Most of us have friends or loved ones who rely on nursing care, whether they are aging, have disabilities or both. Although some people need the kind of intensive care that can only be provided in a nursing home, there are many who can live at home or in other settings in the community, if they have access to direct care workers in their homes.

Helping senior citizens and people with disabilities to live in the community not only affirms their fundamental human dignity, it also gives them an opportunity to participate in community affairs, contribute to Maine’s economy and enrich the lives of their fellow citizens. It’s no wonder, then, that Maine’s families strive to provide home care to loved ones who desire it.

The guiding principle for our long- term care system should be the same principle that Maine families embrace for their loved ones: consumer choice. Senior citizens and people with disabilities must have choices about the kind of care they receive, the people who will provide it and the environment in which it will be delivered.

A consumer-directed long-term care system requires several things. It must provide multiple alternatives for consumers throughout the range of long-term services. Consumers also need complete information in an understandable format, so they can take advantage of the available choices.

The state must allow consumers to act through trusted surrogates, to help them negotiate their way through the system and manage essential tasks. Perhaps most importantly, the system must employ a quality work force to provide the full range of services.

Thanks to the leadership of Senate President Beth Edmonds and House Speaker John Richardson, the Maine Legislature is considering legislation that would make significant strides in all of these areas. LD 1991, A Resolve, To Ensure the Availability of Consumer-Directed Personal Assistance Services, will require the Departments of Labor and Health and Human Services to develop a plan and timeline for increasing consumer direction in the long-term care system. This plan will be based on recommendations by a working group that involved a wide range of stakeholders in the system, including the Disability Rights Center.

Just as importantly, the bill provides a much-needed raise for consumer-directed personal assistants, from $7.71 an hour to $10 an hour. This will help the state meet the challenge of hiring and retaining enough home care workers to provide needed services. Unfortunately, just at the time when the need for direct care and support workers is increasing, those jobs are becoming harder to fill. Employers have a hard time hiring and retaining quality employees, and turnover rates are high.

There are multiple reasons for this, but the most important is that direct care and support workers are not making enough. Average wages and benefits in this field are too low for jobs that are of vital societal importance, are physically and emotionally demanding, have irregular hours and have exceptionally high injury rates. The average home care aide made $8.42 an hour in 2003, and the state wage for such a worker would be $7.71 an hour. The average telemarketer was making $12.08 an hour in 2003.

This wage crunch combines with an important demographic change. Most support workers are women ages 25 to 44, and the number of such women is decreasing at a time when the populations of senior citizens and people with disabilities are increasing dramatically.

The home care workers who are willing to work for these wages do extraordinary work, but it is hard for them to stay in jobs that pay so little, and it is that much harder to bring more quality workers into the field when wages are not competitive. Worker shortages and frequent turnover in these jobs not only create unnecessary training and administrative costs, they also risk gaps in service for people whose lives depend on receiving needed care.

Maine’s families understand that giving their loved ones choices in their care isn’t just the right thing to do, it’s the sensible thing to do. Allowing loved ones to live in a less restrictive setting often reduces costs, and allows them to contribute to the family in many ways.

A consumer-directed health care system is merely the statewide extension of this common sense. Giving people choices improves their lives and increases their opportunities to contribute to the lives of others. However, we cannot provide these choices without paying an appropriate wage to the people who will provide our care.

Hopefully, in considering LD 1991, the Legislature will demonstrate the same wisdom as the families who elected them.

Kim Moody is the executive director of the Disability Rights Center, Maine’s federally funded protection and advocacy agency for people with disabilities.