So when Ivan died he left his Vinalhaven house and land to the community as an eldercare facility. A decade after opening its doors, the Ivan Calderwood Homestead’s eight beds are full and there’s a waiting list.

But lack of space is only one problem. The Calderwood Home faces increasing government regulation and soaring expenses that are not close to being reimbursed through state and federal programs. These problems, to varying degrees, impact all of Maine’s inhabited islands. And that’s why the Maine Seacoast Mission, which has visited those island villages for the past century, held a two-day conference last month in Northport.

Linda Lynch, administrator at the Calderwood Home, said making eldercare sustainable is a continuing struggle. “We survive by ingenuity and fundraising.” She said regulations are so complex and burdensome that she believes government is lowering, not raising the quality of care. MaineCare, the program that reimburses the cost of caring for low-income patients, “just isn’t enough and never has been,” she said.

Lynch said island eldercare is essential. “It’s a lifeline for people. We allow people to age in place because we believe people should be allowed to die at home.” She said the Calderwood residence is designed to feel like home, with a kitchen where residents can congregate. “We could use another five beds,” she said.

More than two-dozen representatives from 13 islands gathered for the conference. They met late into the night and disbanded in time for islanders’ ferry schedules the next day. A facilitator and a couple of state health program officials attended what islanders hope will be the first of a continuing series of conferences on how to provide quality elder care.

On Cliff Island, with a summer population of 300 but just 50 year-rounders, an elderly couple recently moved to the mainland because they needed routine medical care unavailable on-island. Cheryl Crowley came to the conference from Cliff with friend Johanna Corman, who runs the only store on the island. Crowley said she is looking for ideas and resources, particularly for aging islanders. She said a dozen residents are over 70, while a quarter of Cliff’s population is between ages 50 and 70.

“I’m excited about pursuing the tele-medicine,” Crowley said.

Brenda Clark, Isle au Haut librarian and wife of First Selectman and lobsterman Bill Clark, said that providing health care on her island is a challenge. She also believes part of the answer could be tele-medicine, where residents communicate with doctors and other providers through a computer. “We are very fortunate that we are one of the islands visited by the Sunbeam, from the Seacoast Mission,” she said.

She recalled that when her aged father-in-law stayed with her, the Sunbeam’s doctor would ride a bicycle up to the house to spare him a steep walk to the boat. The Sunbeam’s nurse in charge of island health, Sharon Daley, helped coordinate the Northport conference.

Clark said she was grateful to learn about clinics on North Haven and Swan’s Island: “It was really encouraging to see that these things are possible.” Isle au Haut has a year-round population of less than 50 people. “We’re hoping to attract new people to the island but there is a need for health care,” she said.

Chebeague Island has a year-round population of about 350, and offers a seven-bed residence for its elderly. Problems include both finding residents and finding staff willing to work at an island nursing home that provides round-the-clock care. MaineCare has cut back reimbursements so that Chebeague’s Island Commons is operating at a loss, local officials said.

Susan Stranahan, a board member at Island Commons, said local problems are part of a national crisis in health care.

“The need to provide assisted living services for the elderly of Maine’s islands remains as essential as it was when the Island Commons opened its doors 12 years ago,” she said. “But in recent years it has become increasingly difficult to fulfill that mission. MaineCare reimbursements have been cut to the bone, and we often wait months, if not years, for those reimbursements.  Because we are such a small community, we also struggle to keep our seven beds full and to find good help to care for our residents.  If you are looking for evidence that this nation’s health-care system is in need of reform, all you need to do is to look at facilities like ours,” Stranahan said. “We’re surviving because of the dedication and hard work of a few people, not the efficiency and vision of a healthcare delivery system.”    

The noon-to-noon conference was paid for in part by Maine HealthAccess Foundation in Augusta and C.F. Adams Charitable Trust of Boston.

Steve Cartwright is a freelance writer living in Waldoboro.