist seniors with transitioning from a nursing home back into the community. Long-term care is also available through assisted living communities and independent housing with services options. All of these are potentially eligible for financial coverage through Medicaid for seniors who qualify.
Medicaid Eligibility in Maine
When applying for Long-Term Care Medicaid, there are different financial eligibility requirements versus standard Medicaid. For standard Medicaid, the income limits range from $1,677 to $2,589 based on the age of the applicant, with younger applicants allowed higher levels of income. For LTC Medicaid, a single senior can earn as much as $2,742 per month and up to $10,000 in assets after including the $8,000 savings exemption.
If only one-half of a married couple requires nursing home care, the income limit only applies to the senior enrolling. However, all of that income is applied toward nursing home costs minus a $40 personal needs allowance. The nonapplicant spouse has no income limits and an asset limit of $148,620.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 + $8,000 in savings |
| Married Applicants(Only One Spouse Applying) | $32,904 | $2,000 + $8,000 in savings for the applicant and $148,620 for nonapplicant |
| Married Applicants(Both Spouses Applying) | $65,808 | $15,000 if in a shared room including savings exemption or $20,000 for spouses in separate rooms or communities |
*Per year
To qualify, seniors must also be legal residents of Maine and a citizen or permanent residents of the United States.
How to Apply for Medicaid in Maine
The easiest and most straightforward option for applying for MaineCare, the state's Medicaid program, is via the online portal at MyMaine Connection. Seniors or their family members can also download and complete an application and mail it to:
Office for Family Independence
114 Corn Shop Lane
Farmington, ME 04938
Faxed applications can be sent to (207) 778-8429, and in-person applications are welcome at any OFI office. Applications are also accepted via email sent to [email protected]. For seniors who have already submitted an application or for those who need help filling out the application, the helpline is available at (855) 797-4357.
When filling out the application, seniors will need to submit some documentation that may include certified or standard copies of various documents. Below is a quick list of some of the information and documentation that may be needed.
Information You Will Need:
- Applicant Social Security numbers
- Proof of income and assets
- Any information about current health coverage and premiums
- Proof of citizenship or legal residency
- Proof of identity (birth certificate, passport or naturalization papers)
- Front and back copies of immigration cards for those who are not citizens
Additional Medicaid Support & Resources in Maine
Navigating public benefits can be complicated. The below resources can help seniors find and apply for programs that may help with nursing home costs.
| Contact | Service | |
|---|---|---|
| MaineCare Representatives | (855) 797-4357 | MaineCare has a helpline available to prospective applicants that offer direct assistance with the application process and explanations of the eligibility rules. Seniors can get help filling out the online application, submitting it and assistance with application approvals or denials. |
| Office of Aging and Disability Services | (207) 287-3707 | The Office of Aging and Disability Resources offers assistance with benefit applications and scheduling required functional assessments. Seniors can also contact Maine's Assessing Services Agency directly at (833) 525-5784 to schedule a functional needs assessment, though a face-to-face meeting may be required. |
| Legal Services for the Elderly | (800) 750-5353 | Legal Services for the Elderly offers free or low-cost legal help to seniors in civil matters. This can include illegal nursing home evictions and other violations of the resident's bill of rights. |
Can You Use Medicare to Pay for Nursing Home Care in Maine?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Maine
While Medicare doesn't cover nursing home stays over a set duration, it can provide an initial burst of financial assistance in some situations. The following organizations link seniors and family members with advisors able to provide input on individual circumstances.
| Contact | Service | |
|---|---|---|
| Maine Association of Area Agencies on Aging | (800) 639-1553 | The Maine Association of Area Agencies on Aging is the central connection point for the five different regional providers that serve the entire state. Through an AAA, seniors can find out more about available benefits for which they may qualify and how to apply, along with referral services. Each agency has an individual contact number, so the one provided here is for Augusta, though seniors can locate their regional office via the site. |
| Maine Bureau of Insurance | (207) 624-8475 | The Maine Bureau of Insurance offers unbiased assistance in understanding and comparing various Medicare plans. Representatives can also help seniors determine coverage levels for nursing home stays. |
| Maine Senior Medicare Patrol | (800) 750-5353 | The Maine Senior Medicare Patrol helps seniors identify and report instances of Medicare fraud, waste or abuse. |
Other Financial Assistance Options for Nursing Home Care in Maine
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Maine
| Licensing Requirements | To operate in Maine, nursing homes must be licensed by the Medical Facilities Unit and renewed annually. |
| Staffing Requirements | Maine has strict requirements for nursing home staffing, including a registered professional nurse on duty during every shift, a director of nursing and a minimum of one direct care provider per five residents during the day. In the evening, one provider is present for every 10 residents, and one provider is present for every 15 residents during the night shift. |
| Staff Training Requirements | All new staff members must complete an orientation program and CNAs must be provided with a minimum of 12 hours of in-service education per year. Nursing staff must meet all requirements to maintain their licensure. |
| Admission Restrictions | Prior to admission, all seniors must be fully assessed to determine the level and scope of assistance required for their care. Pre-screening for mental illnesses and mental retardation is also required. Any potential resident with care needs that can't be adequately performed in a nursing home or patients determined to be a risk to other residents may not be admitted for residency. |
| Care Planning Requirements | Within seven days of the completion of the original assessment, nursing homes must work with a multidisciplinary team to develop a comprehensive care plan that includes goals and timelines for achievement. Care plans should be implemented immediately and consistently, with monthly reviews documenting successes or new strategies. |
| Dietary and Nutritional Services Requirements | Nursing homes must provide residents with a minimum of three nutritious meals per day, in accordance with any prescribed dietary limitations or cultural preferences. Nursing homes are also required to have a Food Service Supervisor on staff to ensure quality menus and exceptional hygiene practices by all members of the meal preparation staff. |
| Specialized Rehabilitative Services | Residents who need rehabilitative services, such as physical or occupational therapies, must be provided access. If the nursing home doesn't have providers on staff, outside providers may be necessary. |
| Medication and Pharmaceutical Services | Nursing homes must offer medication management services and retain a licensed pharmacist as a consultant to ensure all patient records are up-to-date, policies and procedures meet industry best practices and all drug plans are carried out appropriately. |
| Activities Requirements | Information collected during the comprehensive needs assessment during enrollment should be used to generate an ongoing program of activities. Nursing homes must offer activities to meet the interests of senior residents and help maintain their physical, mental and psychosocial well-being. |
| Infection Control Requirements | Nursing homes must have infection control programs in place to ensure residents have a sanitary environment. Associated staff should be trained on cleaning methods and provided with enough cleaning supplies and equipment to handle cleaning, sterilizing and disinfecting the entire facility. |
| Medicaid Coverage | MaineCare may pay for all or part of the costs of nursing home care for eligible residents in registered facilities. |
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