As Election Day attracts close to, a ballot initiative in Maine to offer common dwelling care is shining a highlight on the inadequacies of the nation’s long-term care system.
The important downside: Although most older adults wish to stay at dwelling when their well being begins to say no or they develop into frail, applications that assist them achieve this are slim in scope, fragmented and poorly funded.
Medicare’s home care benefits are restricted to seniors and adults with disabilities who’re homebound and want expert providers intermittently. State Medicaid applications range extensively however are usually restricted to individuals on the decrease finish of the earnings ladder. Long-term care insurance coverage is dear and covers solely a small slice of the older inhabitants.
That leaves hundreds of thousands of middle-class households struggling to determine what to do when an older relative develops a critical persistent sickness, equivalent to coronary heart failure, or suffers an acute medical disaster, equivalent to a stroke.
“We’re about to have the largest older population we’ve ever had, which is going to need exponentially more care than has ever been needed before. And we’re not prepared,” mentioned Ai-jen Poo, co-director of Caring Across Generations, a corporation working to broaden long-term care providers throughout the U.S.
Maine, with practically 20 p.c of its residents age 65 and older, is exploring a radical response to this dilemma that’s being carefully watched by different states.
Its poll initiative, referred to as Question 1, proposes that dwelling care providers be accessible to all residents, for free of charge, no matter earnings. If enacted, it will develop into the primary such program within the nation.
Adults could be eligible for this system once they need assistance with at the very least one “activity of daily living”: strolling, bathing, dressing, consuming, toileting, private hygiene, and getting in or away from bed. Services coated would come with care from aides and companions; speech, bodily and occupational remedy; counseling; dwelling repairs; transportation; respite care; units for individuals with disabilities; and even, often, small lease subsidies.
Stipends could be granted to household caregivers. Seventy-seven p.c of program funds could be directed to dwelling care aides, in a transfer to strengthen this workforce.
More than 21,000 individuals might qualify for dwelling care providers beneath the brand new program, along with about 5,600 individuals who already obtain providers by Maine Medicaid and different state applications, in accordance with essentially the most definitive analysis up to now, revealed final month by researchers on the University of Southern Maine’s Muskie School of Public Service.
Funding for the brand new program would come from a brand new three.eight p.c tax on wages and non-wage earnings that isn’t taxed by Social Security: a threshold of $128,400 per individual in 2018. Between $180 million and $310 million could be raised yearly, in accordance with numerous estimates. The program could be absolutely carried out by January 2022.
The political battle over Question 1 is fierce, though nobody questions the necessity for reasonably priced dwelling take care of seniors and folks with disabilities. In AARP’s most up-to-date “Long-Term Services and Supports State Scorecard,” Maine ranked final within the nation on affordability of dwelling care.
Among hundreds of individuals affected are Rick Alexander of Blue Hill, Maine. 70, a retired college librarian, and his spouse, Debbie, 64, who has a number of sclerosis.
“Since Debbie has a progressive form of MS, her needs are going to increase,” mentioned Alexander, his spouse’s sole, unpaid caregiver and a supporter of Question 1. “We brought in some paid help years back, but we couldn’t do that for very long: It’s too expensive.”
Alexander needs to maintain Debbie at dwelling so long as potential, however he worries in regards to the bodily calls for and emotional penalties. “I have chronic clinical depression and periodically I go down into the dumps, a long way,” he admitted. “When that happens, it’s hard for me to motivate myself to do anything.”
Also, it’s usually accepted in Maine that one thing must be achieved a couple of extreme scarcity of dwelling care aides — an issue surfacing nationwide. Each week, 6,000 hours of dwelling care providers which were licensed aren’t delivered by Maine companies due to workers shortages, that are notably acute in rural areas, in accordance with the Maine Council on Aging.
Despite these areas of consensus, nevertheless, disagreements surrounding Question 1 are intense and most Maine well being care and enterprise associations oppose it, together with all 4 candidates for governor.
Taxes are a key level of rivalry. Question 1 supporters argue that a comparatively small variety of high-income people would pay further taxes. The Maine Center for Economic Policy estimates that solely three.four p.c of individuals incomes earnings in Maine could be affected, in accordance with a September report.
Citing ambiguous language within the initiative, opponents argue that households incomes greater than $128,400 would even be topic to the tax hike, considerably increasing its affect. A urgent concern is that increased taxes would discourage medical doctors, nurses and different professionals from transferring to or remaining in Maine.
“We have a workforce crisis already, and this increase — which would make our income tax rate among the highest in the country — would be a disaster,” mentioned Jeffrey Austin, vp of presidency affairs on the Maine Hospital Association.
The program is just too expansive and costly to be sustained long run, different opponents say. “We have limited public resources in Maine and those should be dedicated to the people most in need, fiscally and physically,” mentioned Newell Augur, a lobbyist for the Home Care & Hospice Alliance of Maine and chair of the “NO on Question One/Stop the Scam” marketing campaign.
In an announcement, AARP Maine, which has not taken a stand on Question 1, expressed reservations. “Using a payroll tax to pay for HCBS [home and community-based services] is an untested policy at the local level,” it famous.
Also controversial is the board that might be established to function the house care program. The initiative requires 9 members (three from dwelling care companies, three direct care employees and three service recipients) elected by constituent organizations to supervise this system.
“The board wouldn’t be accountable to the governor or the legislature, and Maine taxpayers would have no say over how their money is being spent,” mentioned Jacob Posik, a coverage analyst on the conservative-leaning Maine Heritage Policy Center.
Supporters word that an advisory committee would come with state officers from a number of companies. The board’s construction is supposed to be “responsive to the people providing and receiving the care,” mentioned Mike Tipping, communications director for the Maine People’s Alliance, a grass-roots group that’s spearheading Question 1 and that helped go a 2017 poll initiative increasing Medicaid in Maine, at the moment tied up within the courts.
For all these coverage disputes, it’s clear that Question 1 has appreciable emotional resonance. “I’ve never had people cry signing a petition and tell me how much something like this would have changed their lives,” mentioned Kevin Simowitz, political director for Caring Across Generations.
One of the individuals who’s spoken out publicly is the Rev. Myrick Cross, 75, of St. Patrick’s Episcopal Church in Brewer.
Cross works half time on the church so he pays for aides that take care of his 38-year-old daughter with Down syndrome and his 95-year-old mom, who has suffered from kidney illness, falls, wounds that didn’t heal and pneumonia prior to now a number of years. “I will do whatever I need to keep them home,” he mentioned.
Originally, Cross regarded to dwelling care companies for help, however with charges of $23 to $25 per hour “that was more than I could afford,” he mentioned. Today, three native residents present greater than 50 hours of care every week for $12 to $15 an hour.
“I’m blessed that I’m able to work and to hire all these people to keep us going,” Cross mentioned. “But several members of my congregation are older and don’t have the family resources that we have. This would make the quality of their lives better.”
We’re keen to listen to from readers about questions you’d like answered, issues you’ve been having together with your care and recommendation you want in coping with the well being care system. Visit khn.org/columnists to submit your requests or ideas.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.