Emily Curry worked for 28 years providing care to people who needed it. She said she would still be in the field now – working jobs like caring for people with intellectual disabilities – if wages, benefits and working conditions were better.

But she said low pay and concerns about her own health – trying to work a physically demanding job while having multiple sclerosis – forced her to switch careers.

Similar decisions are being made by many members of what’s known as the direct care workforce, according to a report by the Maine Center for Economic Policy. The progressive think tank released a report Tuesday that recommends Maine’s government boost the pay of direct care workers to help alleviate the workforce shortage.

“It’s like night and day,” Curry said, when comparing her current job as a medical receptionist at Intermed in Portland to being a direct care worker. “I work in the most supportive environment with the most amazing people. I have weekends and holidays off. It was amazing seeing my family for Thanksgiving and Christmas last year.”

Curry, 51, of Portland, said she now earns $21 per hour, compared to $18.45 per hour in her last job, which she quit last year, at an assisted-living facility. Her current job is less stressful, but she would have stayed in direct care if she could have received better pay and working conditions.

The Maine Center for Economic Policy contends that low pay and difficult working conditions in the direct care workforce is leading to a host of problems with being able to deliver MaineCare services, including at group homes for people with intellectual and developmental disabilities, nursing homes and long-term care facilities, home health care, and other direct care workers.

MaineCare, Maine’s name for Medicaid, pays for most direct care services for people with disabilities. The nonprofits that provide the services rely on reimbursement rates to set their wages.

“The reimbursement rates in general are not keeping up with the costs,” said Arthur Phillips, economic policy analyst with the Maine Center for Economic Policy and author of the report. “Many direct care workers are deeply committed to the work, but the pay is making it next to impossible to remain in the field.”

Maine needs to hire an additional 2,300 full-time direct care workers – there are currently about 24,000 such workers in Maine – to meet existing needs, according to the report. With Maine’s aging demographics, demand for direct care workers is only expected to climb over the next decade.

PAY IS AN ISSUE

At a minimum, Phillips said, to be competitive, Maine must improve MaineCare reimbursement rates enough to allow nonprofits to pay their workers 140% of minimum wage. Currently, Maine reimburses at 125% of minimum wage, which was a recent improvement, but not enough to attract workers, Phillips said.

With state the minimum wage at $14.15 per hour, 140% of minimum wage would be $19.81 per hour, while the current reimbursement rate of 125% of minimum wage supports average wages of $17.70 per hour.

Phillips said similar entry-level jobs, such as for cooks, customer service representatives, administrative assistants and janitors, currently pay on average $1.92 more per hour than direct care workers earn.

Current conditions have led to lengthy wait lists for services, people getting less services than they need and the closure of nursing home that can’t retain staff, Phillips said. Some wait lists for certain services for adults with intellectual disabilities are between six and seven years, according to the report. Low reimbursement rates were cited as a reason for closing a group home program for children and young adults with intellectual disabilities at the Morrison Center in Scarborough.

Maine has closed 19% of its nursing homes since 2011, according to the report, and is now down to about 80 operating nursing homes.

The Mills administration has worked to increase funding for nursing facilities and long-term care operators, said Lindsay Hammes, spokesperson for the Maine Department of Health and Human Services.

STATE ACKNOWLEDGES CHALLENGES

“Recruitment and retention of direct care workers is an ongoing challenge in Maine and nationally,” Hammes said in an email. “Their work is central to keeping people in their homes and communities while providing accessible, high-quality services to help people stay healthy and fulfill their personal goals.

“The department is investing in nursing facility reimbursement as part of its MaineCare rate reform plan and it has increased average rates by more than 50% since 2019. Funding in Gov. (Janet) Mills’ supplemental budget, combined with $29 million appropriated last year, yields $39 million in fiscal year 2025 for nursing facilities and $49 million once annualized through the next budget process.

“These nursing facility rate reforms will support the direct care workforce, incentivize permanent staff, and promote quality care and positive health outcomes for Maine residents who live in nursing facilities.”

Hammes also pointed out that the numbers of people receiving direct care in private homes or long-term care facilities has grown significantly since the pandemic.

Ben Hawkins, public affairs director for the Maine Health Care Association, which represents long-term care facilities, said that while they haven’t analyzed the 140% of minimum wage proposal, if enacted it “would be very helpful.”

“The reimbursement rate has not gone up enough to keep up with supply and demand issues,” Hawkins said. “$19.80 would be very meaningful for some workers.”

Curry, who has worked in group homes and assisted-living facilities, said she would have stayed in the field, but eventually she needed to switch careers because of the low pay and long hours in a job that was becoming too physically demanding with her multiple sclerosis.

“It’s one of the most important jobs in the world,” Curry said of caring for people with disabilities. “It was a good feeling at the end of the day knowing I made a difference in people’s lives.”

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