Adelaide Manirakiza went to work Friday afternoon prepared to spend the next 48 hours caring for an 80-year-old woman who needs help with just about everything – bathing, dressing, toileting, making meals, managing medications, running errands.

Manirakiza, who lives in Westbrook, enjoys her job as a state-funded home care worker. She fondly compares her elderly clients to the women who raised her. A war widow and refugee from Burundi, in central Africa, Manirakiza is a former customs official who has been a home care worker since she came to Maine in 2007.

In that time, her pay has risen from $8.50 to $10 an hour, although she gets $7.50 an hour at night, when she’s expected to be sleeping. But she doesn’t sleep, concerned that she should be alert to her client’s needs.

“I worry about them like they’re my mother or grandmother,” Manirakiza said Friday.

Manirakiza is one of more than 10,000 home health and personal care workers in Maine who, after more than a decade of stagnant wages, could finally see their compensation increase in the face of growing demand from Maine’s burgeoning senior population.

Legislation proposed by House Speaker Mark Eves, D-North Berwick, and Rep. Ellie Espling, R-New Gloucester, would increase the hourly Medicaid reimbursement rate paid to home care agencies from $15 to $25.


The lawmakers have proposed separate bills, now before the Joint Standing Committee on Health and Human Services, that are expected to be combined in a move of bipartisan cooperation. It’s one of several efforts in this waning legislative session to address the growing needs of Maine’s rapidly aging population, including affordable housing and family caregiver support.

The bills on home care workers’ compensation would raise their pay from about $9 an hour – usually without benefits or mileage reimbursement – to $15 an hour – possibly with health benefits and mileage reimbursement. The increase would cost taxpayers about $9 million annually.


Proponents say the increase is needed to attract and keep dedicated employees in a competitive job market where starting pay at some retail stores is now $11 an hour. The increase also would help trim long waiting lists for Medicaid-funded home care services and help save the state millions of dollars on long-term care.

The cost of caring for seniors in their homes is an average of 45 percent lower per person than the cost for assisted-living facilities and nursing homes, according to the Home Care & Hospice Alliance of Maine.

MaineCare, the state’s form of Medicaid, spent an average of $558 per month for each client who received personal care services at home in 2010, compared with $4,150 per month for each nursing home resident during the same year, according to a 2012 analysis by the Muskie School of Public Service.


“We need to pay people more than Wal-Mart to attract and keep the employees who do this important, valuable work,” Eves said. “Not only do seniors want to live independently in their homes as long as possible, it’s also the least expensive long-term care option.”

The need for home care workers is growing fast. SeniorsPlus, a Lewiston-based agency that coordinates home care statewide, is seeking workers to provide home care services for 471 clients, said Betsy Sawyer-Manter, executive director.

“We have many people who have been approved for services but are going without because there aren’t enough people to do the work,” Sawyer-Manter said.

Maine’s reimbursement rate for home and personal care services has been stuck at about $15 an hour since 2005. Home care agencies pay their workers about $9 an hour, and the remaining $6 an hour covers a variety of administrative, operational and training costs.

Eves’ bill, L.D. 1350, would require 85 percent of the proposed $10 increase to be spent on wages and employee benefits, including health insurance and mileage reimbursement. Espling’s bill, L.D. 886, also calls for rate increases for registered and licensed practical nurses who provide home care.



Legislators are considering several bills this session that aim to address needs springing from Maine’s growing senior population.

Maine has the highest median age – 43.9 years – and the second-highest proportion of people age 65 and older – 17.7 percent – following Florida’s 18.6 percent, according to the U.S. Census.

Maine also has the nation’s highest proportion of baby boomers – 29 percent of its 1.3 million residents were born between 1946 and 1964 – and they’re turning 65 at a rate of 18,250 a year, according to AARP Maine. By 2030, more than 25 percent of Mainers will be 65 or older, magnifying already serious challenges facing seniors and their communities related to health care, housing, transportation and long-term care.

In addition to a pay increase for home care workers, legislators are considering a $65 million bond bill to help fund the development of 1,000 units of affordable senior housing across the state.

Sponsored by House Speaker Eves and Sen. David Burns, R-Whiting, L.D. 1205 would start to fill a current need for about 9,000 units of subsidized senior housing identified by the Maine Affordable Housing Coalition and the Maine Real Estate Managers Association.

Burns also sponsored L.D. 1078, which would provide a 4 percent increase in MaineCare payments to assisted-living facilities, which haven’t had a rate increase in eight years. Maine has 130 assisted-living facilities that are home to about 4,000 seniors – 3,000 of whom are MaineCare recipients, according to the Maine Health Care Association.


To help low-income seniors stay in their homes, Eves also sponsored L.D. 1095, which would increase the maximum property-tax credit allowed for qualified residents age 65 and older from $900 to $2,000 per year.

To help family caregivers, L.D. 787, sponsored by Rep. Denise Harlow, D-Portland, would provide a state income tax credit for adult day care, respite care or hospice care, resulting in a refund of up to $500 per year.


Few have more to gain from the proposed legislation than home care workers, who make a little over $20,000 a year, on average, according to the Maine Department of Labor. Most of them, like Adelaide Manirakiza, must provide their own transportation to and from clients’ homes, no matter how far, so their real pay is a lot less.

Because Manirakiza receives no employee benefits, she gets health insurance through MaineCare. She also lives in subsidized housing, and she has used family welfare benefits from time to time to make ends meet and raise her four daughters, who are in college.

Sometimes, Manirakiza borrows money from friends to help with her daughters’ expenses. She’d like to be able to pay her own way.

“We do delicate, important, often difficult work,” Manirakiza said. “I have a big heart. I care about people. But this job doesn’t pay enough.”


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