There is full agreement that Maine has the second-highest proportion of people age 65 and older in the nation. There is also wide consensus that the best quality of care and most cost-effective means for people to age is in their homes and in the community. More important, home is where most of us want to be, if we have a choice. In the health care lexicon, this is called aging in place.

A personal support specialist is the backbone of the aging-in-place concept. These direct care workers must have a selfless commitment to those they serve, performing critical housekeeping, meal preparation (and in some cases feeding), transportation, personal hygiene and companionship services. Their attention to their client’s needs often enables other family members to go to work, shop for food, run errands and conduct home repairs and maintenance while knowing their loved one is safe and cared for.

In most cases, however, clients live alone and need this care because they have no one else to support them. Additionally, a personal support specialist’s care helps keep clients away from costly hospital stays and allows patients to return home sooner when they must be hospitalized.

A personal support specialist must complete a 50-hour certification class approved by the state of Maine in order to perform this critical work.

This critical service is in danger of disappearing from the aging-in-place landscape because of the low rate of reimbursement for direct care workers. In 2001, the MaineCare rate of reimbursement for providers of personal support services was $15.14 per hour; today, it is $15 — less than it was 14 years ago! A 15-year stagnant reimbursement rate is now making the service near impossible to deliver for the personal support specialists, the overseeing agency and the person receiving care.

In the last 10 years, non-wage direct and indirect costs for this service have risen by 25 percent, while additional costly mandates have been imposed on agency providers by regulatory bodies. These inflationary pressures, combined with unfunded mandates, have kept the average rate of pay for personal support specialists at a barely livable wage range of $8.50-$10 per hour. This is unsustainable.

In order for aging in place to succeed, providers must be able to attract and retain an honest, dedicated and hardworking workforce and deliver the service with reliability and quality.

The Legislature is considering two bills addressing the issue of reimbursement for direct care — L.D. 1350 and L.D. 886. The dedicated and committed workers who testified during the public hearing all said that they would have to seek other employment if the rate is not increased.

Unfortunately, there has been a recent suggestion that the bills be held over to next session because the Department of Health and Human Services has not concluded work on a rate study started in November.

Non-action in 2015 is a risky proposition. If the reimbursement rate is not addressed in this legislative session, providers will be torn between two very bad options:

• Reduce wages, which would mean the applicant pool for personal support specialists would include those individuals who might not be as reliable or as committed to caring for those in need as current workers are.

• Stop serving MaineCare clients completely and/or close their personal support specialists businesses.

Because of ethics and morals, we do consider the first choice to be viable. That leaves the second option, in which providers would be forced to lay off hundreds of staff and close their doors, having significant ramifications throughout the Maine economy. If we lose this service, these workers are gone, and the goal of aging in place in Maine will become a myth.

Our nursing facilities don’t have enough room now for those who need care, and too many people are on waiting lists because workers can’t be found to care for them in their homes.

The only positive solution to avert this pending crisis is to increase the 15-year stagnant reimbursement rate so providers and direct care workers can return to caring for our elderly community members in their homes, which is most the cost effective and best way to age in place.

Gerard Queally is president and CEO of Spectrum Generations. Steve Farnham is executive director for the Aroostook Area Agency on Aging.