DHHS must not bungle home health, direct-care rules

Maine’s severe shortage of direct care workers on the front lines of caring for seniors and people with disabilities has once again made headlines, as people who need help aren’t getting it — there just aren’t enough care workers, despite a growing demand.

a New Research A study by the Maine Economic Policy Center estimates that the state needs 2,300 more full-time direct care workers (home health aides and long-term care providers) to meet the current needs of Mainers who qualify for assistance. These numbers are estimates at best. The study concludes that “the state does not have comprehensive data that would allow a full picture of the extent of the problem.”

There is no debate that there is a problem.

One look at Maine’s demographic clock shows that without a carefully planned response, this deficit will only get worse. How is the state responding?

The Maine Department of Health and Human Services is drafting new licensing rules for providers known as personal care agencies. These agencies, which provide non-medical in-home care, have historically operated without regulatory oversight.

The proposed rules would replace 25-year-old guidelines and address licensing, staffing, quality standards, record-keeping and enforcement, and would impose new fees and fines.

Monday was the last day for public comment, and there were many opinions, ranging from “These rules have nothing to do with compassion and only about looking good on paper” to “Has anyone at (DHHS) ever been a caregiver?”

But it’s this comment that should resonate most loudly with regulators: “I am deeply concerned about the number of institutions that will be forced to close.”

Clearly, the public wants and has a right to have competent people in these important jobs and to hold those who deliver services meaningfully accountable, but will the new rules solve the problem or only exacerbate the growing care crisis?

Maine cannot afford to further weaken its already fragile health care delivery system. A strong, viable direct care network is the foundation of that system. Home care is desirable and economical, yet it is becoming increasingly impossible to obtain despite growing need.

Clients who need direct care may only need help with daily activities they can no longer do themselves, such as bathing or preparing meals. With the support of a basic trained and certified direct care worker, clients can safely remain in their own homes – and that’s where most seniors say they want to stay.

But when this basic care isn’t available, options are limited and costs soar: Nursing homes are expensive (and, given Maine’s recent string of closures, are expensive if they’re available at all). Hospitalization is even more expensive, and the costs are often paid for by taxpayers, either through MaineCare (the state’s version of Medicaid) or Medicare.

If DHHS leaders think that new rules will solve the problem, they are mistaken. Regulations should not lead to a flood of new direct care providers to meet Maine’s growing need. In fact, an unintended consequence of the state’s actions could be that even more providers are forced out of the industry. That cannot happen.

What’s the answer? Competitive wages. Realistic reimbursement rates. Paying for what’s needed.

In hopes of alleviating labor shortages, the labor portion of MaineCare reimbursement rates (which drive much of the direct care economy) was recently increased to 125% of the state minimum wage. Has this helped? No. Research shows that the amount should be increased to 140% of the minimum wage.

Not only do we need to pay these essential workers what they deserve, but we also need to make their jobs attractive enough so that the essential components of our health care system can survive and grow in response to demand.

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