BANGOR – Vaughn Drost, 83, wakes up every morning at the Stucco Lodge motel in Veazie in the room he shares with his daughter Darlene Garland. The two of them have a bite of breakfast, making use of the microwave and minifridge in their room. Then they head out to spend the day at the Stillwater Health Care nursing home in Bangor, where Vaughn’s wife, Annie, has been a patient for several months.
It’s a daily routine Drost has been repeating since early October, when he and Darlene brought Annie down from their home in Presque Isle to have hip surgery at Eastern Maine Medical Center. They didn’t know it then, but the prospects of Annie’s being able to return to northern Aroostook County were slim.
Though her operation was successful, Annie Drost suffered complications during her hospital stay, including two strokes that left her in a coma for several days. Doctors warned she might not recover, but Annie’s strong character and constitution, along with the unflagging support of her family, pulled her through.
Like many elderly patients, though, she has required a period of nursing care and physical rehabilitation to help rebuild her strength. But because she also needs dialysis three times a week for diabetes, nursing facilities in the northern Aroostook region have refused to admit her – even though she’s been a patient at the dialysis center in Presque Isle for the past eight years.
The nursing homes say they can’t afford to transport patients to the dialysis center – that their patient-transport vans are too busy to manage an extra three-day-a-week commitment, that their staff is already spread too thin to justify even an extra half-hour of an aide’s time away from regular duties.
So Annie Drost – and Vaughn and Darlene – are stuck in Bangor indefinitely.
“We three live together,” Vaughn Drost said during a recent visit at Stillwater Health Care. “And I’ve always said that when we go back home, we’ll all go back together.” He’s been back to Presque Isle just once since October, an up-and-back, one-day trip for an appointment with his own physician.
The rest of the time he and Darlene have devoted to being with Annie.
“My daughter and me being with her is pretty good therapy,” Drost said. “Her face just lights up when we walk into the room every morning.”
Vaughn says Annie’s care at Stillwater has been excellent, and he is grateful for the administration’s generosity toward him and Darlene.
“But everybody’s a stranger to us here,” he said. If Annie were at one of the nursing homes in northern Aroostook County, the other residents and the visitors coming and going in the lobby would be longtime neighbors and friends from the close-knit community, he said. The staff, too, would wear familiar faces. And with Annie safe nearby, Vaughn and Darlene could return to their own home and get on with their lives.
Unable to provide care
Health care in Maine is often a family affair – a corporate family, that is. The County Dialysis Center in Presque Isle is affiliated with The Aroostook Medical Center and its 96-bed hospital. TAMC, in turn, is an affiliate of Eastern Maine Healthcare Systems in Brewer, the administrative parent of both EMMC, where Annie had her surgery, and Stillwater Health Care, where she currently resides. But officials at the corporate headquarters last week had no comment on the Drosts’ situation and no solutions to offer.
The Aroostook Medical Center also owns and operates a small nursing home in nearby Mars Hill called Aroostook Health Care.
Joy Barresi Saucier, vice president of public relations at TAMC, would not speak about Annie Drost’s situation in particular, citing patient confidentiality concerns, but she stressed that nursing homes must assess each potential resident carefully.
“All of the care of that patient becomes the responsibility of the nursing home,” she said. “We evaluate all admissions [at Aroostook Health Care] the same way to see if we can meet their needs.” The amount of nursing care a patient needs, any special therapies, the patient’s cognitive status, treatments such as wound care, and predictable transportation needs all go into the decision, as well as the funding source, Saucier said. If a patient is turned down for placement, it’s because the facility has determined it is unable to provide the needed level of care.
Outside the EMHS family, there are a number of nursing homes within a short drive of the County Dialysis Center.
“There are lots of unfortunate, sad situations,” said Phil Cyr, administrator of the independent Caribou Rehabilitation and Nursing Center in Caribou about 15 miles from Presque Isle. “That’s because the government doesn’t want to pay for services, and nursing homes are caught in the middle.”
Cyr said the problem with dialysis is one of transportation, pure and simple. The one van his facility owns is “on the go every day” taking patients to medical appointments and other activities related to their care. But to take a resident like Annie Drost to dialysis three times a week, dropping her off in the morning and picking her up in the afternoon with a member of the direct-care staff accompanying her on the drive would tie up the van and cost the facility too much in staff time, Cyr said.
Cyr’s sister Rosemarie Louten is the administrator of the Presque Isle Rehabilitation and Nursing Center in Presque Isle. Like Cyr, Louten said transportation and staff time are real obstacles to getting a resident to dialysis, even though the dialysis center is only about a mile and a half away.
Since some dialysis patients have to arrive by 5 a.m. or leave in the late afternoon, she said, the nursing home could lose valuable staff time at critical times of the day.
“A staff member could be gone at least a half-hour at times when staffing is already difficult,” she said.
At the nonprofit Aroostook Regional Transportation Systems, executive director Danny Donovan said ARTS buses drive several area residents to the dialysis center from their homes. In the past, he said, the nonprofit bus service has transported people from nursing facilities, but recently there hasn’t been any demand. Donovan speculated that issues of inadequate funding and inflexible scheduling have created a bureaucratic obstacle to caring for dialysis patients in Aroostook County.
Trying to make it work
Every Monday, Wednesday and Friday morning, Annie Drost is taken by ambulance to the new EMMC dialysis center on Union Street. Vaughn and Darlene follow in their car and keep her company for about six hours as her blood is rid of the excess fluid and waste material that accumulate because her kidneys have failed as a result of her diabetes. In the late afternoon, they all return to Stillwater Health Care.
Annie will need dialysis for the rest of her life.
Stillwater Health Care administrator Kristy Thibodeau said the Bangor area is blessed with an abundance of health care facilities and transportation options for patients – resources that are not readily available in Aroostook County. While discharge planners at Stillwater have worked hard to send Annie back north, the dialysis issue has been a repeated deal-breaker, Thibodeau said.
“There’s no reason she couldn’t be cared for in another facility. We’ve really put extra effort into this because of the special situation,” she said, referring to Vaughn and Darlene’s refusal to go back without Annie.
Maine’s long-term care ombudsman program has the authority under federal and state law to investigate and resolve complaints about nursing home care in Maine. Executive director Brenda Gallant said she has not encountered concerns about access to dialysis from nursing facilities, but she said it happens too often that patients must be cared for in facilities far from their homes due to lack of bed space.
She expressed optimism that Annie Drost’s situation could be resolved.
“Dialysis should not be something that would hold a facility back from admitting a resident,” she said. “It’s a shame this person can’t stay in the area she comes from.” Gallant said demand for dialysis services and other medical care is likely to increase throughout the state as Maine’s population ages, especially given Mainers’ high incidence of diabetes.
“It’s important to make every accommodation possible to keep people as close to home as possible,” Gallant said.
“It seems like discrimination,” Vaughn Drost said in a phone conversation last week. “Any other kind of sickness is no problem [for the nursing homes]. It’s just the dialysis” that’s keeping her from being accepted.
Drost reckons that between maintaining his home in Presque Isle and the expense of living in a motel for five months and eating most meals out at modest local eateries, he’s gone through about $10,000 of the hard-earned savings he set aside during his years of work in the building supply business in Presque Isle.
But, he said, he’ll stay on in the Bangor area until Annie, his wife of 63 years, can go back north with him. If the nursing homes in the Presque Isle area continue to refuse her, Drost said he’ll wait until she’s strong enough to be cared for at home with visiting nurses and go to dialysis on the ARTS bus.
Drost said staff members at Stillwater Health Care have made him and Darlene feel welcome, and they enjoy a daily noontime meal there at no charge. And the owners of the Stucco Lodge in Veazie have been thoughtful and courteous, understanding the stress of living so far away from home for so long.
Despite these kindnesses, Drost, a trim, courteous man who’s careful with his words, says he’s had just about enough of the Queen City.
“I used to like coming to Bangor once in a while,” he said. “But right now, I don’t care if I never come back again.”
To contact the Maine Long Term Care Ombudsman Program, call 800-499-0229 or visit www.maineombudsman.org.