Direct Care Workers in the Lead as Maine Revamps Its LTC System

L to R: Roy Gedat, Helen Hanson, Sen. Margaret Craven, Sen Nancy Sullivan and Julie Moulton

Here in Maine, the Department of Health and Human Services (DHSS) is revamping its long-term care system, and two direct care workers – Julie Moulton and I – are helping to lead the process.

As you know if you’ve been reading this blog, our past legislative session saw four separate bills dealing with long-term care, two involving workers and two dealing with the system. I wrote about three of them in an earlier blog post. The fourth is LD 400, which looks at long-term home-based care and community-based care.

For all but one of the four, DHHS has to report back to the legislative Health and Human Services Committee with findings on how to improve the system. For LD 1059, DHSS will report back to the Insurance and Financial Services Committee.

DHHS figured the best way to do all this reporting and analysis is by setting up a LEAN process. LEAN is a manufacturing term used when companies look into their operations to see what can be removed from their processes to make manufacturing “leaner,” thereby taking less time, energy and money to manufacture something. That leads to more money available for employees, for research, for investment, whatever the company wants to do with it.

The goal of this LEAN process is to reduce waiting lists for consumers to get into programs, to make the long-term care system more transparent, to give consumers more choice about their care, and make it for consumers to switch from one provider to another and to know what care and services are available to them. DHSS also hopes to find savings in the system, which must be passed on to workers in the form of better wages and/or health insurance.

A series of work groups will make it happen. The LEAN core team will lead the process, creating a new map for a streamlined system and developing an implementation plan.

Julie and I, with help from Nicole Brown of the Kennebec Valley Organization, pushed to ensure that workers were also included in this process. At an informational meeting about LEAN on August 11, DHHS said the hands-on people in the system should be the ones on the core team. My thoughts on this were that it shouldn’t be agency CEOs; it should be lower management folks, like schedulers, who deal with workers, consumers, managers, DHHS, EIM, etc. They know the system, like workers do, and know what does and doesn’t work.

My view didn’t prevail – no lower management people made the team – but Julie had more luck. She pointed out that there are approximately 22,000 workers in Maine, and they should have proportionate representation on the LEAN core team.

I guess the people from DHSS agreed, because Julie and I are on the team. The other 18 team members are four consumers, three advocates, five providers, two DHHS staff, and four people who don’t fit into any of those categories. We are all charged with reporting back to our respective organizations and coalitions, which make up the stakeholder groups.

DHHS also set up a worker group to address the issues affecting long-term care staff raised by the four bills. These include:

•   Creating a systematic approach to training, reimbursement and benefits for direct care workers in all settings (LD 400);
•   Providing health insurance to Maine’s direct care workers based on the Montana model (LD 1059); 
•   Analyzing the extent which provider rates and worker wages are standardized to promote overall efficiency in the system and to ensure that the workforce is large enough and well enough trained to provide quality care (LD 1078); and
•   Standardizing administrative reimbursement rates and bringing direct care wages up to $12 per hour (LD 1364).

A consumer focus group will let consumers tell the department what it is like to receive services and offer ideas for improvement. This is fantastic! Both direct care workers and the people we care for are part of the process. How often does that happen?

Our next steps are:

1. Orientation for core team members on September 15. DHHS will go over the work plan, timeline, its expectations, and our roles and responsibilities. DHHS staff will also review related LEAN work that has already been completed on intake and eligibility.
2. Consumer focus group meeting, September 29
3. Core team meets to do its mapping work on three consecutive Tuesdays in October, starting on the 6th
4. Core team and stakeholders will review and comment on the future state map and on the improvement action plan from late October to early November
5. Core team and the bills’ sponsors will meet in early November to finalize the future state map and improvement plan.
6. On December 1, the core team will present its “dynamic improvement plan” to stakeholders and the bills’ sponsors.

As this moves along, I do not know how much of it I can report on. What I can, I will.

I’ve got my work cut out for me during this fall. We workers need to be part of this process because we are with the people we care for, day in and day out. We see what works and what doesn’t. We see where improvements can be made (like in assessments) and what can be left by the wayside.

I am honored to be part of the LEAN core team. I am also very proud to be working with Julie Moulton on this.

This is an interesting time to be in long-term care in Maine, thanks to people like Representative Matt Peterson, 1078’s sponsor; Senator Nancy Sullivan, 1059’s sponsor; Roy Gedat, the DCA’s advocacy director; Allison Lee at PHI; the good folks at Maine PASA; Nicole Brown at the Kennebec Valley Organization; and the fine people in the Direct Care Worker Coalition.

We just got fantastic news about new funding for health care coverage, which came about because of the work we’ve done together. And we’re about to make some changes for the better in the way Maine’s elders and people with disabilities receive the vital care and services they need, and the way we direct care workers are trained and compensated for our crucial work.

Helen Hanson
Home care worker