Mainers are woefully underserved by home and institutional nursing care, report says

The state needs more than 2,300 additional full-time workers to fill the gap in nursing and personal care that Mainers need and are qualified for, according to a new study.

The study, published this week, was written by Arthur Phillips, an analyst with the Maine Center for Economic Policy, a research and policy organization in Augusta.

Thousands of older adults, people with disabilities, and individuals with behavioral health challenges do not receive the personal care and support services they qualify for through state and federal programs, the study found.

There’s a care gap of 23,500 unstaffed hours per week for older people in need of home care through state-funded and MaineCare programs. The center’s analysis estimates that closing just that gap would require 400 additional full-time personal support specialists and another 187 nurses.

Phillips notes that there is no comprehensive data that provides a full picture of the extent of the undersupply of care. Part of the challenge, he says, is that care is delivered through a variety of programs and in a variety of settings.

The report was designed to provide a more granular understanding by depicting care gaps associated with:

Approved care not being delivered
Declines in nursing and residential facilities and beds
Service gaps and years-long waitlists for people with intellectual and developmental disabilities
High employee vacancy rates and long waitlists for organizations serving people seeking behavioral health services.

Maine needs to raise the MaineCare reimbursement rate for the labor portion of direct care supports and services to at least 140% of the state minimum wage to compete in the current labor market, the study says.

In 2020, one MaineCare program that provides nursing and personal care services had an average of about 46% of enrolled members not receiving all approved care. By 2023, that figure jumped to 62%, or about 430 more people who received less care in December 2023 than there were a year earlier.

Nursing home shortages

The cost of operating nursing homes, including labor costs required to recruit and retain sufficient staffing, have risen faster than state reimbursement rates, contributing to closures across the state.

According to the Boston Federal Reserve, from 2010 through 2023, Maine lost 19% of its nursing homes, more than any other state in New England, and served 21% fewer patients.

Hancock, Waldo and Lincoln counties lost between 60% and 100% of their available nursing home beds.

By comparison, roughly 5% of nursing homes nationwide closed over the same period. In addition to the loss of available beds, the percentage that is occupied has declined primarily due to a shortage of direct care workers.

Before the pandemic, nursing facility occupancy was above 90%.

It fell to a low of 74% by late 2021 and early 2022 and sat at nearly 82% as of February 2024.

“One primary driver of these challenges is MaineCare rates have not kept up with the cost of providing care,” the study says.

The minimum additional nursing home capacity needed is about 200 beds. Assuming the average of 4.48 hours per resident day, that would require 157 more workers.

Addressing direct care workforce challenges, the study say, will require a comprehensive approach including collaboration by policymakers with direct care workers, consumers and advocates on developing policies that address workforce issues. Jobs will also need to be improved through better wages, benefits, training and scheduling, especially amid current economic growth and historically tight labor markets.

The center has scheduled a webinar on June 26, at noon, for people to learn more about the issue. Speakers are expected to include Phillips, Jess Maurer from the Maine Council on Aging, Brenda Gallant and Nicole Marchesi from the Maine Long-Term Care Ombudsman Program, and members of the Direct Care and Support Professional Advisory Council.

Click here for the full report.

Click here to register for the webinar.

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