Maine Caregiver Shortage and Home Care Staffing

Your parent qualified for MaineCare. They passed the Maximus assessment. Their care plan authorizes 25 hours per week of personal support. And now nobody can find an aide to fill those hours. This isn't a rare outcome in Maine — it's the normal one.

The Scope of the Problem

The numbers from state reports show how widespread understaffing has become:

Under MaineCare Section 96 (personal care services), the proportion of approved enrollees who are only "partially staffed" — meaning they have authorized hours but their agency can't fill them — rose from 47% in November 2022 to 62% in late 2023.

Across all OADS (Office of Aging and Disability Services) home care programs, 71% of enrollees receive fewer hours than their care plans authorize. That means nearly three out of four people approved for home care are getting less than what a clinical assessment determined they need.

This isn't a billing delay or a paperwork issue. These are real people approved for real care hours who sit in their homes without the help they were promised.

Why Maine's Shortage Is Particularly Severe

Several factors compound in Maine:

Low wages relative to alternatives. Personal support specialists and certified nursing assistants earn wages that compete poorly with retail and food service jobs that don't require personal care duties. When a PSS can earn comparable pay stocking shelves at a grocery store without the emotional weight of caregiving, the labor supply tilts away from home care.

Geographic isolation. Maine is the most rural state in the country east of the Mississippi. In counties like Aroostook, Washington, and Piscataquis, an aide may need to drive 30 to 45 minutes each way to reach a client. That travel time is largely unreimbursed under current MaineCare rate structures — the aide is working for free on the road.

Reimbursement rate mismatch. The structural problem is most visible under Section 96, where care coordination is reimbursed on a per-minute model paying agencies roughly $35 per client per month. Section 19 care coordination pays a flat $158 per client per month. This difference caused SeniorsPlus and several other regional agencies to stop accepting new Section 96 care coordination referrals entirely — a $600,000 shortfall in a single fiscal year wasn't sustainable.

Aging workforce. The caregivers themselves are aging. Recruiting younger workers into a physically demanding, modestly paid field with irregular schedules has proven persistently difficult across all Maine regions.

What Happens When Hours Go Unfilled

When approved care hours go unserved, the consequences fall on family members:

• An adult daughter who works full-time picks up the 15 hours per week that should have been covered by an aide
• A spouse in their 70s provides heavy lifting and transfer assistance that puts their own health at risk
• Safety incidents increase — falls, medication errors, dehydration, and malnutrition happen during the uncovered hours
• Family caregivers burn out, and the person they're caring for ends up in the hospital or a nursing home — the exact outcome the waiver programs were designed to prevent

Strategies for Families

Passive waiting doesn't work in this labor market. Families who actually get care hours staffed tend to take an active, multi-pronged approach:

Self-Directed Care

Under the Section 19 Participant-Directed Option or Section 12 CDAS, your parent becomes the employer and hires their own personal support specialist. This bypasses the agency staffing bottleneck entirely. Adult children, nieces, nephews, and other eligible family members can be hired. Spouses, parents or stepparents of a minor child, and other legally responsible relatives cannot. A fiscal intermediary such as Alpha One handles payroll, background checks, and tax withholding.

The self-directed path requires more administrative involvement from the family — but when agencies literally have no one to send, it may be the only path that produces actual care hours.

Contact All Regional Agencies Simultaneously

Don't wait for one agency to respond before trying others. Each of Maine's five Area Agencies on Aging connects to different personal care agencies. Call 1-877-353-3771 for the statewide ADRC, then contact your regional AAA directly:

• Aroostook Agency on Aging — 207-764-3396
• Eastern Area Agency on Aging — 207-941-2865
• SeniorsPlus — 207-795-4010
• Southern Maine Agency on Aging — 207-396-6500
• Spectrum Generations — 1-800-639-1553

Layer Multiple Programs

Use MaineCare for your parent's primary care hours, then supplement with the State Caregiver Respite Program ($4,500/year in respite reimbursement for dementia caregivers), adult day services (roughly $80/day and often available when home aides aren't), and volunteer companion programs through your local AAA.

Make the Position Attractive

If you're hiring a PSS directly through self-directed care, competing for workers means offering what agencies often can't: consistent hours (not split shifts), reliable scheduling, a reasonable commute, and respectful working conditions. Workers choose positions, and predictability matters as much as pay.

The Maine Home Care, Waivers & Support Guide includes a self-directed hiring checklist that covers the enrollment process, background check requirements, and a caregiver agreement framework for families choosing to staff their own care plan.

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