Maine is the oldest state in the country: 267,181 people — 20 percent of the population — is over age 65. Over the next couple of decades, this cohort is expected to grow by half. Two-thirds are expected to need long-term services and supports in their lives. The complexity of health issues brought about as a result of the aging process, and the resulting need for more care, puts the state on the brink of a care crisis.
Legislative and executive branches at both state and federal levels have failed to confront the urgency of this situation. This failure of leadership to attend to an issue of such magnitude leaves its resolution to only one alternative — a citizen’s initiative.
In Maine, this is not an unfamiliar approach to addressing social issues of importance. Most recently, two referendums, have come before the voters — one to raise the minimum wage and another to expand Medicaid. Shortly, another will come before the voters — Home Care for All, Question 1 on the November ballot.
This referendum directly addresses the challenges brought forth by an increasing aging population by guaranteeing access to home care services for all medically eligible elders without concern about cost.
Most people assume that Medicare — the health insurance program available to nearly everyone 65 and older — covers long-term care costs. It does not. It does cover acute care and short-term rehabilitation services, but not the long-term personal care needs that frequently accompany aging and allow elders to remain in their home and community.
So what do people do? Family caregivers provide most of the assistance older adults receive. In 2013, an estimated 178,000 family caregivers in Maine provided services worth $2.2 billion. About three-quarters of these caregivers are women. And while caregiving can bring joy and satisfaction, it also comes with its own costs, including increased levels of depression and stress and poorer physical health outcomes. Many caregivers cut back on, or altogether abandon, their paid employment, creating financial repercussions for their family and negative consequences for their employers.
When a person has no access to a family caregiver, or needs help beyond what family, neighbors, or friends can provide, their only alternative is to turn to a paid home care worker, a profession that is 87 percent female. These jobs are often poorly paid, have inconsistent hours and provide few opportunities for advancement. It is no mystery that turnover is high and finding enough workers to meet the need is difficult. Providers of home care services in Maine report that each week up to 6,000 hours of home care needs go unstaffed.
But paying for this care, should they find it, is costly. Home care in Maine costs more than in any other state in the country: 30 hours per week at about $20 per hour for one year costs more than $30,000, coming to an estimated 102 percent of the state’s median household income for older adults. The alternative is even more expensive: a private room in a nursing facility comes to more than three times that amount.
So, how do they pay? Most can only turn to their own funds, if they have any. Then, after savings are exhausted and assets gone, eligibility for Maine’s Medicaid program or other state-funded programs may kick in. But what a dismal occurrence in one’s life.
Helping Mainers — whatever their income level — to stay in their homes and communities for as long as possible is the right thing to do. Supporting family caregivers with the often isolating, difficult, and financially devastating care they provide, is the right thing to do. Valuing the work of home care professionals so that they are better trained and compensated and can continue to do the work they love, is the right thing to do.
Question 1 offers Maine a historic opportunity to provide publicly supported care, which will also strengthen the economy. It steps in to assure that older adults receive the in-home help they need. It offers financial support to family caregivers who devote themselves to caring for a loved one. It establishes workforce standards for direct care workers to improve training, wages and job stability hence making this work more appealing and sustainable for the caring people who choose it.
Maine people deserve this support. It is the right thing to do.
Sandra Butler is a professor in the School of Social Work at the University of Maine in Orono. Luisa S. Deprez is professor emerita of sociology and women and gender studies at the University of Southern Maine in Portland. Both are members of the Maine chapter of the national Scholars Strategy Network. Members’ columns appear in the BDN every other week. Their views are their own and do not represent those of any group with which they are affiliated.
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