A nurse works in the room of Chuck Sedlacek — who has tested positive for the COVID-19 coronavirus — Friday, March 13, 2020, as seen through the window of his room at Life Care Center in Kirkland, Wash., near Seattle. Credit: Ted S. Warren | AP

As of 11:30 a.m. Thursday, March 19, 42 Maine residents have been confirmed positive and 10 others are presumed positive for the coronavirus, according to the state. Click here for the latest coronavirus news, which the BDN has made free for the public. You can support this mission by purchasing a digital subscription.

The people who care for Maine’s elderly and disabled populations are facing uncertainties about whether to keep working during a global pandemic.

Growing fear about a contagion from the coronavirus COVID-19 has led some per diem workers — who are called on an as-needed basis — to stop showing up altogether.

Health officials emphasize that elderly people are the most at-risk for contracting the virus, but the people who care for them are in vulnerable positions, too.

Fear of catching the coronavirus or potentially passing it to their older patients has some workers wanting to take out the risk factor entirely.

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“We’ve got call-outs of staff who don’t want to do the work,” said Gerard Queally, president and CEO of Spectrum Generations, a social services organization for elder Mainers based in Augusta.

“Many workers are making minimum wage or just barely above. Now we’re asking them to go into a high-risk situation.”

On Monday, the state Legislature approved a $73 million spending plan aimed at bringing up wages for health care workers and increasing the state’s testing capacities for the coronavirus.

The package includes a $20 million in-state spending plan for health care priorities. Of that, about $15 million consists of rate increases for direct health care providers for nursing homes and assisted living facilities as well as services for people with underlying health conditions and disabilities.

“People are just concerned now to even interact with the elderly,” Queally said. But when workers don’t show up to the job, it leaves agencies scrambling to find replacements.

And when they do, it can stir up anxieties for the client, who may be used to their regular caregiver and uncomfortable with an unfamiliar face. “I see both sides of it. The other thing is even if we get new workers, the [clients] are afraid of the workers,” Queally said.

Not everyone in the industry has the option to not go to work. Such is the case for Rachel Small, who has been working in home health care for 12 years.

She can take sick time off work, although she won’t get paid for it, Small said. Most workers don’t take sick time at all, because they live from paycheck to paycheck, including herself.

“I can’t not work,” Small said. Maine’s privately-owned elder care agencies set their own hourly pay for in-home care workers, but some are paying above the minimum wage as an incentive to keep staff around.

Credit: Courtesy of Home Care Assistance

At Home Care Assistance in Falmouth, employees get two dollars more per hour for picking up shifts that are harder to staff, such as on weekends, said owner Sue Arsenault.

Still, hourly pay for in-home care workers varies from one agency to the next. “It’s kind of all over the board,” Arsenault said. A three-year-old company, Home Care Assistance has 50 employees who provide in-home services.

Most staff have one client to care for at a time, for consistency’s sake, although some may have two at the most, said Arsenault.

Small’s work routine hasn’t changed much as COVID-19 has quickly spread into a worldwide pandemic. She goes to her client’s home three nights a week for 12-hour shifts, where she prepares meals, helps with her client’s personal care and keeps her client company.

Small said that her employer, Spectrum Generations, sent out an email reminding staff to use gloves and other personal protective equipment and to wash their hands often to prevent potentially contracting or spreading the coronavirus.

These things don’t feel out of the ordinary for Small, who’s used to taking such precautions while working. “I know for me, this is just like regular flu season. It’s no different for [my] routine.”

“I put my stuff down and wash hands before touching anything in the [client’s] house,” she said.

Her elderly client isn’t panicking yet, Small said, although she’s worried. “It’s up in the air — we’ve never really run into something like this before,” she said.

The growing pandemic is just added stress for the homecare industry, which has struggled to raise reimbursement rates and increase wages to curb a general labor shortage.

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Small said that because no one wants to work in homecare, agencies have to pay the workers they have overtime, which in turn drives up expenses.

While worker shortage has been a notable problem for the direct care industry over recent years — one which stakeholders have pressed for legislative action to address — it’s creating another issue for clients who need the help.

At Northern Light Home Care and Hospice, workers are following the emergency guidelines outlined by the Center for Disease Control and Prevention, to the letter.

Joe Kellner, the division’s vice president of finance who recently became the incident commander charged with responding to COVID-19, said that they’ve put in substantial screening protocols for staff and patients to assess risk and prevent an outbreak among their clients, although they’re not immune to the industry’s challenges.

They use a scale to identify the most vulnerable patients with immediate needs, which they can employ if staff shortages lead to cutbacks on clients getting help. “That’s something we do whether we’re in a pandemic or not,” Kellner said.

“We’re taking it one day at a time.”

Skyrocketing consumer demand for protective items such as gloves and masks have created setbacks for direct care agencies, too. As panic-driven people rush to buy items in bulk, healthcare agencies are left behind, forced to find other ways to get enough supplies for patients in need.

“We’re concerned right now, because people are using them more, and people are hoarding them,” Queally said. “So we’re running out of supplies for our personal support services for home visits.”

Anticipating the shortage, the agency had ordered extra supplies in February, before public panic ensued. The gloves have been on backorder for four weeks. They still haven’t received them.

“People are reacting in unexpected ways,” he said.

Watch: What older adults need to know about COVID-19