Maine making incremental progress on long-term care

This article, by Sandra Butler of The University of Maine, was originally published on the Bangor Daily News opinion page on February 25, 2020.

Joseph Cyr | Houlton Pioneer Times
Jessica Hemmingway, left, gets her heart checked by peers Sam Keegan, center, and Tammy Tanner during a classroom exercise in December 2017.

In this era of deep partisan divides, policy change can be difficult. This is all too clear at the federal level and was, for many years, in Maine as well. But over the past five months I’ve had the refreshing opportunity to see both bipartisanship and policy progress as a member of the Commission to Study Long-term Care Workforce Issues. The commission, which met five times this past fall, submitted its report to the Joint Standing Committee on Health and Human Services on Feb. 4.

The recommended changes are not as dramatic or wide sweeping as those proposed by 2018’s Homecare For All referendum, which I supported, but rather incremental. Nonetheless, they could be profoundly important to Maine’s direct care workers, the providers who employ them, and the adults with disabilities who rely on their services.

Commissions to study issues hardly represent radical change. One pictures reports gathering dusk on shelves, often with little impact from their work. And, indeed, this is not the first time this issue has been studied in Maine: a previous commission, convened 10 years ago, produced the 2010 Direct Care Worker Report, referred to with frustration by Helen Roy in a recent letter to the editor. Some members of this year’s commission had also served on the earlier one and were emphatic that if we wanted follow through, oversight was essential. I admit to harboring some skepticism myself regarding how much impact a commission might have, but from the first meeting in September through the delivery of the report to the committee five months later, I was continually impressed by the level of commitment by all involved.

The commission, chaired by Sen. Erin Herbig and Rep. Jessica Fay, included legislators from both parties, a direct care worker, representatives from provider organizations and the Departments of Labor and Health and Human Services, and advocates for consumers and workers. At each meeting, experts were invited to inform us both of the current dire situation as well as potential interventions that had been tried elsewhere in the country. We also heard from the public, many of whom came to every meeting.

We learned of the ever-increasing demand for direct care worker services and the difficulty in meeting that demand, resulting in many people going without the assistance they need. We learned how both residential and community-based provider agencies are being squeezed by low reimbursement rates and ever-increasing costs. We learned of the challenges faced by direct care workers, including low pay, inconsistent hours, lack of paid time off, and feeling they and their work are not valued by society or medical teams. We learned how essential direct care workers are to consumers who use their services, and the consequences for them and their family members when those services are not available.

The discussions were interesting, respectful and informative and systematically moved us toward our goal of laying out recommendations in a report. The report included 29 recommendations and suggested legislation incorporating three of the most immediate ones: increasing wages for direct care workers to no less than 125 percent of the minimum wage, adjusting reimbursement rates for provider organizations sufficient to meet their costs, and creating an oversight advisory committee.

When the report was presented to the Health and Human Services Committee earlier this month, I was again impressed by the thoughtful questions posed by legislators who ultimately unanimously accepted the proposed legislation, LD 2109. But the journey is not over. The bill will have a public hearing on Wednesday. There will be a work session, where bills are frequently revised, and then votes by the committee and both chambers of the Legislature.

I remain guardedly hopeful that this long-awaited, much needed policy change may indeed occur. This may not represent revolutionary change, but it is essential for sustaining and growing our long-term services and supports system, on which any of us could depend at some point in our lives. LD 2109 deserves our support.

Sandra Butler is a professor in the School of Social Work at the University of Maine in Orono. Her views are her own and do not represent those of any group with which she is affiliated. She is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.

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