KeepME Home plan for seniors to age with dignity and proper care in their communities progresses
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.
“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, DC 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 of which AARP is a member.
“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 about ARRP’s telephone town hall. “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 bipartisan support, working with Republican Sen. Burns and others. Aging has no political bias.
When family caregivers are not available to provide all the necessary assistance for seniors, paid homecare workers fill the gap.
In Maine, nine out of ten people want to age at home, rather than move to a nursing home. But there is a shortage of homecare workers, partly because the low wages that have forced many into poverty.
“Raising the profile around the crisis 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 Baldacci administration and lawmakers increased it. Homecare 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.”
Homecare 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 called for the rate to be raised to $25/hour, and 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 homecare 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 will now get a pay raise.
Eves worked on the proposal with House Minority Leader Rep. Ellie Espling, R-New Gloucester, who introduced a similar bill. The law that passed combines both proposals. It increases reimbursement rates to providers of in-home, direct-care services by 66 percent to nearly $25 per hour.
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 homecare worker and board member of Food AND Medicine.
Annual turnover rates for home-care workers range between 25 and 50 percent, depending upon the agency. This causes concerns for homecare agencies and directly affects their clients.
SeniorsPlus, a Lewiston-based agency, needs more workers to provide homecare 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.
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 homecare 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.
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’s population is about 1,330,000.
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 increases can be incredibly debilitating and have forced many to choose between paying for medications and food or saving for their property tax bill.
“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.
In 2013 Gov. LePage created a “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 credit has become significantly less than the Circuit Breaker rebates were.
The speaker’s KeepME Home measure was included in the budget process this session. As a result the maximum property tax credit allowed for qualified residents doubled. Property tax relief is a lifeline for many residents; this was a huge success for thousands of Mainers.
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 more than 30 percent of their income on housing.
Sponsored by House Speaker Eves and Sen. David Burns, R-Whiting, LD 1205 would start to fill the current need for subsidized senior housing with a $15 million bond.
“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,” said Eves.
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 Maine State Housing Authority 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 5 out of 14 proposals, thus making the need for the bonds all that much greater.
“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.”
Despite Governor Paul LePage’s vocal an legal attempts to veto the housing bond, it will appear on this November’s ballot.