A recent federal investigation into personal care services providers in Lewiston has brought these critical services public attention. It’s important to clarify some misinformation about this program, which is has strong oversight, is cost-effective and delivers solid results.

Personal care services are regulated at many levels, as witnessed by the federal investigation that illustrates scrutiny at the highest level. At the state level, the Office of Licensing and Regulatory Services requires providers to register with the state. In addition, providers must check the state’s Certified Nursing Assistant registry before hiring an employee to ensure the person is not banned from serving clients in the state.

I think we can all agree that these requirements, on their own, are insufficient. But there is much depth to the checks and balances within the system. The Department of Health and Human Services has hired Elder Independence of Maine, which is contractually responsible for quality assurance, not only for the agencies providing direct care but for those receiving services.

In addition, access to services flows through a single portal, Goold Health Systems, which determines the plan of care. It should be noted that Goold does not provide direct care, so it has no proverbial “horse in the race” when it comes to the outcomes of their assessments.

In terms of enforcement, MaineCare’s Office of Program Integrity investigates reports of suspected fraud and Maine’s Long Term Care Ombudsman responds to complaints lodged by consumers and family members.

Regarding the issue of expense, reports of a 58 percent increase in the cost of personal care services are accurate. But this is one case where the added expense is one Maine taxpayers should embrace, since this growth comes while reducing more costly options.

Maine and the nation have adopted policies that move those who need long-term services away from nursing facility care and to much less expensive home and community based services. In Maine, there has been a 13 percent decrease in the average monthly number of nursing home residents. This translated to a 10 percent increase in the number of consumers receiving care in their homes.

The overall cost of personal care services — $22 million — is dwarfed by the cost of nursing home care, which topped $241 million in 2008. When you compare the cost per consumer, those receiving home-based services cost $12,994 per person. This cost includes personal care and other services, such as nursing services and occupational and physical therapy.

The cost of home-based personal care services for individuals requiring less than nursing home-level of care needs was just $3,704, while the cost-per-consumer for a nursing facility was $27,475. In Maine, 40 percent of those who receive services are eligible for nursing home level care — at an average of more than $14,000-plus in additional cost per consumer — so much for costs “galloping out of control,” as a Sun Journal editorial said. 

Another 11 percent fall just shy of meeting nursing home criteria and all who receive services need help with at least two activities of daily living and constant verbal cueing.

Portraying the work of personal care services provides as “changing light bulbs and sweeping floors,” as the editorial also said, is condescending, insulting and simply inaccurate. It should be noted that the people who do this sometimes thankless work are a lifeline to the consumer.

They provide assistance with daily living, including moving to and from bed; transferring from beds to wheelchairs, offering assistance with eating, drinking and using the toilet; taking a bath or shower; getting dressed and even help with donning or removing prosthetics.

Those needing even more care, especially those without family in the area, usually need help with meal preparation, housework, grocery shopping and laundry. Finally, it’s important to recognize that all research shows that elders who need help would prefer to receive them in the comfort of their own home.

With this being the preference of the consumer and their families and with the cost-savings associated with personal care services, it is crystal clear that this service is a win-win situation — for both the taxpayer and the consumer.

Brenda Harvey is commissioner of the Maine Department of Health and Human Services.


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