Midcoast residents Joe and Consuelo Berry (Photo by Andy O’Brien) and home health worker Adelaide Manirakiza of Westbrook (inset)
Midcoast residents Joe and Consuelo Berry (Photo by Andy O’Brien) and home health worker Adelaide Manirakiza of Westbrook (inset)
Over 30 years ago, a diagnosis completely upended the lives of Joe and Consuelo Berry. At the time, the couple was living in Miami. Joe, now 78, was in the Navy and Consuelo, now 79, had worked as a clerk for the federal government for 27 years. But after having some trouble walking, she went to see a doctor, who diagnosed her with multiple sclerosis. 

“She had to quit her job because they were scared that she’d fall down the steps because she’d fallen before,” said Berry, as he sat next to his bedridden wife in the couple’s mobile home. “She went to the doctor at noontime and he said, ‘You can’t go back to work ever because the MS is getting progressively worse.’”

Shortly after, in 1985, Joe retired from the Navy and the couple moved to midcoast Maine to start a new life. At first, Consuelo just needed a little help walking and Joe recalls a friendly usher assisting her into St. Bernard’s Catholic Church. Then came the wheelchair, and in 2001 Consuelo became permanently bedridden. She has also lost the ability to clearly speak. A few times since then, Joe has had to check his wife into an assisted-living facility — once when he broke his leg in a motorcycle accident and another time when she had to be treated for a bed sore. Last November, he had to leave her with a friend for ten days while he had double bypass surgery. But he says that placing her permanently in a nursing home is not an option because most of them don’t have the staff to properly care for her. Sometimes, it can take an hour to feed her and it’s difficult living in a crowded residential facility without much personal space. And it just isn’t home. 

Fortunately, the couple has good insurance and Joe has served as his wife’s designated caregiver for the past three decades. He receives around $1,400 a month through the company Alpha One, a home care service provider. 

“My job is to keep my wife out of a nursing home,” said Berry. “She’s a bed patient so she has to be fed and has to have her catheter flushed and drained and she has to have a bath. I also make sure she doesn’t get any bed sores because once she gets them they’re hard to cure.”

It’s much less expensive to keep long-term care patients in their homes than in nursing homes, says Marcia Van Buskirk, who directs MaineHealth Care at Home, the program that took over Kno-Wal-Lin’s midcoast home and hospice care program. 

“When people get to a certain age, they want to remain in their own home,” said Van  Buskirk. “That’s where they’re comfortable and that’s where they want to be. They’ve been there all their lives and why should they have to give it up? The majority of the time, even with hospice, ... they can generally stay home until they leave this world.”

But Berry, who is also president of Maine Direct Care Workers Union Local 771, says he doesn’t know how anyone can make a living doing his job. While the couple is financially secure due to their good pensions, he says it would be nearly impossible to live on his caregiving wage and still pay their $950 per month rent along with utilities, food and heat. “The young ones are the ones I feel bad for,” he added. “How do you buy a house in the midcoast for this salary?”

A Massive Labor Shortage

As the economy improves and older workers leave the workforce, low wages and working conditions are presenting a tremendous barrier to filling home health aid positions, say advocates and providers. For years, economists have predicted that Maine, which is the oldest state by median age in the country, would soon face a massive labor shortage as baby boomers retire. And it appears the state’s demographic shift is hitting the home health care industry particularly hard. 

A recent report by the Maine Council on Aging (MCOA) noted that the health care sector has the largest percentage of workers age 55 and older. And with the state’s unemployment rate now well below 5 percent, the competition for workers has been fierce, says MCOA co-chair Jessica Mauer. 

“It’s not a shortage. It’s a crisis,” said Mauer. “People who need help getting out of bed, showered and dressed and having meals cooked are going without that kind of care because we cannot find qualified workers and retain them, given the current climate.”

Mauer, who is also executive director of the Maine Association of Area Agencies on Aging, estimates that between 5,000 and 6,000 hours a day of approved home care plans under MaineCare are going unstaffed because of the lack of home care workers. Van Buskirk says MaineHealth Care at Home has a handful of vacant full-time positions and 10 to 12 unfilled part-time positions. A 2012 Muskie School of Public Service survey found that 58 percent of home care providers reported that their biggest challenge was worker turnover, while fewer than 40 percent of direct care workers reported being satisfied with their wages. However, Van Buskirk says that it’s not just the wages that are turning off applicants, but the lack of benefits and irregular hours. Home care workers often work per diem with up to seven clients, which can require driving long distances to each house in all kinds of weather. 

“Getting a dependable group of people that will stay with you for a long time is a very difficult thing to do in this business,” said Van Buskirk. “The jobs are hard. They’re physically demanding , they’re emotionally draining.… You need to have compassion and the ability to deal with bodily functions.”

And workers also have the option of other jobs in stationary work environments such as retail or fast food that offer the similar hourly wages but with stabler hours. But Mauer says the crux of the problem is that Maine has the third smallest working-age population in the country and is essentially at full employment, so people who are unemployed are typically unemployable for the jobs that are available.

“We have a very low in-migration,” she added. “So if we don’t have workers here who will take these jobs, then we need to bring workers in from out of state. But we’re not building the infrastructure that supports in-migration.”

All of the advocates and care providers interviewed for this story agreed that immigrants, who are often more willing to take lower-paying work, will be critical component to solving the shortage. 

The Immigration Solution?

The direct care workforce in the U.S. is expected to number more than 4 million positions by 2018, marking an increase of 1.1 million since 2008, according to a 2013 report by the Institute for Women’s Policy Research (IWPR). The organization noted that immigrants make up about 28 percent of the home health care workforce, which is about 90 percent female and 56 percent from a minority racial or ethnic group. However, the share of immigrants in direct care positions in Maine is likely much less. Although Maine’s foreign-born population grew by nearly 23 percent from 2000 to 2013, immigrants make up just 3.4 percent of the state’s 1.3 million residents, according to the American Community Survey.

Maine Healthcare Association CEO Rick Erb, who represents nursing homes and assisted-living facilities, says  that his members say their number-one priority is addressing the worker shortage. 

“As we looked at the numbers of people that are moving into Maine and out of Maine, it was clear to us that we need to work on finding new places to recruit people into long-term-care positions,” said Erb.

He added that some MEHCA members have had success hiring from an existing pool of immigrant workers in the Portland area, but the group has not yet developed a plan to bring in workers from out of state. He said recruiting immigrants for rural providers is particularly challenging due to the lack of public transportation, affordable housing and English language services.  But last summer, with the assistance of an economic and community development nonprofit, a Rockland-based company was able to recruit a group of Congolese immigrants to work in one of its assisted-living facilities in the midcoast.  

Davis Long Term Care (DLTC) President Chad Cloutier said he had often worked with employment agencies to find workers, but this was the first time he had enlisted the help of a nonprofit. He said while it was not a “purposeful enterprise” to recruit New Americans, his search led him to Brunswick-based Coastal Enterprises Inc., which provides employment assistance to individuals with specific barriers to employment, such as New Americans. DLTC is temporarily offering transportation and English classes to their new employees and is even providing them with housing in an apartment building that the company owns. Cloutier said about 75 percent of his company’s housing units are rented by its employees. 

“It is kind of an older ‘company store’ model, but it works for the employees and the employer,” said Cloutier. “I’ve seen a happier workforce. I’ve seen people that have a close proximity to their employer. I see people who are happy to have nice apartments to rent, which is not always the case. So to the extent that we can help an employee find housing, I think that it’s a model that I will continue to try to develop.”


Although the company store model has a checkered history, CEI Vice President Carla Dickstein said that providing employee housing might be one way to ensure a reliable workforce in areas with high housing costs like the midcoast. She said her organization used to be in the business of developing affordable rural housing but has since ceased the program because government subsidies are so thin. “We can’t get down to the affordability levels that are needed,” she said, “and there are very few sources for subsidies that are very competitive.” 

The Campaign to Raise the Wage

However, progressive activists point out that if wages were high enough, workers wouldn’t need to live in subsidized housing. Currently, the average wage for a personal care assistant is just $10.22 per hour, according to MCOA, which amounts to less than $23,000 per year if the employee works 40 hours per week and takes no vacations. For a family of three, that’s right around the federal poverty level. 

Home care worker Adelaide Manirakiza of Westbrook says that’s why she was one of the first to sign a petition to put Question 4 on the ballot, which would incrementally raise the state minimum wage from $7.50 per hour to $9 per hour in 2017 and by $1 per hour each year after that until it is $12 per hour in 2020.The minimum wage would then increase at the same rate as the cost of living.

A former customs worker and political activist, Manirakiza says she fled from her native Burundi to Maine in 2007 after receiving threats in response to her efforts in organizing widows and orphans. Manirakiza says she makes about $10 per hour, and at night her pay is reduced to $7.50 per hour when she is supposed to be sleeping. 

“I work 48 hours a week, in a job that is hard and stressful, but I still don’t make enough to pay all my bills,” wrote Manirakiza in testimony to the Legislature last year. “I have MaineCare for my health insurance, AVESTA for affordable housing, and have used TANF to get through hard times because the money I make through my job is not enough to cover all of our basic expenses. All four of my daughters are now in college. Sometimes I have to borrow money or get help from friends to help my daughters. Making $12 an hour would mean I could earn more to support my daughters in college and make sure their education positions them to be qualified to get paid more in this country.”

MEHCA CEO Rick Erb agreed that wages for direct care workers need to go up and said his organization is supportive of Question 4. “I think that most of our members would agree that the amount of money we’re talking about for the minimum wage that is being proposed is the right thing to do,” he said.

However, he added that his members are concerned about “wage compression” for workers further up the ladder if starting pay is forced to increase. He noted that many of MEHCA’s clients are dependent on MaineCare reimbursements to remain solvent and rates would likely have to increase in order to comply with a higher minimum wage mandate. 

It’s also likely that the Legislature would have to increase MaineCare reimbursements for home care, which is currently at $15 per hour, due to the sheer number of agencies that rely on the program. But in the long run, given the high cost of care and the 90-percent occupancy rates of nursing homes, advocates say there will likely need to be much greater investments in home-based care.

“Maybe this needs to become a subsidized industry,” said Mauer. “We’ve subsidized milk production and other crops for years.” 

Immigration Reform & Other Incentives

But simply raising wages may not be enough to attract the needed workforce. According to economist Charlie Colgan, Maine’s wages have lagged 20 percent behind the rest of the country and the effect has been a greatly depeleted workforce. Attracting workers will take more incentives, say advocates. 

The Maine Council on Aging (MCOA) has been lobbying the Congressional delegation to make it easier for recent immigrants like asylum seekers to legally work while they’re waiting several months for their visas to process. The group has also been working on a policy that would increase the amount of time that people on Social Security can work without being penalized, which would allow more seniors to participate in care giving. Other ideas include providing debt forgiveness for college students who work in the direct-care field for a few years. 

And with a baby boomer turning 65 every eight seconds, the Institute for Women’s Policy Research argues that Congress needs to reform the country’s immigration system to allow more working-age immigrants to bolster the workforce. In its 2013 report, the institute noted that one in five immigrant direct-care workers is undocumented, which leaves many “vulnerable to low wages and poor working conditions.” 

Last session, MCOA submitted legislation to create a special commission to study direct-care workforce challenges and develop some recommendations around incentives and career ladders. However, Maine House Republicans defeated the bill after the LePage administration said the measure would “interfere with the work of the executive branch.” Dickstein at CEI said her group is currently working on state legislation that would expand employment resources to immigrant workers, but admitted that the political climate is challenging. 

The Anti-Immigrant Problem

Gov. LePage has made tackling Maine’s demographic problems a priority for his administration and has supported measures to provide debt relief for certain college graduates who stay in Maine. The governor has also strongly backed an initiative to abolish the income tax, arguing that the measure will attract rich, young workers. But he has had a tense relationship with the immigrant community. 

LePage has called asylum seekers like Adelaide Manirakiza the “biggest problem in Maine” and tried multiple times to eliminate food and shelter vouchers for immigrants waiting for their work permits to process. The governor has also made the dubious claim that asylum seekers are responsible for spreading contagious diseases.

The recent rise of white nationalism has created some tensions between the anti-immigrant wing of the Republican Party and the business wing, which is also seeking an inexpensive source of labor. In a recent report advocating for more immigration to Maine, the Chamber of Commerce and the Maine Development Foundation subtly noted the disturbing prevalence of xenophobia in the state.

“The common Maine saying ‘from away’ speaks to a sense of pride in our state, but also to an unnecessary and damaging division, implying that those from elsewhere can never truly be a part of our state’s social fabric and economy,” the report stated. “It also ignores the fact that many Mainers are themselves ‘from away,’ or are descendants of people who came ‘from away.’ This does us a disservice as we look to grow our population, our workforce, and our economy.”

DLTC President Chad Cloutier, who is a lifelong Republican and donor to the party, suggested that the debate has been misrepresented in the media and that the issue is really about whether individuals have been vetted and have gone through the proper legal channels before securing employment. 

“I don’t care what color they are or what ethnicity they are,” said Cloutier. “If they want to do the job and they’re qualified to do it and they are authorized to work in the United States, then I, as an organization, am very happy to give them the opportunity to work for us.”

But Manirakiza says she believes Maine won’t attract more immigrants until it changes its leadership.

“[Gov. LePage] treats us as nothing,” she said. “I heard one day he said all diseases are from immigrants. We brought here HIV, tuberculosis, the ‘ziki fly.’ The behavior of our governor is not encouraging anyone to come over here.”