AUGUSTA — As a direct care worker, Earlina Brown is among thousands of trained professionals who provide basic services – like housekeeping, bathing or medication assistance – that allow elderly and disabled Mainers to live at home.

It’s a difficult job with such low pay that Brown has to decide “what bills I can pay and what bills I can put off” and struggles to fill her car’s gas tank so she can visit her clients.

“I have been tempted to leave direct care work and work any fast food job just so I can make more money,” Brown told lawmakers considering a bill Wednesday to increase state reimbursement rates for her industry. “One thing that holds me back is: Who will take care of my clients? If the state does not take action immediately, we would face a mass exodus of direct care workers.”

After hearing for years about a workforce shortage in Maine’s long-term care sector, lawmakers are now grappling with what is being widely described as a full-blown crisis.

Agencies that provide care to senior citizens and disabled Mainers are struggling to retain and recruit staff who can earn as much or more money at jobs with significantly less physical and emotional stress. Group homes are leaving beds unfilled – despite long wait lists – because they cannot find workers. And families report receiving a fraction of the services for which they are qualified or losing care altogether because cash-strapped agencies close.

Rayma Chiarell told lawmakers that her 39-year-old son with Down syndrome loses sleep and becomes anxious every time his direct care workers change.


“Currently, starting pay at many fast food places is higher than starting pay for many direct care professionals,” Chiarell said. “I think my son deserves to be valued more than hamburgers and fries. When staff turnover occurs, my son has to begin the process of trusting someone new all over again.”

Chiarell and Brown were among several dozen who testified in support of L.D. 2109, which would direct state regulators to set reimbursement rates for direct care workers at no less than 125 percent of the state’s minimum wage, currently $12 an hour.

The bill would also require that minimum wage adjustments and the costs of state and federal mandates be taken into account when setting MaineCare reimbursement rates. And it would create an advisory committee to track progress and report annually to the Legislature.

The legislation stems from a report by the Commission to Study Long-Term Care Workforce Issues, which was unveiled during the same week that Maine’s largest home-care provider announced it will close on April 30. Home Care for Maine, which serves roughly 600 low-income clients, cited low reimbursement rates as a primary factor.

Sen. Erin Herbig, a Belfast Democrat who co-chaired the workforce shortage commission, said the challenges facing the state are complex and “beyond urgent.” Herbig questioned why the state isn’t quicker to react to the loss of hundreds of jobs providing critical services, suggesting the answer likely stems from the way society regards these difficult jobs.

“We owe it to this community to really do something right now because, if not, we are only going to slip further and further into a state of crisis,” Herbig said. “And we cannot afford to do that right now.”


The cost of the bill has yet to be calculated but is likely to be steep. Another emergency measure unveiled last week proposes using $8.5 million from the state’s anticipated revenue surplus to increase reimbursement rates by up to 53 percent.

Both measures will compete with hundreds of others seeking a slice of the estimated $126 million in additional revenue. Gov. Janet Mills also did not include any additional money for direct care worker rate increases in her supplemental budget proposal.

But supporters told lawmakers it would be money well-spent, considering the costs of alternative forms of care.

Stephen Letourneau, CEO of Catholic Charities of Maine, said it costs roughly $170 a month for his social service agency to provide basic services such as buying groceries, doing laundry or housekeeping that help keep someone at home. That is $100 less for an entire month than the $275-per-day that the website says is the average price for nursing home care in Maine, Letourneau said.

Agencies report that untold thousands of hours of care go unprovided each month because of staffing shortages. Betsy Sawyer-Manter, president and CEO of Seniors Plus, which serves western Maine, estimated there are 10,000 unstaffed hours in that agency alone, roughly 4,000 of which are for people who would qualify for care in nursing homes.

DHHS officials did not address the committee on Wednesday but submitted written testimony expressing “questions and concerns about the legislation.” On the core issue of reimbursement rates, for instance, DHHS said the Office of MaineCare Services is currently evaluating rates that will benchmark those rates for Medicaid, private plans and other programs.

“The department does not support major changes until this review is completed but will work with the Health and Human Services and Appropriations Committee as necessary on targeted policy changes in alignment with broader goals,” the department said in the letter. “We understand provider challenges but we also believe, as this committee does, that establishing a rational and streamlined reimbursement system is in the long-term best interest of the department, providers and the Legislature itself.”

The committee will hold a work session on the bill on a later date.

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