Southern Harbor House Admission Policy

I. Introduction

Southern Harbor Eldercare Services (SHES) is a private, non-profit organization. Community-supported donations, grants, MaineCare reimbursement, and private pay funds support Southern Harbor House operations. Its mission focuses on creating an opportunity for community elders requiring social, health, and personal care assistance to remain on North Haven, in a familiar setting, surrounded by friends and loved ones. To that end, Southern Harbor Eldercare Services has established Southern Harbor House, an Adult Family Care Home, intended for community elders. Southern Harbor House will provide care for up to six residents in a home-like setting. This safe environment affords a secure setting that ensures residents are supported and encouraged to reach their full potential. Southern Harbor House staff will accommodate each resident based on their individual need, foster independence through resident directed care plans, and encourage autonomy through activities based on personal and group interests.

Home Environment

Southern Harbor House is handicapped accessible home and includes six private rooms, each with a private half bath equipped with safety devices. All common rooms and bedrooms are located on the first floor. The kitchen, dining and living room, sun porch and atrium are shared with friends and families. The communal bathroom is a full bathroom that is wheelchair accessible and features a shower with rails and a chair; and a walk-in bathtub. Each resident's room contains a private phone and satellite TV hook up; these utilities, along with internet service, are the responsibility of each resident. Each room features personal closet space. Additional storage can be provided for seasonal items and will be considered case by case. Each room is equipped with a call bell system, granting each resident access to support 24 hours a day. 

      Staffing and Staff Training

All staff at Southern Harbor House participate in ongoing training as determined by the Maine Department of Health and Human Services. Southern Harbor House is overseen by the Administrator, who is licensed as a Residential Care Facility Administrator. The Administrator has attended basic training to include personal support services and medication administration and is certified in CPR and First Aid. To maintain a Residential Care Administrator License, the Administrator participates in twelve hours of continuing education annually. The Administrator, Resident Care Manager, Direct Care Team Leader and Personal Support Specialist staff will provide direct care and supervision to residents. The care team will provide coverage twenty-four hours a day with overlap during busy hours to meet the health and safety needs of the residents. These individuals, when they are on duty, perform all the tasks of a home environment including personal care, supervision, medication assistance, meal preparation, laundry, and cleaning. 


As an Adult Family Care Home, Southern Harbor House provides services to the elderly who need assistance with activities of daily living. These services will provide residents with trained staff who will support residents in all areas of personal care including; bathing, dressing, toileting, transferring, and ambulating. Additionally, residents will receive three home-cooked meals daily, snacks, and therapeutic diets as needed; housekeeping and laundry services; medication management; coordination of 3rd party services; assistance with managing personal affairs; transportation to medical and personal appointments, and social events; as well as interactive social and recreational activities based on individual and group interests. 


The facility will provide services without regard to the resident’s race, age, national origin, religion, sex, sexual-orientation, receipt of public benefits or any change in source of payment to the facility. Additionally, the facility will not base any admission decision on the source of a resident’s income.


Southern Harbor Eldercare Services believes that pets are essential companions for those who have them. Southern Harbor House will consider pets on a case by case basis. Consideration for facility safety, pet temperament, ability of resident and staff to care for pet, and veterinary exam results are examples of the required information needed to fairly determine pet residency. All pets must be spayed or neutered and be fully vetted and vaccinated annually at the expense of the resident pet owner.


Southern Harbor House is a non-smoking home. Following Maine Law Title 22 §1580-A, smoking is prohibited within 20 feet of entryways, doors, and windows. Persons who choose to smoke, including residents, must do so in the designated smoking area. 

II. Admission consideration:


Our admission priority supports the mission of Southern Harbor Eldercare Services. The intention is to create a supported family care environment, so that community seniors, when they can no longer remain at home and would otherwise be displaced from the island, can remain on North Haven, surrounded by caregivers and visitors they know and love. 

Admission requirements 

  • A completed Admission Interview at least two weeks in advance of placement.

  • 21 years of age or older.

  • Income and/or resources necessary to meet the financial requirements for housing and services; capacity to pay privately or qualify for MaineCare reimbursement

  • Current medical history and physical exam report within 14 days prior to admission, and then annually.

  • A named health care provider responsible for medical care and a copy of most recent health care provider's orders.

  • A negative PPD (purified protein derivative) and a health care provider's statement that the resident is free of communicable diseases. A PPD is a skin test conducted in a doctor’s office used to diagnose silent Tuberculosis (TB).

  • A completed KEPRO assessment or equivalent assessment. A functional assessment helps individuals, families and providers better understand what services are needed, and how to plan for them.

  • Determination by Southern Harbor House personnel that the needs of the applicant can be met.

III. Admissions Policy

Scope of services – Respite Independent Living Program

Southern Harbor House is pleased to offer short term independent living respite stays from one week up to four months based on availability. Respite residents will enjoy independent living services in one of Southern Harbor House’s state-of-the-art handicapped accessible private suites as well as the use of all Southern Harbor House’s sun filled living areas. Private suites may be shared by couples, relatives, or friends when occupancy levels permit.

Services include:

  • Furnished private suite (bedroom and 1/2 bath) with emergency call bell, linens, twin bed (queen or second twin bed provided for couple or second person), bedside table, lamp, easy chair, wardrobe, bookcase, refrigerator, and TV (cable subscription is $7.50/month)

  • Heat, air conditioning, and electric

  • Use of the private spa room (shower, walk-in tub, and emergency call bell)

  • Use of all common areas (sunroom overlooking Southern Harbor, living room, game/TV room, dining room, open kitchen, and front porch.)

  • Home cooked breakfast, lunch, and dinner served family style or, upon request, in your room

  • Washer and dryer available for independent use daily, or wash and fold service upon request

  • Daily housekeeping (bed linens are changed weekly or on request)

  • 24-hour staff availability for companionship, security, and emergency response

  • Social activities

  • Arrange or provide on-island transportation for medical needs

  • Arrange or provide off-island transportation for medical needs

  • Coordination of third-party services (medical or personal)

Scope of services – Residential Program

Southern Harbor House is licensed by the State of Maine as a Level III Adult Family Care Home.  Southern Harbor House will provide the same level of service from the respite independent living program as well as ADL (activities of daily living) services to residents so long as the needs of the resident can be met by the program of the facility.  ADL services include;

  • Personal care assistance including bathing, dressing, and toileting

  • Transfer and ambulation assistance

  • Meal preparation

  • Housekeeping and laundry services

  • Medication management and monitoring

  • Transportation to medical appointments

  • Social activities and entertainment

  • Supervision and guidance

Service Coordination

Southern Harbor House will assist residents to coordinate 3rd party services that a resident may need or require to achieve social, medical, spiritual, and personal care needs. Southern Harbor House will assist residents to coordinate the following types of services (please note that these services are not provided by Southern Harbor House staff nor included in Southern Harbor House’s rates): 

  • Physical and Occupational therapy services

  • Visiting Nurse

  • Physician

  • Dietary consultation

  • Diagnostic testing/evaluation

  • Spiritual services

  • Holistic health services

  • Personal grooming i.e. hair stylist or barber

Ability to Pay

Prospective residents must demonstrate the capacity to pay privately or qualify for MaineCare.  Private pay residents will provide a personal financial statement and supporting documentation sufficient for admissions staff to determine the period the resident will be able to pay privately. Private-pay residents who qualify for Respite Independent Living have the option to qualify for income adjusted rates with proper documentation.


Southern Harbor House is limited in the services it can reasonably provide. Our model of care reflects a level of family care designed to support residents who wish to age in place. The ability to meet a resident’s needs is determined through a comprehensive combination of evaluations based on the assessment of an individual’s service plan, progress notes, facility staff observations, RN consultation, family or designated representative observations, and resident choice.

Non-Emergency Discharge

Southern Harbor House will assist residents in the case of a non-emergency discharge and will provide the resident or his/her designated representative a minimum of fifteen (15) days’ notice. All pertinent information including the resident records, reasons for transfer or discharge, effective transfer date, notice of resident’s right to appeal transfer, contact information for the Long-Term Care Ombudsman Program, contact information for the Office of Advocacy, Department of Health and Human Services for applicable cases, and notice of the resident’s right to be represented by self, legal counsel or an appointed representative will be transferred with resident to new placement.

Emergency transfer or discharge

In the case of an emergency discharge, no written notice is required. Southern Harbor House will make all reasonable effort to inform the resident and his/her designated representative at the time of discharge. Southern Harbor House will assist the resident and their family or designated representative to find appropriate placement.

Involuntary discharge

A resident would not be discharged or transferred involuntarily except for in the following extenuating circumstances:

  • Resident has a documented, irreconcilable violation of admission contract.

  • Resident’s continued tenancy has become a direct threat to the health or safety of other residents.

  • Resident intentional behavior has resulted in physical damage to Southern Harbor House, other residents, it’s staff, or visitors.

  • Southern Harbor House documents that the needs of the resident can no longer be met as the program is designed.

  • The license of Southern Harbor House has been revoked, surrendered or not renewed.

Hospital transfer

A resident who is transferred to a hospital for any reason is not considered discharged and the obligation of Southern Harbor House does not terminate. Private pay residents who are transferred to a hospital for a period of 1-14 days will be charged twenty-five percent (25%) the daily rate for that period. Private pay residents who are transferred to a hospital for a period of 15-30 days will be charged one hundred percent (100%) the daily rate for the facility to guarantee a bed hold. MaineCare will dictate cost of care for residents supported by MaineCare. 

IV. Admittance Process


This process is part of understanding the needs of a potential future resident and whether Southern Harbor House can successfully and safely support them within the guidelines of our license and capabilities. Important to welcoming a new resident to the home setting is the recognition that each person brings a unique background of life experiences. Each potential resident will be visited at home by the Administrator and one member of the Aadmission Committee. 

The process of admitting a resident to Southern Harbor House will occur in four phases. Each phase is designed to support the resident, their family, and the staff of Southern Harbor House make the most appropriate decision for the individual as they relate to their needs. 

Phase 1 Application

Any person wishing to apply for residency at Southern Harbor House will be provided with the following documents;

  • Southern Harbor House Admission Policy

  • Resident Application Form

  • Primary Care Provider Medical Summary

  • Southern Harbor House Medical History Form

  • MaineCare Long-term Care Application

  • Functional Assessment – RN Consultant

Phase one documents capture important elements about a resident’s current health status that are used to determine if Southern Harbor House is a good fit for the candidate. A functional assessment will be used to determine the level of care that is most appropriate for the resident.

Phase 2 – Interview

The interview is conducted by the Administrator and a member of the Admissions Committee and the resident and/or their personal representative. During this phase of admittance, a resident has been initially determined to be a good fit for the facility and wishes to learn more about the specific needs, goals and interests of the resident.

Phase two documents include:

  • Level of Acuity Questionnaire

  • Personal Care Needs Questionnaire

  • Personal Supports Questionnaire

  • Occupational and Educational History Questionnaire

  • Pet Preference Questionnaire

  • Spiritual Beliefs Questionnaire

Phase 3 - Contract

During phase three, an individual as been determined to be eligible for long-term care services at Southern Harbor House. At this time residents will begin planning their transition from their home to Southern Harbor House. 

Phase three documents include;

  • Southern Harbor House Resident Contract

  • Insurance and Financial Inventory

  • Personal Inventory List

  • Policy Receipt

  • Advance Directives Notification

  • Provider HIPPA Policy Information

After a home visit, each potential resident is invited, and strongly encouraged, to visit Southern Harbor House and participate in a common activity, such as lunch or dinner, where the current residents can meet and introduce themselves to the prospective resident and vice versa.

Adopted 08/30/2017
Updated 12/18/2017
Updated 6/18/2019