A Crisis for Direct Care Workers

With so many of Maine’s Nursing home’s in trouble another crisis has emerged, the falling number of direct care workers.

Dan Neumann/Maine Beacon

By W.P. Miner

DEER ISLE: On October 15, the nursing home of Deer Isle saw its final resident leave the facility. Island Nursing Home is one of four long term care facilities to announce its closure in September, and its closure reveals a more complex and systemic problem — the vulnerability of Maine’s direct care workers.

Maine is the oldest state in the union, and its nursing homes have perhaps been the hardest hit institutions during the pandemic. By March of 2021, long term care facilities had accounted for 10 percent of COVID diagnoses statewide, and 60 percent of total deaths. While vaccinations have largely addressed this problem, the threat of further closings has led Governor Janet Mills to propose the release of $146 million in state and federal relief funds for nursing homes and primary care providers. Unfortunately, the issue has proved to be more complicated than a check alone can solve.

“The landscape for nursing homes right now is pretty dire,” said Representative Jessica Fay, a Democrat representing Raymond. “We had a crisis before COVID and COVID really exacerbated it.” 

Now in her third term as a member of the Maine House of Representatives, Fay argues the problems that nursing homes are facing existed prior to COVID. She says many providers are unable to meet the required number of available staff to take in new patients, or in some cases to even remain open. 

Island Nursing Home on Deer Isle operated for nearly 40 years in a remote area of Maine only to close its doors earlier this month. Last December, the home was hit by one of the most severe COVID outbreaks in the state. Fourteen residents died, and nearly 150 residents and staff members suffered illness. Now, with the pandemic more in control, staffing challenges have become the main concern.  

Neither an endowment nor available state funds were sufficient to keep the institution open. To re-open, the facility is in need of CNAs, housekeeping and food service staff, but despite access to funding, much of the contract staff can no longer afford to live near the residents they cared for. 

“We live in a community, a coastal community, and it is gentrifying very quickly,” said Representative Genevieve McDonald, a Democrat representing Deer Isle and other coastal communities. “We saw an increase in people moving here during COVID to get out of the cities, and our housing market has gone through the roof. So houses are not affordable at this time. Rents are nonexistent.”

On the island there are attempts to build affordable housing to address this problem; however, the community has been forced to raise funds through private fundraising and donations as the money provided by the state has largely been allocated for primary care reimbursements, not community projects.

A clear and obvious problem, and yet, exhaustion still remains the most listed reason for individuals leaving the direct care workforce, with 80 percent of care facilities citing “burnout” as the primary reason for staff exits. 

Angela Westhoff, President and CEO of the Maine Health Care Association, has attempted to combat this issue by establishing a “bonus structure” that would include “time off with pay” and other benefits that would “keep people’s spirits high” and “engaged in the work.” However, in a draining job “surrounded by the passing of people’s loved ones,” problems remain. 

“With everyone raising their minimum wage requirements we’re competing against other sectors to recruit new workers,” Westhoff said. “If you can work at a convenience store or a big box store and make the same amount of money, or more, than working in a very demanding and stressful job then it makes it tough to recruit people to an industry that you don’t get paid as much, or the same and have kind of a easier work schedule. There’s a lot of requests for working overtime in this kind of field because there aren’t enough workers right now.”

Rep. Fay also notes the demands of caring for older still needs to be addressed.

 “If you’ve been working really hard for 18 to 20 months and making $15, $18, $20 an hour, and you have an opportunity to go someplace and do something that’s a little less physically and emotionally stressful, and earn the same amount of money. I mean, I certainly don’t fault folks for wanting to do that,” Fay said. 

Ultimately, Rep. Fay argues that until we value the work of Maine’s direct care workers, we cannot value “the people that they’re caring for.” Both she and Westhoff have advocated for the establishment of career ladders within the care industry.

Regardless of what is decided, Maine’s nursing homes are in trouble. “There are people who are in their homes now, and are just not getting the care that they need,” said Evan Popp, a journalist from the Beacon who’s been covering the nursing home crisis. “They’re older and they need support getting up in the morning or making food – basic kind of needs like that.”

Popp believes more closures are likely, especially given the growing size of the waiting list for care facilities.

In fact, the Maine Health Care Association estimates that 125 residents were left needing new placement following the four closures in September, and without reform and a significant increase in the available workforce, more of Maine’s most vulnerable citizens will be left without care and a place to go. 


Jessica Piper and  Michael Shepherd (September 1st 2021). More Maine nursing homes plan to close with staff shortages prompting ‘cascade’ fears. Bangor Daily News. Christopher Burns (August 31st 2021). After 40 years, Deer Isle nursing home will close this fall. Bangor Daily News. Patty Wight (March 15th 2021). In Maine Nursing Homes Besieged By COVID-19, Staff Have Provided More Than Medical Care. Maine Public.


Categories: Health

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