Community Concepts to end adult day services program

PARIS — Community Concepts, Inc. (CCI), the nonprofit social-services agency serving Oxford, Androscoggin and Franklin counties, has announced that it will shut down the last of its adult day services programs, effective January 31.

But while Community Concepts lays the blame for the program’s demise on the state, officials with the Department of Health and Human Services say it is the local agency that dropped the ball.

The closing will affect approximately 50 clients and nine staff members in locations at High Street in Paris and Congress Street in Rumford. 

According to Community Concepts spokesman Mary Ellen Therriault, the agency will continue leasing the High Street building, with “no immediate change,” because that site also houses staff from its property management arm.

The final nail in the adult day services program follows earlier restructuring by Community Concepts in November 2005, that shuttered a second Rumford location offering the program, as well as one in Farmington.  Eight employees were said to have lost their jobs in that realignment, designed to try and keep some offerings up and running.

Launched in December, 2001, as a service designed to provide daytime care for senior citizens — especially those with Alzheimer's or other forms of dementia — the program soon expanded to other adults with mental health challenges.  The service allowed families to place their loved ones in a safe, monitored environment while they went to work, or ran the necessary errands of life. 

“Basically, it was for someone who can’t or shouldn’t be left alone,” said Therriault.  “We provided health monitoring — making sure they take their medicine, personal care as necessary — showers and that kind of thing, nutrition based on their specific medical needs and socialization activities. 

“We would have trips into the community as well as have folks come in and do activities with them,” said Therriault. 

At its high point, Community Concept’s adult day services program served 128 people in the tri-county area.

With the help of those services, clients were able to continue living in their communities, forestalling the need for institutional care, said Community Concept’s executive director, Matthew Smith, in a recent press release.

Smith said he worries about the demise of locally based support for mental health, fearing it will lead to greater stress on other public services.

“Our clients will be faced with worsening conditions and may be forces to seek help at hospital emergency rooms, or find themselves involved with the police [and] our courts,” he said.

“Folks won’t have this service anymore, so what are they going to do when they end up having a crisis?” asked Therriault, rhetorically.  “They are going to end up in the emergency room.  They are going to end up at the police station.”

“The long-term effects on our elderly, our poor, and those among us that suffer from mental illness will be devastating,” said Smith.

“It’s going to end up costing us all more in the long run,” added Therriault.

Already, Community Concepts has fielded calls from both clients and family members expressing concern over the loss of services and questions about where they can turn.

“Unfortunately, there isn’t much to refer them to,” said Therriault.  “There is no other place to take people for day services.  There is no other program like this anywhere [in the area].”

To explain why Community Concepts will no longer provide adult day services, Smith pointed the finger at the state.

"In February of 2005, the Department of Health and Human Services changed its MaineCare practices, reducing client time for mental health services, which translated directly to the loss of essential revenues to support the program," he said.

Therriault said these changes resulted in the number of hours MaineCare would pay for being slashed in half, across the board.  Fees structures also were reduced and “made more complicated”, she said, resulting in the adult day services program running at a monthly deficit of "thousands and thousands of dollars" since DHHS enacted its new rules.

But Geoffrey W. Green, deputy commissioner of operations and support for DHHS says the fault lies with Community Concepts.

Under MaineCare regulations, day services — which consist of activities — are reimbursable at approximately $15.00 per hour, per person.  Skills development — described as a “specific and specialized service” — is billable at a higher rate of approximately $50.00 per hour. 

“CCI was billing for day services at the higher rate for skills development,” said Green, “but the service being provided did not meet the requirements for skills development specified in the rule.

“DHHS staff attempted to work with CCI to modify its program so that billings would be consistent with the service being provided,” said Green.  “We thought that the agency had made the necessary adjustments.  In fact, CCI opened two additional sites this past summer.” 

But at Community Concepts, the story seems to be one of the little guy being bullied by the behemoth of the state, with little or no assistance, and no recourse but to eventually throw in the towel. 

“We tried really hard.  We tried since February,” said Therriault, referring to the various consolidations, service changes and recruitment efforts reportedly undertaken to keep the program running.

“We just couldn’t sustain it,” she said.  “We were running at a deficit since February, trying to make it work.  But at some point we knew we had to accept that we are a nonprofit and we had to be able to at least make it a go of it [financially].”

“We are aware that other day services providers have had to modify their programs to come into compliance,” said Green.  “The Department [DHHS] has worked cooperatively and successfully with them to do so.  CCI is the only provider we are aware of that has opted to close its program.”

That closure now leaves as many as 50 local families hanging, and the people Smith laments as “vulnerable citizens” without a safe harbor, possibly exposing them to increases risks.

“I think that what we would like people to know is that this change that happened at the DHHS level is really just one small piece of what is becoming a trend to reduce community-based care,” said Therriault.  “It is actually going to result in higher costs.  It is something that we are concerned about and we think that the community should be aware and concerned, as well.”

“DHHS will focus its efforts on making sure that the clients affected will continue to receive needed support services,” said Green.