DHHS must not bungle home health, direct-care rules

Maine’s dire shortage of direct-care workers, the people on the front lines of serving Maine’s aging and disabled populations, has – once again – warranted news headlines. People in need of help are not receiving it. There simply aren’t enough caregivers, even as demand grows.

A new study from the Maine Center for Economic Policy estimates the state requires 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. Those numbers are, at best, guesstimates. The study concludes: The state maintains “no comprehensive data that provides a full picture of the extent of the problem.”

That there is a problem is not in dispute.

One glance at the demographic clock ticking in Maine proves that, absent a carefully crafted response, this is a deficit that will only worsen. How is the state responding?

Maine’s Department of Health and Human Services is in the process of drafting new licensing rules for personal care agencies, as these providers are known. The agencies (which deliver nonmedical, in-home care) have historically operated under the regulatory radar.

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

Monday was the final day for public comments. There were many. They range from, “These rules have nothing to do with compassion and everything to do with what looks good on paper,” to “Has anyone (at DHHS) ever been a caretaker?”

But the comment that should resound the loudest with rulemakers is this: “I am deeply worried about the number of agencies that will be forced to close their doors.”

Obviously, the public wants and deserves qualified personnel in these critical jobs and meaningful accountability for those who provide the services. But will new rules solve the problem, or only exacerbate the growing care crisis?

Maine cannot afford to further weaken its already tottering health care delivery system. A strong and viable direct-care network is the foundation of that system. Care in the home is preferable and it is economical. But it is becoming increasingly impossible to obtain, even as need grows.

Direct-care clients may only require assistance with daily activities they no longer can perform on their own, such as bathing or meal preparation. With help from direct-care workers, who have received basic training and certification, the clients may safely remain in their homes. And that’s where most elders say they want to stay: at home.

But if this basic care is unavailable, the options narrow and costs soar. Nursing homes are expensive (if any are available, given the rash of recent closures in Maine). Hospital stays are even costlier. And taxpayers often foot the bill, underwritten by MaineCare (the state’s version of Medicaid) or Medicare.

If the leaders at DHHS think new rules will solve the problem, they are mistaken. Regulations will not inspire a rush of new direct-care providers to fill the growing needs in Maine. In fact, the unintended consequence of the state’s action could be to drive out even more from the business. That must not happen.

What is answer? Competitive wages. Realistic reimbursement rates. Dollars where they are needed.

In hopes of alleviating the workforce shortage, the labor portion of MaineCare reimbursement rates (which drive much of the direct-care economy) were recently raised to 125% of the state’s minimum wage. Did that work? No. Surveys indicate that amount needs to grow to 140% of minimum wage.

Pay these critical workers not just what they deserve, but make those jobs attractive enough to ensure that a fundamental component of our health care system can survive and grow to meet demand.

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