Maine Tables Report on Improving Home- and Community-Based Care

Helen Hanson

Well, our report is complete, but it has not yet been presented to the Legislature.

As you know if you’ve been reading this blog, I am part of a team that was appointed by the state of Maine to recommend ways that the Legislature’s Health and Human Services Committee could streamline long-term care service delivery, address equalities in the services provided, and hopefully gain some cost savings, which can be passed on to workers in the form of livable wages and benefits such as paid time off and health care coverage. We finished our work in early January, and the report was supposed to be released later that month.

But I just learned that the Department of Health and Human Services (DHHS) has put it on the back burner instead.

Maine is working its way through severe cuts to public education and all social service programs. It is really disastrous. DHHS is using this as its reasoning to put the report on the back burner.

But even with the budget crashing down around us, DHHS was ordered by the Legislature to report back in January 2010. And we on the LEAN Core Team were working hard in December to get the report ready for the Legislature when it convened. Some people in DHHS were working even harder than we were.

As a direct care worker involved in this process, I am frustrated by this outcome and by the lack of accountability.

We came up with some great recommendations:

  1. Consolidating seven home- and community-based programs into three
  2. Making it easier for those needing services to navigate the system
  3. Making the self-directed option more readily available to those needing services
  4. Adding surrogates for consumers — people who can make decisions on a consumer’s behalf, with his or her permission — into the formula
  5. Working on rule changes that would involve Medicare
  6. Proposing better ways to handle case management

Not to mention tackling all sorts of worker issues, like improving wages and training for workers and encouraging more teamwork from workers.

We had even started working on implementing some of the recommendations. I honestly do not know how that is all playing out.

Combining the seven home- and community-based care programs into three would require some rules changes, since some of these programs are Medicaid-funded, and the state needs approval from the Centers for Medicare and Medicaid Services to change those rules. I’ve been told that process takes three months.

We had set a target of mid-March was set to start working on those changes, with the goal of having them in place by July 1. A sub-group of the core team was supposed to be working on this, but I do not know if they still are.

What I do know is that it is extremely frustrating. It’s hard not to feel as if all our hard work was all for naught, like the system will not change.

Not to worry, though. Worker members of Local 771 and Maine PASA are putting their heads together to come up with a strategy to get DHHS to budge. At this point, I do not know what that will look like, but we’ll be meeting about it today.

And one thing I do know for sure: We will be making some noise about this, somehow, some way.

Helen Hanson, CNA and home care worker
Graduate, Voices Institute National Leadership Program