Maine nursing homes are closer to meeting the Biden administration’s proposed minimum staffing standards than their counterparts in most other states, but recent payroll data show that still fewer than one in 10 are meeting these proposed standards every day.

And while some long-term care advocates said the national standards should go further, nursing home industry leaders said it would be difficult for a rural state like Maine to find the workers to meet the required minimums, which could lead to more closures.

The Biden administration in September proposed federal standards that would require nursing homes to have a registered nurse on duty at all times, and establish minimum care hours per resident from registered nurses and nurse aides.

During the second quarter of 2023 — from April to June — Maine nursing homes met the proposed minimum care hours from both registered nurses and nurse aides an average of 59 out of 91 days in the quarter, according to analysis from The Maine Monitor, USA TODAY and Big Local News at Stanford University, the latest federal staffing data. The data is collected by the Payroll-Based Journal from the U.S. Centers for Medicare and Medicaid. 

Only Alaska was higher with an average of 88 days. The national average was 18 days.

However, only 8% of Maine nursing homes met both standards on all 91 days of the quarter. This still places Maine third in the country behind Alaska and Hawaii. (The national average was 1%.)

Part of the reason Maine nursing homes are more prepared to meet the standard could be because the state already has its own nursing home staffing requirements, including minimum staff ratios.

However, long-term care resident advocates and industry leaders said the biggest challenge for Maine homes would be meeting the proposed requirement for registered nurses on duty at all times.

Brenda Gallant, Maine’s long-term care ombudsman who advocates for nursing home residents and their families, praised the effort to establish national minimum standards. She viewed staffing as the most important aspect of quality of care in a nursing home. However, Gallant said, she would have liked to see the proposal go even further.

“Honestly, why is it taking the country so long to do the right thing, both by residents and staff?” she said. “We can’t expect people to want to do this work without sufficient resources and when there isn’t sufficient staffing.”

Studies have tied staffing to quality of care and called for the establishment of a federal minimum staffing standard.

The Maine Health Care Association, which represents 200 nursing homes and assisted living facilities across the state, has called the proposed minimum an unfunded mandate that could lead to more nursing home closures. 

In less than three years, the number of nursing homes in Maine has dropped from 93 to 83, some of which have cited staffing challenges as part of the reason. The federal payroll data included staffing information from 85 nursing homes for the second quarter of this year, but two more have since closed. 

Angela Cole Westhoff, the organization’s president & CEO, said Maine nursing homes are among the closest to meeting Biden’s proposal because the state already has some of the highest standards in the country and because Maine homes serve residents who often have higher care needs, which requires them to provide more staffing per resident.

But workforce shortages are already stressing the industry, she said, adding that there needs to be significantly more investment from policymakers to better train and pay direct care workers.

“Essentially, every single nursing home in Maine has multiple jobs posted,” Westhoff said. “We already want more staff. The issue is that Maine simply does not have the workers available to meet our needs.”

While Maine is comparatively better than most other states, the fact that other states are so low demonstrates there is a significant challenge to meeting this proposal, said Jess Maurer, executive director of the Maine Council on Aging.

The proposed rules for nurses and nurse aides would be phased in over three years for most homes, but rural areas would have five years to meet the new standards. The proposal also includes $75 million for staff recruitment and training.

Maurer said the proposal should include additional support and funding for rural communities where it will be hard to find the workers to meet these standards, especially in Maine because it is the oldest state and has among the lowest working-age population in the country.

“We’re the first in the country to deal with this, but we will not be the last,” she said. “We should be the canary in the coal mine. The Feds should be looking at how many nursing homes have closed in Maine and why and who is going to follow because they can’t meet these staffing ratios in small, rural areas.”

Best and worst performers

Even some of the nursing homes doing the best at meeting the proposed requirements were critical of the proposal.

Seven of Maine’s 85 nursing homes met both Biden requirements on all 91 days of the quarter. Among those were two Maine Veterans Homes, in Augusta and Bangor. Both locations have a five-star rating from the federal government based on staffing, health inspections and quality measures.

Rebecca Gagnon, Chief Operating Officer of Maine Veterans Homes, said the homes might have met the proposed minimum staffing requirements because they are “consistent with the unique VA regulations” they already are required to meet, such as round-the-clock presence of a registered nurse.

These existing requirements make operations more costly due to workforce scarcity, Gagnon said.

“Although Maine Veterans’ Homes assumes that the recent change proposed by CMS concerning minimum staffing requirements is prompted by a priority of ensuring care for nursing care residents, we are concerned that the mandate will have the opposite, unintended effect of complicating the availability of services for Maine’s seniors as the industry continues to struggle to meet staffing levels,” Gagnon said.

Cove’s Edge in Damariscotta also met both the proposed registered nurse and nurse aide hours on all 91 days of the quarter and has a five-star rating from the federal government. But MaineHealth, which owns and operates Cove’s Edge, said it had “serious concerns” about a national ratio.

MaineHealth is able to invest and subsidize staffing across all its facilities because it is the state’s largest health system, but it comes at a cost and stand-alone nursing homes may not be able to do the same, said Katie Fullam Harris, chief government affairs officer for MaineHealth.

The existing labor shortage, especially for nurses, is creating pressure across the entire healthcare system.

On any given day, MaineHealth hospitals have 60 to 70 people waiting to be discharged to a nursing home or rehab but there’s nothing available, she said. Cove’s Edge has an additional unit that is currently empty because reimbursements are too low to staff it, Harris said.

“If you mandate a staffing ratio for which there’s no justification, all you will do is put further pressure on a system that is already in crisis,” she said.

Four of the five nursing homes least prepared to meet the proposed standards are owned by Genesis Healthcare, which is one the largest long-term care providers in the country with nearly 250 skilled nursing homes and assisted living facilities in 22 states, according to the company’s website.

Cedar Ridge Center in Skowhegan met both of Biden’s requirements on one day of the quarter and has a two-star rating from CMS. Pine Point Center in Scarborough met both requirements on two days and has a four-star rating. Sandy River Center in Farmington met both on four days and has a one-star rating. Sedgewood Commons in Falmouth met the requirements on five days and has a three-star rating.

A representative for Genesis did not respond to requests for comment.

The proposal on the table

If Biden’s proposed minimum standards are implemented, nursing homes that accept Medicare and Medicaid would be required to provide residents with a minimum of 0.55 hours of care from a registered nurse per day and 2.45 hours of care from a nurse aide per resident per day. And a registered nurse would need to be on duty at all times.

Current standards require a registered nurse or licensed practical nurse to be on duty at all times.

Public comments on the proposal were accepted through early November.

Minimum staffing standards would improve safety and quality care in nursing homes, Xavier Becerra, secretary of the U.S. Department of Health and Human Services, said in a press release at the time.

“When facilities are understaffed, residents suffer,” Becerra said. “They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance. Comprehensive staffing reforms can improve working conditions, leading to higher wages and better retention for this dedicated workforce.”

The Centers for Medicare and Medicaid has estimated that about three-quarters of nursing homes nationally would need to increase staffing to meet the proposal.

Maine nursing homes are already required by state law to have one direct-care staff member for every five residents during the day; one for every 10 residents in the evenings; and one for every 15 residents overnight.

These standards are very close to the three hours of care per resident from a registered nurse and nurse aides that would be required under the national standards, said Gallant, with the ombudsman program.

Gallant said she’d like to see national standards go even further and require 4.1 hours of direct care for each resident. This number comes from a 2001 study by CMS into quality of care, which recommended that registered nurses, licensed practical nurses and certified nurse aides provide a total of 4.1 hours per resident per day. (This recommendation included a standard for LPNs, but Biden’s proposal does not.)

On average, Maine nursing homes met the nurse and nurse aide minimums recommended by CMS in 2001 on 14.5 days of the quarter, according to the analysis of payroll data.

The ombudsman program has conducted focus groups with direct care workers across the state to hear about concerns. In these discussions, Gallant said she’d heard from workers who felt like they couldn’t call in sick because there was no one else to come in.

“There’s not a choice about providing sufficient staffing. Period. There’s just not. That’s what facilities exist to do: take care of people,” she said. “People want to do a good job. If you don’t have sufficient staff, it becomes impossible.”

The primary challenge in a rural state like Maine would be meeting the requirement to have a registered nurse on duty at all times, according to both Gallant and Westhoff, with the industry group representing Maine nursing homes.

“The Feds should be looking at how many nursing homes have closed in Maine and why and who is going to follow because they can’t meet these staffing ratios in small, rural areas.”

Jess Maurer, executive director, Maine Council on Aging

Nearly a quarter of Maine’s nursing homes — 20 out of 85 — met the proposed minimum registered nurse hours on every single day of the 91-day second quarter, according to the analysis of payroll data. This ratio is higher than all other New England states. Nationally, only 6% of nursing homes met this proposed minimum on every day of the quarter.

According to an analysis from the American Health Care Association, about a third — 28 out of 85 — Maine homes would currently meet a 24/7 registered nurse requirement, Westhoff said.

Low MaineCare reimbursement and workforce shortages are driving nursing home closures, Westhoff said, which causes a ripple effect across healthcare as hospitals and other facilities absorb the backlog of patients.

Rather than regulations and obligations, there should be a focus on innovation and solutions, said Maurer with the Maine Council on Aging. For example, it might be a better use of time to regulate staffing agencies, which are expensive for nursing homes and are intended as a stopgap during an unforeseen staff shortage but are increasingly becoming the norm.

And it’s long overdue to increase reimbursement rates for this work, she said. 

“We should be talking about, as humans, what do we value and how do we want to receive care? And we should pay for it.”

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The story Maine nursing homes lead nation in meeting the Biden administration’s proposed staffing standards, but challenges loom appeared first on The Maine Monitor.

ALBION — Over 50 years, Eric and Rebecca Rolfson have created a rural oasis in this central Maine farming community. On 123 acres, they have hand-built a log cabin and renovated a 200- year-old family farmhouse.

They have created a maple syrup business, cultivated hayfields that serve local dairy farmers and cut a community trail system through their woods. This is where they plan to grow old, on land where Eric Rolfson’s parents are buried.

So they were shocked last July when they received a letter from LS Power, a New York City-based power and transmission system developer.

The Rolfsons learned they were among 3,500 or so landowners with property on the potential route of the Aroostook Renewable Gateway, a roughly 140-mile overhead transmission line that would connect the largest wind farm east of the Mississippi River with New England’s electric grid.

A map shows a potential 150-foot wide corridor slicing north-south through the Rolfson’s property.

Standing in the farmhouse’s yard in mid-November, looking up at the wooded ridge that could someday trace the path of transmission lines strung from 110-foot towers, Eric Rolfson expressed his frustration and fear after a lifetime of pouring his heart into the land.

“We love it here,” he said. “We can’t imagine looking up at those towers.”

When it was approved last June by lawmakers and signed by Gov. Janet Mills, the bipartisan legislation enabling the Aroostook Renewable Gateway was hailed as an achievement that would finally unlock northern Maine’s green energy potential while lowering electric rates. 

But already the Aroostook line is beginning to feel reminiscent of another controversial corridor — the troubled New England Clean Energy Connect project, the six-year effort by Central Maine Power’s parent company to build an overhead transmission line from Quebec to Lewiston.

After years of court battles, a citizens referendum was overturned in April and work was allowed to resume. Crews are being reassembled to finish the now-estimated $1.5 billion project, the company said, with plans to energize the line in 2025.

Meanwhile the Rolfsons, and neighbors in Albion, Palermo, Freedom, Thorndike and Unity, are organizing in opposition to the Aroostook line.

They have held protest rallies. They set up a Facebook page with 1,000 members and created a citizen group, Preserve Rural Maine. They’ve hired a Portland attorney with experience fighting transmission lines, including NECEC.

Nearly a dozen towns have enacted temporary moratoriums.

This wasn’t supposed to happen.

The 2021 citizens’ initiative aimed at killing NECEC also contained unprecedented language that requires the legislature to approve any new “high-impact electric transmission lines.”

The idea was to provide a check on developers seeking to push projects through communities that opposed them. The Aroostook line was the first test of the new law and, based on the fight brewing here, it’s not working as planned.

Two problems are becoming obvious. First, rank-and-file lawmakers were asked by key legislative leaders to endorse the project before even knowing where the transmission corridor would run. Second, language in an initial 2021 transmission line bill encouraged new lines to be located in existing rights-of-way or corridors “whenever feasible.” But feasible is a broad term, leaving it to developers to assess what’s technically and financially doable.

The prospect of new transmission corridors going through resistive communities has led some lawmakers to take a step back.

Eleven relevant bills were proposed for the upcoming legislative session, ranging from study alternatives to preventing eminent domain takeovers to rescinding approval altogether. None got the initial go-ahead this month from the Legislative Council, the 10-member leadership body that controls the flow of legislation, although one was granted on appeal. The council includes two Aroostook County lawmakers who are key champions of the project: Senate President Troy Jackson, a Democrat, and Senate Minority Leader Trey Stewart, a Republican.

There’s wide agreement that Maine and the region will need more transmission lines to carry clean energy and phase out the fossil fuel generation linked to climate change. But the highly organized opposition against the Aroostook venture is raising a critical question about how Maine is pursuing its interconnection goals. 

What lessons have politicians and policy makers learned from the NECEC debacle, or from Northern Pass in New Hampshire, the failed attempt to construct a 192-mile overhead line from Quebec that was killed in 2018 after stiff community opposition?

Northern Pass, NECEC and Aroostook Renewable Gateway have something in common. They were designed to carry high-voltage power over lines strung on tall towers running through wide swaths.

By contrast, a similar-size project now being built from Quebec to New York City, the Champlain Hudson Power Express, plans to run cables underground and underwater in narrow corridors. Another cross-border proposal, Twin States Clean Energy Link, would put some of the line under state roadways.

The Aroostook Gateway is the product of decades-long ambitions to connect Maine’s northernmost county with New England’s electric grid, and boost the local economy by building wind, solar and biomass power plants.

It remains in its early stages, planned to come on line in 2029. LS Power has yet to seek key permits from utility and environmental regulators.

As the process unfurls, two additional questions loom: Will Maine push ahead with an unpopular overhead transmission design that has snarled two similar high-profile projects? With an eye on lessons from Northern Pass and NECEC, is it still possible to bury cables underground?

For its part, LS Power stresses that no routes have been finalized.

The company met in July with residents along proposed route options to hear their concerns. It plans a second round of meetings in early 2024 and expects to adjust the route based on feedback.

The route is subject to change until all permits are in hand, the company said, no sooner than 2026.

The company even explored placing towers along sections of Interstate 95, but that idea was rejected by the Maine Department of Transportation. 

One thing not likely to change, according to Doug Mulvey, the company’s vice president for project development, is the alternating current, overhead wires design. LS Power is familiar with underground projects, working on one in San Jose, Calif., Mulvey said.

But burying a high-voltage line that carries the required direct current from Aroostook County to central Maine would cost roughly five times more than the overhead option, he said. That would be a non-starter because a top reason the $2.9 billion project won a competitive bid process at the Public Utilities Commission is it promised to save electric customers money.

“Everyone in the state, everyone we talked to, is extremely concerned about rates,” Mulvey said.

Adding to the complexity, LS Power and the PUC are bogged down in negotiations over details of the power purchase and transmission service agreements. Mulvey told the Portland Press Herald that the impasse was putting the project at risk.

Renewable energy versus ratepayers

The Aroostook Renewable Gateway checks a lot of boxes on the wish list for Maine’s clean energy aspirations.

The line would connect to a 170-turbine wind farm in southern Aroostook County called King Pine, to be built by Boston-based Longroad Energy. The $2 billion project would have a capacity of 1,000 megawatts, producing enough electricity to power 450,000 homes. Other generators, such as solar or biomass, might someday also be able to use the line.

In approving King Pine and the power line last January, the PUC estimated that most Maine residential electricity customers would pay an extra $1 a month — or $1 billion in total — for a 60% share of the project. The rest would be paid by Massachusetts customers as part of that state’s clean energy acquisitions. The actual megawatt-hour cost of electricity hasn’t been made public.

When it was approved by the PUC, the project was hailed by Mills’ energy office as a way to combat the impact of volatile natural gas costs on electricity supply, while creating economic opportunities in northern Maine. Jackson said it would unlock affordable, homegrown renewable energy and create good jobs.

“With today’s vote,” Jackson said at the time, “we are the closest the state has ever been to making the northern Maine transmission line a reality, and unleashing the untapped economic potential and power of Aroostook County.”

All this seemed far away in Albion, roughly 130 miles south of the planned wind project. This is dairy farm country in a state where the industry has been shrinking for decades. But here, 10 dairy farms hang on, evident by the hayfields and pastureland spread across rolling hills.

Driving the country roads, what sticks out most isn’t the cows. It’s the signs. Election season is over but what looks like roadside campaign signs are everywhere. Black-and-white signs read: “Keep LS Power off our land.” Yellow signs with an outline of a transmission tower say, “Stop Gateway Grid,” with the weblink, PreserveRuralMaine.org.

The signs are on the Noyes Family Farm, a third-generation dairy operation with 100 cows that grows corn and hay on 370 acres. Chuck Noyes and his daughter, Holly, were part of a protest at the Albion town office in late July. It was organized to call attention to concerns ranging from loss of farmland to electromagnetic radiation from overhead wires.

In mid-November, Holly Noyes came to the Rolfson farmhouse, with several residents who formed action committees in their communities, to talk about next steps. Over pancakes and the farm’s maple syrup, they discussed a path forward.

“What are our next steps if the legislature isn’t going to listen?” asked Josh Kercsmar of Unity, vice president of the Preserve Rural Maine group. “Where can we turn?”

‘No real input’

This is not what lawmakers had in mind in 2021 when they considered LD 1710. The bill created the Northern Maine Renewable Energy Development Program and directed the PUC to seek proposals for a transmission line that would ship power from green-energy generators in Aroostook County into the New England grid. Jackson, who represents a district in far northern Maine, was the lead sponsor.

But some interest groups that testified on the bill, such as the Maine Farmland Trust, urged lawmakers to remove the “wherever feasible” clause, to “ensure that there is a strong preference for proposals that are collocated with existing utility corridors and roads, and as such, avoid further impacts to important natural and working lands.” No changes were made.

And after the passage in June of LD 924, a follow-up, legislative resolve sponsored by Jackson, Stewart and others to signal specific approval for the Aroostook Gateway, some lawmakers felt the process was being rushed.

“My big concern,” said Rep. Steven Foster, R-Dexter, “is that we’re approving this line, it’s going through 41 communities, but there was no real input during the legislative process before the approval was made.”

Foster, who serves on the legislative committee that handles energy matters, represents towns through which the line could pass.

He proposed a bill for the upcoming session to reconsider the project’s PUC approval. It was rejected by leadership in early November, along with all but one of the proposed remedial measures — a bid from Sen. Chip Curry, D-Waldo, to prevent eminent domain from being used to build the line.

“I think (Senate) President Jackson and others are determined to get this project done,” Foster said. “And I’ll leave it at that.”

Jackson’s perspective, however, is that some lawmakers who oppose wind farms were “piling on” to create obstacles.

After meeting with the Albion-area organizers, Jackson said he’s sympathetic plight and wants LS Power to do its best to mitigate impacts. But he doesn’t see how the lines can be buried, based on the PUC’s bidding criteria.

“That’s not what the PUC asked for in its request for proposals,” Jackson told The Maine Monitor. “They would have to re-bid the whole thing. You’re going to have different costs and ratepayers are going to be impacted.” 

But by selecting a project with overhead transmission lines, Maine is ignoring a lesson from both Northern Pass and NECEC, according to Beth Boepple, a Portland attorney who represented opponents in both cases. It’s technically feasible to run high-voltage cables underground along existing corridors or roadways, she said, and that’s what Maine should require.

“It’s one of the lessons we should have learned,” she said. “We don’t need to reinvent the wheel.”

One difference, Boepple said, is opponents have organized early. There’s still time to press the PUC and permitting agencies such as the Department of Environmental Protection to require underground cables. That could avoid long and costly legal battles, she said.

“We’re a long way from going to court,” she said. “There’s a lot that can be done through the permitting process.”

But even at this early stage, the process is fraught with competing tensions, according to Bill Harwood, Maine’s public advocate. 

The developer requested and won some assurances before investing millions of dollars. But the legislature had to sign off on a major project without key information.

Customers statewide want lower-cost electricity. Local residents, though, don’t want giant towers and overhead wires on their land. 

“Going forward,” Harwood said, “we need to think carefully about whether there’s a better way.”

The story Aroostook power corridor faces opposition from landowners appeared first on The Maine Monitor.

One lunchtime in 2021, a longtime resident at Woodlands Memory Care of Rockland started throwing up. His fingernails turned purple, and his skin became red all over. He was lethargic and fidgety, and his breathing grew shallow, according to the facility’s daily care notes.

The resident was well known at this residential care facility in Maine’s Midcoast region. Former facility employees told The Maine Monitor and ProPublica that he was a nationally renowned concert pianist who continued to play a portable keyboard in his room even as his Alzheimer’s disease advanced.

It wasn’t until a family member arrived and asked if the resident had eaten peanuts that employees realized that he was having an allergic reaction to the peanut butter sandwich that he had been served for lunch, according to the facility care notes. Staff used an EpiPen to treat his anaphylactic shock and took him to the hospital. He died days later, though no official records were made available that show the cause of his death.

The employee who gave the sandwich to the resident wrote in the facility care notes the day after the incident that they “didn’t know” that the resident “was allergic to peanuts.”

In interviews with the Monitor and ProPublica, however, four former employees said the resident’s severe peanut allergy had been documented throughout the facility: in his resident profile, in his room and posted in the kitchen.

“It said it everywhere you looked around him that he was allergic to peanut butter,” said Stacy Peterson, who served as the human resources coordinator at Woodlands of Rockland from 2018 to 2020.

So it was a mystery to the former employees how the resident had been served a peanut butter sandwich that day for lunch.

After receiving an anonymous complaint, the Maine Department of Health and Human Services investigated the incident and cited Woodlands of Rockland for two resident rights violations — first by failing to protect the resident from a severe allergic reaction and the second time by not reporting the case to the state. (The citations do not identify the resident.)

Under state regulations, the health department had the power to impose a fine of up to $10,000 or issue a conditional license that would bar Woodlands of Rockland from accepting new residents for up to 12 months. But it did neither. Instead, it simply required the facility to submit a report, called a plan of correction, stating how it intended to address the deficiencies.

In that plan, Woodlands of Rockland acknowledged that the resident’s allergy had been documented but disputed the health department’s characterization that the facility violated the resident’s rights in the incident. Still, it promised to discipline the employee who served the sandwich and to retrain others on how to handle allergies and to report incidents.

The health department’s modest response to the peanut allergy incident exemplifies its approach to oversight, an investigation by the Monitor and ProPublica found. The health department rarely imposes fines or issues conditional licenses against the state’s roughly 190 largest residential care facilities, classified as Level IV, which provide less medical care than nursing homes but offer more homelike assisted living alternatives for older Mainers.

From 2020 to 2022, the health department issued “statements of deficiencies” against these facilities for 59 resident rights violations and about 650 additional violations — involving anything from medication and record-keeping errors to unsanitary conditions and missed mandatory trainings.

Despite these violations, however, it imposed a fine only once: a $265 penalty against a facility for failing to comply with background check rules for hiring employees. And it issued four conditional licenses: three in response to administrative or technical violations and one in response to a variety of issues, including a violation of a resident’s privacy rights.

By contrast, Massachusetts, which has 269 assisted living facilities, doesn’t shy away from imposing stiff sanctions. From 2020 to 2022, the state suspended eight facilities’ operations for regulatory violations.

The paucity of sanctions in Maine comes at a time when Level IV facilities like Woodlands of Rockland — which are similar to what are known generally as assisted living facilities in other states — are expanding their presence in the state. The share of Maine’s population that is 65 or older, 21.7%, is the highest percentage in the country.

As the Monitor and ProPublica have reported, the state’s decision in the mid-1990s to tighten the requirement to qualify for nursing home placement helped spur thousands of older Mainers, many with significant medical needs, to move to these nonmedical facilities — which are subject only to state regulations that hold them to much lower minimum staffing, nursing and physician requirements than nursing homes, which face both state and federal scrutiny.

In stark contrast to how rarely Level IV facilities face sanctions, nursing homes in Maine are often hit with considerable fines for regulatory violations.

Health department spokesperson Jackie Farwell said that plans of correction are often sufficient for improving conditions at facilities. She added that as part of an effort to improve the long-term care system in Maine, the state has been considering rules changes to “establish fines and sanctions as more meaningful deterrents.” But she declined to elaborate on the specifics.

Dan Cashman, spokesperson for Woodlands Senior Living, which runs 14 Maine facilities including the one in Rockland, said the company has “a zero-tolerance policy” and has taken disciplinary actions against any employees who were found to have violated residents’ rights.

Cashman added that the company is in favor of stronger state action against individuals found to have violated residents’ rights to prevent them from working in residential care settings again.

But long-term care advocates say the health department is not doing enough to crack down on facilities, as opposed to individuals, and is allowing poor conditions to persist for vulnerable residents.

Richard Mollot, executive director of the Long Term Care Community Coalition, a national advocacy group focused on improving nursing homes and assisted living facilities, said stiff sanctions should be imposed more, so that there’s a “meaningful ladder of sufficient penalties to ensure that facilities are properly motivated to take steps to ensure resident safety.”

Otherwise, Mollot said, facilities have no incentive to change their behavior. “To pussyfoot around resident neglect or abuse,” he said, “is essentially encouraging. It’s allowing it to happen.”

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A review by the Monitor and ProPublica of state inspection records from 2020 to 2022 shows that the health department employed the lowest intervention possible, even for some of the most serious abuse and neglect incidents. 

In the summer of 2021, for instance, a resident at Crawford Commons in midcoast Maine was found to have sexually abused another resident multiple times, according to the state’s investigation. The health department cited the facility for two resident rights violations but only required it to submit a plan of correction.

A year later, a resident in Jed Prouty Residential Care Home in the Penobscot Bay region was found around 6:30 a.m., naked and asleep on the floor, “soaking wet with urine,” after falling sometime after 10 p.m. Witnesses said the resident had been crying for help and complaining of thirst until medics responded. No efforts had been made by staff to move the resident from the floor or provide clothing, according to the state’s investigation. Again, the health department cited the facility for a resident rights violation but only required it to submit a plan of correction.

Similarly, in 2021 and 2022, the health department also investigated Woodlands of Rockland for two other serious incidents. In one, a certified nursing assistant at the facility slapped a resident who had spit at and attempted to bite her, according to the state’s investigation.

In the other, a resident wandered out to the facility’s locked courtyard, but employees didn’t notice that she was missing until they went to give her medications nearly two hours later, according to the state’s investigation. When the resident was found outside in the snow at around 8:40 p.m., employees wrapped her in blankets and called for emergency medical care. The resident died in hospice days later, and the state investigation cited the cause as “complications of hypothermia.”

In the end, both incidents also led to plans of correction.

Woodlands of Rockland has been disputing the health department’s characterization that the facility violated the resident’s rights in the courtyard incident. But Cashman declined to elaborate on the specifics.

Edward Sedacca, CEO of Magnolia Assisted Living, which runs Jed Prouty, said his company took over the operation of the facility in August 2022, a month before the incident, and has since made it a priority to enhance its staffing and training. “The staff we inherited was lacking in overall general knowledge,“ he said. “Magnolia has built an infrastructure well beyond that required under regulation to enable us to provide a higher level of care to all of our residents.”

Crawford Commons did not respond to requests for comment.

For Maine’s nursing homes, however, the response to similar incidents has been very different.

From 2020 to 2022, more than half of nursing homes in Maine received fines — 98 penalties in all, totaling nearly $700,000 — according to U.S. Centers for Medicare and Medicaid Services reports. These fines were imposed in response to a range of violations, including not following COVID-19 infection prevention protocol, making medication errors, not reporting unexpected deaths and failing to protect residents from harm.

In 2020, for instance, an employee at Pinnacle Health & Rehab, a nursing home in Canton in western Maine, “lost it” when a resident became combative, according to CMS investigation records. The employee punched the resident, who ended up with a black eye and bruising around the eyebrow. CMS fined the facility $41,650.

A year later, a resident at Heritage Rehab and Living Center, a nursing home in central Maine, wandered off the premises at night using a walker and was found later by police by the side of a road in the rain. No one at the facility had noticed that the resident was missing, according to CMS investigation records. CMS fined the facility $71,243.

Ken Huhn, administrator of Pinnacle, said the employee was fired, and he made it clear that “that type of behavior would not be tolerated” at his facility.

Heritage did not respond to requests for comment.

“To pussyfoot around resident neglect or abuse is essentially encouraging. It’s allowing it to happen.”

Richard Mollot, executive director of the Long Term Care Community Coalition

Even without the involvement of CMS, which does not regulate assisted living facilities around the country, the health department has the power to adopt a tougher approach toward Level IV facilities. Under state regulations, for instance, it can impose a fine when an incident poses “a substantial probability of serious mental or physical harm to a resident.”

Long-term care advocates told the Monitor and ProPublica that under this standard, some of the egregious abuse and neglect incidents in recent years at Level IV facilities should have resulted in stiff sanctions.

“Because the incidents are so egregious and show such disregard for the well-being of residents, they would have warranted some significant penalty and not just a pro forma requirement that the facility submit a plan of correction,” said Eric Carlson, director of long-term services and support advocacy at Justice in Aging, a national legal advocacy nonprofit focused on ending poverty among seniors.

Paula Banks, who has served as the executive director of another Woodlands facility in Cape Elizabeth and as an assistant administrator of a Maine nursing home, said the fear of such sanctions would be effective. If she were still helping run a residential care facility, she said, it would spur her to take immediate action to address any problems.

“What’s the impetus to change if there’s no consequence?” said Banks, who now runs a geriatric consulting and care management firm.

But Dr. Jabbar Fazeli, who has served as medical director at multiple residential care facilities and nursing homes in Maine, said that rather than imposing sanctions, the state should require more medical attention by increasing nursing hours and requiring a medical director to be on the premises.

“If they had more medical care, I would say 50% of these issues will self-resolve,” Fazeli said.

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The health department metes out sanctions in only a small percent of the incidents it hears about each year. Most of the time, it hardly does anything.

To better understand the health department’s process for looking into potential issues, the Monitor and ProPublica analyzed a database of incidents reported to the state by Level IV facilities themselves. Unlike the state inspection records, the database of facility-reported incidents gives a window into what happens earlier in the health department’s enforcement process.

Level IV facilities are required to report an incident to the state when a regulatory violation may have occurred or when a resident’s safety was put at risk. We focused particularly on reports of incidents with the potential for direct harm: the cases of abuse and neglect.

From 2020 to 2022, the state received more than 550 reports of abuse and neglect incidents from Level IV facilities, according to the Monitor and ProPublica analysis. Of those, 342 cases involved residents abusing other residents, 102 cases involved “elopement,” in which residents wandered away unsupervised, and 61 cases involved a staff member abusing a resident.

The analysis shows that in nearly 85% of these incidents, state investigators took “no action” — which, according to Farwell, means that the health department decided not to investigate. She said this could have been for a range of reasons, such as when a facility has already taken corrective action, when state investigators do not expect to find a regulatory violation, or when an incident is being investigated as part of another case or is expected to be reviewed later.

The analysis also shows that the health department did not step up its enforcement even when individual facilities repeatedly reported similar issues.

From 2020 to 2022, 13 Level IV facilities, including Woodlands of Rockland, each had at least 10 abuse and neglect incidents, collectively reporting 348 cases to the state. Even after these facilities had reported multiple cases, the health department still took no action in 91% of them, the analysis shows.

Farwell said state investigators do pay attention to repeated incidents. “If patterns are observed, specific issues may be flagged for follow-up at the next scheduled survey,” she said.

But such follow-ups might not happen for many months, depending on the timing of the next inspection required for license renewal, which takes place only once every two years.

Dionne Mills, who served as the program coordinator at Woodlands of Rockland from 2019 to 2021 and also worked at two other Level IV facilities, said she became aware of the lack of state oversight during her time at the Rockland facility. She said she reported multiple incidents to the state until eventually a state investigator told her that they were too overwhelmed with complaints and that she would have more success taking her concerns to the media.

“The state is so super busy that they only have time to look into the absolute worst-case scenario,” Mills said.

Farwell disputed Mills’ account, noting that state investigators made seven visits to Woodlands of Rockland from 2020 to 2022, the time period when the facility was under investigation for the courtyard, peanut allergy and slapping incidents. Mills’ account “is inconsistent with the number of onsite visits that were conducted at this facility,” she said.

According to Farwell, the health department has 13 investigators — and is in the process of hiring two more — to inspect more than 1,100 assisted housing facilities in the state for license renewals and to investigate any incidents.

Mollot, of the Long Term Care Community Coalition, said the health department needs to do more against facilities with a history of repeated incidents, such as requiring independent monitoring and, possibly, revoking licenses.

“Faced with the fact that these facilities have reported over and over and over and over and over again incidents of abuse and neglect, why have there been a paucity of enforcement acts?” Mollot said.

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Several former employees told the Monitor and ProPublica that the history of repeated incidents at Woodlands of Rockland illustrates what can happen to a facility’s standards when the health department takes little enforcement action.

From 2020 to 2022, Woodlands of Rockland had the highest number of abuse incidents reported by a Level IV facility — 48 cases in all, including 38 in which a resident abused another resident, according to the health department database.

But the health department investigated only five of the incidents that Woodlands of Rockland reported, took no action on the rest and imposed no sanctions other than requiring the facility to submit one plan of correction.

With little pressure from the health department, efforts to address recurring problems “were nonexistent when I worked there,” Mills, the former program coordinator, said.

“What’s the impetus to change if there’s no consequence?”

Paula Banks, former executive director of a Woodlands facility in Cape Elizabeth

Joshua Benner, who served as a residential care aide at Woodlands of Rockland from 2018 to 2020, said he found it concerning that when the facility was cited by the health department, none of the managers at the facility shared with employees what problems had been found.

“Every other health care place that I’ve ever worked, you have interventions, usually after the state comes in, to go over what you’re dinged on and what can be improved,” said Benner, who has worked at a nursing home and two other residential care facilities.

Cashman, the Woodlands spokesperson, denied that Woodlands of Rockland had “an ongoing or systemic problem” with abuse incidents, noting that the bulk of the cases involved a small number of residents “whose progressively worsening dementia-related behaviors became more and more challenging.”

In response to these residents’ behaviors, Cashman said Woodlands of Rockland has been proactive and taken “multiple interventions,” including resident care plan updates, medication modifications, referrals for hospital treatment and discharge planning.

Cashman said Woodlands of Rockland and its employees have been doing “their best to manage what can be extremely difficult behaviors by individuals living with significant cognitive impairments.”

But Banks said something is amiss if any facility has repeated incidents, noting that she would have been alarmed to see more than one or two incidents of abuse in three years, let alone 30 or more as Woodlands of Rockland did.

“When you have people in your building and you took them in and you told their families you would take care of them and you took their money,” Banks said, “I don’t care what’s going on. I don’t care if you have a staff of three. You’ve got to take care of your people.”

The story Maine rarely sanctions residential care facilities even after severe abuse or neglect incidents appeared first on The Maine Monitor.

It takes about 13 minutes to drive from Schemengees Bar and Grille in Lewiston to the Papermill Trail/Miller Park boat launch in Lisbon. The fastest way is along Route 196, leaving the area locals call Lincoln Street Flats, cutting southeast across the city, past businesses, homes and places of worship and into neighboring Lisbon where the road crosses the Androscoggin River.

The tree-lined streets look quintessentially New England this time of year with the leaves’ red-orange hues.

It’s not known if the Lewiston shooting suspect, Robert Card, took that route after his deadly rampage at the bar and a bowling alley on Wednesday evening. But investigators found his Subaru abandoned at the boat launch shortly before 10 p.m. that night.

He hasn’t been seen since. 

With the search for Card now extending into a third day, investigators face a massive challenge: the suspect in Maine’s deadliest mass shooting has escaped in a state with an estimated 17.5 million acres of forest land and numerous rivers, vast expanses of uninhabited land dotted by small communities, farms, logging roads and two lane highways. 

More than 350 law enforcement officials in Maine were taking part in the manhunt, said Mark Latti, spokesman for Maine Inland Fisheries and Wildlife. Authorities spent Friday conducting extensive searches by air and boat, said Department of Public Safety Commissioner Michael Sauschuck.

Divers with the Maine State Police, Warden Service and Marine Patrol were getting ready to search a small section of the wide and meandering Androscoggin River, which stretches from Maine’s western border at the town of Gilead, through downtown Lewiston, until it meets the Kennebec River and eventually the sprawling Atlantic Ocean. 

A utility is using its dams to lower the water-level of the river in the area, but Sauschuck made it clear that would not be law enforcement’s only area of focus.

But the message from authorities on Friday was clear: they need the public’s help to locate a man they consider armed and dangerous. So far, more than 530 tips have come in from the public.

“Every minute this goes on we’re more and more concerned,” Sauschuck said. “That’s why we’re working 24/7.”

Maine has been here before

Maine’s vast wilderness and forest lands have shielded suspects from capture before. As the search dragged on Friday, the challenges ahead to locate Card evoked memories of past manhunts.

In 2015, Robert Burton, accused of killing his girlfriend, eluded capture for about nine weeks before he gave himself up. He lived in the woods in Piscataquis County, in central Maine, county officials and the Bangor Daily News said at the time.

It was the longest manhunt in state history. Tracking dogs and electronic road sign warnings were used in the extensive manhunt for Burton, the newspaper said. State police said he was suspected of hiding in the woods and stealing provisions from nearby campsites, Reuters reported at the time.

Three years later, it took officers from 200 jurisdictions during a four-day manhunt in the woods of Maine in April 2018 to locate John Williams, who was later convicted of fatally shooting Somerset County Sheriff Eugene Cole, Maine media reported at the time.

In Pennsylvania last month, convicted murder Danelo Cavalcante, 34, escaped from prison and avoided capture for nearly two weeks despite a massive manhunt to apprehend him. The New York Times reported it was a federal aircraft that detected a “heat signature” — an object giving off more heat than its surroundings — that eventually located him.

Robert Card knows the area 

Robert Card’s family has lived in Bowdoin for generations, and members of the family own hundreds of acres in the area, The Associated Press reported. Officers were at a home believed to belong to Card’s brother Thursday night. 

“This is his stomping ground,” Richard Goddard, who lives near the family, said of the suspect, according to the Associated Press. “He knows every ledge to hide behind, every thicket.”

Like the rest of Maine, Androscoggin and Sagadahoc counties, which were under shelter in place orders until Friday as police searched for Card, are heavily wooded, with a majority of their landmass covered by forest. 

Of Androscoggin County’s roughly 307,000 acres, 63% consists of forests, according to a 2018 report from the U.S. Forest Service, compared to 60% of land in smaller Sagadahoc County.

Overall, 89% of Maine is covered by forest land, excluding water.

“We do look at all of these situations as if the individual could be there,” Sauschuck said of the focus areas for the search. “And if that’s the case, you’ll see tactical teams at some point” dressed in casual clothing “just because they’re out in the woods and they’re going to be out crawling around.”

Dense underbrush and downed trees are a couple complicating factors in searching through Maine’s varying woodlands and topography, said Bryan Courpois, a veteran search and rescue volunteer and president of Pine Tree Search and Rescue.

Gridded searches over a set tract of land can be bogged down by searchers having to stop and check underneath trees. The search can be much more efficient if the members of the team know each other well, Courpois said. That situation could be complicated when law enforcement personnel from multiple jurisdictions are on the scene. 

“It’s also sometimes dictated by the experience of the ground searchers and how well that particular group has worked,” Courpois said. “If there’s some people on our team that I’ve worked with a number of times … we can probably cover an area more efficiently than we could if we had some less experienced people.”

The search area 

Investigators were focused Friday on a boat launch on the Androscoggin River, using a remotely operated vehicle, or ROV, underwater to search. Divers will join the search as early as Saturday.

“They’re using, right now, a remote-operated vehicle, a ‘submersible ROV,’ which they operate with a tether from the shore and basically it’s got propulsion and the ability to change depth … They’re also going to be physically in the water with scuba divers,” Latti said in an interview with The Maine Monitor.

Latti stood on Route 196 by St. Matthew’s Episcopal Church in Lisbon near the search area along the Androscoggin River. Police would not let anyone closer to the boat launch down the road.

Overhead helicopters with the Maine Forest Service and New Hampshire State Police were also supporting the search for Card, Latti said. He said he did not know if the helicopters had any heat detecting equipment onboard, although the Portland Press Herald reported crews were using thermal imaging to scan the water. 

That heat-detecting technology becomes less effective if a body has been submerged in a cold river like the Androscoggin, a dive rescue expert told The Maine Monitor.

Whether by air, walking along the shoreline or remotely from land each approach comes with a trade-off between the area that can be covered and the level of detail that search ultimately provides.

“The helicopters that were above can cover a lot of ground, but they can’t focus as well as somebody walking along the shoreline,” Latti said.

When dive rescue and recovery teams start searching for a person, whether dead or alive, they rely on evidence and witnesses to determine where that person was last seen in relation to the body of water, said Justin Fox, a veteran diver for Colorado public safety agencies and president of Dive Rescue International.

Without evidence of where a person enters the water, a search area expands significantly, Fox said. Rather than closing in on a certain location, investigators have to first rule out where a person is not.

“I think that there’s a lot of unknowns in this instance,” Fox said of the kinds of information investigators in Maine have at this time. 

Should Card have drowned in the Androscoggin, then any targeted location effort might have to extend miles downstream with the flow of the river.

“There’s also the potential for the water to move a [drowning] victim,” Fox said. “So instead of sinking straight to the bottom, if there’s a current significant enough to move them, then they would also have to search downstream of the point last known.”

Card’s whereabouts were still unknown by Friday afternoon.

“He could be anywhere at this point,” Kenneth Gray, a retired FBI Special Agent and a senior lecturer at the University of New Haven’s Henry C. Lee College of Criminal Justice and Forensic Sciences, told the Boston Globe. “He could be in Canada. He could be down in Massachusetts. He could be anywhere in the Northeast.”

New Hampshire State Police have sent SWAT team members to assist with ground searches in Maine, said an agency spokeswoman. 

Detectives with New Hampshire’s major crime unit are also helping investigators at multiple crime scenes. The Special Enforcement Unit is providing air support with its helicopter, she said. 

Troopers were also providing mental health services to people involved in the shooting, and shuttling blood donations from New Hampshire hospitals to Maine hospitals.

“New Hampshire State Troopers will continue to remain vigilant and visible, especially along our Maine border until this situation is resolved,” said Commissioner Robert Quinn in a press statement. “We will provide additional resources as requested by law enforcement partners.”

What the experts say

Edward Davis, who was Boston’s police commissioner during the 2013 Marathon bombings, said the situation was somewhat similar to what occurred in his city during a days long manhunt for the suspects. 

One big difference: greater Boston is an urban environment, whereas the area being searched in Maine is largely rural.

The bombings happened on April 15, 2013 and the second suspect, Dzhokhar Tsarnaev, was not located until April 19. He was hiding in a boat parked in a Watertown backyard. 

During a manhunt, Davis said investigators typically set up a grid around the area to organize the search. They also scour social media and interview acquaintances to understand where the suspect might go.

Investigators would also see if the suspect had a second “switch car” or a boat they could use to evade police. They would use the suspect’s cell phone to track their location and look at surveillance video to locate them.

Card’s cell phone was found in his home by law enforcement, the Associated Press reported. Investigators also found a note.

Scott Sweetow, a longtime firearms instructor and military reservist who is now president of S3 Global Consulting, LLC, said it was apparent to him that Card had military training and knew how to handle a weapon. But he was optimistic he would be found.

“The average SWAT officer (federal, state or local) is likely to be far more proficient with long guns than this guy, and also part of a well trained team,” Sweetow said. “It may take some time, but they will eventually catch this guy.”

The story Maine’s vast rural expanse complicates the search for Lewiston shooting suspect appeared first on The Maine Monitor.

Mass shootings at a bowling alley and bar that left 18 people dead in Lewiston on Wednesday evening have brought Maine’s complicated relationship with guns and how to regulate them to the forefront once again.

In the past three years, state lawmakers have proposed nearly four dozen bills to regulate the sale, carry and liability of guns in Maine, but most have not passed the Legislature. A “yellow flag” law enacted in 2019 lets law enforcement take guns away from someone they suspect of posing a threat to themselves or others, but officials concede it is underutilized.

Maine ranks in the middle of the pack among other states when it comes to gun safety laws, according to Everytown for Gun Safety, a gun control group, and the laws in place appeared to have done little to stop the suspect in the mass shooting in Lewiston.

Maine does not require a permit to carry a firearm in most cases. State lawmakers have rejected proposals for background checks and limits on accessories that make guns more easy to shoot. It also does not have a ban on assault weapons, unlike two other New England states.

Kristen Cloutier, who lives in Lewiston and is the Assistant House Majority Leader, said the shooting in her hometown was “surreal and heartbreaking,” and called for “bold” legislative action to address gun violence.

“This has only strengthened my own resolve to do whatever I can to help prevent similar tragedies like this from happening again in other communities. As a state, we must do more to address gun violence and keep ourselves, our families, our friends and our neighbors safe,” Cloutier wrote in a statement to the press. 

“Words are not enough — they never have been. We must take bold action,” she added.

The Maine Gun Safety Coalition immediately called on state lawmakers to pass an assault weapons ban calling the events in Lewiston “horrific, senseless tragedies.”

Rep. Rebecca Millett (D-Cape Elizabeth), a member of the state’s Gun Safety Caucus, said it was very difficult to talk about the mass shooting in Lewiston, after spending years fighting “bad gun bills” and trying to advance gun safety laws.

“The years I had to listen to my colleagues stand and say we don’t need gun safety legislation and Maine is the safest place in the country. To have my worst nightmares happen, is just devastating,” Millett said in an interview with The Maine Monitor. 

Details emerge about man alleged to have shot 18 people 

A manhunt was underway Thursday by police to find the man suspected of firing multiple shots at two locations, killing 18 and wounding 13. Photos released by law enforcement show a man carrying a semiautomatic style rifle.

The suspect, Robert R. Card, 40, of Bowdoin, has a history of mental health problems and is a trained firearms instructor, according to the Associated Press.

Card is a petroleum supply specialist and Sgt. 1st Class in the Army Reserve, a spokesperson for the U.S. Army confirmed to the Portland Press Herald Thursday. The spokesperson told the newspaper that Card enlisted in 2002 and has received multiple awards but has not been deployed in combat.

Maine State Police Thursday issued an arrest warrant for Card on eight counts of murder. Col. William Ross said during a press briefing the counts will increase once the 10 other victims are identified. Ross said Card is considered “armed and dangerous,” and urged people not to approach him but to call 911 or tip lines 207-213-9526 or 207-509-9002.

The Sun Journal reported that Card had spent two weeks at a mental health facility this summer. It is unknown if Card was voluntarily admitted or involuntarily committed to the facility.

People who are involuntarily committed to a psychiatric hospital by a district court may not own or possess firearms in Maine, according to state law. Violating the law is a class D misdemeanor crime.

The Associated Press reported Thursday that police took Card for an evaluation in mid-July after military officials grew concerned about his erratic behavior while he was training with the U.S. Army Reserves at the Military Academy at West Point in New York, according to an official who spoke to the AP on the condition of anonymity because they were not authorized to publicly discuss the information. The official told the AP that military commanders called the New York state police, who took Card to the Keller Army Community Hospital for evaluation.

When asked at a press briefing why Card was able to access a gun despite his reported history of mental health challenges, Mike Sauschuck, commissioner of the Maine Department of Public Safety, said “those are all valid questions and certainly questions that we are looking into now, but not questions that we can answer today,” given the ongoing manhunt.

Maine grapples with foreseeable harm

Maine legislators passed the “yellow flag” law in 2019 that allows police to petition a court to remove guns from a person that a medical expert says presents “a likelihood of foreseeable harm” to themselves or others either because of suicidal or violent threats against others.

The Associated Press reported that Maine’s yellow flag law is weaker than so-called “red flag” laws found in some 20 other states. The Maine law requires police first to get a medical practitioner to evaluate the person and find them to be a threat before police can petition a judge to order the person’s firearms to be seized, the AP said.

It was not clear Thursday if the law came into play regarding the suspect in the Lewiston shooting.

Maine’s yellow flag law is underused, police acknowledge. Maine Public Radio reported that the law was used two dozen times in the first two years it was in effect. Earlier this year, law enforcement noted that the law is “not being used on a regular and responsive basis” and cited a lack of available medical professionals to complete the assessments, according to a report.

Barbara Cardone, spokeswoman for the state judicial branch, said Thursday involuntary commitment orders and petitions under the “yellow flag” law are confidential court records. She declined to say whether any such court records existed for Card. 

“All of these kinds of records are confidential, so I cannot provide you with any information,” Cardone wrote.

Edward Davis, who was Boston’s police commissioner during 2013 Marathon bombings, said the weapon in photos released by police appeared to be an assault-style rifle, most likely an AR-15 or an M-4, which is the military version of the AR-15. 

Davis, who now runs his own security company, noted that he spends time in Maine and has had tense conversations with Mainers about gun ownership. 

“I have guns, but they need to be regulated,” Davis said in an interview with The Maine Monitor. 

The suspect in the shootings, Card, has a history of mental health problems. “We should have an absolute prohibition on anybody like that having guns,” Davis said.

Maine will now grapple with how to respond to one of its worst mass casualty events. 

Similar shootings have shaken the country, including the 2022 Buffalo grocery store shooting that killed 10, and the 2021 spa shooting spree in Atlanta that killed eight people.

“We continue to monitor the horrific situation in the greater Lewiston area as the manhunt is underway for the person of interest in the Lewiston mass shooting. We grieve for the families of the 18 who were killed and 13 injured in this senseless tragedy,” Maine House Republicans said in a news release on Thursday.

Stephen King, famous Maine horror and science fiction author, said on X, formerly known as Twitter, Thursday morning that these kinds of shootings don’t happen in other countries.

“The shootings occurred less than 50 miles from where I live,” he wrote to his 7 million followers. “I went to high school in Lisbon. It’s the rapid-fire killing machines, people. This is madness in the name of freedom. Stop electing apologists for murder.”

A tired fight for change

Everytown For Gun Safety, a gun safety advocacy group, ranked Maine 25th in the nation in terms of gun laws.

Maine law prohibits any person convicted of a crime and sentenced to a year or more in prison from possessing a firearm. People under a protection from abuse order for harassing, stalking or threatening an intimate partner or child also may not possess a gun.

State lawmakers in recent years have rejected ideas to prohibit people from possessing “rapid-fire modification” devices for guns that increase the number of bullets that can be shot at one time or to require background checks for purchasers at private gun shows.

Maine lawmakers also rejected a proposed background check exemption for people with concealed weapons permits when they go to purchase a firearm, and legislation that would regulate the manufacture, distribution and possession of “untraceable and undetectable” firearms.

A proposal that would allow certain people to carry concealed handguns on school property narrowly failed in the Maine Legislature in June. 

Several more pieces of gun legislation are expected to be discussed by lawmakers next year when the Legislature reconvenes in January.

Millett, the lawmaker from Cape Elizabeth, has a bill that would allow a person to bring a civil lawsuit against gun manufacturers for selling “abnormally dangerous” guns, because the product was “most suitable for assaultive purposes” rather than hunting, self-defense or sport, or because it converts a legal firearm into an illegal firearm, or is marketed to minors.

She said in an interview Thursday it is time for legislators to listen to the people they represent and to be proactive about gun safety.

Still, lawmakers will face barriers to getting substantial legislation passed next year while they meet for a short time and with restrictions on the kinds of bills that can be worked on.

“We had a host of bills this past session and a good deal of them didn’t go anywhere,” Millett said. “And now that we’re in the short session there’s a lot less latitude for legislators to put in any new legislation for consideration.”

At least one proposed bill that will go to lawmakers next year would restore gun rights to some people convicted of nonviolent crimes if they are not convicted or any additional crimes and 10 years have passed. Criminal law experts have already raised multiple concerns about how the bill is written.

Ten states, including Massachusetts, Connecticut, and New York, have assault weapons bans. 

On the federal level, President Joe Biden again called for a ban on assault weapons following the shooting in Lewiston. 

Biden urged Congressional Republicans to work with Democrats to pass a bill that would ban assault weapons and high-capacity magazines. He also called for universal background checks, safe storage of guns and an end to liability immunity for gun manufacturers.

The story Mass shooting turns spotlight on Maine’s sparse gun laws appeared first on The Maine Monitor.

With residents under a shelter-in-place order, the streets of Lewiston were mostly empty for much of Thursday, but for a heavy media presence and scores of local, state and federal officials gathered at City Hall in the morning.

In the wake of shootings that left at least 18 dead in Maine’s second largest city, local residents and officials expressed shock that the nation’s epidemic of mass shootings had come to their community and grappled to make sense of the past day’s events.

“It’s just so surreal. You don’t expect this in Lewiston, Maine. We’re in one of the safest states in the country,” Lewiston city councilor Bob McCarthy said in a phone interview Thursday.

“I feel for all the families that are involved. There’s a hole that’ll never be filled,” he said.

Gov. Janet Mills at a press conference Thursday morning confirmed that 18 people were killed in related shootings Wednesday night at Just-In-Time Recreation, a bowling alley at 24 Mollison Way, and Schemengees Bar at 551 Lincoln St. Thirteen people were injured.

It is the deadliest mass shooting event in Maine history and the deadliest so far this year in the U.S., according to a database maintained by the Associated Press and USA Today in partnership with Northeastern University and data from the nonprofit organization Gun Violence Archive.

“Lewiston is a special place. It’s a close knit community with a long history of hard work, of persistence, of faith, of opening its big heart to people everywhere,” Mills said at the press conference, her voice hoarse from working through the night.

It’s where she met and married her husband, and raised their children, she said.

“I’m so deeply sad,” Mills said.

Later in the day, Miia Zellner, 22, and Hunter Kissam, 27, nailed paper hearts to trees along Lisbon Street. “To my community,” they read. 

Massachusetts natives who now live in Lewiston, Kissam said they’re “very shocked.”

“(We’ve) been saying to others we’ve never felt safer than here and to see this happen to this community is baffling,” he said.

Just-in-time Recreation, the bowling alley where one of the shootings occurred, issued a statement on Facebook Thursday that expressed the shock that so many were experiencing.

“None of this seems real, but unfortunately it is,” the statement said. “We are devastated for our community and our staff. We lost some amazing and whole-hearted people from our bowling family and community last night.”

Similarly, the owner of Schemengees Bar and Grille, another shooting scene, said: “In a split second your world gets turn(ed) upside down for no good reason.”

A former mill town along the Androscoggin River in central Maine, Lewiston has long been a city of immigrants. In the mid-1800s, Lewiston’s population nearly doubled within a decade as French Canadians poured into the city to work in the textile mills, according to the Franco-American Collection at the University of Southern Maine. Lacking the funds to move back to their hometowns in Quebec and New Brunswick, many put down roots that remain strong to this day.

The Basilica of Saints Peter and Paul, a towering Gothic-style cathedral anchoring the city center, is the most striking example of Lewiston’s deep Franco American roots.

Nearly a century and a half later, a new wave of immigrants moved to Lewiston. Somali refugees, fleeing civil war, came in large numbers starting in the early 2000s. By many accounts, the new residents helped revive the city, which had long been in decline with textile mills gone.

Downtown Lewiston is home to four of the five poorest census tracts in the state. Nearly half of the residents living in the city’s Tree Streets neighborhood — the 30 blocks between Kennedy Park and the Colisée — live below the poverty line.

The city of 37,000’s often divisive politics play out in the city council. More recently, tensions have bubbled to the surface as the city struggles to find solutions to a housing crisis and revelations about decisions made by city leaders in both private and public about homeless shelters and affordable housing have come to light.

But on Thursday morning, those disagreements were the least of their concerns. Outside City Hall, councilors Linda Scott and Bob McCarthy embraced each other: “We put everything aside,” Scott told McCarthy.

“The residents of Lewiston need each other right now and we need to support each other at this time,” Mayor Carl Sheline said after the press conference. “I urge everyone to check on their neighbors.”

McCarthy said much the same: “Just talk to your friends and family. Give them a call. If you’re feeling you need something, reach out.”

He added that there will be more community support, “but nothing can be done until this guy’s caught.”

As of Thursday afternoon, officials had not publicly disclosed the victims’ identities. Maine State Police Col. William Ross said at the morning press conference that authorities had identified eight individuals so far and were in the process of contacting next of kin.

A “person of interest,” Robert R. Card, 40, of Bowdoin, has been charged with eight counts of murder. As more victims are identified, the number of charges will likely go up, Ross said.

A massive manhunt that includes more than 350 law enforcement personnel from state and federal agencies is underway for Card, Maine Department of Public Safety spokesperson Shannon Moss said.

Shortly after midnight on Thursday, Auburn Mayor Jason Levesque told reporters gathered outside a makeshift reunification center at Auburn Middle School that at least 40-50 people were reunified with their worried loved ones.

“At this point, there is a significant amount of shock going on with people that were actually witnesses…” Levesque said. “Obviously when I was bringing people in that were looking for their loved ones, there is fear, there is panic, there’s worry. Understandable.”

“But the people that were actually there tonight, it was what I didn’t hear. It’s a shock. It’s hard for me to explain,” Levesque said. “I just want people to go home and hold their families.”

Taking a moment to steady himself, he said that not everyone who showed up at the middle school found their loved ones, but declined to say more.

The massive response to the tragedy played out across the communities, including the Central Maine Medical Center. 

When the first patient arrived at about 7:25 pm Wednesday, there were approximately 25 medical personnel ready and available, hospital officials later recounted. By the time the 14th patient came in about 45 minutes later, the team had ballooned to as many as 60.

“It has been a very challenging 16 hours,” said Dr. John Alexander, the Chief Medical Officer for the hospital’s parent company, Central Maine Healthcare.

By Thursday morning, dozens of reporters buzzed around outside of Lewiston City Hall ahead of a press conference. The sidewalk leading to the city offices was also dotted with law enforcement from municipal, state and federal agencies.

The streets surrounding the city’s downtown were otherwise sparsely populated and stores on Lisbon Street were closed as the city, other parts of Androscoggin and Sagadahoc counties remain under a shelter and place order from Maine State Police.

Lewiston resident Oscar Perkins, 62, was with a friend a few blocks away from Central Maine Medical Center on Wednesday night as emergency vehicles zipped across town with their sirens blaring and lights flashing.

“We [were] counting police cars and paramedic cars and lost count because there were so many of them,” Perkins said.

Perkins sat on a bench across from Kennedy Park on Thursday morning, watching as the commotion outside of city hall unraveled in front of him. He’s lived in Lewiston for over 30 years and said he has never seen anything like this happen before.

“Lewiston has never experienced that, and me neither. I’m from a big city, Cleveland, and nothing like this has ever happened,” Perkins said. “I know one thing: it will bring a lot of people together and scare a lot more people.”

“I’m just going to say, coming from a soon-to-be-mother, it’s really scary. Nothing like this should be going down,” Kassie Horton, 18, said. Her and her partner, Damien Horton, 20, live in an apartment building at the corner of Lisbon and Park streets.

The Hortons were sitting in front of the Lewiston Public Library Thursday afternoon with their friend, Damion Dobson, 30, who said he was walking along Strawberry Avenue a block away from Mollison Way Wednesday night when he heard sirens and saw fire trucks and ambulances rushing to the scene at the bowling alley.

Damien Horton was at work Wednesday night at ReEnergy on Alfred Plourde Parkway, across the street from the Walmart Distribution Center where initial reports said there was more gunfire. Officials later clarified that those reports were unsubstantiated.

Kassie Horton said she was sitting at home, hearing the sirens and calamity outside and thought, “What’s going to happen if he doesn’t come home?”

The story A city, and a state, in shock appeared first on The Maine Monitor.

A manhunt involving at least 100 law enforcement personnel was underway in Maine early Thursday morning in the wake of mass shootings in Lewiston that left at least 16 dead and dozens wounded.

Details continue to remain fluid. A news conference is scheduled for 10:30 a.m.

Here’s what we know as of 7:30 a.m.:

The Associated Press reported there were 16 deaths. But earlier, Androscoggin County Sheriff Eric Samson put the figure at as many as 22 people died.

State Police have identified 40-year-old Robert R. Card II as a person of interest in the shootings that rocked the city of Lewiston Wednesday night. The Bangor Daily News was the first to report the identity.

Card, a resident of Bowdoin, is a firearms instructor trained by the military, according to a police bulletin viewed by the Associated Press, and was committed to a mental health facility for two weeks this past summer.

“The document also said Card had reported hearing voices and had threatened to carry out a shooting at the military training base in Saco, Maine,” the AP reported.

The Lewiston Sun Journal reported that police, fire and rescue personnel descended on Sparetime Recreation, which was recently renamed Just-In-Time Recreation, on Mollison Way about 7:15 p.m. during a youth bowling night.

Shortly afterward, reports came in that there was another shooting four miles away at Schemengees Bar & Grille on Lincoln Street.

Seven deaths were reported at Sparetime Recreation bowling alley, and an unconfirmed number at Schemengees Bar & Grille Restaurant, the Bangor Daily News reported.

It appears to be the worst mass shooting in Maine history. The Associated Press reported that the shooting was the country’s 36th mass killing this year. The AP and USA Today maintains a database with Northeastern University. At least 188 people have died in those killings, which are defined as incidents in which four or more people have died within a 24-hour period, not including the killer — the same definition used by the FBI.

Separately, The Trace, a nonprofit dedicated to covering guns and shootings, reported in early October that in 2023 there have been 531 incidents in which four or more people were wounded or killed with guns. The Trace cited Gun Violence Archive, which tracks shootings through news and police reports.

A lockdown has been called across Androscoggin County, with police asking people to shelter in place, lock their doors and stay inside late Wednesday evening. People are asked to stay off the streets so police can defuse the situation.

Authorities in Lisbon and Bowdoin also issued shelter in place orders.

A vehicle of interest was located in Lisbon Wednesday night, according to a notice distributed to The Maine Monitor, and law enforcement is asking Lisbon residents to shelter in place as authorities work in the area to locate Card.

Those who notice anything suspicious are asked to call 911.

In Auburn, Maine Monitor reporter Emily Bader reported that Mayor Jason Levesque said that at least 40-50 people were reunified with their worried loved ones at Auburn Middle School shortly after midnight Thursday. They had been brought over by a city bus after giving statements to police. More people were likely to be brought to the school as the night went on.

“At this point, there is a significant amount of shock going on with people that were actually witnesses…,’’ Levesque said. “Obviously when I was bringing people in that were looking for their loved ones, there is fear, there is panic, there’s worry. Understandable.’’ 

“But the people that were actually there tonight, it was what I didn’t hear. It’s shock. It’s hard for me to explain,’’ Levesque said. “I just want people to home and hold their families.’’

One man told the Monitor that his adult daughter had started her first night at a bowling league at Sparetime Recreation. He said his daughter was next to the shooting suspect at the bowling alley when he burst in. She bolted out of the bowling alley and into the nearby woods.

 “I have four daughters and she’s the toughest but this destroyed her,’’ the man said.

Melinda Small, the owner of Legends Sports Bar and Grill, told the Associated Press that her staff immediately locked their doors and moved all 25 customers and employees away from the doors after a customer reported hearing about the shooting at the bowling alley less than a quarter-mile away around 7 p.m.

“I am honestly in a state of shock. I am blessed that my team responded quickly and everyone is safe,” Small told The Associated Press. “But the same time, my heart is broken for this area and for what everyone is dealing with. I just feel numb.”

Lewiston Mayor Carl Sheline, in a post on Facebook, said “I am heartbroken for our city and for our people. Lewiston is known for our strength and our grit and we will need both in the days to come.”

This story will be updated as more information becomes available.

Statements and reaction to the shootings:

Central Maine Medical Center: “Central Maine Medical Center is reacting to a mass casualty, mass shooter event.”

Maine Medical Center: “Maine Medical Center has alerted on-call staff and created critical care and operating room capacity in anticipation of potential patient transports coming from the Lewiston shooting this evening. At this time, MMC can confirm it will receive one patient transport from Central Maine Medical Center. Other MaineHealth facilities are also standing by and preparing to provide care.”

White House: “The President spoke by phone individually to Maine Governor Janet Mills, Senators Angus King and Susan Collins, and Congressman Jared Golden about the shooting in Lewiston, Maine and offered full federal support in the wake of this horrific attack.”

Gov. Janet Mills: “I am aware of and have been briefed on the active shooter situation in Lewiston. I urge all people in the area to follow the direction of State and local enforcement. I will to continue to monitor the situation and remain in close contact with public safety officials.”

U.S. Attorney General Merrick Garland: “The Attorney General has been briefed and will continue to closely monitor the situation. Federal law enforcement agencies are assisting our state and local law enforcement partners in Lewiston, Maine.”

Sen. Susan Collins: “As our state mourns this horrific mass shooting, we appreciate the support we’ve received from across the country, including the call I received from President Biden offering assistance.”

Sen. Angus King: “Senator King is deeply sad for the city of Lewiston and all those worried about their family, friends and neighbors. He’s receiving regular updates, awaits further details from local authorities, and will be headed directly home to Maine once the Senate’s final vote is held tomorrow afternoon. Given the shelter in place currently underway, he asks all in Androscoggin County to allow first responders to address the threat, stay indoors, and report any suspicious behavior to the local authorities.” (Later): “President Biden just reached out to Senator King directly and offered any federal assistance he can provide to help the people of Maine. Senator King expressed his deep appreciation to the President for the outreach and support. Given the horrific nature of the events in Maine, Senator King will now be headed to Maine on one of the first flights available — he wants to be home to support Lewiston in any way he can.”

Rep. Jared Golden: “Like all Mainers, I’m horrified by the events in Lewiston tonight. This is my hometown. Right now, all of us are looking to local law enforcement as they gain control of the situation and gather information. Our hearts break for those who are affected and we encourage everyone to follow the directions of the authorities as they conduct their work.”

Rep. Chellie Pingree: “I am closely monitoring the reports of mass shootings in Lewiston. The unfolding violence is shocking and I am holding the affected communities in my prayers.”

The story The latest on Lewiston mass shootings appeared first on The Maine Monitor.

With pharmacists around the country walking off the job or threatening to do so, Maine pharmacies have experienced sudden closures, infrequent hours and frustration from customers who say they’re unreliable.

Over the past several weeks, employees at Walgreens and CVS, the nation’s two largest pharmacy chains, staged walkouts or did not show up for work to protest what organizers told The Washington Post are conditions that threaten the safety of employees and patients.

The walkouts show pharmacists feel “safety is so compromised that it’s actually better to not open the pharmacy,” than to open it, said Emily Dornblaser, a founding faculty member of the University of New England School of Pharmacy and director of interprofessional education.

“They just can’t meet the needs of the people that need them. And in doing so, they’re potentially putting other people at risk.”

There have been no reports of walkouts at Maine pharmacies as of Friday, but national organizers told CNBC that Walgreens walkouts are scheduled for Oct. 30 to Nov. 1. It is unclear whether any Maine pharmacists will participate.

Meanwhile, at least eight Walgreens have closed since 2020.

There is a shortage of pharmacists in Maine and nationwide, Dornblaser said. It started in the mid-2000s, when a shortage prompted a number of pharmacy school openings. But then the 2008 recession hit, and pharmacists who may have otherwise retired continued to work, she said.

Starting about six years ago, Maine finally met the demand for pharmacists — and then some. Jobs became more competitive, wages dropped, and so did applications to pharmacy schools.

In the fall of 2018, UNE School of Pharmacy reported 273 students enrolled in its Doctor of Pharmacy program, according to data from the university. By the fall of 2022, enrollment had dropped to 116 students, a nearly 60% decrease over five years.

Maine’s only other pharmacy school, at Husson University in Bangor, admits 65 students per year, according to its website.

“Right in the middle of that, then, is a pandemic,” Dorblaser said.

Complicating the equation is that pharmacists are doing a lot more than filling prescriptions.

“We’ve definitely seen a lot more added to our plate: testing, delivery of vaccines. We’re right now in the introduction phase of the 23-24 COVID vaccine, along with our flu vaccine, along with the (respiratory syncytial virus) vaccine,” said Steve Maki, president of the Maine Pharmacy Association.

“So, I mean, there’s a lot of additional services and things that three years ago weren’t even on our radar of, ‘Oh my gosh, this is now something we have to adjust for and we have to plan for.’”

Maki, who has been a pharmacist since 1996 and opened Spruce Mountain Pharmacy in Jay in 2009, said the pharmacy landscape “seems like it changes right before our eyes.”

“Three years ago, pharmacists weren’t even considered as providers in the state,” he said, referencing a bill passed during the 130th Legislature that amended wording to the Maine Pharmacy Act to add that a pharmacist is a “provider of healthcare services,” but did not effectively change what pharmacists do.

The additional responsibilities led to “substantial burnout,” Dornblaser said.

Compounding that, wages for pharmacy technicians, who provide critical support by counting and filling pills, stocking shelves, giving immunizations and assisting customers, have remained low for years, Dornblaser said.

The average hourly wage for a pharmacy technician in May 2022 was $18.12, according to the Bureau of Labor Statistics. Dornblaser said during the pandemic-induced workforce shortage in other industries, she often heard of techs lured from pharmacies for better-paying jobs.

“You had people who had really a large amount of responsibility in the job in terms of keeping people safe, who weren’t compensated nearly as much as somebody working at … a McDonald’s,” she said.

Not only are pharmacists overworked and pharmacies understaffed, but there are fewer brick-and-mortar locations for people to get prescriptions filled.

Since 2020, Walgreens has closed locations in Auburn, Bangor, Fort Fairfield, Guilford, Millinocket, Newport, Pittsfield and Portland, according to pharmacy board licensing records that were confirmed by a Walgreens spokesperson.

Walgreens, CVS and Rite-Aid, which had already closed hundreds of stores nationwide before the pandemic, have since announced hundreds more closures.

Walgreens announced in June it would close 150 stores and in 2021, CVS said it would close 900 stores by next year.

Rite-Aid, which closed its Maine locations by early 2018, announced earlier this month it filed for bankruptcy and will close hundreds of stores.

In rural areas, inconsistent hours, staff shortages and closures mean residents can’t depend on their local pharmacy to get their medications — if they even have a pharmacy near them.

Peter McCormick spends his summers on Campobello Island, just over the bridge from Lubec, in Canada. When he’s there, he transfers his prescriptions from a Walgreens pharmacy near his primary residence in Vermont to the one closest to his summer home, 40 miles away in Machias.

One Friday last summer, he received a notification two prescriptions were ready for pickup and made the 50-minute drive to Machias. When he got there, he said, the pharmacy was closed. A clerk told him, “We don’t have enough pharmacists,” and he could try the Calais Walgreens an hour away.

“A woman standing nearby said to me, ‘Don’t bother going to Calais because the Walgreens there is closed, too,’ ” McCormick said.

“Thankfully I had enough medication to get me to Monday, but the episode caused me an unnecessary three-hour round trip and would have been a much bigger problem if I hadn’t ordered my refills somewhat early. Overall, very disappointing,” he said.

Last month, Walgreens signed a consent agreement with the Maine Board of Pharmacy that said the chain’s Machias and Calais locations closed without notification and did not meet the state requirement that pharmacies are open for at least 40 hours per week on multiple occasions. It agreed to pay a $10,500 fine.

Walgreens paid at least $68,000 in penalties last year after failing to meet staffing requirements.

“There are times when we must adjust or reduce pharmacy operating hours, or temporarily close a store, as we work to balance staffing and resources in the market to best meet customer demand. When this occurs, we make every effort to minimize disruption for patients and customers by selecting days with the lowest prescription demand to ensure that there is a nearby pharmacy to meet immediate prescription needs,” Walgreens spokesperson Kris Lathan said in an email.

“We also provide patients as much advance notice as possible through signage, automated phone calls, updates to our online scheduler, and adjustments in refills,” she said, but did not respond to specific questions from The Maine Monitor about the penalties, store closures or walkouts.

Lance Keen of Cooper said those stores are a “mess,” with “sporadic closures and can’t be relied on.”

He, too, experienced an incident where he ran out of a prescription and was unable to get it refilled in a timely manner, causing him “physical distress.”

With his usual pharmacy being 20 miles away, Keen said he has to be more attentive to when he needs to send in refill requests. He has also started to get his prescriptions delivered through Express Scripts, a prescription benefit manager that offers home delivery.

Mail order services offer convenience and consistency, especially for people in rural areas, like McCormick or Keen in Washington County, but Dornblaser worries an overreliance on them is a missed opportunity to develop “that community relationship.”

“Often it’s the pharmacist that you sort of casually mention something to and they can sort of say, ‘You know, that sounds like this,’ or, ‘You should go get that checked out,’ ” she said.

They can catch potential drug interactions, administer vaccines or serve as an easily accessible healthcare professional to answer questions.

The possibility of more closures worries her.

“We are a very rural state and, you know, having access to a healthcare provider can be such a lifeline for people,” Dornblaser said. “And the loss of a pharmacist or a pharmacy in a community has a pretty big impact overall.”

The story Shortage of pharmacists leaving customers in peril appeared first on The Maine Monitor.