Disaster looming for older people and their families

To the editor;

    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.

    There is full agreement that Maine has the second highest proportion of people age 65 and older in the nation. There is also wide consensus that the best quality of care and most cost effective means for people to age, is in their homes and in the community. More important, home is where most of us want to be, if we have a choice. In the healthcare lexicon, this is called aging in place.

    A Personal Support Specialist, also known as a direct care worker, is the backbone of the aging in place concept. This direct care worker must have a selfless commitment to those they serve, performing critical housekeeping, meal preparation (and in some cases feeding), transportation, personal hygiene, and companionship services. Their attention to their client’s needs enables other family members to go to work, shop for food and run other errands, and conduct home repairs and maintenance while knowing their loved one is safe and cared for. For our many clients who live alone and need this care because there is no one else to support them, this direct care worker is the life-saver that lets them remain at home.

    Additionally, Personal Support Specialists care helps keep clients away from costly hospital stays and allows patients to return home sooner when they are hospitalized. Before a Personal Support Specialists can help an older or disabled adult age in place, they must complete a 50 hour certification class approved by the State of Maine. We all have known people in our families or in our neighborhoods who have relied on a Personal Support Specialists for their care as they have 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. That’s right, it is less than it was 14 years ago! A 15-year stagnant reimbursement rate is now 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 near stagnant at about $9.50 per hour yet minimum wage went up 20 percent during 14 years; inflation increased the their cost of living and their employer’s cost of doing business by 32 percent. 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 wage 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 provision requiring provision of health insurance or payment of a penalty – effective on many employers on January 1, 2016. This new cost cannot be absorbed into the rate and we fear most employers will stop serving older people and the disabled who get state assistance to stay home through MaineCare or the Maine Home Based Care programs. Most of the more than 5,000 Maine people 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 now 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.

    There are two bills addressing the issue of reimbursement for direct care – LD 1350 and LD 886. Unfortunately, there has been a recent suggestion that the bills be held over to next session because DHHS has failed to complete work on a rate study started last November. Non-action in 2015 is not an option. If the reimbursement rate is not addressed in this legislative session a current crisis turn to a disaster for too many older people 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 most the cost effective and best way to age in place. The Legislature must act and fund an increase for Personal Support Specialist service.

Steve Farnham, executive director

Aroostook Agency on Aging

Noelle Merrill, executive director,

Eastern Agency on Aging

Larry Gross, executive director

Southern Maine Agency on Aging

Gerard Queally, president and CEO

Spectrum Generations

Betsy Sawyer-Manter, executive director

SeniorsPlus