With a citizen initiative on the ballot for this November, Maine is poised to become a national leader in the critical debate about how to provide care for a rapidly aging population and how to ensure those who provide care earn a decent living. There is little question about the need for action — the current system fails too many people who need care as well as too many who provide it.

The answer provided by the proposed universal home care program is bold and suitable to the scale of the challenge. The initiative would ensure that all seniors and people with disabilities, regardless of income, can get the care they need. The initiative would also create a structure to improve the pay of caregivers and empower workers to advocate for their interests, recognizing that Maine’s care problem can’t be solved without also ensuring the state can retain and recruit enough caregivers. As a result, the initiative has captured the attention of citizens across the state, and even many outside it.

Maine, more so than most states, faces a growing elderly population that needs care. About 20 percent of current residents are past age 65 — well above the national average — and the elderly share of the population is increasingly at a more rapid pace than the U.S. average. At some point, most elderly persons will need additional care to help with activities of daily living, such as eating, bathing and medication management.

Yet, Mainers need help affording care. The annual cost of home care for many is more than most Maine families earn each year; and institutional care is even more expensive. Though some Maine residents qualify for existing public programs that help pay for this care, too many don’t.

Though a few Mainers may have saved enough money to pay for those significant expenses, many need to rely on their friends and families. However, families are often busy with children of their own and struggle to spend time providing additional care. As a result, many elderly residents are left without the necessary care they need and then suffer the indignities.

At the same time, the state needs more skilled caregivers. Each week, an estimated 6,000 hours of needed home care in Maine is unable to be staffed.


Attracting and retaining a skilled workforce requires adequate pay and the ability to have a long-term career. Unfortunately, pay for the direct care workforce is not much above the minimum wage. Nationwide, about 20 percent of home care workers live below the poverty line and more than 50 percent rely on public assistance to make ends meet. Training and advancement are often hard to come by, and poor treatment by patients or their families is too common. As a result, turnover is very high, with about two thirds of home care workers leaving the job every year.

The universal home care program would help solve both of those problems. It would fund care for all seniors and people with disabilities in the state through a tax on high-income earners — estimates suggest that 27,000 Mainers would qualify for care. The initiative would also create a mechanism to increase wages and training and help professionalize home care careers. A democratically-elected board with representatives of care workers, care agencies and seniors and Mainers with disabilities and their families would have the ability to ensure workers on the front lines are paid decent wages and benefits. Similar boards have proven successful at not only improving working conditions, but also building power for workers so that they can advocate for themselves and their profession. If care workers don’t have the power to professionalize their field, jobs in this growing industry are likely to remain unfilled.

All told, the universal home care program would be a major step forward toward answering the care crisis and help provide dignity and independence for Maine families — both those in need of care and those providing it.

David Madland is a senior fellow and senior adviser to the American Worker Project at the Center for American Progress Action Fund.

David Madland

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