No Elder an Island

For many seniors on Maine’s islands, the prospect of settling into a mainland care home is disquieting. The alternative requires a whole community’s investment.

No Elder an Island
Illustration by Kelsey Grass
By Jesse Ellison

On the day she moved out of the North Haven home where she’d lived since 1952, Harriet Pendleton woke at 3 a.m. It was early January, among the quietest times of year for the island’s 350 or so year-round residents, and a day that Pendleton had been alternately dreading and looking forward to. She wasn’t moving far, just a mile or so up the street, but the move carried with it an existential weight. Pendleton, who turned 90 last August, was to be the first resident of a brand-new eldercare facility called Southern Harbor House.

For Pendleton and her family, the nonprofit adult family care home (or AFCH, the state’s term for a small, residential care facility) opened just in time. Shortly before Christmas, her adult children found themselves in a situation familiar to many: Pendleton, whose husband died in 1995, wanted to stay in the house she lived in with her adult son, but she’d recently fallen and been taken by ambulance and ferry to a mainland hospital. She was released, but her family worried she’d fall again. More than anything, Pendleton just wanted to stay on the island, but the closest eldercare facility was in Rockland, some 12 miles and a 70-minute ferry ride across Penobscot Bay.

Everyone on North haven seems to have had a friend, neighbor, or relative who wanted to age in place but was eventually forced to leave the island.

“There comes a point where you have to ask yourself, ‘Okay, she wants to stay home, but is it safe?’” her daughter, Julie Brown, said. “You don’t want her to fall and get hurt and have to be taken over in an ambulance. You want to get her over there before that point. But you also want to keep her happy.”

Before Southern Harbor House opened, just three of Maine’s 15 year-round island communities had their own eldercare homes. Chebeague Island, in Casco Bay, opened its Island Commons assisted-living facility in 1999. In Penobscot Bay, the Ivan Calderwood Homestead opened on Vinalhaven in 2001, and Islesboro’s Boardman Cottage opened in 2005. Maine’s islands skew older than the state as a whole — at 50, North Haven’s median age is substantially higher than Maine’s highest-in-the-nation average of 44.7. And the challenges that make running any eldercare facility formidable — notably, staffing, along with operating costs that well exceed insurance reimbursement rates — are even more pronounced in island communities. For seniors on Maine’s islands, receiving care and assistance in old age often means having to spend one’s final years away from the close-knit communities where many have spent their whole lives.

Everyone on North Haven seems to tell a version of the same story — they’ve all had a friend, neighbor, or relative who wanted to age in place but was eventually forced to leave the island. The experience, many say, can be isolating.

“Even for the most well-intentioned and focused person, once somebody’s on the mainland, they’re mostly inaccessible,” says Southern Harbor House administrator Lindsey Beverage. “There’s sort of a honeymoon phase when everyone goes to visit, and then over time, it just diminishes.”

Beverage, who spent a decade as the island’s outreach coordinator, remembers a couple named Fred and Helen Popp, separated from each other and from the island after she had a stroke and had to go to the mainland for treatment. “Everything about that experience seemed so wrong,” Beverage says, “and I think the separation intensified Fred’s decline, I really do.”

For years, North Haven residents talked about trying to open a place like their Vinalhaven neighbors had — it came up often at the monthly coffee hour at Waterman’s Community Center. But North Haven has a third of Vinalhaven’s population, and the project seemed financially untenable until 2014, when a seasonal resident named Mary White pledged to donate her farmhouse to the effort. It was a perfect spot, close to the ferry terminal, with harbor views. Beverage and others formed a committee and, together with the island’s sustainable housing organization, launched a $3.5 million capital campaign, to cover startup costs, seed a small endowment, and renovate the farmhouse top-to-bottom, transforming it into a sun-drenched space with an open kitchen, a courtyard, and six private rooms with bathrooms.

Practically the whole island turned out for the open house last July, but renovating the space was only a first step. Before Southern Harbor House could start accepting residents, Beverage had to navigate a bureaucratic web to get licensed as an AFCH and approved to accept MaineCare, plus hire and train seven employees to keep the home staffed around the clock. Sharon Daley, of neighboring Islesboro, helped open that island’s Boardman Cottage some 15 years ago. “If I had known what we were getting into,” she recalls, “I would have been scared to death and wouldn’t have done it. The different steps, regulations, fundraising, licensing — it’s huge. It just goes on and on.”

“It’s sort of like going back to the way things used to be, where neighbors help neighbors.”

Jess Maurer, Maine Council on Aging

In 2001, Daley came together with representatives from the other island communities to establish an informal advisory network; its members get together annually for a conference on aging and have monthly check-ins by phone. Beverage connected with the group early on and says the guidance and support were critical.

“It’s a hard business to run,” she says. “The finances are pretty grim. So anybody saying they’re going to get into it, they need that support.”

Every commodity on the islands — food, fuel, electricity — is more expensive than on the mainland. Maine’s nonprofit Island Institute has estimated that residents of Maine’s unbridged islands spend up to 18 percent of their income on electricity and heating oil alone — mainland Mainers pay about half that. An AFCH can’t simply pass these costs along to its residents, the majority of whom are on MaineCare, which reimburses at rates far below private insurers. At Islesboro’s Boardman Cottage, all eight current residents are MaineCare recipients. Recently, Daley’s ad hoc group successfully lobbied the state to raise reimbursement rates for MaineCare patients in offshore facilities, but state money still doesn’t touch the costs of running one. MaineCare reimburses offshore facilities $26,000 a year per patient. Simply keeping one staffer on the clock 24 hours a day, at a $12 hourly wage, costs more than $100,000 a year.

And filling those positions at all is a challenge. “People can make a lot of money on the islands in the summertime,” Daley says. “We can’t match those salaries, and caregiving is hard.” Residents on Peaks Island (year-round population 900) and the Cranberry Isles (year-round population 150) have explored the possibility of facilities of their own, Daley says, but she has a hard time envisioning any island smaller than North Haven (and that describes all the remaining island communities) having enough residents or staff to make the numbers work.

Southern Harbor House declined to share any budget numbers, including its projected annual operating costs, but with just six beds, there is almost no scenario in which income from residents alone can cover the facility’s costs. “The reality is that nobody can do this without outside financial support,” Beverage says, “particularly in a small care home where you don’t have that economy of scale.”

As Pendleton sat back in her chair and sighed, the room burst into applause.

Beverage and her peers hope to pad their endowment over time with bequests and planned giving. On Vinalhaven, volunteers raise $10,000 to $15,000 annually for the Calderwood Homestead by collecting returnable bottles. The staff at Islesboro’s Boardman Cottage find donors respond best when asked to fund specific needs — to buy a washing machine, say, or fill the heating oil tank. They also sell coffee at the ferry terminal, host potlucks, and bring sandwiches and baked goods to town meetings. “Because we ask for so much money every year, it’s good for people to see us doing our part,” administrator Maura Michael says. “And the state tells us all the time, ‘There’s no pot of gold at the end of the rainbow — you guys need to do this yourselves.’”

“It’s sort of like going back to the way things used to be, where neighbors help neighbors,” says Jess Maurer, executive director of the Maine Council on Aging. “Island communities are particularly adept at that. They never lost it.” All the same, Maurer says, the state’s regulatory framework isn’t helping. “Do we need layer after layer after layer of regulations and safety that makes it so costly to build and run these as any sort of a business? Who’s going to build those sorts of facilities? Even as a nonprofit, you just can’t. I watch these communities get all tangled up in insurance and liability and background checks and what they can and can’t do. . . . It doesn’t have to be so painful.”

Still, Daley argues, there’s something to be said for the islands’ scaled-down, community-driven approach. “I feel like the islands have figured out how to do eldercare, and the rest of the country needs to follow,” she says. “Almost all of the eldercare homes on the mainland are really large, and I think even though they try hard, it becomes more institutionalized. Everyone is lined up in wheelchairs. Staff is usually overworked, and it’s heavy work. People are more and more isolated. People don’t like to visit. My father was in a place like that, and I had to brace myself every time I walked in. These places are not like that.”

On the morning of Harriet Pendleton’s move to Southern Harbor House, her friend took her on a drive to her favorite part of the island while her daughter brought over her things. When Pendleton arrived, clutching her walker, she walked slowly into her new room, and her family and the assembled staff all seemed to hold their breaths. As she sat back in her easy chair and sighed, the room burst into applause.

Later, as she explored the rest of the house, Pendleton remembered her only previous visit, during the house’s grand opening. “There were so many people here,” she recalled. “I don’t think I ever saw so many people in North Haven as that day.” She fell quiet as she looked around the sunny kitchen, then added, “I haven’t felt as bad today as I thought I would. I thought I’d feel just awful, but I don’t.”

For the next six weeks, Pendleton was the only resident of Southern Harbor House. As of press time, one other has joined her.