Five Questions: Assistance Plus Chief Operating Officer Jill Jolicoeur

What’s your biggest challenge right now?

I would say the biggest challenge right now is the workforce. We’re struggling to meet the needs of our clients because of a critical shortage in the workforce. Getting essentially entry level workers is where we’re struggling, just competing with other businesses. We provide hands-on and high-level care, and people can go work at McDonald’s for the same as what we’re paying them here.

(We) just completed a big workforce report with the Longterm Care Workforce Commission with the state of Maine. We’re proposing to raise minimum wage for the type of workers that we employ at $15, so there would always be 125% of minimum wage to help us fill that unmet need. Because Medicaid funding is critically low and Medicaid has had no proactive means of addressing rates, we didn’t even have funding to address the last two minimum wage hikes. We had to take that out of our own pocket. It’s not in our (contracted) rate. We’re struggling with the entry-level workforce. We’re struggling with the workforce period just because the unemployment rate is so low.

We can’t pay more because we don’t have the funding to pay more. Our current rate studies we have are based on data from five years ago. The struggle is people think that we can just pay it, you know, and (we’ll) better attract (workers), but we’re not funded to pay it because Medicaid hasn’t increased the reimbursement. It has to come through the rates. The contract just dictates what they pay us, but the reimbursement is what allows us to pay them. Health insurance isn’t in the reimbursement, earned benefit time, none of those things have been calculated into the current reimbursement model.

Medicaid just had to put out a new contract because they weren’t even aware of how critically underfunded a lot of our businesses were. It’s going to be the first time in Maine that they’ve actually had a rate-setting model. It’s serious, because if one agency closes, the whole system kind of starts falling under and it’s more (work) for them to get it back up than it is just to keep it going.

Who has influenced you the most in business?

I would definitely say my mom. My mom (Johnna Bowen) owns this company, and she’s been on a five-year retirement plan. We have a year left, and then I take over ownership and become the (chief executive officer). She’s a nurse. I went to school to be a nurse, and we both went through master’s degrees together. We went at the same time a couple of years ago and finished our (different) master’s degrees. She’s really been the primary influence of me wanting to do this type of work, because I saw her doing it from the time I was a child.

We’ve spent a lot of time here getting proactive, and a lot of the proactiveness is really with the state of Maine — with the Department of Health and Human Services, and the Office of Child and Family Services. It’s on really fixing the service at the state level, so the delivery as a business is easier. It’s a lot of structuring that we’re working on right now, and I spent the last five years doing that here, and in the last year it’s really gotten better.

What skills do you value the most in employees?

A lot of what we look for is just our core values — commitment, integrity and compassion. If you have those three things, you can be a direct care worker. We can teach skills to people. Each service has an entry level position that you could walk in the door with a diploma or (high school equivalency). We can teach you all the skills that you need to work with clients.

This job isn’t for everyone. This is direct care giving. That’s why Walmart is enticing to (some) people, because in this job you have to … give people a bath, you have to help them brush their teeth. There’s a lot of hard work that goes into it. If you have the right personality or you want to make a difference (we are a good fit). That’s our tagline — if somebody really wants to make a difference, we can teach the skill to anybody.

The nice part is you can grow with us. I started as a personal support specialist, and I worked up slowly through just about every position that the company has. I’ve been here since I was 15. I’ve held almost every position that I’m licensed or certified to hold here. People can start entry level, and they can get a career path if they want it, but not everybody who comes wants that. Some people just want to stay at the caregiver level forever.

What was your biggest misconception about being in business?

I was going to college to be a nurse practitioner. I was enrolled. I was starting my master’s degree. I had a newborn baby at home, and I thought that I could pull it off. I mean, my daughter was probably just a few weeks old, and (the program) required me to go back and forth to Bangor to do clinicals (supervised interactions with patients). And I said, “Oh, I don’t know how I’m going to do this.”

I started researching online other degrees that I can get that wouldn’t require me to do clinical practicums. That’s when I came across this health care administration degree. And so I thought, “Oh, great! I’ll do that because my mother’s talking about retiring in four or five years.”

So I dove right into it. I really had no idea the politics behind health care and behavioral health. I was pretty naïve five years ago. I didn’t know that everything required lobbying and legislative action. If we want a rate increase every year, we have to go in front of the (Maine State Legislature’s) Health and Human Services Committee, and get public testimony and have clients and employees (testify). We have to constantly lobby to get the funding or to change the delivery of service.

I had no idea that health care … was political. I think that’s the least fun part of the job, the politics. The part that I love is actually delivering the care to people that need it and knowing that we’re making a difference in our community.

Where will your business be in five years?

I believe we’ll be doing similar services as we’re providing right now, given that we are properly funded. This year is a real critical point. We’re being heard, luckily, under the new governor. They’re hearing us, and they’re listening. It’s just the funding is taking too long.

If we get a proactive rate model, in five years I see us diversifying and adding a lot of services that we don’t currently have. When I want to add a new service, I have to be very patient and thoughtful, because if the services we’re delivering are underfunded, it’s really hard to start another one. I see us getting into more grant-type opportunities.

I would like to start a day care for our employees to give them as a benefit, to allow them to continue working. And to have a day care that specializes in kids that have behavioral needs.

In the last year we started shared living, which is a model where we match a client with a contractor, not an employee. We pay the contractor a monthly stipend. We move a client with intellectual disabilities in after they are matched with your personality and your living environment and your kids, your dogs and cats and whether you’re a smoker or not. Then we monitor the relationship monthly, and it keeps these clients, as their parents age, in an environment where they’re safe. And it keeps them from being institutionalized. We only have a handful of clients, but we’re always looking for new shared living contractors that want to make this type of difference. It’s almost like adult foster care.

If we were well-funded, we’d love to start children’s foster care where we start matching kids with families. There’s a real shortage of foster families and we’d love to do the matching process like we’re doing with the shared living.

We also want to help people work through substance-use disorders. We have a lot of goals. We’d love to add a residential facility. So when, people don’t have the option or don’t want to be in a shared living environment, we would house people with developmental disabilities together in a small, 10-bed facility.

The funding has to be adequate before we can take anything new on, and currently all the services’ funding is not adequate. The only adequate funding is when we deal with private insurers or private out-of-pocket payers. Where someone calls and they can afford to pay us our hourly, it’s in our benefit to do that, because then we can play or pay our employees more.

But the Medicaid funding is critically low. So there’s not, there’s not any profit in the delivery of services.

I’m not sure if it was this week or last week, but the two representatives that are on the (Longterm Care Workforce) Commission will present to the Department of Health and Human Services. Hopefully that lengthy report that we wrote will turn into results. We gave them a very systematic approach of how to address the service delivery, the rate issue and the workforce. If they implement those key components, it’ll make this type of service delivery for anybody doing Mainecare funding easier because there’ll be proactive things in place rather than reactive. Every year we have to go in front of the legislature and try to get a funding hike. When minimum wage goes up or a mandate of electronic visit validation (is imposed), or you now have to give employees 40 hours a week of earned-benefit time — if that’s not proactively built in the rates. Every time the law or the state or the feds change rules, we have to go and change the rules with the legislature, and it’s kind of ridiculous.

Here we are just struggling, trying to deliver the service with our rule book that’s more than 5 inches thick. Mainecare has to be responsible to just be proactive with it. We’re hopeful that they take our feedback. The commission wrote a very lengthy report, and if they follow the guidelines, I think it’ll make it easier for everything — nursing homes, boarding homes, home health care, and behavioral health. All of the services need a proactive approach from the state.

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