This chart describes existing or enacted direct-care workforce initiatives in this state as of March 2004. The information was collected as part of a national survey of state initiatives on the long-term care direct-care workforce. Additional details about this state may be found in the full report.

This report provides an overview of the efforts of six Center for Medicare and Medicaid Services (CMS) grantees to make health care coverage more affordable and accessible to direct-care workers. It discusses the key advantages and disadvantages of three approaches employed by grantees: subsidization of employer-based coverage, combining basic insurance and tax-free accounts, and funding outreach programs, which promote public-private partnerships. An attached spreadsheet provides a description of each intervention, identifying key components, costs, and their potential sustainability.

This report identifies promising practices in direct care worker marketing, recruitment, and selection in states receiving Centers for Medicare & Medicaid Services (CMS) grants. Grantees used different techniques to improve recruitment and retention outcomes, including computer-based registration, marketing campaigns, realistic job previews, structured interviewing, and expanded orientation or mentoring of new employees. The report concludes that sustaining and replicating these interventions will require further research about associated costs and benefits and dissemination of this information.

This report describes successful strategies for expanding health care coverage to direct-care workers. Five strategies are discussed: making employer-based insurance more affordable, expanding public insurance coverage, establishing coverage through collective bargaining, building insurance costs into Medicaid reimbursement, and assisting workers with health care expenses. The report provides examples and models for each strategy that can be adapted by advocates and policymakers in other states.

This issue brief is part of the Maine Center for Economic Policy's series of Choices issue briefs. It is an update to the Without Care: Maine's Direct Care Worker Shortage issue brief. The author discusses the state of wages and benefits for direct-care workers in Maine, stating that they are disproportionately low. In addition, the author discusses the growing 'care gap' highlighting the fact that the aged (65+) population in Maine is growing faster than the pool of available direct-care workers. The author suggests that low wages, poor benefits, and inadequate Medicaid reimbursement rates makes it difficult to attract and retain workers and provide quality care.

After describing the scope and causes of difficulties recruiting and retaining paraprofessionals to care for people with disabilities, this article identifies possible solutions and documents promising initiatives undertaken in Maine. Recommendations include increasing wages and benefits, providing career ladders, cross-training paraprofessionals, promoting consumer direction, and instituting more selective recruiting practices.

In 2001 the Centers for Medicare and Medicaid Services (CMS) awarded Real Choice Systems Change (RCSC) Grants to states and other entities working to improve state long-term care systems. Twenty grantees began one or more initiatives to improve the recruitment and retention of direct service workers. This report focuses on the workforce initiatives of these 20 grantees, with an in-depth look at 7. The report strongly recomends that policymakers, providers, and consumers address workforce problems.

This paper provides an overview of health coverage interventions tested by Centers for Medicare and Medicaid Services direct service workforce grantees. Four case studies in North Carolina, New Mexico, Maine, and Washington State are examined and individually assessed. The author then draws out common challenges, key design features necessary for success in providing health coverage to the direct-care workforce, and concludes with a discussion of policy implications in addressing these issues.

This report reviews the findings of an outreach project conducted during the first six months of 2005. The aim of the project was to help connect direct-care employers and employees in Maine with DirigoChoice, an innovative state program aimed at expanding health care coverage. As a result of their research, the authors conclude that ''other states experimenting with innovative health coverage plans will need to address major challenges -- such as the part-time nature of direct-care work, low wages, and low reimbursement rates -- to ensure coverage for these critical health care workers.''

This report summarizes wage and salary data provided by fourteen Maine home care agencies in April 2002, with an update in January 2003. The document provides hourly wage information for 52 individually defined positions, job summaries/descriptions, and a full description of benefits offered by the 14 agencies, including availability of health insurance and vacation policies.

Interviews with ten workers involved in leadership teams of the Northern New England LEADS (Leadership, Education, and Advocacy for Direct-care and Support) Institute are provided here. The LEADS Institute is a regional culture change initiative aimed at building a core of strong leaders among direct-care staff, supervisors and administrators. The workers describe their experiences in the program, changes they have been involved in, successes, and challenges.

This fact sheet gives an overview of the direct-care workforce in Maine. It notes that direct-care workers comprise the second-largest occupational group in the state, and that demand for direct care is growing rapidly. The fact sheet uses data from the Census Bureau's Current Population Survey to show that direct-care jobs are marred by uncompetitive wages and inadequate health coverage; many direct-care workers in Maine rely on public programs simply to meet their basic needs.

Arguing that ''quality long-term care depends on healthy direct-care workers (DCWs)'' and pointing out that many of these workers lack health insurance, this Maine-based fact sheet provides information about why this is the case and why it matters to workers, employers and consumers.

This report examines Maine's emerging care gap and the growing need for direct-care workers (DCWs) in the state. The author argues that uncompetitive wages, inadequate Medicaid funding, and lack of training and supervision for DCWs has lead to a workforce crisis demanding public policy solutions. The report describes initiatives currently taking place in the state and offers a possible direct-care workforce policy agenda.

This report evaluates measurable outcomes of the LEADS Institute, an initiative that sought to develop person-centered care at 12 long-term care facilities by providing training, technical assistance, and cross learning opportunities. Interviews with stakeholders, job satisfaction and work environment surveys, data on turnover and absences, document review, and ''lessons learned'' discussions provide evidence of improvements in management, job quality, public policy, and the quality of communication within long-term care settings.

This evaluation brief provides an overview of the PHI Northern New England LEADS Institute. Launched in three states in 2005, LEADS was designed to give greater support to direct-care workers and their supervisors through the use of training programs, leadership teams, and peer mentoring. Results from the program's evaluation show evidence that sustained interventions supported by strong leadership can result in greater job satisfaction and improved retention. A summary of lessons learned is also listed.

This report focuses on examples of state legislation seeking to increase the hourly wages or benefits of direct-care workers. The thirteen bills or legislative appropriations included in the report increase wages through Medicaid reimbursement rates, amending current laws, or providing health insurance parity.

A Department of Health and Human Services study of direct-care workers in Maine assesses the current state of the workforce, the state's care gap, the cost of raising wages, health benefit options, and the Maine direct-care worker registry. Among the report's recommendations are an expansion of Maine's DirigoChoice and an extension of state employee health benefits to workers employed by MaineCare. The report also discusses methods of upgrading the direct-care worker registry.

In 2004, pilot projects in four cities (Rochester, New York; Phoenix, Arizona; Portland, Maine; and Louisville/Lexington, Kentucky) were launched in order to help connect direct support professionals and the public employment network of One-Stops. This white paper summarizes the progress of the pilots' model practices in their first year. The Department of Labor plans to expand the project to additional states in the future.

The history of Maine PASA, how it started and grew, is illustrated in this report as a timeline of activities, challenges, and outcomes. Over the grant period of 2001-2005, the project went from an idea to address the workforce shortages by building a worker organization to an incorporated, non-profit worker association with a statewide membership of over 600.

This report outlines the scope of the shortage of direct-care workers in Maine; provides data on the direct-care workforce, including wages, benefits, job satisfaction levels, stress factors, and reasons for leaving; and recommends sector-wide actions to improve retention. The report's major recommendation is the construction of a comprehensive career ladder for entry-level direct-care workers, which will ensure that workers' skills are transferable among different health care settings.

This report identifies the causes of the shortage of certified nursing assistants, personal care attendants, home health aides and other direct-care workers in Maine's long-term care system, and recommends actions to address them.

Practice Profiles are descriptions of recruitment, education and retention programs.

OHI: Comprehensive retention program for direct support professionals

These individuals and organizations are included here because they are actively involved in leading direct-care workforce activities in this state.

Coastal Enterprises, Inc.
www.ceimaine.org

36 Water Street
PO Box 268
Wiscasset, Maine 04578
t: (207) 882-7552

Maine PASA Connections
www.mainepasa.org/Connections/index.htm

t: (800) 268-6612

The Maine Personal Assistance Services Association
www.mainepasa.org

Barbara Asnes
P.O. Box 719
South Freeport, Maine 04078
t: (207) 890-0773
e: basnes.mepasa@gmail.com

Edmund S. Muskie School of Public Service
www.muskie.usm.maine.edu

Elise Scala
96 Falmouth Street
P.O. Box 9300
Portland, Maine 04101-9300
t: (207) 797-6997
e: scala@usm.maine.edu

Direct Care Worker Coalition
www.mecep.org/direct_care_worker_coalition.asp

Lisa Pohlmann, Maine Center For Economic Policy (MECEP)
P.O. Box 437
Augusta, Maine 04332
t: (207) 622-7381
e: lpohlmann@mecep.org

Home Care Alliance of Maine
www.homecarealliance.org

Vicki J. Purgavie, Executive Director
20 Middle Street
Augusta, Maine 04330
t: (207) 623-0345
f: (207) 623-7141
e: vicki@homecarealliance.org

State of Maine homepage: www.maine.gov

Maine Long Term Care Ombudsman Program
www.maineombudsman.org

Brenda Gallant, State Long Term Care Ombudsman
One Weston Court
P.O. Box 128
Augusta, Maine 04332-0128
t: (207) 621-1079
e: bgallant@maineombudsman.org

Office of Elder Services - State Unit on Aging
www.maine.gov/dhhs/beas

Diana Scully
11 State House Station
442 Civic Center Drive
Augusta, Maine 04333
t: (207) 287-9200
e: diana.scully@maine.gov

Bureau of Elder & Adult Services
www.state.me.us/dhs/beas

Medicaid Agency - HCBS waiver programs
11 State House Station
442 Civic Center Drive
Augusta, Maine t: (207) 624-5335
f: 04333

Maine Registry of Certified Nursing Assistants

Sally A Flesher
State House Station 11
35 Anthony Ave
Augusta, Maine 04333
t: (207) 287-9310