Opinion: The painfully low regard we have for the old and poor

Maine’s health care system fails our elders

Posted:  Monday, February 18, 2019 - 8:30am

You love your elderly father and abruptly, he’s had a stroke. He can’t get around the house on his own any more. Someone must help him to the bathroom, shower him, help him put his clothes on. Furthermore, he is poor. He has no assets. His medical services are covered by Medicare and by Maine’s version of Medicaid, MaineCare.

So who will help your father out at home? You? You have a full-time job. Another family member? They have jobs as well and live in California, or Florida, or Timbuktu.

Is there a local person whom you trust?

Then get ready to pay $20 to $40 an hour for the help. Oh, wait! MaineCare provides daytime assistance in the home for those deemed eligible for long-term care (i.e. a nursing home) but who want to remain in their own home.

Good luck with that. A person who qualifies under the Elders and Adults with Disabilities Waiver of Medicaid for long-term care enters into a labyrinthine process that leads to …… misery.

First a Tennessee-based company called Maximus will send out a nurse to assess just how many hours per week of help with “Activities of Daily Living,” such things as dressing, housekeeping, or going to the bathroom, your father requires. That figure may be anywhere from a few hours to 60 hours per week.

MaineCare contracts with several companies in the state to provide that help.

These companies are called Home Care Coordinating Agencies. One such company is Elder Independence of Maine (EIM), a division of SeniorsPlus, which itself is an Area Agency on Aging. EIM (or another company) will be in charge of working with your father to get the home care he qualifies for.

That care comes through a Personal Care Provider company certified under MaineCare. That company will assign an in-house helper, called a Personal Support Specialist, to your father (and only for daytime; MaineCare apparently does not pay for overnight care).

Yet, when you have jumped through all these hoops, which will take many weeks, you discover that your father is getting almost none of the daily help he requires. Why? Because Personal Support Specialists are few and far between.

The Personal Care Provider companies in Knox County that are certified under MaineCare do not have nearly the number of workers for the number of MaineCare patients in this area. Those that they do have often abruptly quit.

And why is that? After all, they are paid minimum wage, now a princely $11 per hour in Maine.

It certainly has to do with the low pay and lack of benefits, but that in turn stems from the painfully low regard we have for the old and poor.

They are at the bottom of our hierarchy of esteem.

Esteem comes from a Latin word meaning “estimate the merit of.” We use it today to signify respect, honor and even reverence. The old and infirm garner none of that, to judge by how fiercely the health care system pushes them toward nursing homes. Their “merit” is zero.

To allow an older disabled person to remain in his or her home requires the system to acknowledge the humanity of that person, that they are more than just the MaineCare number by which they so often are referred. 

If we held older people, particularly those who can no longer be the dynamic individuals they once were because of illness or disability, in higher esteem, the people who take care of them might gain a degree of stature that is conspicuously absent right now, to judge by their pay.

Personal Support Specialist is a ponderous title for a truly admirable position. Too bad the health care system doesn’t see it the same way.


Melissa Waterman lives in Rockland