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'I Just Cannot Get The Help I Need' — Direct Care Worker Shortage Leaves Older Mainers Unsupported

Patty Wight
Maine Public
Linda Smith and her husband, Frank.

The COVID-19 pandemic has exacerbated what advocates say was already a crisis shortage of long-term care workers in Maine. That has left more older adults without the medical support they need to age at home.

The issue is also forcing some patients to become stuck in the hospital because they can’t be discharged home or to long-term care facilities.

Each day, Linda Smith makes a point to get up about half an hour before her husband, Frank. She needs that time to get herself ready, because once Frank wakes up in their West Gardiner home, she has to focus on taking care of him. She’s 70. He’s 89 and has dementia.

“When he gets up, I never know what kind of a mood he’s going to be in. And he demands his coffee. So I have to start waiting on him like a three-year-old,” Smith says. “I have to shave him. I try to let him dress himself, but he falls asleep while doing it.”

Smith’s daily challenges are compounded by her own health issues. She has cancer in her liver and sacrum, as well as lymphedema, which makes her arms weak. She has tried to get help by signing up for home health care for her husband.

“It’s close to a year and a half I’ve been trying to get help, and I just cannot get the help I need,” she says.

Recently, Frank’s condition deteriorated. He had to go to the hospital on Christmas Day and was ultimately placed in a rehabilitation facility. Smith then got a letter from the Department of Health and Human Services warning that home-based-care services would be suspended while her husband was receiving institutional care.

“And it says when he was admitted on Dec. 25, ‘Your place in the program is being held open for you for 60 days. If you return home within 60 days, your care manager will talk to you about your needs and arrange for services to begin again in your home.’ They never even started. They were never here,” she says.

That’s because there aren’t enough workers, says Betsy Sawyer-Manter, president and CEO of SeniorsPlus in Lewiston. She says every week, thousands of home health care hours go unfilled.

“I am talking about 6,000, 7,000 hours of authorized care,” she says. “If there were workers, they’re already approved to get hours in their home, and we just don’t have the workforce to do it.”

The shortage is also an issue in long-term care facilities, says Dr. Rebecca Spear, a geriatrician at MaineGeneral in Augusta. More and more, she says, she witnesses patients who are hospitalized and their families decide it’s time to transition into a nursing home or assisted living facility, but can’t.

“Unfortunately, based on the nature of limited availability of long-term care places right now with the COVID-19 pandemic, what we’re seeing is that people will remain in the hospital for weeks, or even months, waiting,” she says.

The shortage of direct care workers in Maine has been a brewing crisis for years that’s intensified with the onset of COVID-19.

“Clearly the glaring elephant in the room is that these folks are not paid enough,” says Democratic state Rep. Jessica Fay, co-chair of a legislative commission formed in 2019 to study the problem and its effect on the state’s economy. “The takeaway was that these jobs are foundational to our economy. And I think in a similar way that we talk about child care and the impact that that has on the economy and people’s ability to participate in the economy, the caregiving workforce has a similar impact.”

Fay is sponsoring a bill this session that would increase wages for direct care workers to at least 125% of the minimum wage. That would boost pay to a little more than $15 an hour. The bill would also implement other recommendations from the commission that aim to improve job quality and retention, including establishing a career ladder.

Fay says these policies would help foster another crucial change, by raising a simple question.

“Culturally, how do we value this work?” she says.

Advocates say low pay has plagued the supply of the direct care workforce for a long time.

“Less than a decade ago, it had been 20 years since home care agencies had gotten a rate increase,” says Jess Maurer, executive director of the Maine Council on Aging.

Maurer says a 2015 study prompted an increase in rates, but they’ve remained flat since then. And she says the pandemic has merely exposed the severity of the problem.

“I think it’s just the inevitable conclusion of ignoring a problem for too long. It’s like you ignore the leak in your roof for 20 years, and your roof falls in,” she says.

Back in West Gardiner, Smith says she wonders if her husband could have avoided hospitalization if he had received home health care. He’s still in a rehabilitation facility.

“I hope for help. To have my husband back home, and to have the help we need,” she says.