By Ramona du Houx
Maine is the oldest state in the nation. One in four Mainers will be over the age of 65 by 2030, according to U.S. census projections. The rapid aging of Maine’s population and workforce has significant implications for economic growth and is challenging employers, health systems, municipalities and state leaders to find ways to attract and retain workers, create new housing options, and to deliver services to enable seniors to remain healthy and able to live in their own homes.
Maine Speaker of the House Mark Eves and the Maine Council on Aging (MCOA) are engaged in a collaborative initiative to help seniors with these issues.
Speaker of the House Mark Eves talking about his KeepME program. Photo credit MPBN
“I was very compelled to put a focus on these issues. It’s gratifying to be engaged in this initiative and to be able to lead it, as Speaker, with an incredible group of people from The Maine Council on Ageing,” said Eves.
They started with Round Table meetings in 2013 where more than 500 community, business, finance, education and policy leaders discussed the issues in depth. “We had a great cross-section of society represented at the four meetings. We also went to Washington D.C. and met with the Congressional Delegation, and will be returning to attend the White House Summit on Ageing.”
On January 17, 2014, the Maine Summit on Aging attracted nearly 400 participants from around Maine who added to a conversation and planning process that formed the basis for the Maine Aging Initiative. That led to the Speaker’s KeepME Home plan.
“At the summit we changed the conversation from this is a real challenge to this is a great opportunity for the state to lead,” said Eves. “We are the oldest state. We need to embrace it. We need to show the way.”
MCOA is a group made up of 30 different organizations focused on aging issues in our state, one of them is AARP and they held a telephone town hall.
“12,000 people called in from all over the state, and heard Sen. Burns and myself talk about the initiative. They were engaged and we answered a lot of questions,” said Eves. “It was incredible.”
The Speaker also convened a Legislative Caucus highlighting the priorities generated from all the meetings. At every step of the way the Speaker has ensured the initiative received bi-partisan support, working with Republican Sen. Burns and others. Aging has no political bias.
The Speaker’s KeepME Home plan has bills under consideration that would:
- Boost pay for in-home care workers who have not had a raise in nearly a decade;
- Expand property tax credits for seniors;
- Create affordable housing for seniors in each of Maine’s 16 counties through a $65 million housing bond.
Step 1: Boosting homecare workers pay to meet a crisis—
When family caregivers are not available to provide all the necessary assistance for seniors paid home care workers fill the gap.
In Maine nine out of 10 people want to age at home, rather than move to a nursing home. But there is a shortage of homecare workers and part of the reason why is due to the low wages that have forced many into poverty.
“Raising the profile around the crises that is happening in our direct care workforce is important. If we don’t do something about it now—It’s going to get worse and worse and worse,” said Eves. “We are doing right by our seniors and those who care for them. The need is dramatic. A stronger direct care workforce will make it possible for more seniors to stay in their homes, and remain independent.”
Maine’s reimbursement rate for home and personal care services has been stuck at about $15 an hour since 2006, when the Baldaccci administration and lawmakers increased it. Home care agencies pay their workers about $9 an hour, and the remaining $6 an hour covers a variety of administrative, operational and training costs.
“It’s hard to retain people if they aren’t earning a decent salary. It’s difficult, emotional work. Some are live-in workers. They are always on call and need special training,” said Eves. “The increase of wages should help retain good workers; otherwise you have a revolving door and end up with workers who don’t have enough experience to do a quality job.”
Home care workers earn a little over $20,000 a year, on average, according to the Maine Department of Labor. But most of them have to provide their own transportation to and from clients’ homes, no matter the distance, so their real pay is a considerably less.
Eves's bill calls for the rate to be raised to $25/hour. The bill requires that at least 85 percent of the increase "must be used for wages and employee benefits including health care, mileage reimbursement, training costs and other benefits."
Increasing homecare workers pay is more cost effective than the nursing home option. MaineCare spent an average of $558 per month for each client who received personal care services at home in 2010, compared with $4,150 per month for each nursing home resident during the same year, according to a 2012 analysis by the Muskie School of Public Service.
Adelaide Baramburiye Manirakiza, a homecare worker from Westbrook, said at the public hearing that she loved caring for her clients, but the pay is not enough to support her family. Manirakiza cares for an 80-year-old woman who needs help with bathing, dressing, toileting, making meals, managing medications, and running errands.
“I have been working as a home care worker for the last seven years. I work 48 hours a week, in a job that is hard and stressful, but I still don’t make enough to pay all my bills,” said Manirakiza. She receives no employee benefits, gets health insurance through MaineCare and has to live in subsidized housing. “We do delicate, important, often difficult work. I care about people. But this job doesn’t pay enough.”
Manirakiza is one of more than 10,000 home health and personal care workers in Maine who need a pay raise.
Eves worked on the proposal with House Minority Leader Rep. Ellie Espling, R-New Gloucester, who introduced a similar bill.
“We have a significant number of seniors living here in Maine and many of them want to stay in their homes,” said Espling. “These bills ensure that services are available to our seniors so families have the support they need to continue to care for their loved ones in the comfort of their homes.”
The amended bill, LD 1350, combines both proposals from Eves and Espling. It would increase reimbursement rates to providers of in-home direct-care services by 66 percent to nearly $25 per hour.
During a public hearing on the proposal, in-home care workers and the seniors they care for urged support for the pay boost.
“I have a wonderful homecare worker that helps me a few times a week. This is what keeps me in my beloved home and gives me my independence,” said Ray Polley, a senior from Wales. “If I had to move out there would be a part of me that wouldn’t be there anymore.”
DHHS agrees that there is a need to increase the pay for direct care workers to attract and keep dedicated employees.
Speaker of the House Mark Eves in his office at the State House in Augusta. Photo by Ramona du Houx
Homecare workers are a growing job sector in Maine—
Homecare workers make up the fastest growing occupation in the country. The Bureau of Labor Statistics projects that between 2010 and 2020 the demand for personal care aides will increase 71 percent and will produce more than 600,000 new jobs nationally.
In Maine, the overall job growth between 2008 and 2018 is projected to be just 2 percent, yet for personal care aides, it’s projected at 26 percent.
“If we ignore the poor working conditions that cause care providers to be distracted and stressed due to their financial insecurity, we are compromising the care that people receive. Current staffing shortages and increased demand means that we need to do something now to attract and retain quality employees,” said Ted Rippy, a home care worker and board member of Food AND Medicine.
Annual turnover rates for homecare workers range between 25 and 50 percent depending upon the agency. This causes concerns for home care agencies and directly affects their clients.
SeniorsPlus, a Lewiston-based agency needs more workers to provide home care services for 471 clients, said Betsy Sawyer-Manter, executive director. “We have many people who have been approved for services but are going without because there aren’t enough people to do the work.” SeniorsPlus is a member of the MCOA.
John Wiley lives at home in Waterville and wonders about the future. Photo by Ramona du Houx
In 2013 Sandy Butler, a professor at the School of Social Work at the University of Maine, completed overseeing a study on the job experiences of home care workers in Maine. The study followed a group of 261 personal support specialists for 18 months who were working for agencies serving all 16 counties of the state. More than a third of these workers quit their jobs during this time.
Butler wrote in the Bangor Daily News that the leading reason they left, “was the inability to support themselves and their families given the low wages and the instability and part-time nature of the hours. Related compensation issues included lack of mileage reimbursement, paid sick time and paid vacations.”
Another heartbreaking reality the study showed was that the workers who left didn’t want to for they loved their profession.
“They enjoyed working with elders, believed — like most of us do — that it was important to help people remain in their homes for as long as possible, had high levels of job satisfaction, and generally would have chosen to continue in the field if the compensation had been better,” said Butler.
“We hear about a worker shortage, but what we have is a wage shortage,” said Christine Gianopoulos, board chairwoman of Home Care for Maine Inc.
Step 2: Increasing property tax relief for seniors—
According to the state’s Revenue Services website, “nearly 200,000 Maine households qualify for a partial refund of property tax assessed and/or rent they paid in 2011.” Maine population is around 1, 330,000 people.
Low-income households have a high burden of property taxes, compared with higher income households making the property tax Maine’s most regressive tax. For seniors living on fixed incomes property tax increase can be incredibly debilitating and have forced many to choose between paying for medications and food or saving for their property tax bill.
“We’re trying to increase the Circuit Breaker Program back to the level it had been, with the maximum $2,000 rebate for seniors and $1,500 for non seniors,” said Eves.
The Speakers bill, L.D. 1095, would increase the maximum property-tax credit allowed for qualified residents age 65 and older from $900 to $2,000 per year.
In 2013 Gov. LePage created a new ”Property Tax Fairness Credit” to replace the state’s Circuit Breaker Program. The credit is refundable and is implemented through the state’s income tax rather than as a separate rebate. But the maximum value of the new credit is significantly less than the Circuit Breaker rebates were.
In April, 2014, the legislature doubled the Property Tax Fairness Credit to a maximum of $600, or $900 for those 70 or older.
“About one in three of the lower income households pay more than 10 percent of their income in property taxes. Less than one in fifty of the higher income households pay more than 10 percent of their income in property taxes. Thus the overall burden of property taxes is highly skewed by income,” wrote economists of Maine Center of Economic Policy in a report.
Step 3: Create a $65 million affordable housing bond—
According to a recent study from a Massachusetts consulting firm, contracted by the Maine Affordable Housing Coalition, the shortage of affordable housing units by 2022 would grow to 15,000. The calculation is based on the number of people over the age of 55 spending greater than 30 percent of their income on housing.
Sponsored by House Speaker Eves and Sen. David Burns, R-Whiting, L.D. 1205 would start to fill the current need for subsidized senior housing with a $65 million bond to build about 1,000 new units in 40 buildings across the state, as well as fund improvements to existing homes to help seniors age in place.
“We would have projects in all 16 counties that would be managed through Maine State Housing Authority (MSHA). Making sure that all counties are included is a very important piece of the language in the bond. “Still, it’s just starting to meet the incredible need out there with 9,000 seniors on the waiting list now—in a few years that’ll be 15,000.”
The scarcity of affordable senior housing is huge. There are builders using public subsidies and tax programs to try and meet the need but they are barely scraping the barrel.
“Basically our housing has not kept up with our longevity,” said Jessica Maurer, executive director of the Maine Association of Area Agencies on Aging. “And as the population ages, those who live on fixed incomes — like Social Security — spend more of that income on their mortgage, rent or repairs. In some cases, their homes are simply too big for them, or they’re too costly to heat in the winter.”
According to Harvard’s Joint Center for Housing Studies, “low-income households aged 65 and over rely on Social Security payments for 85 percent of their incomes.”
Currently there is a booming demand for market-rate apartments, which fetch higher rents and attract more developers.
The kinds of apartments that the state needs for seniors most likely won’t get built without state bonds and federal help. A federal low-income housing tax credit subsidy helps to build about 90 percent of all affordable housing in the U.S. by giving tax breaks to banks or other entities that provide the investment.
A developer applies to MSHA for one of two types of credits. Once approved by MSHA, the developer then sells that credit to a bank or other firm that can write off a percentage of the investment over the following decade. MSHA then finds other subsidies to pay the remainder, or gives the developer a loan. The federal government only allocates MSHA about $2.6 to $3 million each year in these tax credits. In 2014, MSHA was only able to approve five out of 14 proposals. Thus making the need for the bonds all that much more.
“The decision was motivated by the fact we’ve been all over the state having community conversations with seniors finding out what they would like and what they need. We’ve found if they couldn’t stay in their immediate home they want to stay in their community,” said Eves. “We want to make sure these units are built in a way that connects the residents with the fabric of their community. Making sure seniors have access to downtowns so they can shop and go to restaurants as well as being able to access services as they age.”
Speaker of the House Mark Eves in his office at the State House in Augusta. Photo by Ramona du Houx
But Governor Paul LePage has never been forthright in backing bonds and has help voter approved bonds hostage until he has gotten what he demanded from lawmakers.
“I would hope that we could agree on the incredible need. It would be a lost opportunity if we didn’t take leadership on this issue. We can’t wait any longer. We need to start building. People across the state immediately understand the problem. It’s personal for everybody.”