Residents of the Jefferson Green share a meal on Aug. 1. Communal mealtimes provide an opportunity for residents to enjoy the social connection that is one of the key aspects of engaged aging. (Bisi Cameron Yee photo)
A small but meaningful handful of Lincoln County’s aging population resides in five separate homes owned and managed by ElderCare Network of Lincoln County. Those homes – located in Damariscotta, Edgecomb, Jefferson, Round Pond, and Waldoboro – are commonly referred to as the Greens.
ElderCare Network of Lincoln County was founded in 1996 by Dr. Alan “Chip” Teel in conjunction with community development consultant Peter Werwath and Beth McPherson, of the Genesis Fund, a nonprofit lending organization focused on affordable housing.
Teel, now the network’s executive director, has a long career in both family medicine and geriatric care. He has been a physician for more than 30 years and has served as the medical director for both The Lincoln Home in Newcastle and for Cove’s Edge, the skilled nursing and long-term care facility on LincolnHealth’s Miles Campus in Damariscotta.
Teel’s skills and experience along with those of his two co-founders dovetailed perfectly to implement ElderCare Network’s mission statement “to improve the way we care for elders in Lincoln County by providing quality assisted living for elders of all incomes.”
It was a daunting task, Teel said.
A foundational element of ElderCare Network’s business plan was to provide a place to live for low-income seniors, with a formula that expected two-thirds of its residents to be needs based with the remaining one-third being private pay. The flaw in the formula, according to Teel, was that it didn’t take into account the level of need.
“As soon as we opened we were flooded with people who were on state assistance not only from the community but also from all of the other commercial players in town who couldn’t meet the needs because the people didn’t have the resources. So we very quickly became the recipients of all of the low-income elders in Lincoln County and it was rare to have a private pay individual. We were 90-95% state assistance and that has been true for most of our existence,” Teel said.
Long-term care is a major expense for a state, a county, or an individual family.
“Most of us are quite unaware that long-term care is something that you have to find and pay for yourself,” Teel said. “I think most people say ‘Doesn’t insurance cover that? Doesn’t Medicare cover that? Doesn’t somebody else pay for that?’ And I think it’s a real sticker shock for people that no, the state only steps in and pays it when you are completely destitute.”
Those residents who rely on MaineCare face additional limitations. Funds allotted from their social security or other income for personal spending are capped at $70 a month. The state does not pay for extras like phone, internet, or cable service. It does not pay for incidentals like toothpaste and toiletries.
“Being able to go out to a movie or dinner or go to a show, buy a new outfit – all of those things are technically out of reach forever,” Teel said of residents who depend on the state for their care.
While the state raised its reimbursement rates for assisted living facilities this year, The Elder Care Network operated for 25 years on funding that didn’t pay enough to break even.
“We were able to hold it together,” Teel said. “Mostly by determination to not fail.”
He credits the survival of the Greens to creative fundraising, aggressive grant seeking, and having an active board with members who pitched in and shared their skills, both administrative and practical.
It was close though. Teel said the COVID-19 pandemic “nearly put us under.”
Throughout the pandemic close quarters like those at residential facilities and nursing homes proved to be breeding grounds for viruses, but the caretakers and administration at the Greens dug in and aggressively managed the challenges. In the 18 months before a vaccine was developed there was not a single case of COVID in the five houses, Teel said.
That kind of intense vigilance came at a cost. Visitation was restricted, costs spiraled, necessary maintenance was deferred, and there were no new residents to help foot the bill.
Two Greens closed. The Boothbay Green was sold to help cover the shortfall in operating expenses. The Wiscasset Green closed in order to consolidate residents and staff to better control costs.
The worst of the pandemic is now in the rearview and with the reimbursement rates from the state for adult family care homes increasing by as much as 110%, Teel finds room for optimism. According to a Dec. 7 email from Jackie Farwell, director of communications at the Maine Department of Health and Human Services, the department implemented the rates effective Jan. 1, 2023 “to help support access to this service for Maine people with a range of needs and to support providers in paying competitive wages and benefits for direct care staff.”
Farwell also referenced the work done by the Cabinet on Aging, established by Gov. Janet Mills in 2022 to help Mainers age “in ways and settings that best serve their needs.”
Among the cabinet’s proposed priorities are increasing access to housing with service options, elevating strategies that attract and build direct care workforce capacity, supporting community interventions that address social isolation and loneliness, and supporting and promoting volunteerism and community service. These priorities are all reflected in the work being done at the Greens.
The Greens were conceived to provide a home-like environment in their own town for people who could no longer live alone. Houses were chosen from existing stock and featured traditional architecture, a counterpoint to the larger, more institutional spaces available. Each home has its own flavor and character, influenced by its residents and staff.
The Edgecomb Green was once the town’s grade school and Margaret Ellsworth, a former school teacher, now lives in what was once a classroom. A bookshelf sits by the bureau with her latest read – still a favorite hobby.
“It’s a home, not an institution,” Ellsworth said. “It’s my home.”
Hodgdon Green in Damariscotta is a showcase for the individualized care that Teel considers critical to the complex challenge of graceful aging. Residents there like their breakfast made to order. Hiram Sibley takes cornflakes with a sliced banana. It’s cream of wheat with brown sugar for John Banta. Eleanor Mitchell gets a generous drizzle of syrup on her waffles, and 102-year-old Lila Blechman tucks into the half dozen fried eggs with fruit that she eats every morning. Blechman credits her longevity to her diet – and her sense of humor.
Environment plays an important role in ElderCare Network’s commitment to homelike living. There are comfortable sitting rooms with bookcases and communal televisions. Most homes have gardens or window boxes that are tended in part by residents. The dining room at the Jefferson Green has a bay window overlooking Damariscotta Lake and a centerpiece of fresh flowers. But it’s Freddie, the house Chihuahua often referred to by residents and staff as a “four-legged vacuum,” who plays an even more important role.
“When you come to a facility like this, as lovely as it may be, you don’t have much purpose,” said Trudi Hodgkins, Freddie’s owner.
After being taken in on a trial basis with the consent of residents and staff, caring for the diminutive dog has become a vital and therapeutic part of all the residents’ daily lives.
The Greens were intentionally placed on well-traveled paths: near the post office, across from a school, next to a church or market, on the way to the transfer station. These locations were meant to encourage community involvement, to mitigate the loneliness and disconnection often experienced by individuals as they aged.
A large window in the dining room of the Waldoboro Green looks across a ball field to Miller School. Christine Glidden likes to watch the school buses arrive every morning; her daughter, who died two years ago, was a teacher there. Seeing the children gives Glidden the sense of continued connection to her family and to her community, which is so fundamental to ElderCare Network’s mission.
“You think of them all the time like they were still here and it helps,” she said. “All the good memories and everything.”
Each home has caregivers on site 24/7. They are the linchpins that keep everything running to state standards. While the increase in state reimbursement brought about a much-needed increase in caregiver pay, hiring and maintaining staff to meet the needs of the approximately 40 residents across five houses remains a constant challenge.
“There are a lot of easier ways to make a paycheck than doing the very emotional and sometimes physically demanding work of being a caregiver,” Teel said.
Still, the Greens have their fair share of dedicated longer term employees.
“If we do it well the caregivers love their job, the residents love their caregivers, they become like family,” Teel said.
When doctors told Patti Gettis that rheumatoid arthritis was impinging on her vital organs, she decided she wanted to face the end of her life surrounded by flowers. So the caregivers at Round Pond Green helped her fill the walls of her room with a garden of decorative wisteria and sunflower decals.
She calls it her “field of dreams.”
Teel considers one of the biggest injustices in the elder care world to be that “all of the things that would make life more interesting are unfunded.”
The hard thing is to provide enough extras, he said. His wish list includes more music, more art, more activities, more outings, more visitors.
According to Teel, 60% of residents who live in a nursing home never have a visitor.
“That’s a mind-boggling number,” he said.
With staff stretched thin, volunteers are crucial for bringing programs into the homes for people who have difficulty getting out into the community. Securing a reliable and effective cohort of volunteers is yet another challenge; the efficacy of any planned activity or program is dependent not only on the characteristics of each specific home, but also on the needs and interests of each distinct individual.
“It takes a concerted effort for a moderate amount of time to build fulfillment,” Teel said. “It does have to be championed.”
The reimbursement increase from the state not only allowed for higher wages for direct support staff, it also made new projects more viable. While the Wiscasset Green remains shuttered for now, Teel is working to bring it back as a home geared toward those with more significant cognitive decline. He wants it to be at the forefront of a new paradigm of care focused on reversing Alzheimer’s disease through lifestyle change – healthy eating, exercise, brain games, improved sleep, overnight fasting, better treatment of depression and anxiety.
“A very different approach than looking for a magic pill,” he said. He is targeting an opening in the spring of 2024.
For Teel, complacency is not the answer. The answer is in the future, in how ElderCare Network of Lincoln County can differentiate itself from other care models, in how it can be a part of the next generation of successful aging in place, in how the Greens will remain relevant and important in the county and state’s landscape of elder care.
“Most of these 90-year-olds in this house and in this network were members of this community – bus drivers and cooks at the school system and housekeepers and waitresses and school teachers and everyone else in our community,” Teel said. “Their stories are not unique to any generation. Their stories are us.”
Those interested in exploring the residential services or volunteer opportunities available at the Greens, including respite care and adult day care, can call clinical care coordinator Diana Leeman at 563-2148.
(Bisi Cameron Yee is a freelance journalist living in Lincoln County.)
