By COLIN HICKEY
Staff Writer Sunday, May 06, 2007

She makes $8.55 an hour after 14 years as a personal support specialist for Maine-ly Elder Care in Oakland. And that wage comes with no health insurance, no paid vacation, no retirement plan, not even reimbursement for the many miles she puts on her car traveling to patients.

The 57-year-old Benner also suffers from asthma and allergies and had back surgery about 30 years ago -- her surgeon at the time recommended she avoid physical labor. Given such health issues, Benner is hardly an ideal person to be lifting, pulling and supporting elderly patients day after day.

Benner, though, does not complain -- except maybe on a rare occasion.

"I love my job," she said. "I love my old people."

Diane Bickford, a fellow personal support specialist, echoes those sentiments.

"That is probably the only reason we stay in it," the 64-year-old Bickford said.

Benner and Bickford are the kind of people who keep the direct-care industry -- more than 22,000 people who provide hands-on health assistance to the elderly, adults and children with disabilities -- from collapsing.

They continue in the profession despite poor pay and benefits, lack of respect and the physically and emotionally draining nature of the work.

But make no mistake, the direct-care industry is not healthy. The abysmal compensation has led to a shortage of workers and high turnover, a situation that leads to great instability and quality of care concerns for care givers, agencies and patients alike.

The demographics of the state, moreover, indicate the instability likely will grow worse -- and soon.

In a meeting last fall, the Kennebec Valley Organization -- a grass-roots group formed to address social concerns -- noted that the population of Mainers 65 or older is expected to grow 65 percent over the next 25 years. (Kennebec Valley Organization has made issues facing the direct-care industry a priority cause).

During the same period, the number of women 25 to 44 -- those most likely to be direct-care workers -- is expected to fall 10 percent.

Customers have long grown accustomed to the cancellation call. They realize that the personal support specialist or home health aide or certified nursing assistant they saw last week may not last long -- not when most retail jobs can offer better wages.

In real dollars (income adjusted for inflation) the median wage in the direct care industry actually decreased from 2001 to 2005, according to information from the U.S. Bureau of Labor Statistics.

The Legislature, meanwhile, is considering a bill that would require any small business with more than 25 employees provide up to nine days of paid sick leave annually to full-time employees.

Denise Stevens, owner of Maine-ly Elder Care, said she would love to offer that to her employees. But to do so, she said, would put her out of business, and she said her company would not be alone in this regard.

"And really if something is not done about this," she said, "we are headed for disaster."

Joan Nunnally does not compromise when it comes to her older sister's care.

Nunnally is proud that her sister, 75-year-old Barbara Fenning, has never had bed sores despite being a bed- ridden Alzheimer's disease patient. She brought Fenning into her Mercer home to care for her for the last 21/2 years.

Nunnally, though, is only one person.

"It is difficult for me," she said, "because I'm 67 years old. When there is nobody else I do it alone, but I have a bad back and in this kind of business you can hurt yourself quite easily."

Nunnally, a retired certified nursing assistant, gets help through Hospice and Assistance Plus, a direct care agency based in Benton.

She is grateful for the help she gets. At the same time, she sees the instability in the industry.

"It is really a revolving door of people who come in," she said. "I think there is a difference in some of the aide's qualifications. I think you have some that are more compassionate and more experienced in how they do their work."

Sometimes, too, Nunnally gets a call that the person scheduled for that day is not coming.

In some cases, that is because the aide has left the profession.

Nunnally, who retired as a CNA in 1989, can't blame those who do.

"I think I was earning a higher wage then," she said, "than some people in direct care receive now."

"There are so many people in need now," she said, "and there are less workers. I think the agencies sometimes have a hard time finding people to work."

Stevens, who employs 70 direct-care workers, can attest to the hardships faced by agencies.

She estimates her annual turnover at 30 to 40 percent.

She said keeping workers under 30 is her biggest challenge. That group, she said, tends to have greater salary needs.

Stevens said retirees looking to supplement their income probably are the most stable segment of her work force.

In 2005 retail workers in Maine earned a median wage more than $1 an hour better than personal and home care aides, according to the U.S. Bureau of Labor Statistics.

Stevens has little power to change this situation. The rates she gets for services are determined by the state, and those rates, Stevens said, are extremely low.

From that state-determined reimbursement, Stevens has to pay salaries and cover her other operation costs.

Benner, one of Stevens' employees, doesn't criticize her boss for the low compensation. She understands the restraints placed on Stevens.

"I was just talking to a girl I used to work with who said she would love to come back but just can't afford it," Benner said, "even though her husband works."

Wages are just part of the problem, according to Debbie Halm, vice president of administration for Senior Spectrum. Halm heads the organization's Bridges Home Care program.

"We still have the issue that people need health-care coverage," she said.

The Maine Direct Care Worker Coalition estimates that one-third of Maine's home-care workers have no health insurance.

Yet another issue is that most direct-care workers have no guarantee on their work hours. Stevens said if a client dies or needs hospitalization, one of her workers might see her work week go from 40 to 20 hours.

"How can you plan for a budget," she said, "when you have 40 hours one week and 20 hours the next?"

Like Stevens at Maine-ly Elder Care, Halm said she must deal with an annual turnover rate of 30 to 40 percent.

"We find it incredibly challenging to fill that need for direct-care service workers," she said.

The industry has long relied on professionals who see the care they provide as more a mission than an occupation.

Benner said she manages to survive economically because she has family that supports her good work.

"I'm very fortunate," she said. "I live in my brother's apartment house. I give him what I can for rent, and sometimes I don't give him anything. I flat out can't afford it."

Bickford is on a tighter budget than Benner. She started with Maine-ly Elder Care this year and makes $7.75 an hour.

Yet she left a job as a sales manager in the corporate world to become a direct-care worker.

The move made no sense economically. But Bickford has no regrets.

"This has been my life-long ambition -- to work with the elderly," she said.

Maine Sen. President Beth Edmonds, sponsor of a bill aimed at helping provide health coverage to direct care workers, calls the situation horrid.

"If you look around at who is going to be going to be taking care of you as you age or should you become disabled," she said, "you will find there are not enough people to do that work. And the ones that are there are dedicated, loyal folks who given the wage structure, and given the lack of health insurance, can't persist in these jobs."

Colin Hickey -- 861-9205

chickey@centralmaine.com