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DOVER-FOXCROFT, Maine — Janet Flaherty got an alarming call last October from the agency tasked with coordinating in-home care for her 82-year-old mother. It could no longer send her mom’s home caretaker. It knew of no other aides who could care for her mother, either.
Flaherty’s mother, Caroline, has for two years qualified for in-home care paid for by the state’s Medicaid program. But the agency could not find someone to hire amid a severe shortage of workers that has crippled facilities for seniors across the state.
With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.
“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Flaherty, an insurance saleswoman.
Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces — the growth of the retirement population and a simultaneous decline in young workers — that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent.
The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.
“We have added an entire generation since we first put the safety net in place but with no plan whatsoever for how to support them,” said Ai-jen Poo, co-director of Caring Across Generations, which advocates for long-term care. “As the oldest state, Maine is the tip of the spear — but it foreshadows what is to come for the entire country.”
Last year, Maine crossed a crucial aging milestone: A fifth of its population is older than 65, which meets the definition of “super-aged,” according to the World Bank.
By 2026, Maine will be joined by more than 15 other states, according to Fitch Ratings, including Vermont and New Hampshire, Maine’s neighbors in the Northeast; Montana; Delaware; West Virginia; Wisconsin; and Pennsylvania. More than a dozen more will meet that criterion by 2030.
Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.
Experts say the nation will have to refashion its workforce, overhaul its old-age programs and learn how to care for tens of millions of elderly people without ruining their families’ financial lives.
The results of not doing so fast enough are already visible in Maine. At the Hibbard Nursing Home in a rural slice of the state, Beth Lagasse cried softly as her father recovered down the hallway in Room 113.
Lagasse’s mother broke her back in May and died in June. Her father suffered a stroke in July. The nursing home near her has no open beds, so she drives an hour every day to care for her ailing father after spending months caring for her mother.
Lagasse has not been able to read a book, go canoeing or take care of her 1-year-old Shetland puppy, Paddy, since her mother first got sick. Lagasse, a physical education teacher, and her three siblings cannot afford the cost of 24/7 care, although Medicare temporarily covered her father’s hospitalization.
“I love them. I love them dearly,” Lagasse, 55, says of her parents. “I just wish this weren’t so hard.”
Over the past two years, Mark Honey’s rare form of muscular dystrophy has proved so debilitating that he has lost control of his hands, legs and arms. Living alone in the small town of Ellsworth, Maine, Honey, 63, has for about 18 months looked for a nursing home where he can receive 24-hour care.
But with nursing homes across Maine closing at an unprecedented rate, Honey has been unsuccessful. Medicaid pays for a care aide to come to his home for 70 hours a week. But the state has told Honey it cannot find enough workers to cover the hours, even though he legally qualifies for the care.
Care workers in Maine were paid about $11.37 an hour in 2017, according to an AARP report, with a 2019 minimum wage of $11 an hour. As Kristi Penny, who has cared for Honey for four years, noted over the phone: “Even Dunkin’ Donuts pays you more.”
Honey said he lives in fear of one of the caretakers getting sick and quitting or finding another job. “When you’re confined to a bed, there’s not much you can work with,” Honey said. “It only takes one or two of the girls being sick, or one of the two of them quitting, for me to not be covered. And then you’re up the creek without a paddle.”
With its 65-and-older population expected to grow by 55 percent by 2026, Maine needs more nurses, more home-care workers and more physicians than ever to keep pace with demand for long-term-care services.
But the rising demand for care is occurring simultaneously with a dangerously low supply of workers. About one-third of Maine’s physicians are older than 60. In several rural counties in the state, close to half of the registered nurses are 55 or older and expected to retire or cut back their hours within a decade.
Maine’s largest long-term-care provider, North Country Associates, has been forced to temporarily close admissions in each of its 26 nursing homes because of staffing shortages, sometimes for as long as several months, in an unprecedented change from a few years ago.
It has also permanently shut down two of its nursing homes over the past year, while about a dozen nursing homes across the state have closed their doors over the past several years. Mary Jane Richards, chief operating officer at North Country Associates, said she has already raised wages four or five times in a bid to hire or retain staff.
“There are simply just not enough people to go around,” she said. “We try to elevate our wages, but then the nearest facility brings theirs up.”
Betsy Sawyer-Manter, president of the SeniorsPlus agency responsible for placing care workers with Medicaid enrollees, said she was not surprised by Flaherty’s story of failing to find a worker for her mother, despite qualifying for care. Sawyer-Manter said that every week her agency cannot fill more than 6,000 hours of direct care that have been authorized by the state because of worker shortages.
“If there aren’t any workers in that area, there’s nothing we can do,” Sawyer-Manter said. “As people retire, we just don’t have enough workers to do all the jobs we need done.”
From 2015 to 2050, the number of Americans 85 and older will increase by more than 200 percent, while those ages 75 to 84 will rise by more than 100 percent, according to AARP. By contrast, the number of Americans younger than 65 will increase by about 12 percent.
America’s federal programs have not kept pace with this enormous demographic shift. With a few minor exceptions, Medicare does not pay for long-term-care services. Medicaid offers limited benefits but is available only to the very poor. The private market also has not been able to fill the void, as 7 percent of costs in the long-term-care market are covered by private long-term insurers.
The United States is projected to have 7.8 million job openings for care workers by the middle of the next decade, making it among the fastest-growing professions in the country, with millions of new openings created by higher demand; millions of care workers retiring; and millions more finding new professions, according to the Paraprofessional Healthcare Institute, an advocacy organization. The total cost of caring for America’s elderly will double from $2.8 trillion to $5.6 trillion by 2047, a report by the consulting firm PwC found.
“The U.S. is just starting this journey, and Maine is at the leading edge,” said Jess Maurer, executive director of the Maine Council on Aging. “As we are living longer, all the systems that have always worked for us may have to be changed.”
Congress created a commission to study the long-term-care problem. In 2013, it issued dozens of recommendations, including a “national strategy” to help family caregivers, but “a fair number of these things have not been implemented. Those that have been implemented are being implemented far too slowly,” said Bruce Chernof, co-author of the commission’s report and president and chief executive of the SCAN Foundation, which advocates on long-term-care issues.
“Left unaddressed, this will be catastrophic. We as a country have not wrapped our heads around what it’s going to take to pay for long-term care,” Chernof said.
Other countries have responded to their aging populations with government-provided care, and many have beefed up the number of aides and providers. America and England are the only economically developed nations in the West that do not provide a universal long-term-care benefit, said Howard Gleckman, author of a book about long-term care and a senior fellow at the Urban Institute, a nonpartisan think tank.
“With climate change, towns get burned down, or people die in fires,” which helps focus national attention, Gleckman said. “This is one family at a time suffering in silence.”
Albert Rose sits on the wharf of his seafood business and fumes that he cannot find help with his daily work of moving and unloading 50 crates of lobster, each often more than 100 pounds. In Harpswell, median age 57, he lives in the oldest town of America’s oldest state.
Rose, 40, has suffered from two torn rotator cuffs and a herniated disk but continues to perform the heavy labor himself in part because he has for the past five years been unable to find young workers, absent sporadic help from college students during their summer vacations.
“Ten years ago, every spring you had young people wanting work on the wharf or want to work on a lobster boat,” Rose said. “I haven’t seen a single person this spring or summer looking for boatwork.”
Maine’s aging population, and its dearth of young workers, falls particularly hard on poorer businesses and parts of the state that do not have enough resources to compete amid the shortfall.
Piscataquis County, a region in the north battered by the closure of its lumber mills, will see the number of people ages 75 to 84 increase by 81 percent from 2015 to 2025, according to the Muskie School of Public Service at the University of Southern Maine.
The biggest impact likely is in health care for the elderly.
There are 34 physicians in the county, about 70 percent less than the state average per person, and fewer available nursing home beds per person, according to a Maine Health Access Foundation report. Half the physicians in the county are older than 50, as are half the nurses.
Stepping into the breach is Pine Tree Hospice, one of the few dozen volunteer hospices in the United States. The hospice’s volunteers do not provide medical services, but they go to the homes of patients in end-of-life care, cooking, cleaning or playing a game of cribbage. About one-quarter of the volunteers are themselves in their 70s. They like reciting the hospice’s motto: “We can’t add years to your life, but we can add life to your years.”
When Jane Stitham began as the executive director of the hospice about a decade ago, she urged as many elderly people as possible to call for free end-of-life care. But over the past two years, Stitham said, the hospice has shifted its focus to recruiting new volunteers, as its waiting list has grown dramatically. Every month, Stitham has to turn away one to two people whom the hospice cannot reach.
“There are far too few younger people in the mix of volunteers,” said Meg Callaway, who ran a program in the county focused on helping older people.
Cliff Singer, who runs an Alzheimer’s clinic in an isolated northern region of the state, said his waiting list has more than doubled to 70 people, meaning it takes 10 months for patients to see him. Singer is trying to hire nine nurses, which would allow him to cut his waiting list dramatically, but he only has three, in part because of fierce competition from other hospitals and clinicians.
“It feels awful not to be able to help more people,” Singer said. “But we really can’t.”