Every Thursday morning, 55-year-old personal assistant Maureen Egan of Rockport drives to Camden to spend a few hours with her client, an elderly lady who lives who lives on a quiet side street with her small dog. At 77, Egan’s client suffers from mild dementia and needs a little help with the routine business of life — meals and housework, shopping, transportation and so forth.
“She has someone with her every day,” Egan said, including a registered nurse from a nearby agency who visits weekly to set up medications and other agency staff who help with personal care.
Egan doesn’t work for an agency and has no formal health care training. She was hired as a companion and a driver. Sometimes that means sitting together at the kitchen table working on an art project or composing poetry. Sometimes Egan helps her client pay her bills or organize her home, which is filled with the eclectic accumulation of an interesting life.
Sometimes they hop in the car and go to a knitting circle, a mahjong group or a medical appointment. Then they might do a little grocery shopping or have a bite of lunch someplace.
“My clients are really more like friends or family,” Egan said. That’s the way she likes it, and her clients like it, too. She has been doing this work for about 10 years and has no shortage of customers despite never advertising her services.
“It’s all by word of mouth, but more people call me than I have time for,” she said. She charges $25 per hour and currently spends time with Gail and two other clients in the midcoast area.
All across Maine, families struggle with keeping elderly parents and other loved ones safe in their own homes. Each situation is different, but in many cases, bringing in a professional caregiver is part of the solution, whether it’s for skilled nursing services such as wound care or medication management; for hands-on personal care such as bathing and dressing; or for companionship, social activities, home management and transportation.
While there are dozens of home-care agencies in Maine that provide such services, sometimes reimbursable by Medicare, Medicaid or private insurance, a small cadre of caregivers like Maureen Egan work for themselves, getting paid out of pocket to provide the help aging Mainers need to maintain their independence. In the process, they often make deep and satisfying personal connections that may mean more than the income they earn.
For 68-year-old Joanne Ricca of Searsmont, who worked for many years as a nurse practitioner before retiring at 65, accepting a position as a personal assistant to Maggie and John Foskett of Camden was a life-changing decision.
Ricca years earlier had nursed her parents through their old age and death. She’d been friends with Maureen Egan for many years and knew of her work with the elderly in the midcoast. “It was clearly so meaningful to her,” Ricca said. “One day I told her, ‘If you ever have too much work, pass it on to me.’ I really missed my parents and having old people in my life.”
Not long after that conversation, Egan contacted her with a “perfect match” — an elderly couple, the Fosketts, who had recently given up driving but were still deeply engaged in the community and needed someone to help from time to time with transportation and other logistics.
“I went in and met them. They were the most amazing couple. It was love at first sight for all of us,” Ricca said. “They didn’t hire me because of my nurse practitioner skills; they hired me because they thought I was fun to be with and could enjoy things like going to a museum with them.”
They paid her $25 per hour. “I would think, ‘I can’t believe I’m getting paid for this,’” she said.
She started in 2012 as their driver but soon found herself also helping Maggie Foskett, who was an artist, prepare for exhibits and other events. She picked up a little cooking and other tasks around the house as needed. Over time, Ricca’s clinical background came into play. Her clients began asking her to not only drive them to their medical appointments but also to accompany them, take notes and help them navigate the complexities of the health care system.
“I essentially became their health care advocate, which I think just about everyone needs these days,” Ricca said. Because of her training, she also was able to step up and handle medical situations as they arose. That role also put her in close contact with the Foskett’s adult children, including their daughter Kate O’Neill, a retired nurse who lives in southern Maine.
“[Ricca] started out as a driver and a helper, but it morphed into something much larger than that,” she said. Ricca’s growing intimacy with her parents gave her and her siblings, who all live at a distance, enormous comfort. “It was a lovely, satisfying, rewarding relationship for all of us.”
Maggie Foskett died at 95 in 2014, and John at 97 in January. Ricca feels their loss acutely. “After my parents died, I didn’t think anyone would ever love me that way again,” she said. “I would have done anything for them.”
At the Home Care & Hospice Alliance of Maine, a trade association representing home care agencies, executive director Vicki Sebell said paying out-of-pocket for private caregivers is not an option for everyone.
“Maine is not a very wealthy state. Obviously, this is not a choice that’s available to the majority of people who need care,” she said. Medicare and Medicaid will pay for many in-home services, she noted, though there are long waiting lists for some programs.
For Mainers who can afford to pay $25 or more per hour, many agencies provide private-duty staff, including registered nurses, personal care assistants, housekeepers and more. Those employees typically earn about half what the agency charges and enjoy benefits such as paid time off, a predictable schedule, inservice training and insurance that covers both professional liability and workers compensation in the event they are injured on the job.
In addition, Sebell said, agency staff undergo background checks for criminal history or other security problems.
All that structure and regulation protects clients, staff and the agencies themselves, but for many clients and their caregivers, the noncorporate, personal approach holds more appeal. Another option is the hyper-local agency, such as Coastal In-Home Care, a tiny new agency developed by 65-year-old Sally Davis, who also lives in Camden.
After retiring from a career in elementary education, Davis took a job as the activities director at Camden Hills Villa, an independent-living apartment complex for seniors in one of Camden’s refurbished old mills.
Now she comes and goes there as a privately paid caregiver, providing nonmedical services, including assistance with bathing, dressing and taking scheduled medicines, to a handful of residents as well as to others who live nearby in their own homes. Concerned that she might be at financial risk if there were ever an accident, she recently formed the agency, which now boasts two part-time caregivers in addition to herself.
“I didn’t want to lose everything I had,” she said, explaining her decision to establish the legal entity of the agency. But she retains the personal connection and commitment she felt when she first started, values and sentiments she learned while caring for her own aging parents. Family dynamics can be tricky, she said, and it is often easier for an outsider like her to provide loving, respectful care to an older person that it would be for a family member.
Davis usually charges $25 per hour and pays her staff about $13. She conducts background searches on her staff unless they have already been vetted by a larger agency or other employer. All her clients have been referred by other clients or their family members
Everyone interviewed for this story said the word-of-mouth approach works well in protecting clients from unscrupulous individuals posing as private homecare providers. That below-the-radar network of trust can be hard to tap into, said Kate O’Neill, but it’s worth making the effort.
When her father and mother were wintering in Florida, she found a local caterer who would deliver meals to their home twice a week.
“One day I asked the caterer if she knew anyone who would be interested in driving for my parents, and she said her brother would be good,” O’Neill said. Out of that chance connection grew a warm, personal friendship that lasted the rest of her parents’ lives and endures now.
On the other hand, she noted, working with an agency is no guarantee of security. When her father was nearing the end of his life and receiving 24-hour care in his Florida home, one of the agency staffers stole her mother’s wedding ring. “It was really quite devastating,” she said. “The agency promised to look into it, but we never heard anything more.”