Almost half of Texas counties have nowhere to get prenatal care, let alone deliver a baby. This plan offers legislative proposals to shore up what’s left.

On Nov. 20, the Biden administration released a list of proposals for long-term management of the Colorado River. The river, which provides water to 40 million people across seven Western states, 30 tribes and parts of Mexico, is in crisis. Climate change, drought and overuse have depleted its flow by 20% since 2000. After months of stalled negotiations among the Colorado River Basin states over how to address the chronic water shortages, the federal Bureau of Reclamation has now released four alternatives for managing the Colorado River.

It’s unclear how the states will respond to the proposals, despite dire warnings that climate change will further stress the already overtaxed water supply. Meanwhile, there is uncertainty over whether or how the incoming Trump administration will impact negotiations.

The Upper Basin states — Colorado, Utah, Wyoming and New Mexico — have long clashed with the Lower Basin states — California, Arizona and Nevada — over who should bear the brunt of future cutbacks from the beleaguered river. After failing to reach an agreement earlier this year, the Upper and Lower Basin states filed two competing proposals for the river’s long-term management to the federal government. Despite their current legal obligation to send a certain amount of water downstream, the Upper Basin states argue that they should be able to send less, while the Lower Basin states, which use much more water than their Upper Basin neighbors, contend that any cuts should be shared more evenly across the region during times of scarcity. Meanwhile, the Colorado River Basin tribes, which have historically never received their fair share of water, and conservation organizations have also submitted their own proposals for consideration.

The ongoing conflict has sparked fears that the states will end up embroiled in litigation after the current agreement expires.

The current crisis came to a head in 2022, when water levels in Lake Mead and Lake Powell dropped so low that they threatened hydropower generation. In response, the states adopted a short-term agreement to cut water use and raise the reservoirs’ water levels in 2023. But those rules expire in December 2026.

The Bureau of Reclamation was hoping that the states would come to an agreement over how to share the river’s dwindling water supply long before that deadline, but so far, negotiations have been mired in gridlock. The ongoing conflict has sparked fears that the states will end up embroiled in litigation after the current agreement expires.

Here’s what you need to know about the latest proposals, and what might come next:

Reclamation’s four alternatives were light on the details.

The proposals provide little advice about how, exactly, to divvy up the water; the agency says they are merely intended to provide “a path forward” for negotiations.

The first option focuses on what federal agencies can do in the absence of an agreement among the states to protect “critical infrastructure.” Shortages would be determined by the elevations of Lakes Powell and Mead, which serve as holding tanks for the Upper and Lower basins, respectively. Cuts would be distributed based on the region’s arcane water rights system, in which older rights take priority. The second “hybrid” proposal combines the first one with comments from tribes and other stakeholders. The third, which incorporates comments from environmental organizations, suggests that Lower Basin cuts should be triggered by water levels in reservoirs as well as factors like rain, snowmelt, and river and groundwater flows across the basin, rather than concentrating solely on Mead and Powell. The fourth is a hybrid of the proposals submitted by states, tribes and conservation organizations, with multiple options regarding which entities would bear cuts  

Notably, the Biden administration did not include in their entirety either of the proposals from the Upper and Lower Basin states. “Clearly, Reclamation is laying out options that have a compromise built in, or incentive for compromise,” said Edith Zagona, research professor of water resources engineering at the University of Colorado Boulder.

The proposals are broad, and experts caution against reading too much into them. Many more details about how the cuts will be determined and shared still need to be hashed out. “It’s hard to know where this is going,” said Mark Squillace, a natural resources law professor at the University of Colorado Law School.

So far, water managers are remaining relatively tight-lipped about what they think of the alternatives.

In a press briefing after the alternatives were released, Tom Buschatzke, the director of the Arizona Department of Water Resources and the primary negotiator for Arizona, said that the various proposals had some really positive elements. At the same time, however, he said he was “disappointed that Reclamation chose to create alternatives, rather than to model the Lower Basin states’ alternative in its entirety.”

Similarly, Becky Mitchell, Colorado’s water commissioner and negotiator for Colorado, said in a statement that her state “cannot speak directly to the contents of Reclamation’s matrix of potential alternatives at this time,” but remains firmly committed to the Upper Basin states’ alternative.

The Biden administration will analyze the proposals and craft a draft environmental impact statement, which it plans to release later this year.

Uncertainty remains about how the Trump administration will impact Colorado River talks.

Negotiators have expressed optimism that the process will continue as planned under the incoming administration. Historically, the federal government has relied on the states to come to an agreement, and new administrations have had little impact on negotiations. Shrinking water supplies are not a partisan issue, said Jennifer Pitt, the Colorado River program director for the National Audubon Society, adding, “The fact of the matter is there’s less water in the Colorado River.”

But the Trump administration could still have an impact on the Colorado River’s future. It could refuse to advance Biden’s proposals, for example. Donald Trump has not only threatened to gut federal agencies, he’s also talked about revoking Inflation Reduction Act funding, which has paid for conservation initiatives and water-saving incentives in the Lower Basin. “That funding helped ward off the acute crisis that the Colorado River faced in 2022,” Pitt said. What will happen if it ends is anyone’s guess.

Multiple recent studies have found that climate change is bringing the Colorado River to a tipping point.

A study released last month, which modeled the drought vulnerability of Colorado’s Western Slope river basins, concluded that the Colorado River may soon reach a grim milestone: There will not be enough precipitation, full stop, to keep Lake Powell full. Other recent studies have found that future drought in the Colorado River Basin may be worse than previously anticipated and much harder to recover from.

Meanwhile, conservation organizations feel they cannot implement strategies to conserve water and restore habitats effectively until the seven states come to an agreement. Ultimately, to avoid jumping from climate change-fueled crisis to crisis, the states need come to an agreement for how to divvy up the water — and they need to do it sooner rather than later, Pitt said. “We’re stuck at the cusp of a crisis and a big fight.”

The post The Biden administration weighs in on Colorado River management appeared first on High Country News.

The fertilizer was promoted as an environmental win-win for years. An untold number of farmers and ranchers across Texas have spread it on their land.

Russell Marinari, 23, graduated from the Maine Maritime Academy in Castine in May and is now   working as third mate on Deepwater Titan, an offshore drillship in the Gulf of Mexico. Marinari works three weeks on and then has three weeks off. 

“I summered in Boothbay and knew I wanted to work on the water,” he said. “I have a full-time salary and I only work 50 percent of the year. I think that’s pretty cool.”

The excitement of working at sea for months and exploring new places has long attracted people to nautical careers.

But a number of factors, including the pandemic, have left the United States with a marked shortage of merchant mariners, who largely work on commercial ships that at times transport weaponry and supplies to the U.S. military, provide disaster relief and support international trade.

Thomas Lord, a 1987 Maine Maritime Academy graduate and now executive vice president of Seiden Krieger Associates, said the shortage of mariners has been a major topic of discussion recently, and that many mariners have postponed retirement so the true magnitude of the situation has yet to be felt.

“The crisis is with the mariners, the shipboard folks,” said Lord. “They are raising the alarm that we need more mariners.”

A 2021 report from the Baltic and International Maritime Council and the International Chamber of Shipping described a shortage of around 26,000 officers certified to work on ships in international waters and predicted it would triple by 2026.  

The report forecast that there would be a need for an additional 89,510 officers by 2026 to operate the world’s merchant fleet. BIMCO said there were at the time 1.89 million seafarers operating over 74,000 vessels around the globe.

Ann Phillips, a retired Navy rear admiral who heads the Department of Transportation’s Maritime Administration, told a Congressional committee last year that the mariner shortage was exacerbated by COVID-19 but has been a problem for several years.

During the pandemic, hundreds of thousands of mariners were stranded at sea during the peak of the crisis, with many ports refusing to allow crew ashore. Some were at sea for 20 months, according to reporting by The Washington Post, even as demand for their services skyrocketed.

Ninety percent of the world’s goods move by sea, a figure that became glaringly evident during the pandemic, as containers stacked up in ports, waiting to meet insatiable consumer demand.

Phillips cited a 2017 study that found the U.S. did not have enough mariners with unlimited tonnage credentials to sustain a full activation of the Ready Reserve Force, which has around 50 vessels and supports the deployment of U.S military forces worldwide. The study found a deficit of 1,839 mariners. 

“This optimistic scenario assumed that all qualified mariners would be both available and willing to sail as needed,” she said.

Recruitment efforts 

Roland Rexha is secretary treasurer of the Marine Engineers’ Beneficial Association, a union that dates back to 1875 and represents U.S. Coast Guard licensed officers in foreign and domestic trade.

He said the shortage has become acute since the pandemic. To appeal to new recruits, he said, the industry needs to offer higher wages, internet access onboard, better food and a schedule that makes it possible to raise a family.

“If we don’t have enough people, it then becomes an issue with our supply for our sailors and our soldiers,” Rexha said. “It would be catastrophic. We deliver tanks, helicopters, ‘bullets and beans,’ as they say.”

George Tricker, vice president for contracts and contract enforcement for Seafarers International Union, said his group has an active recruiting effort and is streamlining its application process.

“As an industry, we have to make ourselves more visible,” he said. ”Back in the day you were on ships that stayed in port for several days so that you could sightsee. Now you are in and out of the port so quickly. It’s less of an adventure and more of a job.”

Zach York, 23, graduated from Maine Maritime Academy last spring and spent the summer working for a ferry company part-time and joined a union in August. He shipped out in late September as third mate on Major Richard Winters, a cargo ship.

York, who is from Sewell, N.J., said going out to sea ran in his family, noting that his dad attended the United States Merchant Marine Academy at Kings Point and he has been racing sailboats since he was six. 

“It’s a big learning curve,” he said of his new job. “It’s not a training ship. It’s not the same culture. You’re learning a lot every day and trying to put the pieces together, as they say.”

Each job comes with its own contract. York had the option of a 60-day posting or a 120-day posting and opted for the longer one because it will allow him to be home for 115 days.

Industry shifts

Craig Johnson, interim president of the Maine Maritime Academy, graduated from the academy 30 years ago and sailed with the Merchant Marine for seven years before coming ashore.

Johnson said the academy does its best to give students a taste of life at sea. During their four years at the school, they go on three 75-day training cruises — two on an academy vessel and one on a commercial ship.

He said the industry knows it has to make life better for mariners, starting with connectivity, noting that most ships now have Starlink satellite internet. Not long ago he was on a training vessel and received an alert that his son’s blood sugar was low. His son was miles away, yet Johnson was able to address the issue immediately. This is a big change from before. 

“When you went out to sea, you were very disconnected from the world,” Johnson said. “Thirty years ago you lined up at a payphone with 20 other sailors to make calls. In the Nineties came the cell phone that you could use when in port. But now you can do your business at any time.”

He is a member of a working group looking at the mariner shortage and said it’s clear the issue is no longer simply about wages, but amenities.

“This shortage of qualified mariners is something I have never seen before,” Johnson said. “It’s a defense crisis for us too. This is a huge problem worldwide.”

Johnson said at the end of the day, one has to have stamina to work at sea.

“You’re working seven days a week, 12 hours a day. You’re really on call all the time. That’s why people on shore love the mariners,” he said. “They are problem solvers. You can’t call AAA when you’re out at sea. You have to solve problems in real time.”

Note: This story was co-published with Open Campus, The Hechinger Report, and The Washington Post.

CLEVELAND — With no car and a toddler, Shamya Jones enrolled this fall at the four-year university in her small town in Mississippi — Delta State University.

She planned to major in digital media arts, but before she could start, the college eliminated that major, along with 20 other degree programs including history, English, chemistry and music.

“They’re cutting off so much, and teachers [are] leaving,” Jones said. The cuts “take away from us, our education.”

Across the country, rural students like Jones are feeling short-changed and frustrated.

Many of the comparatively few universities that serve rural students are eliminating large numbers of programs and majors, blaming plummeting enrollment and resulting financial crises. Nationwide, college enrollment has declined by 2 million students, or 10 percent, in the 10 years ending in 2022, hitting rural schools particularly hard. An increasing number of rural private, nonprofit colleges are not only cutting majors, but closing altogether.

“We are asking rural folks to accept a set of options that folks in cities and suburbs would never accept,” said Andrew Koricich, a professor of higher education at Appalachian State University in Boone, North Carolina. “It’s almost like, ‘Well, this is what you get to learn, and this is how you get to learn it. And if you don’t like it, you can move.’ ”

For many rural students, there are already few places to go. About 13 million people live in higher education “deserts,” the American Council on Education estimates, mostly in the Midwest and Great Plains, where the nearest university is beyond a reasonable commute away.

Meanwhile, more than a dozen private, nonprofit universities and colleges that are in rural areas or serve large proportions of rural students have closed since 2020, data show.

“It is creating a second class of people to say, ‘You pay your taxes just like everybody else does. You vote like everybody else does. But you just can’t have the same choices as everybody else, because there aren’t enough of you here,’” Koricich said of the cuts. “In a lot of rural places, the idea of choice is sort of a fiction,” he said.

Rural-serving institutions are defined by the Alliance for Research on Regional Colleges, or ARRC, which Koricich directs, as those located in counties classified as rural and not near a metropolitan area.

Even some flagship universities that serve rural communities are making big cuts. West Virginia University this fall began the process of eliminating 28 undergraduate and graduate majors and programs, including most foreign languages and graduate programs in math and public administration. The University of Montana is phasing out or has frozen more than 30 certificate, undergraduate and graduate degree programs and concentrations. A course review is also underway at branch campuses of Pennsylvania State University due to declining enrollment.

But most of the cuts have occurred at regional public universities, which get considerably less money from their states — about $1,100 less, per student, than flagships, the ARRC calculates. Regional institutions educate 70 percent of undergraduates who go to public four-year schools, according to the American Association of State Colleges and Universities. These campuses are also more likely than other kinds of institutions to enroll students from lower-income families and who are the first in their families to go to college, the Baltimore-based Art & Science Group consulting firm found.

St. Cloud State University in Minnesota is cutting 42 degree programs, for example, including criminal justice, gerontology, history, electrical and environmental engineering, economics and physics. The University of Alaska System has scaled back more than 40 programs since 2020, including earth sciences, geography and environmental resources and hospitality administration. Also during that period, Henderson State University in Arkansas dropped 25 and. Emporia State University in Kansas cut, merged or downgraded around 40 undergraduate and graduate majors, minors and concentrations.

The State University of New York at Fredonia is dropping 13 majors. SUNY Potsdam is cutting chemistry, physics, philosophy, French, Spanish and four other programs. The University of North Carolina Asheville is discontinuing religious studies, drama, philosophy and concentrations in French and German.

Related: In this shrinking Mississippi Delta county, getting a college degree means leaving home behind

“Some institutions have no other options” than to do this, because of financial problems and plummeting enrollment, said Charles Welch, president and CEO of the American Association of State Colleges and Universities and a former president of Henderson State and the Arkansas State University System, both of which have cut programs.

At Delta State, for instance, enrollment is down by nearly a quarter since 2014.

A drop in tuition revenue stemming from that decline created an $11 million hole in the university’s budget, President Daniel Ennis told the campus last year. When Ennis got to Delta State, he also found the university was overestimating its revenue from facilities and merchandise.

“At a certain point there’s going to be less of everything — personnel, money, equipment and opportunities — because we have to rightsize the budget,” Ennis said.

But the American Association of University Professors, which represents faculty, said in a 2021 report that problems such as enrollment drops made worse by the pandemic are being exploited by administrators to close programs “as expeditiously as if colleges and universities were businesses whose CEOs suddenly decided to stop making widgets or shut down the steelworks.”

Welch said schools are often simply trying to reduce program duplication among campuses in the same systems and compensate for having less financial support than flagship universities.

“The challenge that our institutions have is that they tend to be lower resourced than institutions in urban areas, or flagship institutions. They can’t rely on big endowments,” Welch said. The pandemic, he said, “threw a whole additional layer on top of what those institutions were already facing.”

Many of the majors affected are in the humanities and languages, making those disciplines less available to rural students than they are to people who live in urban and suburban areas.

These subjects “do much of the work of helping students dream beyond their realities,” said Michael Theune, who chairs the English Department at Illinois Wesleyan University, a private, nonprofit school that has also eliminated majors. “We are paring down the sense of the vastness of our world and the possibilities of university students to experience it differently.”

Some rural-serving public universities and public universities in largely rural states have now undergone repeated rounds of cuts. Youngstown State University in Ohio, for instance, axed Italian, religious studies and other majors in 2021, then six more this year. In all, more than 25 programs have now been eliminated there, many of them in the humanities.

The university, in a message to the campus, pointed out that there were no students at all in 10 of those majors. But students and faculty say it was still important to offer them.

“It is easy to just write us off as, ‘Oh, well, do they really need that school?’ when there are so many other majors,” said Owen Bertram, a senior theater major whose program has so far escaped the cuts. “But I don’t think it’s that simple.”

Bertram, who is also student government representative for the university’s College of Creative Arts, said it’s hard to watch his classmates who wanted to study humanities struggle with the questions, “Do I stay?” “Do I leave?” “Is it worth it?”

At many of the schools, it’s too early to tell if the program cuts will lead to even lower enrollment. In some cases, however, enrollment has continued to decline. At Emporia State, enrollment is down by 14 percent in the two years since about 40 majors were eliminated there.

These cuts come at a time when the proportion of rural high school graduates going to college is falling. Fifty-five percent enroll right after high school, down from 61 percent in 2016, according to the National Student Clearinghouse Research Center. That’s a lower rate than the national average.

Low-income and Black students are disproportionately impacted by program cuts. The University of North Carolina Greensboro, for example, is in the process of phasing out 20 degree programs, including anthropology and physics. More than half the students are low income and 28 percent are Black, according to the state university system.

“UNCG should be a place where anyone should be able to come and get an affordable education in whatever they want,” said Holly Buroughs, a physics major who started a petition protesting the cuts.

“Is a first-gen student like me going to come next year and not see the UNCG that I fell in love with and the opportunities I had?” asked Azariah Journey, a second-year graduate student in history who comes from a rural town in Kentucky.

Related: A community college promises a rural county it ‘hasn’t been left to die’

Dominick Bellipanni is one of the last remaining music students at Delta State as the department is being phased out. He received a scholarship to study piano, which he isn’t sure he would have gotten at the state’s larger, more competitive universities.

Bellipanni is from Indianola, a once-busy crossroad 30 minutes from the university, where he grew up hearing stories about businesses that once operated there but closed.

“Used to be, used to be, used to be,” he remembered people telling him.

Now he’s hearing that again.

His professors talk about how there used to be more music recitals, more scholarships, more money, said Bellipanni, who said he plans to leave the Mississippi Delta when he graduates.

“All you hear is, ‘We used to have this, because we used to have more students.’ ”

Contact writer Jon Marcus at 212-678-7556 or jmarcus@hechingerreport.org.

This story about rural college majors was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education, and Open Campus, a nonprofit newsroom focused on strengthening local coverage of higher education. Reporters in the Open Campus Local Network contributed: Mississippi Today’s Molly Minta, WUNC’s Brianna Atkinson and Signal Ohio’s Amy Morona

The post ‘Easy to just write us off’: Rural students’ options shrink as colleges slash majors appeared first on Mississippi Today.

Mounting costs from storm damage, economic losses and expected repairs continues to mount. Also the latest county breakdown in lives lost.

Helene damage costs in NC more than $53 billion. Who will pay is unclear. is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

In the first major update to assisted living and residential care regulations in more than 15 years, the Maine Department of Health and Human Services has proposed significantly increasing staffing requirements, among other changes.  

Advocates have applauded this step as necessary to meet residents’ increasing medical needs and address gaps in care, but facility representatives say the associated costs could lead to “catastrophic outcomes.”

During a public hearing earlier this month, the department proposed big changes to the current staffing ratios, including doubling the number of direct care workers at residential care facilities overnight and setting stricter rules in memory care units that go beyond the state and federal staffing requirements at nursing homes.

The new expectations, which are not accompanied by additional funding, came as a surprise to most in the industry, who thought the regulations would be limited to the licensing structure.

The proposed updates come after an 18-month investigation into the state’s largest residential care facilities published by The Maine Monitor and ProPublica 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.

Assisted living programs — which the state currently categorizes in 10 tiers — serve older Mainers, adults with intellectual and developmental disabilities and people with mental illness. These 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 significantly,” said Brenda Gallant, Maine’s long-term care ombudsman, the state’s advocate for residents and their families. This is in part because nursing homes have closed and been converted to assisted living facilities, and because people are aging at home for longer, waiting until they’re older to move into a facility. 

“Current regulations for assisted housing have not kept pace with the increasing needs of residents,” Gallant said. “This is an opportunity to improve the quality of care for residents that should not be missed.” 

Facility owners and administrators, however, warned that increased staffing requirements will be difficult to meet due to workforce shortages. During the Nov. 13 public hearing, one resident services director in Saco said they have been trying to hire a nurse for more than two years. Another administrator said their last opening took two months to fill and when they finally hired, the candidate had “no qualifications” and required months of training.

Staffing levels

When the proposed changes were announced on Oct. 23, DHHS summarized them as simplifying the licensing process. As it stands, there are 10 different levels of assisted housing that vary depending on the number of beds, the needs of the population they serve and whether they accept MaineCare.

The proposal simplifies these 10 levels into two: assisted living facilities and residential care facilities. Assisted living facilities offer private apartments whereas residential care facilities are closer to nursing homes, with private or semi-private bedrooms. 

“This simplified structure is designed to improve licensee understanding of and compliance with the rule,” DHHS said in its announcement. “The provisions of the proposed rule have been updated to reflect current best practices in assisted housing.”

It was these updates that took the facilities by surprise. The current staffing ratios for residential care facilities with more than 10 beds require one direct care worker for 12 residents during the day shift; one for 18 residents during the evening; and one to 30 overnight. Facilities with 10 or fewer beds must have at least one responsible adult present.

Under the proposed regulations, facilities with more than 10 beds would need to have one direct care worker for eight residents during the day and evening shifts; and one for 15 residents overnight. Facilities with 10 or fewer beds would need to have at least two responsible adults on duty at all times.

The proposed staffing requirements for memory care units are stricter: one direct care worker to five residents during the day and evening shifts; and one worker to 10 residents on night shifts. These staff ratios would be more than what is required in nursing homes.

The update stipulates that memory care units must also have one additional employee during the day shift “who is delegated to provide direct observation of residents and who does not have additional assigned duties.” At the public hearing, providers expressed confusion about the role of this employee and said it would be a challenge to keep the responsibilities so narrow.

Experts and advocates have told The Monitor that residents with Alzheimer’s disease and other dementias are among the most vulnerable because they can have a tendency to wander. During the course of The Monitor’s investigation one facility owner called the current staffing requirement “scary,” “unsafe” and “completely inadequate.”

Gallant, the long-term care ombudsman, said staffing problems in residential care rank third among the most frequent complaints her program receives.

“The staffing numbers are a starting point and I expect there will be more discussion,” she said. “But the providers have to understand that they are taking care of more complex residents and staffing needs to reflect that.”

The proposed regulations also add a definition and required assessment for risk of “elopement,” or an incident in which a resident is “leaving a secure facility without authorization or supervision.” The Monitor and ProPublica found that there were at least 115 reported elopements at Maine residential care facilities from 2020 to 2022, according to state inspection records and a database of incidents reported to the health department.

Numerous providers said they were concerned that these regulations marked a step away from assisted housing as a “social model” towards a “medical model” more closely aligned with a nursing home. Yet some acknowledged that the needs of residents in these facilities have increased. 

Gallant said the state estimated in recent years that between one-fourth and one-third of residents served in residential care would qualify for a nursing home — at least 26 of which have closed in Maine over the last decade.

Mark Kaplan, a physician who has patients in assisted housing facilities, said he has seen the residents’ needs grow. Within one week, he saw a resident with end-stage liver disease waiting for a liver transplant, another who was on dialysis, and another who had COPD and heart disease.

‘Significant new costs’

The changes came as “quite a shock,” said Angela Cole Westhoff, president and CEO of the Maine Health Care Association, which represents nursing homes and assisted living facilities across the state.

“The lack of communication contrasts starkly with the open dialogue with the department with respect to nursing facility rate reform, where comments, both positive and negative, have been welcomed as a vital part of the regulatory process,” Westhoff said in her testimony.

DHHS held a listening session on assisted housing changes last December and considered suggestions from the long-term care ombudsman. But aside from the listening session, Westhoff said there had been “zero communication with the affected providers about this rulemaking.”

Westhoff and facility administrators said they would be happy to participate in focus groups with the state to find solutions that would pose less of a financial burden. At the hearing, they repeatedly asked the state to “hit pause” on the process.

DHHS is required to present the proposed regulations to lawmakers by Jan. 10 in order for them to be reviewed and approved during the upcoming legislative session. A DHHS spokesperson did not respond to questions about what would happen if it missed that deadline in favor of more discussion.

The staffing requirements will mean adding about 2,000 more direct care workers, according to estimates from MHCA.

“This industry is not financially positioned to incur significant new costs without a corresponding increase in MaineCare spending and private pay pricing,” Westhoff said. “With the increased staffing and other costs that the new rule would impose, assisted living and residential care facilities will be further financially strained.”

During the three-hour public hearing, providers strongly disputed DHHS’s assertion that the rule was expected to have “minimal fiscal impact on licensed providers.”

DLTC Healthcare & Bella Point, which owns and operates 17 residential care facilities, estimated the change would cost an additional $108,000 for each 30-bed facility.

The director of finance and human resources for Schooner Retirement Community, Schooner Memory Care and Fallbrook Woods estimated the three facilities would need to add 68 full-time-equivalent employees, totaling $4.5 million.

Woodlands Senior Living, which operates 16 facilities in Maine, said it would need to hire more than 300 staff members across its facilities, totaling nearly $13 million.

Many providers said they would likely have to pass these costs on to residents unless the regulations came with an increase in MaineCare reimbursement from the state.

DHHS spokesperson Lindsay Hammes said the department could not comment during the rulemaking process and noted that the proposals could change based on public comments, which are being accepted until Nov. 25. 

Encroaching regulations

Island Commons, a 7-bed non-profit facility on Chebeague Island, said it already runs a deficit of $150,000 annually due to low MaineCare reimbursement, which it offsets by fundraising every year. The facility estimates that increased staffing requirements would add another $190,000.

Four of the facility’s beds typically go to MaineCare residents, and the other three are private pay, said Amy Rich, the administrator. The added costs would likely increase the private rates by 30 to 40 percent to about $325 a day. This would be “untenable” for those residents, said Nancy Olney, the community outreach manager.

Increasing rates would cause private-pay residents to spend down their savings faster, which would put them onto MaineCare sooner, Rich said. She added that many facilities are already dropping MaineCare beds because of the costs.

Rich said the proposed regulations are “encroaching” into the nursing home realm. Her facility would be required to have a license for its adult day care program; a registered nurse would be required to help write training policies; and she would need to add another direct care worker around the clock.

She sees the proposed regulations as moving away from allowing facilities to rely on what she called a universal worker: someone who is a cook or cleaner but also a certified residential medication aide who can help out when needed.

“It’s so clinical,” she said. 

While she acknowledged that some facilities are having trouble addressing residents’ growing medical needs, she doesn’t think the solution is for DHHS to introduce significant changes without provider input.

A better approach, she said, would be to require facilities with repeat problems to increase their staffing, rather than changing the ratios across the board for facilities like Island Commons, which hasn’t been cited for any deficiencies in recent years.

When asked about whether doubling the staff would impact her, Helen Nannery, a resident at Island Commons, said it could mean more activities. Janet Martin, another resident, added: “It’s better. You’d have more workers.”

Rich acknowledged the work day is easier when they have more people on duty: “It is great. It’s just not feasible because of the financial impact.”

‘The stakes here are high’

While testimony at the public hearing consisted largely of facility owners and administrators who opposed the proposed regulations, Gallant, the long-term care ombudsman, and a representative from Legal Services for the Maine Elders both testified in support. AARP Maine told The Monitor it also planned to support the rule changes. 

A survey of direct care workers in assisted living and residential care facilities across the state found that most workers would like to see increased staffing, said Nicole Marchesi, who works in the ombudsman’s office. Increasing staff ratios can help prevent burnout and turnover, she said.

“Staff tell us they do not feel they are leaving their shift providing quality care because of the current staffing ratios,” Marchesi said. “These staff continue to express the frustration around caring for residents who are nursing home level of care in assisted living. When staffing is insufficient, resident safety is jeopardized.”

The long-term care ombudsman and Legal Services for Maine Elders also recommended having license renewal and survey inspections completed annually, rather than every two years, and creating a standard practice to follow up on plans of correction when facilities are cited for deficiencies. 

In our investigation, The Monitor found that DHHS rarely sanctioned facilities in cases where residents unsafely wandered away — in the vast majority of cases, investigators never inspected the facilities, conducting only a desk review or no investigation at all.

Gallant, the ombudsman, also asked DHHS to publish survey results on its website and make the website more user-friendly so residents and families can better access the information and compare facilities.

“The stakes here are high,” wrote John Brautigam on behalf of Legal Services for Maine Elders. “These rules have the potential to 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.”

Rollins, who grew up in Glen Rose and once led the Texas Public Policy Foundation, will need Senate confirmation before becoming agriculture secretary.

Wausau Pilot & Review staff

As Thanksgiving approaches, many American families anticipate the warmth of shared meals and cherished traditions. However, in today’s polarized political climate, these gatherings can also become arenas for contentious debates, potentially straining familial bonds.

Experts offer strategies to help families navigate these challenges, ensuring that the holiday remains a time of gratitude and connection.

Understanding the Challenge

Political differences have always existed within families, but recent years have seen these divides deepen. A 2023 Quinnipiac University poll revealed that 61% of voters hoped to avoid discussing politics during holiday gatherings, highlighting a widespread desire to sidestep potential conflicts.

“Surveys show that most people look at these sort of Thanksgiving political discussions with dread,” said Jennifer Wolak, a political science professor at Michigan State University who studies the psychology of compromise. “Most people say they hope to avoid having political conversations because they’re conflictual, they’re argumentative. And people also carry these really strong stereotypes about the other party.”

Strategies for Harmonious Gatherings

1. Set Clear Boundaries

Establishing guidelines before the gathering can prevent unwanted political debates. Discussing and agreeing upon topics to avoid can help maintain a peaceful atmosphere. “Perhaps even having an honest conversation with your loved ones before the holiday meal or activity begins [and] to say ‘Is it possible that we could leave some of these differences at the door?’” Natalie Hernandez, Senior Director at Penn State’s counseling and psychological services, told Fox43.

2. Practice Active Listening

When political topics arise, listening without immediate judgment can foster understanding. Engaging with genuine curiosity about others’ perspectives can de-escalate potential conflicts. “Go in with a genuine curiosity and willingness to listen,” said Todd Schenk, an associate professor at Virginia Tech.

3. Focus on Shared Values

Highlighting commonalities rather than differences can strengthen familial bonds. Discussing shared experiences, traditions, and values can redirect conversations toward unity. “Thinking about funny family stories and past vacations or trips or experiences you’ve had … think about some of these topics that might allow you to feel that sense of connection without engaging in conflict,” rElizabeth Dorrance Hall, a communication professor at Michigan State University, told Bridge Michigan.

4. Choose the Right Time and Place

Sensitive discussions are best held in private, away from the larger group setting. This approach allows for more thoughtful and less confrontational exchanges. “A very sensitive conversation is best not done in front of jeering friends or family,” Schenk added.

5. Agree to Disagree

Recognizing that changing someone’s deeply held beliefs over a single meal is unlikely can reduce frustration. Accepting differing opinions without attempting to convert others can preserve harmony. “Persuasion is possible and a common reason for engagement,” Schenk said. “However, it is difficult and, when it happens, typically the result of sustained dialogue.”

The Role of Empathy and Respect

Empathy plays a crucial role in navigating political differences. Understanding the experiences and values that shape others’ beliefs can lead to more compassionate interactions. “There’s no reason that your MAGA uncle and your woke niece can’t sit down together around the table and have a conversation,” said Colorado Governor Jared Polis, co-head of the National Governors Association’s “Disagree Better” initiative.

When to Avoid Political Discussions

In some cases, steering clear of political topics may be the best course of action, especially if past experiences suggest that such discussions lead to conflict. Focusing on neutral subjects like family stories, hobbies, or shared interests can keep the atmosphere light and enjoyable. “Sometimes the holidays are one of the few times of the year that families get together… Rather than have conversations about politics, it can be comforting to reminisce over family stories and memories,” Hall added.

Conclusion

Thanksgiving offers an opportunity to celebrate togetherness and gratitude. By approaching political differences with empathy, respect, and thoughtful communication, families can ensure that their gatherings remain a source of joy and connection, even in a divided political landscape.

Republicans finishing 2nd in close contests for NC Supreme Court and legislature protest groups of voters, hoping to change the outcome.

Protests put some final NC election results on hold. Candidates hope to disqualify enough voters to win. is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.