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Maine’s Universal Home Care proposition could mean big changes for seniors and their caregivers

Kate Ward
Nov. 1, 2018

An initiative on the ballot in Maine this November could bring free home care for seniors and higher wages for their caregivers, setting the stage for a solution to the “silver tsunami” senior care crisis that’s hitting the nation.

The Universal Home Care proposal, also known as Question 1, seeks to address two big problems plaguing Maine: a rapidly aging population and a lack of qualified caregivers whose work is vital to enabling seniors to continue to live at home. The number of homecare workers in Maine, which ranks as the oldest state in the country with nearly 20 percent of its population being over the age of 65, is simply not enough to fill the needs of the aging population. The Maine Council on Aging, which is remaining neutral on Question 1, reports that an estimated 6,000 authorized hours of home care services aren’t being delivered each week by agencies due to a lack of staffing. Meanwhile, most American seniors say they prefer to “age in place” rather than enter a nursing home or institution, but this looming shortage of home care workers means that it often falls to immediate family members to provide the required home care.

Proponents of the Universal Home Care Proposal are hoping that the bill will be a radical overhaul of the senior care system in Maine and serve as a blueprint for other states in the U.S.

What is the Universal Home Care Program?

The ballot initiative proposes to make free home care available to all Maine seniors and people with a disability, regardless of income. Mainers 65 and older and those with disabilities who need assistance with one or more activities of daily living would be eligible for the program. Currently, Medicare covers medical expenses exclusively, and while Medicaid provides some funds to cover home care services, it is limited and only available to lower income individuals.

The initiative would put in place a 3.8 percent tax on individual income above $128,400. According to the Portland Press Herald, “Wage earners who are employees would split the cost of the tax with their employers. For every dollar the employee earns above $128,400, the employee would pay a 1.9 percent tax, and the employer would pay a 1.9 percent tax. Business owners and self-employed residents would be responsible for paying the full 3.8 percent tax on their income above $128,400.”

Supporters of the initiative say seniors who do not qualify for Medicaid funds end up burning through their retirement savings and are eventually forced to move out of their homes and into an institution against their wishes. They say middle-class families are specifically bearing the brunt of it. If Question 1 passes, the initiative is expected to be fully in place by January 2022.

What does the Universal Home Care Program mean for caregivers?

Supporters of Question 1 say improving the lives of homecare workers is a major goal of the initiative and one that is long overdue. Taking control of the funds out of the hands of the legislature and putting it directly into the hands of caregivers and the people they care for by installing a board to control the trust is how they hope to ensure that caregivers begin to see real changes in their profession for the better.

If passed, 77 percent of the funds raised would go directly to care workers to improve wages, training, benefits and working conditions, according to Communications Director for the Maine People’s Alliance Mike Tipping. By using the money for a combination of training and pay increases, proponents say more workers would be inclined to go into the field and those in the field would be more highly qualified to provide even better care.

Tipping points out that the current homecare turnover rate is an astounding 67 percent, and many point to low wages as a major reason behind why more people are not going into the homecare field. Currently, a homecare worker in Maine is making just above minimum wage for work that is intensive, difficult and often emotionally taxing. Many workers who love their jobs and the people they care for have found themselves forced to take other positions just to be able to provide for their own families.

Leighann Gillis, a homecare worker in Portland for the last seven years, describes the current situation in Maine as completely dysfunctional. She says the high turnover rates affect her personal life as well because she can’t count on anyone as backup when she needs time off.

“We’ve gone through five people in the last year and a half. It’s crazy,” Gillis says, agreeing that the low pay rate is at the root of the state’s problems. “You can get the same amount of pay working at a fast food franchise and you’re not responsible for the health and safety of another human being. It makes it difficult to stay.”

In addition to higher wages, the initiative also guarantees the right to homecare workers to join or form a union. This would put caregivers in a position to collectively bargain for better wages, conditions and training across the board for all homecare workers in the state. Tipping points out that, contrary to the suggestion made by opponents of the proposal, no worker would be required to join a union.

Why is there opposition to Question 1?

Opponents say the language around the 3.8 percent tax is unclear and could mean families with a combined income of over $128,400 would be hit with the increase — instead of just individuals who earn over that amount. Proponents say they mean this to be a tax on the individual wealthier taxpayers — an estimated 2 percent of the wealthiest people in Maine — and that the language can be ironed out by the legislature before anything goes into effect.

Newell Augur, Chairman of the No on Question 1 Campaign and attorney for the Homecare and Hospice Alliance of Maine, says he has many concerns regarding the proposal. While he acknowledges caregivers need to be making more money, he stresses that the Homecare and Hospice Alliance has been working for years to get that money from the state. Augur says they have increased reimbursement for caregivers by $16 million over the last four years and have no plans of stopping.

“We know that’s not enough,” Augur says. “We need to do more, and we will do more.”

He is also concerned that the proposed board that will be charged with running the trust will not be accountable to the state legislature or to the Maine taxpayer. Potential privacy issues are a major concern for opponents, as well. Augur expressed concern that patient information will not be protected the way it currently is and that it could be used for political campaigns.

No one, however, seems to feel that the current situation is sustainable, even if there are disagreements as to how to move forward. Augur says there has already been so much work done to improve the system and work should continue to be done within that system.

“We already have a pretty good long-term care system here in Maine, so let’s work on improving that foundation,” he says.

But proponents say there are too many seniors being driven out of their homes each day due to lack of funds and that working within the current system is not enough.

Learn more about the Universal Home Care Program

If you are a Maine resident, the results of the vote on Question 1 this November could have a direct impact on your life and the lives of your loved ones. Find out more about the proposed initiative here.

This vote is being watched closely by states all over the U.S., as an aging population and a decreasing homecare workforce is a growing problem across the country. Communities are looking for ways to deal with the situation before it becomes unmanageable. If you are a caregiver anywhere in the U.S., the ins and outs of this proposal are important to understand, as we could see versions of this initiative pop up in other states in the country sooner rather than later.

Read next: In-home care: What are your options?

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