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.”
Almost exactly one year ago, Graham Platner, who has no political experience, was cherry-picked by out-of-state political activists.
According to a person familiar with the campaign, Daniel Moraff and Leanne Fan, who have made a name for themselves by recruiting populist candidates across the country, traveled to Maine and rented a house near Platner’s home in Sullivan to convince him to run for the US Senate. Throughout the process, Moraff became Platner’s “right-hand man”, the person described, speaking on condition of anonymity for fear of backlash.
But homing in on Platner as a newcomer to oust long-serving Republican Susan Collins came at a cost. The Wall Street Journal recently reported that Moraff asked for an expedited, cheaper background check to be completed in a matter of days. The firm Moraff and his team contracted with also did not do a candidate interview or questionnaire, per the Journal’s report.
The fallout of those decisions happened on a colossal scale. In a midterm year with record spending across the country, the Democratic party had come to pin its hopes on Platner to help clinch Senate control with his meteoric campaign and ability to unite independent and progressive voters alike with a clear, anti-establishment message.
Controversies ensued, bringing with them straight-to-camera videos of Platner explaining and denying various scandals. Finally, an allegation that broke the dam this week: a woman he dated accusing him of sexual assault, of drunkenly forcing her to have sex with him after coming to her house uninvited. Asked in an interview on CNN whether Platner raped her, the woman, Jenny Racicot, replied: “By definition, yes, absolutely.”
His support collapsed. Platner waited days as calls grew for him to withdraw. Then on Wednesday, he released an 11-minute video announcing the end of his campaign that left Maine voters scrambling and betrayed, and the country wondering: how did this happen?
“It feels like some of the first rules of politics may have been broken here,” said Andrew Feldman, a national progressive strategist. “We were seeing rookie mistake after rookie mistake, and now we find ourselves in this situation.”
David Farmer, a Democratic strategist based in Maine, said the vetting process for Platner was tantamount to “malpractice”.
“I’ve had to have these conversations with candidates in the past – where you sit down and you ask them really tough questions,” Farmer said. “What drugs have you used? Have you ever had an affair? You ever cheated on your wife? You ever cheated on anybody? It’s really uncomfortable and probing, and a miserable event for everybody involved.”
The person familiar with the campaign said that Moraff and Fan “fell in love with an aesthetic without knowing the state” that ultimately did a “disservice” to Maine’s working-class voters.
Platner’s campaign did not respond to the Guardian’s request for comment on the methods used to check the former nominee’s background.
A rising star and an early redemption arc
Platner’s early campaign days – after he announced his run in August of last year – saw a rare rush of grassroots excitement as he criss-crossed the state for town halls, with backing from Bernie Sanders and an ad produced by Zohran Mamdani’s 27-year-old media strategist, Morris Katz.
An oyster farmer and marines veteran, Platner issued plain-spoken warnings that Maine’s working class had been hollowed out – healthcare was unaffordable, young people couldn’t buy homes – and said he’d survived only because of the veterans’ benefits he receives from being “blown up” too many times in combat. His searing indictment of the political establishment matched the anti-Washington mood and anger many Democrats felt toward their party’s leaders.
“His tone, his look, his voice, his message captured a frustration with Washington, a frustration with economic injustice,” Farmer noted.
Democratic leaders had someone else in mind: the 78-year-old term‑limited governor Janet Mills. But Mills hadn’t yet announced her run. In the meantime, 41-year-old Platner positioned himself as the gruff local businessman hardened by tours in Iraq and Afghanistan, pushing for generational change. Once Mills entered, he quickly framed her as emblematic of the status quo, arguing that a Chuck Schumer‑backed candidate would mirror Collins‑style “fake moderation”.
The Democratic establishment was skeptical of Platner from the outset, concerned that he brought too much baggage to the race against a seasoned incumbent. But progressives say the party is also to blame for pushing Mills as an alternative. If she had been elected, Mills would have been the oldest freshman in Senate history.
Platner brushed off his earlier scandals: Reddit posts from 2013 to 2021 where – among other things – he called white rural Americans “stupid” and “racist”, questioned why “Black people didn’t tip” and said sexual‑assault survivors should “take some responsibility … and not get so fucked up”. While apologetic, he characterized the posts as side-effects of severe PTSD and disillusionment from combat.
He tried to get ahead of more controversy by revealing a covered-up skull-and-crossbones tattoo that resembled a Totenkopf, a symbol known for its use by the Nazi SS. Platner said it came from a night drinking with military buddies in Croatia 18 years earlier. “I’m not a secret Nazi,” he told the Pod Saves America hosts.
Platner and his allies in Congress argued the uproar was overblown. At the time, Platner told the Guardian that Mainers related to his struggle and didn’t see the posts or tattoo as disqualifying. Many voters also said they could look past his mistakes and viewed his redemption arc as genuine. “If what the voters wanted were people who were grown in vats and had never done or said anything that they might regret their entire lives, we’d have a very different country,” Moraff told the Journal in May.
But inside his campaign, cracks had started to appear. In October, Platner’s political director, Genevieve McDonald, and his finance director both left his team. The latter, Ronald Holmes III, said his “professional standards” no longer “fully aligned with those of the campaign”. McDonald said Platner’s failure to fully disclose the extent of his Reddit posts led to her departure. She went on to question whether Platner really didn’t know the meaning of his tattoo.
Bracing for the worst
There was lingering concern among Maine locals and political operatives that more would come out about Platner’s past. One voter at a town hall in April asked him – point‑blank – if there were examples of sexual misconduct in past relationships that could emerge and endanger his chances. Another said that she was extremely wary about how untested Platner was.
Ultimately, his star continued to outshine the septuagenarian governor’s lackluster campaign. Mills, citing dwindling financial resources, eventually dropped out of the race, giving Platner a glidepath to the nomination.
And then – 10 days before the Democratic primary – reports revealed that Platner’s wife, Amy Gertner, had confided in McDonald about sexually explicit messages he’d sent outside their marriage, disclosures she made in an attempt to get ahead of any opposition research.
In extraordinary fashion, Platner was summoned to Washington DC to answer lawmakers’ questions about the latest controversy. Shortly after the meeting, the New York Times reported that previous partners described “unsettling” and “toxic” behavior. One of the women, Lyndsey Fifield, a conservative operative who dated Platner from 2013 to 2015, alleged he frequently grabbed her by the shoulders, once yanked her out of a taxi by her wrist, and during one argument twisted her arm behind her back, shoved her into a bedroom and held the door shut until she was “calm”. Fifield also cast doubt on Platner’s claim that he was unaware that his tattoo was a Nazi symbol, telling the Times that he referred to it as “my Totenkopf”.
Platner rejected Fifield’s claims and branded them as “politically motivated”.
While some voters were deterred, Platner still ended up clinching more than 70% of the vote in the primary. National Democrats, however, were left to grapple with a catch‑22: what would be an insurmountable scandal? And would it be worse than if Collins, who had helped overturn Roe v Wade and backed several key Trump policies, was re‑elected to a sixth term?
“It’s like a frog being in a pot of boiling water. If you raise the temperature slowly, you don’t know it’s boiling until it’s too late,” said Farmer.
The final straw
When Politico published their story on Monday, outlining Jenny Racicot’s claims that Platner raped her nearly five years ago, the condemnation came hard and fast. Endorsements evaporated and calls for Platner to withdraw were immediate. As he denied the allegations in a lo-fi self tape, it became clear this would be the red line for those who had stood by him until this point.
“The messenger was not the right person to match the inspiring message,” said Adam Green, executive director of the Progressive Change Campaign Committee. “It is really unfortunate for the overall project of trying to challenge corporate power and shake up a broken political system.”
It would be another two days before Platner published another video announcing his decision to end his campaign, claiming the allegations against him were part of a coordinated political attack.
Troy Jackson, who campaigned alongside Platner while running for the Democratic nomination in the Maine gubernatorial race, and is now one of several candidates running to replace him, told MS Now: “Graham told me point-blank that there was nothing in his past that I had to worry about. And he lied to me. And he lied to a lot of us.”
Now, as Democrats battle with the feeling of deja vu from Joe Biden’s withdrawal from the 2024 presidential race, it’s left some unnerved about whether the Maine Senate race is still winnable. “It’s so upsetting because it feels like we’ve been completely bamboozled by a candidate that so many people believe in,” said Feldman.
LEWISTON (WGME) Nearly three years after the Lewiston mass shooting, the Maine Resiliency Center is asking the public to share how the tragedy has affected them and the community.
The nonprofit has launched a survey to better understand the impacts of the mass shooting in October 2023 and to help guide future support efforts.
The director of the Maine Resiliency Center said the ripple effects have spread widely and the organization wants to hear from anyone who has been affected.
“You could have been a service provider who is providing therapy or counseling for people; you could have been a funeral home director or city employee; you could be someone who lives in this community and knows somebody who is directly impacted or you could be directly impacted yourself. All of those opinions and information are really valuable to us as we look to support the broader community moving forward,” the director said.
To take part in the survey, go to maineresiliencycenter.org.
Politics
Our political journalists are based in the Maine State House and have deep source networks across the partisan spectrum in communities all over the state. Their coverage aims to cut through major debates and probe how officials make decisions. Read more Politics coverage here.
AUGUSTA, Maine — The Maine Supreme Judicial Court on Friday upheld Secretary of State Shenna Bellows’ decision to keep a referendum banning transgender girls from female school sports off the November ballot.
The high court ruled Bellows was “not only authorized but was constitutionally bound” when she moved in May to throw out more than 1,500 signatures gathered by out-of-state circulators who never agreed to submit to Maine’s jurisdiction.
The unanimous ruling from the six-justice panel closes out a monthslong legal fight that began when Bellows’ office invalidated more than 12,000 signatures submitted by Protect Girls’ Sports in Maine, leaving the petition 532 signatures short of the 67,682 needed to qualify.
The group, backed heavily by Republican megadonor Richard Uihlein, had argued Bellows overstepped her authority by enforcing a settlement that ended a 2023 First Amendment lawsuit over Maine’s ban on out-of-state circulators, rather than letting Maine voters decide whether to loosen the state’s residency rules for petition circulators.
The court rejected that argument, finding Bellows was bound by the Maine Constitution’s residency requirement for circulators except where a federal injunction narrowly excused her from enforcing it, and that four nonresident circulators who never checked a box consenting to Maine jurisdiction fell outside that carveout.
Justices also rejected the campaign’s fallback argument that one circulator’s belated affidavit, filed months after the Feb. 2 filing deadline, should have salvaged her roughly 61 signatures, citing a state law requiring circulator affidavits to be filed when the petition is.
The decision effectively ends the campaign’s bid for the 2026 ballot, though the court noted proponents could still gather the roughly 500 additional signatures needed to try again for the 2027 ballot.
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