Crisis nears for society’s vulnerable

Recently the Maine Department of Health and Human Services released a report documenting a growing health care crisis affecting some of our state’s most vulnerable residents: the elderly and adults with disabilities.

The report makes abundantly clear that, without change, the crisis will only get worse.

The DHHS study, titled “A Study of Maine’s Direct Care Workforce: Wages, Health Coverage, and a Worker Registry,” quantifies what has been known anecdotally for some time now – that Maine’s elderly are facing a critical shortage of direct care workers, a shortage that will grow more acute as Maine’s population, like the rest of the nation’s, continues to age.

Direct care workers are the folks who are on the front lines, day in and day out, providing care and assistance to elderly Mainers and adults with disabilities, and the DHHS report reveals some astonishing facts about their compensation and the prospects for long-term care into the future:

? Demand for direct care workers is outpacing supply, and demographic trends indicate a serious and growing work force shortage over the next 20 years.

? The proportion of Maine’s elderly population relative to the whole population is increasing by the decade and is projected to increase from 13.9 percent in 1995 to 21.4 percent in 2025. The population most likely to require long-term care – those over 85 – will grow 26 percent from 2000 to 2015.

? Median wages for many of Maine’s direct care workers are just over the federal poverty level and have not kept pace with inflation, making them uncompetitive with other entry-level jobs.

? Maine’s median wages for direct care workers on average are less than those of all other New England states.

? Many Maine direct care workers are uninsured, either because health coverage is not offered by their employers (particularly in home care) or their low income levels limit their ability to take up their employers’ plan with co-pays.

There are more than 22,000 direct care workers in Maine today. And yet, even as demand increases, there is not enough incentive for workers to stay in or join this work force. While many direct care workers love their work, many are forced to seek other employment in order to support their families.

In Maine in 2005, the median annual income – assuming full-time, year round work – for a certified nurse’s aide was about $21,000, $20,000 for a home health aide, and $17,800 for a personal care attendant. Most home care workers actually work part-time, per diem. Many direct care positions – especially in home care – provide no health benefits, which means that most direct care workers must pay their own health insurance premiums out-of-pocket or remain uninsured.

With low pay and few benefits, it is no surprise that many individuals who might choose a career as a direct care worker are opting for other lines of work that pay more and-or provide minimal benefits. As a result, Maine’s elders and adults with disabilities face waiting lists and high turnover in the direct care work force.

Quality care depends on quality jobs. Those who avail themselves of long-term care say that a reliable and competent worker is the most important factor in evaluating the quality of care they receive.

Maine’s Legislature has an opportunity to address this crisis in the current session. Several bills that would provide increased wages and health benefits to direct care workers are pending in Augusta.

Investing in Maine’s direct care work force makes sense. The administrative overhead and training cost of replacing an employee who leaves the workplace for a job that provides health coverage averages around $2,500 per worker. Those are dollars that could be much better spent providing adequate compensation to the current work force.

Perhaps more importantly, the quality of long-term care is an issue that affects all of us individually as well as our families, friends, neighbors and co-workers. The odds are that you or someone in your family will need direct care at some time in the future – perhaps sooner than later. To ensure there is someone available to provide that care, we need to do more as a state. Without action, hundreds of Maine people will be without care when they most desperately need it.

Joyce Gagnon of Benton is the membership coordinator for the Maine Personal Assistant Service Association and a former home care worker.