Greg Payne knew he wasn’t going to make any headway as soon as the governor’s fist hit the table.

Payne, who works for Avesta Housing and heads the Maine Affordable Housing Coalition, met with Gov. Paul LePage in January 2017. He hoped to persuade LePage to finally authorize the sale of $15 million in senior housing bonds that nearly 70 percent of Maine voters approved in November 2015.

It was far less than the $65 million initially sought by senior advocates, and it would only make a dent in the mounting housing crisis facing older Mainers. But they figured it was better than nothing, given the state’s rapidly growing senior population.

Payne thought he had good news for the Republican governor. The state’s debt management adviser had confirmed that issuing the housing bonds wouldn’t hurt Maine’s finances. LePage wasn’t swayed. Not even a little bit.

“He kind of exploded when I said that,” Payne recalled recently. “He slammed his fist on the table, swore at me and told me the bond adviser was wrong.”

More than a year later, the bonds remain unspent, LePage’s reasons for blocking the funding remain unclear and 225 much-needed units of affordable senior housing still haven’t been built. That’s a tiny portion of the more than 9,000 new senior housing units needed now, or the 15,000 units needed by 2022, according to the housing coalition.

And that’s just one way that the LePage administration and the Legislature have failed to address some major problems facing Maine as its senior population increases. Elder advocates say critical deficiencies persist for seniors statewide – especially in rural areas – including health care, long-term care, hospice, family caregiver support, nutrition, housing and transportation. In several instances, they say, the governor, other lawmakers, and the Maine Department of Health and Human Services have either dropped or rejected efforts to improve senior health care, address senior hunger and poverty, and help Alzheimer’s patients and their families.

Neither the governor’s office nor the spokeswoman for DHHS responded to repeated requests for comment and information for this story.

Senior advocates say there’s no time to waste. Maine’s population is now solidly the oldest in the nation, with the highest median age of 44.7 years – meaning the younger population is dwindling – and tied, with Florida and Montana, for the largest proportion of residents age 65 and older – 19 percent of the state’s 1.3 million people. Maine is also the most rural state – another complicating factor – with more than 60 percent of its residents living outside a metropolitan area, according to the U.S. Census.

Some strides have been made in the past five years, since the Portland Press Herald/Maine Sunday Telegram published a yearlong series, “The Challenge of our Age,” starting in 2013. Early wins and losses will be highlighted Wednesday at the fifth annual Maine Wisdom Summit (formerly the Maine Aging Summit) in Augusta, which was organized by the Maine Council on Aging and championed by former House Speaker Mark Eves, a recent Democratic candidate for governor who is among LePage’s top political adversaries.

But senior advocates say the most notable progress has been made at the local level, by volunteers and nonprofit agencies on the front lines, with negligible or limited efforts by DHHS and other state agencies.

In the last few years, more than 100 communities across Maine have established Aging in Place initiatives to help seniors stay in their homes as long as possible. Largely volunteer and grant-funded, they include home repair teams, transportation networks, nutrition programs, exercise classes and regular social gatherings that combat debilitating isolation experienced by many seniors.

“At a time when it’s been difficult to move big policy issues through the legislative process, we’ve seen a lot of people picking up the slack at the local level,” said Lori Parham, executive director of AARP Maine. “You hear the administration talking about helping seniors, but we just don’t see significant action on major issues like housing, health care or rebalancing the long-term care system.”

LIMITED PROGRESS SO FAR

In recent years, state agencies and state-sponsored nonprofits have fostered home renovation initiatives to help seniors stay out of nursing homes, bank training programs to combat elder abuse and transportation networks to help seniors get where they need to go.

The Maine Housing Authority subsidized construction of 666 new senior housing units that were completed from 2014 to 2018, which is an average of 133 units each year. The average since 2001 is 90 units per year.

However, because Maine has some of the oldest housing in the country, senior advocates say it must ramp up affordable senior housing construction to meet the needs of a senior population that’s expected to increase 41 percent over the next decade, from 270,229 in 2017 to 381,870 in 2027, according to a 2018 report from the Muskie School of Public Service.

Maine also continues to receive praise for its Long-Term Care Ombudsman Program, its uniform patient assessment program for long-term care planning, and its residential alternatives to nursing home care. All three were highlighted in a recent AARP public policy report on “Promising Practices” to avoid long-term nursing home care.

In recent years, Maine lawmakers also passed long-overdue increases in MaineCare, or Medicaid, reimbursements to nursing homes and home care agencies. But a tight job market, lack of trained workers and record-low unemployment have driven up operating costs and made it hard to attract and keep quality employees.

The average daily MaineCare reimbursement rate for nursing home residents increased from $183.59 in 2013 to $222.59 in 2018, according to Rick Erb, head of the Maine Health Care Association.

Still, three nursing homes have closed this year, in West Paris, Jonesport and Patten – all rural communities where long-term care needs are expected to increase. Now, there are just 96 nursing homes across the state, down from 105 in 2013.

Mike Hastings, a volunteer with Harpswell Aging at Home, climbs a ladder while installing fluorescent light fixtures in the basement of one of the community’s senior citizens.

Meanwhile, annual MaineCare spending on long-term care services and supports increased 16.6 percent or $147 million in just three years, from $890 million in 2013 to $1 billion in 2016, according to a Medicaid Innovation Accelerator Program report released in May.

Contrary to “rebalancing” long-term care spending priorities that many believe must happen, the cost of nursing home care increased 29 percent during that period, from $238 million to $398 million, while spending on less costly home health care decreased 21.7 percent, from $7.6 million to $5.9 million.

“We have not made systemic progress around long-term care and health care because DHHS has not been a good partner,” said Jess Maurer, executive director of the Maine Council on Aging.

“This administration has been focused on removing people from benefits instead of implementing lower-cost solutions that would include expanding benefits that would allow people to age well at home and not in institutions,” Maurer said. “It would have been so much better if we had an administration that supported investment in infrastructure that promoted aging in place.”

LOST OPPORTUNITIES

Senior advocates tick off a number of things that the LePage administration and the Legislature have done or failed to do that run counter to seniors’ best interests. Here are a few:

In 2015, LePage turned back a five-year, $2.5 million federal grant that would have promoted colonoscopies among older Mainers. At the time, a broad coalition of health care providers decried the governor’s action, noting that colon cancer was largely preventable with routine screenings but was expected to kill 240 Mainers that year.

In 2016, DHHS failed to apply for about $300,000 in federal funding to extend support programs for 28,000 Mainers who have Alzheimer’s disease and 69,000 unpaid family caregivers.

“We sought DHHS permission at least twice to (prepare an application) but were declined,” said Larry Gross, head of the Southern Maine Area Agency on Aging. “While awards are made competitively, Maine had been a strong performer in the first round of funding and our (project coordinator at the federal level) was eager to receive an application.”

This year, the state also likely failed to apply for as much as $1 million in similar funding for dementia programs, despite prodding from the Alzheimer’s Association, Maine Chapter. DHHS didn’t respond to questions about grant funding applications.

Gross compares the lack of urgency about aging issues to government inaction on climate change. “It’s going on all around you, but you keep denying it,” he said.

Jody Harris has another theory. She’s associate director of the Maine Center for Economic Policy, a nonpartisan research group that promotes economic justice for Maine residents.

“The LePage administration appears to be trying to solve the federal deficit at the state level,” Harris said. “(It) doesn’t agree with applying for federal grants because it impacts federal taxes. But Mainers pay federal taxes, too, so why shouldn’t they benefit?”

Harris noted that the LePage administration’s effort to reduce the number of Mainers participating in the federally funded Supplemental Nutrition Assistance Program has heightened the stigma around food stamps, and she fears it may keep some seniors from seeking the benefit as the need grows.

The monthly average number of Mainers receiving food stamps in recent years dropped by 41,291 people, or 18 percent, from 230,536 in 2014 to 189,245 in 2016, according to a 2017 federal report.

About 28,700 Maine seniors participated in SNAP in 2015 and 46 percent of Maine households that receive SNAP benefits include a senior or a person with a disability, according to the Center on Budget and Policy Priorities, a progressive think tank.

“Twenty-five percent of SNAP benefits go to Mainers over age 60 and we expect that number to grow as the state’s older population grows,” Harris said.

SENIORS IN POVERTY

In the last five years, the number of Maine seniors living in poverty increased 6 percent and the number of adults over age 60 who said they didn’t have enough food increased from 12.2 percent to 15.6 percent, according to America’s Health Rankings Senior Report 2018.

Yet this year, the Legislature dropped a $500,000 proposal to expand Meals on Wheels, a meal-delivery program that some view as basic health care in a state like Maine.

“In this era of divided government, we end up picking and choosing, trying to anticipate what will have broad enough support to survive (the governor’s) veto,” said Rep. Drew Gattine, D-Westbrook, who is House chairman of the Legislature’s Appropriations Committee.

Gattine said it frustrates him that some older Mainers don’t have enough food, especially when Meals on Wheels is a program that helps seniors stay healthy, remain in their homes and avoid costly hospital visits or institutional care.

A Maine-based study recently showed that meal-delivery programs have clear health benefits for home-bound seniors.

From 2013 to 2014, Maine Medical Center and the Southern Maine Area Agency on Aging collaborated on a two-year meal-delivery program that was featured in the American Journal of Managed Care in June.

The grant-funded program provided daily meals to 622 Medicare patients for one month following hospital discharge. The hospital readmission rate dropped from 12.3 percent to 10.3 percent and saved $3.87 in medical costs for every dollar spent on meals.

“It doesn’t make any fiscal sense to shortchange programs like Meals on Wheels because it’s only going to drive up other costs,” Gattine said.

HOUSING BONDS UNSPENT

As LePage’s second term wanes and candidates line up to take his place, senior advocates say they hope the next administration proves to be more cooperative and proactive in addressing senior issues.

As for the $15 million in housing bonds, Greg Payne, with the Maine Affordable Housing Coalition, said he hopes the candidates live up to their campaign promises and issue the bonds, whoever wins the election.

Jess Maurer, with the Maine Council on Aging, was at the January 2017 meeting with LePage about the housing bonds and she corroborates Payne’s recollection of the heated conversation.

In the nearly three years since Maine voters approved the housing bonds, the governor has offered many reasons for withholding the funding, from wanting to prevent a few developers or legislators from becoming “millionaires overnight,” to falsely claiming that the apartments wouldn’t be rent-restricted. He also doubted that Mainers knew what they were voting for.

“Every time we asked, he came up with another reason,” Payne said. “Maybe he has a deep philosophical reason for not issuing the bonds. Maybe he just couldn’t stand letting Mark Eves get a win. I honestly don’t know what the real reason is, because he’s clouded the truth so much.”

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