When Kendra Brewer of Boothbay broke her leg in a fall in 2012, she faced a long summer without a paycheck since her employer, grocer Hannaford, didn’t provide paid sick leave.

That experience, coupled with a lack of health insurance, put Brewer in financial distress and sparked her desire to change careers and find work that offered benefits such as paid time off for illnesses. Now, Brewer, 21, is preparing to become a certified nursing assistant in hopes of getting steadier work and benefits.

“It’s pretty hard financially when you can’t get full-time hours and even worse when you face a health crisis and have to miss your few part-time shifts without pay,” Brewer said.

Brewer was one of the 214,400 Maine workers, or 36 percent of the total workforce, who lacked paid sick leave, according to a 2010 report by the Institute for Women’s Policy Research. The report, the most recent figures available, found that 41 percent of Maine’s private sector workers and 16 percent of local government workers lacked paid sick days.

Hannaford, for its part, said it provides “competitive pay and benefits.” The grocery store chain, Maine’s largest private employer, said the amount of time off received by full- and part-time workers depends on factors such as hours worked and longevity with the company.

But the issue of paid time off for sick leave or family leave has become a national issue attracting the attention of presidential candidates. No state laws in Maine require businesses to provide paid sick leave, but efforts have been waged in recent years to require paid family leave – paid time off to care for a new or sick family member.

“Having no paid sick days creates a health and ethical dilemma. You’re facing wage loss or even job loss if you don’t show up. You’re having to choose between work and illness. Often people go to work sick, which is plain disgusting in terms of the food industry and dangerous for the child-care or elder-care industries,” said Eliza Townsend, executive director of the Maine Women’s Lobby and the Maine Women’s Policy Center.

Nationally, 53 percent of workers get paid leave for their own illness and 39 percent get paid leave for the birth of a child, according to a 2014 report by the White House.

In 2012, Connecticut became the first state to require companies to offer paid sick leave. California and Massachusetts, as well as some cities such as Washington, D.C., have similar laws. A sick leave law will take effect this year in Oregon.

“It’s a very important issue, especially for women workers who tend to be the primary caregivers for their families. People need time off if their kid is sick and can’t go to school or if they’re sick themselves,” said Jeffrey Young, a partner and labor and employment lawyer with law firm Johnson, Webbert & Young.

“It’s a particularly hard issue for the relatively low-wage worker. You need that income so you go in sick to work. It’s such a major work-related issue and public health issue that it’s a presidential issue,” Young said.

Many small businesses object to paid leave requirements, saying the costs are too onerous.

The National Federation of Independent Businesses is against government mandates such as requirements to provide paid leave.

However, studies show that employees don’t abuse the benefit and providing paid sick time helps reduce overall illness at a company, improves morale and loyalty, according to a June 2014 White House report.

A survey of 251 employers conducted after Connecticut implemented a paid sick leave program found that employees did not take unnecessary sick days. Half of the businesses reported no increase in costs from the program, while 19 percent of the companies said the increase cost was less than 2 percent, according to the White House report.

Some Maine businesses do find a way to offer sick days or paid time off, which can be used for vacation, personal time or sick leave.

Shoe retailer Lamey-Wellehan gives workers five days of paid time off at two-thirds of their salary. The benefit kicks in after one year for employees who work 30 hours or more a week. Employees get paid a portion of their salary for any unused days and can roll over the unused days to the next year.

“If there is a human need, we can meet it,” said Jim Wellehan, president and co-owner of Lamey-Wellehan. “The greatest asset we have is our employees. We try to treat people well. People don’t abuse the benefit. It helps build loyalty and reduces our turnover rate.”

Meanwhile, payment technology company WEX Inc. has a paid time-off policy that allows employees to take time off as needed for any reason – personal illness, family member illness, personal errand or vacation. Employees begin accruing paid time off as soon as they start work at the South Portland-based company.

“We believe offering flexibility in our PTO (paid time off) policies, but also in providing the ability for employees to come in late, leave early, step out mid-day, etc., to deal with the many life situations that we all face,” said Jenifer Rinehart, WEX senior vice president of human resources. “We also use remote working opportunities, where feasible, to give additional flexibility to our employees.”

Young said he expects more businesses across the country will have to adopt more worker-friendly policies as the workforce becomes tighter and unemployment shrinks. Unemployment in Maine dipped to 4 percent in December, lower than the national rate of 5 percent, and the lowest level in the state in nearly 15 years.

“Many larger employers offer these benefits. As the labor market gets more competitive, smaller and smaller employers – to retain their workforce – will have to adopt these benefits. The process is moving very slowly, but moving that way,” Young said.