Maine
Use of antipsychotics in Maine nursing homes climbs
Sherri Parker, assistant director of nursing at Caribou Rehab and Nursing, recalled a woman who came to her facility and was so sedated by the prescribed antipsychotic medication she had been taking at home that they couldn’t keep her awake for therapy because “she’d fall asleep in front of you.”
Parker, who handles gradual dose reductions at the nursing home, said she worked with a doctor to wean the woman off the medication. By the time the resident transferred back home two months later, “she was a completely different woman,” Parker said — able to eat on her own and be home alone while her husband went to work.
“I’ve seen a stopped antipsychotic medication on many people and sometimes I’m like, ‘Wow, they’ve actually done really well.’ That just goes to show me that it really wasn’t necessary to keep them on that,” Parker said.
But in recent years, she has seen an increase in these medications. At the end of last year, while reading referrals from the hospital for new residents, Parker said nearly every one had a prescription for an antipsychotic medication. She said it’s likely they were prescribed the medication while living at home or when they went to the hospital before ending up at her nursing home.
Statewide data shows the percentage of Maine nursing home residents receiving antipsychotic medication is increasing.
While the rate for short-stay residents, like the one Parker recalled, is relatively low, Maine’s rate for long-stay residents is higher than the national average. Short-stay residents are in a nursing home for less than 100 days, often recovering from surgery or being discharged from a hospital, according to the U.S. Centers for Medicare and Medicaid Services.
In the years after federal regulators cracked down on rates of antipsychotic medication given to long-stay nursing home residents, Maine became a success story, dramatically reducing its rate between 2011 and 2017 from 27 to 17 percent.
But since then, Maine’s rate has crept back to 20 percent, higher than the national average of 14.7 percent and the sixth-highest across all states, according to the U.S. Centers for Medicare and Medicaid Services. Among all American adults, the rate of antipsychotics was less than 2 percent.
Antipsychotics are a type of medication, including Risperdal and Seroquel, designed to manage psychosis and delusions. They’re often given to patients with a diagnosis of schizophrenia or bipolar disorder. The side effects can be severe, including tremors, heart and circulatory problems, high cholesterol and sedation. They can be particularly problematic for older adults, even potentially shortening the lives of nursing home residents by increasing the risk of drowsiness, confusion and falling, said several experts.
CMS data on nursing home rates of antipsychotics exclude people diagnosed with schizophrenia, Tourrette’s Syndrome and Huntington’s Disease.
“Antipsychotic medications are especially dangerous among the nursing home population because of their potentially devastating side effects, including death, and the use of antipsychotic medications among nursing home residents is an indicator of nursing home quality,” a CMS spokesperson told The Maine Monitor.
Treating an episode, not a behavior
Dr. Susan Wehry, associate clinical professor at the University of New England in Biddeford and a board-certified geriatric psychiatrist, said there are times when antipsychotic medications are necessary to prevent a resident from harming themselves or others, but those occasions are rare.
“I understand an acute need for using a chemical restraint, but call it what it is: This is not treating a behavior; this is treating an episode of agitation that you can’t figure out how to address another way,” Wehry said. “You’re basically sedating the person.”
Wehry said what is often depicted as challenging behaviors from residents with dementia is actually the resident trying to communicate an unmet need. They may not have the language to say what they want, so rather than sedating the resident, it’s important to find out the cause of their frustration, she said.
Parker, with Caribou Rehab and Nursing, said she’s seen residents come off these medications and become more alert, social and talkative. And sometimes there’s no change in behavior, which she said begs the question why the resident needed to be on the medication in the first place.
As of this month, roughly 19 percent of Caribou Rehab and Nursing residents were on antipsychotics, slightly below the statewide average. Parker recalled when their rates were 5 percent and how proud she was, but said the numbers can fluctuate as admissions come in with pre-existing prescriptions.
“I tried really hard with my antipsychotic numbers to be down, and then just slowly they crept up again as we took admissions,” Parker said. “I would love to see my numbers come down and I know those are some things we have to work on.”
Multiple experts and advocates point to a number of explanations for Maine’s rising statewide average, such as staffing shortages and reliance on temporary agency staffing, diminished attention to the problem, MaineCare underfunding for nursing homes, and the all-consuming nature of the COVID-19 pandemic, which demanded more attention on infection control.
Staff who are overwhelmed with duties or haven’t had time to build relationships with residents may turn to medication rather than spending time on de-escalation techniques when residents have challenging behaviors.
“It’s a disappointment to see the rates have increased because I know we can do better,” said Brenda Gallant, Maine’s long-term care ombudsman who advocates for nursing home residents and their families.
Gallant was part of the coalition in 2012 that led the effort to reduce Maine’s rates of antipsychotics, with Wehry and numerous other advocates, providers and organizations.
Multiple people involved in that effort said the success was due to the commitment of a broad coalition that involved statewide trainings, workshops, mentoring programs, grants for innovative programs like Music and Memory, and resources such as a handbook for providers.
The guidance urged providers to take a holistic approach to treating dementia patients, which included education for family members on the risks associated with the medication, staff training programs that identify specific areas of competency and a collaborative transition process with hospitals.
“Initially, we were leaders,” Gallant said, adding that at one point Maine was ranked the seventh-most improved state in 2016, according to federal data cited at the time by the Maine Partnership to Improve Dementia Care in Nursing Homes.
Nationally, the rates during that time decreased from about 24 percent in 2011 to 14.3 percent in 2019, while Maine’s crept back up. But this data also can lag slightly: the collection period for the current data on this quality measure was Oct. 1, 2022 to Sept. 20, 2023.
“The tip of the iceberg”
In recent years, some experts have become concerned about an overreliance on medication for older adults, including Dr. Jabbar Fazeli, who has served as medical director for multiple nursing homes and assisted living facilities in Maine. He said antipsychotics could be the “tip of the iceberg,” and that facilities also use mood stabilizers and sleeping pills as a way to sedate residents.
Fazeli served as co-chair of the Maine Partnership to Improve Dementia Care in Nursing Homes and has been outspoken about reducing overreliance on medication for older adults. Before the federal government decided to focus on the issue, it was difficult to push back against a “pervasive” culture of using antipsychotic medications, Fazeli said.
Durgin Pines in Kittery, where Fazeli served as medical director for more than a decade until last month, maintained a rate of antipsychotic medication that was always below 5 percent, he said. Currently the facility has a rate of 4.2 percent, according to the Centers for Medicare & Medicaid Services. Fazeli said the success was dependent on a joint effort with the director of nursing, assistant director of nursing and the administrator to try all other options before resorting to an antipsychotic medication.
In recent years, lawmakers and the federal government have also become concerned about nursing homes “erroneously” claiming residents had schizophrenia as a way to “mask the facilities’ true rate of antipsychotic medication use,” the agency said in a release last year. CMS conducted onsite surveys to look at schizophrenia diagnoses and conducted audits of how nursing homes coded these residents.
An oversight organization said this does not appear to be a problem in Maine. The nonprofit that provides quality improvement organization services in New England, Healthcentric Advisors, said it has “thoroughly analyzed” Maine data and determined the state is not seeing an increase in schizophrenia diagnoses.
Fazeli added that in his 26 years in geriatric care, Maine is better than most other states, including those he worked in like Missouri, Massachusetts, Connecticut and New Hampshire.
But after a lot of initial energy in Maine, attention on the issue slowed, especially during the pandemic, Gallant said.
Many said the pandemic was all-consuming for nursing home providers, making it difficult to keep the focus on reducing antipsychotics while keeping up with evolving regulations and caring for residents who were forced to be quarantined.
Wehry, the geriatric psychiatrist, said it was understandable for rates to climb back up in the first months of the pandemic, but “that’s no longer an adequate excuse.” She said a lot of nursing homes reverted back to institution-centric care that forces residents to conform to their environment rather than create an environment that works for them.
“I think it’s broader than just the individual person who’s getting the antipsychotic. I think the culture change, which people worked so hard to introduce, also backslid in the pandemic,” Wehry said.
Ruta Kadonoff, who worked for the national nursing home industry group during the 2012 effort to reduce antipsychotic medication, and traveled across the country providing education on the issue, said Maine’s biggest challenge is workforce shortage.
Staff need adequate training on how to “get inside the world of a person with dementia,” time to work with a resident who is upset or struggling to communicate a need, and support to provide person-centered care that allows them to build relationships with residents. None of that is possible in a facility that is understaffed, has high turnover or relies on temporary agency staffing.
“Until we address that, I don’t think it’s realistic to think we’re going to address other quality issues,” Kadonoff said. “It’s a bandaid to try to address other things without dealing with the underlying fact that we just don’t have the people to provide this care and to do it well.”
Healthcentric Advisors, the quality improvement organization, said it has been meeting with the long-term care ombudsman and the Maine Health Care Association, which represents the state’s nursing homes, about refocusing attention on this issue. They plan to update and reintroduce training modules that condense the most useful tools and resources, which will be rolled out in late fall.
The Maine Department of Health and Human Services said it has identified the increasing use of antipsychotics in nursing facilities and encouraged the stakeholder group to reconvene along with nursing facilities administrators and medical directors. In January, DHHS published a stakeholder group report, Improving Quality in Maine’s Nursing and Residential Care Facilities, and noted that “this metric is likely to be among those tied to reimbursement as part of nursing home payment reform,” spokesperson Lindsay Hammes said.
Gallant, the ombudsman, said it’s important to return attention to this problem “if we want to make progress and get back to the place that we had initially in terms of really being leaders. I think that should always be our goal: to do the very best that we can for residents in our nursing homes.”
For many hunters, drawing a Maine moose permit is a once-in-a-lifetime opportunity. After years — and sometimes decades — of applying, the excitement of seeing your name among the winners quickly turns into a new challenge: planning for the hunt.
Whether you’re going on your first moose hunt or preparing for another trip into the Maine woods, there are several important steps permit winners should take as soon as possible.
Hire a registered Maine guide
Many permit winners hire a registered Maine guide to help locate a moose, scout hunting areas and navigate unfamiliar country. You’re paying for their knowledge, experience and time spent scouting before the season ends. Even if you’re a Maine resident, hiring a guide should be a consideration. Most hunters don’t have the time to make multiple scouting trips, and trail cameras aren’t always an option because cell service is limited or nonexistent in many hunting areas.
If you’re considering hiring a guide, don’t wait too long. Available openings often fill up the night of the lottery.
Book lodging for your moose hunt
Sporting camps, cabins, campgrounds and hotels near popular moose hunting areas will also fill up quickly. If your hunt will take place hours from home, securing lodging should definitely be one of your first priorities. Waiting until summer will leave you with fewer options and a longer commute to your hunting area.
Find a meat processor
The state maintains an official list of moose meat processors. The last thing you want to be doing is calling around on a warm September day trying to find a butcher willing to take your moose. Processors can only handle so many animals each season, and much like guides and lodging, many fill their schedules quickly. Calling ahead and having a plan in place can save a lot of stress after a successful hunt.
Line up your hunting partners and helpers
If you’re not hunting with a guide, it’s helpful to know who will be accompanying you. Aside from sharing the experience, friends and family can help scout, call, spot animals, film the hunt and retrieve a harvested moose.
How will you retrieve the moose?
Depending on where the animal is harvested, you may need an ATV, side-by-side, trailer, winch, ropes or other equipment to retrieve it. Keep in mind that ATVs and side-by-sides are prohibited in the North Maine Woods, so you may need to quarter and pack the moose out instead. In that case, game bags, packs, knives and saws will be essential, while items such as a jet sled or game cart may help make the job easier.
Gather your moose hunting gear
In addition to your weapon, consider what you’ll need for the hunt itself. Tarps, coolers, headlamps, GPS units, an inReach, radios, rain gear and extra fuel can all make a hunt more comfortable and efficient.
If you’re planning on getting away from the roads, you may need or want a wall tent. You’ll also need cots or other sleeping gear, a heating source, water, cooking gear and emergency supplies. A spare tire, jumper cables, chainsaw and basic tools can also be invaluable when traveling remote logging roads.
Prepare for meat care and transportation
Make plans to have coolers, ice, transportation and storage well before opening day.
Sight in your rifle or practice with your bow
Don’t be the hunter who misses because their scope was 8 inches off, got bumped during travel or hasn’t been checked since last season. Confirm your rifle is properly sighted in before the hunt, and shoot again after arriving in camp. Stock up on ammo and spend time practicing from realistic field positions.
Don’t overlook shooting sticks, either. Many hunters regret leaving them behind. Shot opportunities are often farther than expected, and a stable rest can make all the difference when anticipation and excitement start to take over.
The same applies if you choose to bring a bow. Reps, shooting from different positions and accurately judging distance can all improve your chance of success.
Scout your zone
If you don’t hire a guide, make sure you’re familiar with your hunting area. Not only will you likely run into other hunters during the week, you may arrive at your preferred spot only to find another truck already parked there. Having backup options is key.
Conditions also vary dramatically from year to year, so what worked for hunters last season may not work this fall.
Depending on the weather, moose may be farther away from roads, requiring hunters to do more walking. Last September’s hunt saw lower success rates in every wildlife management district compared to 2024.
Moose biologist Lee Kantar noted that drought conditions and slightly earlier September dates can lead to changes in moose behavior. Drought and warm weather likely affect moose movement, feeding patterns and activity levels, resulting in moose staying closer to areas with moisture and green vegetation.
“If bulls are not widely searching for cows, if bulls and cows are bedding or ruminating more in dark growth during the day, and if hunters do not adjust and ‘go in after them’, then success will drop,” Kantar said
The same challenges can affect October hunts.
Study maps, use onX, review aerial imagery and learn access roads before the season begins. Many logging roads shown on maps are no longer passable or have been blocked off.
Prepare physically for the hunt
Even hunters who plan to hunt from roads may end up walking several miles in a day.
Just getting into a producing moose area can require long walks down logging roads, skid trails or old cuts. Moose hunting can be physically demanding, with long days outdoors, rough terrain, bugs and heavy lifting. Spending a few months improving your fitness can make the experience more enjoyable.
Create a checklist
Make a list of everything you’ll need including licenses, permits, firearms, ammo, retrieval equipment, coolers, camping gear, food, water and emergency supplies. The more organized you are, the smoother the hunt is likely to be.
VINALHAVEN, Maine (WGME) — Two boaters are charged and a third is dead after he went overboard in Downeast Maine.
Just before 5 Thursday, Maine Marine Patrol says a boater fell overboard in “Hurricane Sound” near Vinalhaven.
He’s identified as 57-year-old Marshal Ames.
Marine Patrol says before they arrived, a good Samaritan from Hurricane Island was able to reach Ames and began CPR, but he was pronounced dead by first responders.
Officers say when the other crewmembers arrived on shore, they got into a fight with them.
The crew members, 39-year-old Geoffrey Barrett and 27-year-old Theodore Lane, are facing charges including assault.
The Maine State Police major crimes unit is now part of the investigation.
Scott A. Harrison, Ed.D., M.B.A., is a senior advisor at The Harrison Group, a consultancy based in Yarmouth.
Maine has long valued local control in education. That tradition reflects an important belief that communities should have a strong voice in shaping their schools. But local control should not prevent us from asking a harder question: Are there core functions that could be delivered more effectively through a single statewide framework?
One of the most important is educator evaluation and professional growth. Maine law already recognizes the importance of this work. Under Title 20-A, Chapter 508 (Educator Effectiveness), districts must implement performance evaluation and professional
growth systems that evaluate educators, assign effectiveness ratings and support
professional growth.
The law further requires superintendents to use those ratings to inform key human capital decisions, including recruitment, hiring, induction, mentoring, professional development, compensation, assignment and dismissal. In short, educator evaluation is not intended to be a compliance exercise. It is intended to be a primary lever for the continual improvement of teaching and learning.
In 2012, LD 1858 sought to advance that vision by giving districts broad flexibility to design their own systems. Districts could choose instructional frameworks, establish measures of effectiveness and determine how evaluators would be trained and calibrated. The goal was to balance local autonomy with professional accountability.
More than a decade later, however, the evidence suggests that flexibility alone has not produced consistent results.
My research involving 130 educators across four Maine school districts found only modest perceptions of performance evaluation and professional growth systems’ effectiveness.
On a four-point scale, average ratings ranged from 2.48 to 2.99. While educators generally agreed that districts provide individualized growth plans and can differentiate levels of instructional effectiveness, they rated several critical implementation areas notably lower, including instructional coaching, evaluator training, feedback quality, evaluator calibration and the use of evaluation data to inform professional learning and personnel decisions.
Although the sample was relatively small, the findings closely mirror what I have observed while working with predominantly rural Maine districts over the past decade.
The qualitative findings were equally revealing. Teachers and administrators described systems that are often cumbersome, inconsistently implemented and difficult to sustain. Educators reported spending significant time developing goals and documenting evidence, while administrators acknowledged that competing priorities frequently reduce evaluation to a compliance exercise rather than a meaningful opportunity for growth.
Participants cited insufficient training, inconsistent expectations, limited coaching support and weak connections between evaluation results and professional learning. Perhaps most significant, though not surprising given the realities of today’s schools, the primary obstacle appears to be not commitment, but capacity — the time, expertise and tools required to implement these complex systems with fidelity.
Designing and sustaining high-quality evaluation systems requires expertise in instructional leadership, observation and feedback, adult learning, professional development, data use and evaluator calibration. While some districts have built this capacity, many — particularly smaller and rural systems — have not. Even where expertise exists, time remains a major barrier.
Effective evaluation depends on regular observation, coaching, feedback and calibration. Yet for principals balancing instructional leadership with the daily demands of running a school, carrying out these responsibilities consistently can be extraordinarily difficult.
As a result, Maine has effectively asked more than 250 districts to independently build and maintain highly complex educator effectiveness systems. The outcome is predictable: uneven quality and implementation, and variable impact on teaching and learning.
This raises an important policy question: Should every district continue to design, train, calibrate and maintain its own evaluation system, or would educators and students be better served by a common statewide framework supported by regional and state expertise?
A statewide approach would not eliminate local control. Districts would continue to make decisions about hiring, staffing, curriculum, budgeting and school improvement priorities. Instead, the state would provide shared infrastructure: a common instructional and evaluation framework, validated tools, evaluator training, calibration supports, professional learning resources and implementation assistance.
The benefits extend beyond evaluation. A common framework would create stronger alignment across Maine’s educator pipeline. Colleges and universities could align coursework, clinical experiences and assessments to the exact same standards used in schools while sharing responsibility for educator success beyond initial placement.
Preparation programs, districts and the state would become partners in a continuous system of educator development, creating mutual accountability for results and a stronger return on Maine’s investment in teacher preparation.
Such alignment matters. As systems thinker Peter Senge observed, people working within the same system tend to produce similar results. If we want more consistent outcomes for students, we must pay closer attention to the systems shaping educator practice.
A statewide approach would not eliminate local control. Districts would continue to make decisions about hiring, staffing, curriculum, budgeting and school improvement priorities.
A common framework would establish a shared language and clearer expectations throughout the career continuum. It would also make continuous improvement easier. Rather than asking hundreds of districts to independently revise complex systems, the state could evaluate implementation, refine practices, share lessons learned and respond to emerging research. Educators have experienced too many short-lived initiatives that consume considerable time and effort before fading away.
A coherent statewide system would provide greater stability and more meaningful long-term improvement. The question is not whether local control matters. It does. The question is whether every district should be expected to independently build and sustain complex systems that require specialized expertise, significant resources and ongoing refinement.
If Maine is serious about improving outcomes for students, it should rethink which functions are best managed locally and which are better supported through statewide infrastructure. Educator effectiveness is one example. There are likely others.
In a previous op-ed here, I argued that Maine should reconsider whether teacher compensation is best negotiated district by district. The same question applies here. When critical human capital systems are essential to student success, a coherent statewide framework may be better positioned to advance equity, efficiency and effectiveness while preserving local decision-making where it matters most.
The goal is not less local control, but a smarter balance between local autonomy and statewide support — one that strengthens schools and improves outcomes for every student, regardless of geography.
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