Emily Curry left the field of direct care in Maine after she said the hours and workload became untenable. (Courtesy of the Maine Center for Economic Policy)
Emily Curry had worked in assisted living as a certified residential medication aide in Maine for almost eight years. Throughout that time, she’d often thought about leaving the profession, though her belief that she made a difference in her clients’ lives kept her going.
However, after her employer changed ownership last year, she said that days got longer, breaks became fewer and slated raises did not come to fruition. Curry decided to leave direct care and now works as a medical receptionist in Portland.
“There were so many days that I would leave in tears, feeling like I had failed my residents, because I was set up to fail,” Curry shared in a report on Maine’s direct care system released Tuesday. “The system is just so broken.”
The report, produced by the progressive Maine Center for Economic Policy in partnership with the Maine Council on Aging, picks up where last year’s study on direct care work left off. The first such report found that low pay and poor benefits led to high poverty, turnover and burnout among direct care workers in Maine.
The second installment, authored by MECEP analyst Arthur Phillips, quantifies the gap between the care needed and available for seniors as well as adults with intellectual and developmental disabilities in Maine.
More than 23,500 hours of care that Mainers are entitled to goes undelivered every week, though this figure is likely an underestimate when accounting for reporting inadequacies and people who do not qualify for public programs, Phillips concludes.
The gap
In Maine, care is delivered through a variety of programs and settings, which has made assessing the care gap convoluted.
Synthesizing findings from state departments and service hubs, MECEP estimates more than 23,500 unstaffed hours per week for older people in need of home care through state-funded and MaineCare programs. Approximately 400 additional personal support specialists and 187 nurses are needed to close the care gap, according to MECEP’s analysis.
Overall, Maine has an aging population.
At the same time, people are increasingly seeking out home care, rather than long-term care in nursing homes and residential facilities that have been seeing capacity decline in recent years. From 2010 through 2023 Maine lost 19% of its nursing homes, more than any other state in New England, and served 21% fewer patients, according to an analysis by the Boston Federal Reserve.
The shortage of nursing homes has also put a strain on hospitals, the MECEP analysis concludes, noting an estimated 200 people are stuck in Maine hospitals each day who could otherwise be discharged to a nursing home. Given this, MECEP estimates that at least 200 additional nursing home beds and 157 more workers are needed to meet demand.
The MECEP report also found a significant service gap faced by adults with intellectual and developmental disabilities, estimating the state needs to add nearly 1,600 workers, not unlike gaps seen nationwide.
These shortages extend into behavioral healthcare services as well, with a point-in-time survey of behavioral health providers in Maine conducted this winter revealing more than 8,000 clients waiting an average of 32 weeks for mental health counseling.
These findings, though significant, don’t capture the entire picture as the data does not include people who choose not to pursue care for any number of reasons, such as administrative hurdles, or people who don’t currently qualify for MaineCare and state-funded programs.
Additionally, these numbers also do not account for people who drop out of the labor force to provide care for loved ones, a dynamic highlighted by the recent Maine State Plan on Aging Needs Assessment.
The assessment included a survey of informal caregivers. Among those employed, 65% reported going to work late, leaving early or taking time off to provide care. Meanwhile, 17% of employed respondents had to leave a job altogether.
Recent steps to address the gap
While the care gap persists, Maine leaders have established policies in recent years in an attempt to address its underlying causes.
For example, some of the data MECEP analyzed came out of information gathered through a long-term care workforce commission that the Maine Legislature convened in 2019. The commission — composed of experts, advocates and impacted people — released recommendations, including the need to increase wages and reimbursement rates to cover the costs of providing services.
In 2021, the Legislature passed a measure requiring that the labor portion of MaineCare reimbursement rates for all direct care workers be set at 125% of the state minimum wage. However, the MECEP report noted, the reimbursement structure still allows providers to pay some workers less than that amount to avoid wage compression while balancing the need to recruit new workers. More than 1,000 direct care workers were hired at wages below 125% of the minimum wage, according to data from 2022.
On the federal level, the $1.9 trillion American Rescue Plan Act, passed in the wake of the COVID-19 pandemic, also provided a boost to the direct care sector, though temporarily.
Maine Gov. Janet Mills’ administration directed more than $120 million of these funds to recruitment and retention bonuses for home- and community-based care providers. Additionally, the Maine Department of Health and Human Services distributed bonuses to more than 24,000 direct care workers, which correlated with state workforce recovery and retention following the pandemic.
The Maine Jobs and Recovery Plan, through which the state delivered these federal funds, also included a pilot program called Respite for ME, which provided up to $2,000 in reimbursements to family caregivers for expenses such as respite care, counseling and training. The Legislature has since extended the program and raised the grant cap to $5,171 per caregiver.
Justin Dyer, who provides care at group homes for adults with brain injuries in Kennebec, says he feels he is doing a thankless job with no support. (Courtesy of the Maine Center for Economic Policy)
Proposed solutions
In the MECEP analysis, Phillips offers some other potential solutions.
For one, Phillips advises that the state further raise the labor reimbursement to at least 140% of the state minimum wage. He also suggests that the state consider funding innovation grants to help employers pilot programs to explore best practices for worker recruitment and retention.
Data collection is another area in which Phillips sees possibility for improvement, particularly through annual surveys of agencies to measure vacancies, turnover and working conditions, as well as having the Maine Health Data Organization regularly measure the direct care gap.
Overall, MECEP recommends routinely considering the direct care workforce in all policy making, suggesting the creation of an advisory board of care workers, recipients and providers to formally advise policymakers on compensation and retention strategy. Such a board would also expand on Maine’s existing Direct Care and Support Professional Advisory Council, which engages direct care workers in ways to improve workforce challenges and could also provide formal recommendations to policymakers.
Curry and other direct care workers who MECEP highlighted in the report consistently cited low pay as a main reason that hiring and retention is difficult.
Gray resident Stephanie Hatcher, who has worked in the field of developmental and intellectual disabilities for 31 years, said she has had to work multiple jobs to pay her bills.
“I see people in similar roles in other fields making far more than I do,” Hatcher told MECEP. “My sister is a physical therapist in a hospital, and she makes $52,000 more than I do. My other sister is a teacher, and she makes $30,000 more. I think that shows an undervaluing of the people we support, not just an undervaluing of those providing the support.”
Another through line in worker responses was that the cost of education and training to enter the field is a deterrent.
Justin Dyer, who cares for adults with brain injuries at several group homes in Kennebec, said legislators could solve many of the problems in direct care by offering free training through technical colleges that can build toward a four-year university degree.
Curry said she was angry that low pay, lack of training and other challenges in the field led her to leave the work she loves.
“I hated the overtime and I hated the low pay, but I loved the job itself,” Curry said. “I could go home at the end of every day knowing that I made someone’s life a little better. I see this as a societal issue. Every job has value. How is it that this job of taking care of human beings and keeping them alive and happy and comfortable and clean has less value than almost every other job?”
SUPPORT NEWS YOU TRUST.
The post Maine seniors shorted more than 23,500 hours of direct care each week appeared first on Maine Morning Star.