SACO — Every day, the men and women on our team are on the front lines of providing quality care to Maine people in their homes.

As a result, we at MaineHealth Care at Home, the state’s second-largest visiting nurse and home health care organization, know well the challenges facing those who need help to stay functional in their homes. This insight leads us to oppose Question 1 on the Nov. 6 ballot, despite the proposal’s seeming good intentions to provide what its supporters describe as “universal home care.”

Put simply, Question 1 does not adequately address the needs of Maine people who need care in their homes, and, as concerning, it would create an inefficient and poorly designed system in what would be a failed effort to address the issue.

Let’s start with the challenge.

To begin, Maine has the oldest population in the nation, a statistic driven by a large cohort of people nearing retirement age as well as a high proportion of elderly residents. This means the needs of older Mainers are only going to grow in coming years.

We share the concern that some elder adults who are not eligible for MaineCare are forced to spend down their life savings to qualify for home-based care, or are placed into nursing facilities, often far away from families, but that is only one aspect of the problem.


Our first-hand experience tells us there is a shortage of direct care workers to provide care to this growing population. Also, the challenges for Maine seniors trying to stay in their homes go well beyond a lack of caregivers. Many of our elderly face food insecurity and rising housing costs.

What’s needed, then, is a comprehensive approach to helping Maine people age in place, one that provides them with adequate shelter, food and the support they need with daily living. And, given the demographics and the growing need, any solution needs to be sustainable and affordable over the long term.

Question 1 would do none of these things.

The referendum calls for raising taxes on Maine families who earn more than is subject to Social Security taxes by 3.8 percentage points. It then directs the more than $300 million generated by this tax be used by an independent board to provide in-home care to any Maine resident who needs it, regardless of income.

What it doesn’t do is address the shortage of workers to provide care. What it doesn’t do is meet the full range of needs that our elderly have as they try to maintain in their homes. What it doesn’t do is provide any accountability or opportunity to adjust the program to keep it sustainable.

There are also serious unintended consequences with this approach. The higher taxes would kick in for many middle-class professionals, including physicians, making it hard to recruit those people to our state.


The independent board it creates would lack accountability to the Legislature or executive branch and ultimately to Maine people, which is concerning considering it will be managing hundreds of millions of dollars in taxpayer funds each year.

This approach also would be redundant to MaineCare, and there is no clarity in the proposal as to how the two would work together.

As CEO of MaineHealth Care at Home, I’ve personally lobbied our legislators to do more to help Mainers age in place. And we’ve had some success. Over the past five years, we have secured an additional $15 million in reimbursement rates to help us attract and retain qualified people to provide the home care that Mainers need.

Is it enough? No. But a poorly thought-out plan that throws money at this problem without regard to what really needs to be done is not the way to address it.

I urge all Mainers to join me in opposing this ill-advised referendum by voting “no” on Question 1, and then I ask that you stay engaged and tell lawmakers to come to the table and do the hard work of creating a comprehensive and sustainable approach to meeting this growing need.


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