If the Legislature fails to act to protect core community supports for older Mainers, the home-based care system in Maine may fail, leaving vulnerable older adults in need of critical care with nowhere to turn and forced to make decisions they don’t want to.
Most of us would prefer to age at home if given the choice.
A personal support specialist or personal care attendant, also known as a direct care worker, is the backbone of aging in place. Direct care workers have a selfless commitment to those they serve, providing critical housekeeping, meal preparation (in some cases feeding), transportation, personal hygiene, toileting help and companionship services. Their attention to their clients’ needs enables other family members to go to work, shop for food and run other errands while knowing their loved one is safe and cared for. For our many seniors who live alone and need this care because there is no one else to support them, this direct care worker is the lifesaver that lets them remain at home.
Additionally, care from personal support specialists helps keep clients away from costly hospital stays and allows patients to return home sooner when they are hospitalized. Before a personal support specialist can help an older or disabled adult age in place, he or she must complete a 50-hour certification class and an 8-hour orientation. We all know someone in our family or in our neighborhood who has relied on a personal support specialist for care as they aged.
This critical service is very much in danger of disappearing from the aging in place landscape. The reason for this potential loss in service is that the MaineCare rate of reimbursement for providers of personal support services was $15.14 in 2001 and today it is $15. A 15-year stagnant reimbursement rate is making the service near impossible to deliver for the personal support specialists, the overseeing agency and the person receiving care.
Wages for these critical workers have been stagnant at about $9.50 per hour, yet the minimum wage went up 20 percent over 14 years. Meanwhile, inflation increased their cost of living and their employers’ cost of doing business by 32 percent in that time. Expensive and unfunded mandates have been placed on employers. These factors mean employers are finding it very difficult to attract and retain quality workers to these jobs because of low wages and few, if any, fringe benefits. It is a competitive marketplace for quality workers, and these employers are at a severe disadvantage.
The proverbial straw breaking the camel’s back for employers is a new mandate — the Affordable Care Act requiring provision of health insurance or payment of a penalty — effective Jan. 1, 2016. This new cost cannot be absorbed into the rate, and we fear most employers will stop serving older adults and the disabled who get state assistance to stay home through MaineCare or a Home Based Care program.
Most of the more than 5,000 Mainers now getting this care qualify for nursing home placement. If they lose their support staying at home, there is just no room in Maine’s nursing homes for them — most nursing homes have a waiting list. Even if a bed could be found, the cost of institutional placement is much more than help to stay home and would be an unnecessary additional burden for taxpayers.
House Speaker Mark Eves, D-North Berwick, and Rep. Eleanor Espling, R-New Gloucester, have proposed bills to solve this problem. The Health and Human Services Committee of the Legislature worked with both to find an effective solution. LD 1350 is headed before the Appropriations Committee, which will consider this bill for inclusion in the state budget. If the reimbursement rate is not addressed in this legislative session, a crisis will turn to a disaster for too many older adults and their families.
The only truly positive solution to avert this pending crisis is to increase the 15-year stagnant reimbursement rate so providers and direct care workers can continue to care for our community members in their homes, which is the most cost-effective and best way to age in place. The Legislature must act and fund an increase for personal support specialist service.
Steve Farnham is the executive director of the Aroostook Area Agency on Aging. Noelle Merrill is the executive director of the Eastern Area Agency on Aging, which serves Hancock, Penobscot, Piscataquis and Washington counties.