Maine At Forefront Of Struggle To Find Workers To Care For Aging Population

Aug 20, 2019

Maine is struggling to find enough workers to care for its aging population, especially in rural areas of the state.

The number of aging Mainers continues to grow – one-fifth of the state's population is now older than 65. And too few younger workers are entering the industry. Jess Maurer, of the Maine Council on Aging, advocates for improved elder care. She spoke about the care gap with Maine Public’s Morning Edition host Irwin Gratz.

GRATZ: Welcome.

MAURER: Thank you. Thanks for having us.

So, let's start by outlining the problem. What kind of lack of elder care workers are we talking about. How bad is it?

Well, we are talking about people who do direct care. So those are people who help people with what we call “activities of daily living.” So, if you have some trouble getting out of bed or getting dressed, getting washed, preparing meals - even eating - that's the kind of activity we're talking about. Direct care workers - and those can be people that come into a home, people who work in an assisted living facility or a nursing home or an adult day program - they're a kind of worker that works doing the same kind of work across different settings.

Is this problem specific to Maine with its older population?

No. We are really at the leading edge of a very interesting demographic phenomenon where we have fewer younger people and an older population that is living longer than ever before. And other rural parts of the country are dealing with the exact same thing.

Earlier studies showed there were 6,000 “unstaffed” hours of “approved home care” each week. And you said that number is actually closer to 6,500. Let's talk about that a little bit. What are we talking about when we talk about hours of approved home care?

If you are on a waiver, if you're low income and you have certain needs, you can qualify for some home care services. Once you qualify it's a right for you to have. And the problem is that there sometimes aren't enough workers, particularly in rural Maine, to meet your needs. When you get this benefit, there's a plan that says, “You get this much care.” and then there's a care coordination agency that will help you sometimes connect to that care. And that's how we know what this number is - the 6,500 hours of care that has been approved but isn't being delivered because we don't have enough people to deliver the service.

So unlike other social service issues, this this is not necessarily a money issue - for at least these people.

It's not a money issue for these people because, you know, the money exists to pay for the service. The problem, really, is sort of like trying to operate a business with your hand tied behind your back. You can't increase wages, so you can't attract new workers. You can't compete with other segments of the economy that are taking your workers. And so you can't hire and you can't - we can't - perform the work.

And you end up with this shortage of labor as opposed to a shortage of cash, right?

Cash, yes - but it's but it is tied, I want to just say, to the reimbursement rates, because the state sets the rate. MaineCare says we're going to reimburse you at this rate. And nobody's saying, “How much do you need to perform this service for us?” They just say, “We're going to pay you that, and take it or leave it.”

So who winds up being affected by all of this? Obviously for starters someone who is older and or disabled and needs the personal care, but I take it it reaches beyond that.

Yeah. At the personal level it certainly impacts not just the person doing the caregiving, or the spouse of that person if they're trying to provide care for somebody who has great need, but then also the family members who are often working. And about 50 percent of family caregivers are still employed in the workforce, and if they can't find a worker to take care of their mom or their dad or their spouse, they often have to quit their job. Again, at a time when we have a shrinking working age population, we need all the workers we can get. So, it has a double impact. Ultimately, folks who don't get the care they need often end up in hospitals. And that is a new trend we're seeing. Hospitals are warehousing older people because they can't send them home because there isn't appropriate home care, and there's no bed to send them to in an assisted living or nursing home facility.

That's a more expensive place for them to be so that simply exacerbates all sorts of other problems.

Absolutely. It's not a good formula for anybody.

The Legislature did approve a commission to study the long-term care workforce. Talk a little bit about what the commission's goals are supposed to be and when it might report something back.

The commission should start its work in September. The purpose of the commission is to really understand the scope of the current need for direct care workers and what our anticipated growth will be, and then really understanding, what are the strategies the state can put in place? There are three things that need to be the focus of this commission's work: One is how do we increase the pipeline of workers in? So, we're talking about young people, new Mainers and older people. And then how do you create a clear career path? Once someone is in, how do they get more benefits for being in the workforce longer, but then how do they move from a direct care worker to an O.T., to a nurse?

O.T. – occupational therapist?

Occupational therapist, sorry. And then the third piece is, how do you increase quality of workplace? And so that includes benefits, being able to work full-time, vacation, supervision training - all of those things.

Jess Maurer, of The Maine Council on Aging, thank you very much for the time. I appreciate it.

You're welcome.