In her column this week, Senator Susan Collins reminds us that November is National Home Care and Hospice Month, which recognizes the crucial role of “highly skilled and compassionate home care” to our nation. Some local home health workers may think Collins’ reminder of their unique contribution is particularly timely.

Effective November 12, some area home health workers who provide companion care will be receiving a wage “adjustment,” according to Kathy Bean, Director of Miles and St. Andrews Home Health and Hospice. The adjustment translates to a pay cut for affected employees.

Bean said the move was necessary to offset a budget deficit in the companion care program and returns to a pay formula that was in place in 2009. She said the wage adjustment will save her program between $28,000 and $30,000 in this fiscal year and will affect about 28 workers. Staff would have faced layoffs without these cuts, she said.  

Important work, poor compensation

Companion care workers, also known as personal support specialists, provide a variety of services to the elderly and sick that allow them to stay in their homes. These workers help with bathing, dressing, errands, housework, transportation and meal preparation.

For loved ones, companion care brings peace of mind that someone is checking in when they cannot. For primary care physicians, home health workers can be their eyes and ears, alerting them to early signs of problems. Not only does helping people stay at home reduce healthcare costs, it's often the key to the emotional well-being of many patients.

While critical to so many, home health jobs are not well paid. A 2009 New Hampshire study reported the hourly wage of home health workers averaged $10/hour in 2008 and concluded the pay level “fell short of a livable wage.”

The survey also showed that low pay was a key factor in the high rate of job turnover. High turnover rate is not only costly to employers, more importantly, it means a break in continuity of care for patients.

A quick survey of online advertisements for personal support specialists (PSS) in Maine showed many with starting salaries of $8.35. Indeed.com, a national employment company, estimates average wages for specific jobs based on job advertisements over the last 12 months. For personal support specialists in Maine, they estimated an average yearly wage of $19,000, which equates to an hourly wage of $9.13.

MIT’s Living Wage Calculator suggests that a single adult in Lincoln County needs $9.32/hour to live, while a single parent with one child needs $20.48/hour. According to these data sources, the average companion care worker is not making a livable wage in Maine.

Bean would not release pay rates for home companion workers or the range of wage adjustments that will be enacted this month, but said Lincoln County Healthcare’s wages were consistent with the market. “Market data are used to calculate wages, we pay more than most for the PSS employee, plus they get mileage and shift differentials,” she wrote in an email.

Why the wage adjustment

Bean said the reasons for the change are complicated. The Hospice and Home Health program consists of three separate divisions: private companion (in home), professional (nursing home) and hospice care. There are also three levels of home healthcare workers: personal support specialists, certified nursing assistants and home health aides (from lowest to highest level of training). For the last few years, these workers have been paid at rates commensurate with their skill level no matter where they worked in the program.

Bean said the professional and hospice programs have seen patient numbers and the need for workers halved, while companion care volume has doubled since 2009. Many of the more highly trained full-time employees, who had worked primarily in professional and hospice care, are now working more hours in companion care. They carried their higher pay rate with them to companion care work.

Bean said in gearing up for this fiscal year she needed to find a way to balance last year’s budget deficit. “Rather than cut positions to make this a sustainable program, we went back to what we were doing in 2009 and that was separate wages for separate jobs.

“If you are working in companion care, you get paid a PSS wage,” Bean said.

Bean said she did not consider any wage adjustments for herself or other administrative or nursing staff. She said when the Miles and St. Andrews programs merged in 2008, she had to cut 11 positions. “I did not get a pay cut but I no longer have six people helping me with the job that I do,” she said.

To date, Lincoln County Healthcare has not proposed wage cuts for its employees to balance deficits, but all employees have lost some earned time benefits. Bean said this latest wage change corrects an earlier wage adjustment. “We made a change in the wage structure two years ago that allowed these employees to be paid above their pay grade. Now, we have adjusted the pay rate to reflect the job they are working,” she said.

Lincoln County Healthcare relies on market data (salary data for similar positions in similar-sized organizations) to set wages for its employees, including its top administrators.

A market-based approach to wage setting is a rational and easily-defended method, but is it fair? For Lincoln County Healthcare’s top ten earners, whose total compensation package in 2010 ranged from $150K to $400K, the market works in their favor. But for home health workers, whose job health experts agree is valuable to patients and keeps healthcare costs down, the market is a poor estimator of worth.

Bean said the local healthcare organization is “struggling” in the current economy. With wages that are barely livable, home health workers are undoubtedly struggling as well.

Sue Mello can be reached at 844-4629 or sumello@boothbayregister.com.