Frustrated with used needles littering city streets, some local officials have called for renewed restrictions on syringe service programs, which they say contribute to the recent rise in needle waste.

But harm reduction experts say the needle waste — and high rates of infectious disease among injection drug users in Maine — is evidence that these programs should be expanded, not restricted.

Syringe service programs offer supplies, including sterile needles, naloxone and fentanyl, and xylazine test strips, to people who inject drugs, with the goal of reducing overdose deaths and disease outbreaks.

The programs also help connect people to services and serve as a critical “touch point for people who are otherwise marginalized from the health care system,” said Dr. Robin Pollini, an epidemiologist and harm reduction expert at West Virginia University.

Maine’s first syringe service program, The Exchange, operated by Portland’s public health department, opened in 1998 and remains the only municipally run program in the state. The Maine Center for Disease Control and Prevention certifies the programs and the sites where they can operate. Although program operators must provide notice of their intent to file for certification, municipalities do not have a role in the certification process, which has led to complaints from some city leaders that programs pop up in their towns with little to no consultation.

As of last year, 13 of the 32 certified programs were in operation statewide, according to the Maine CDC’s latest annual report. While some programs have been in operation for over a decade, the majority — eight of the 13 that are active — opened within the past four years.

For more than two decades, state rules limited programs to a 1-for-1 exchange, meaning they could only provide one sterile syringe for every used one a person brought in. In late March 2020, Gov. Janet Mills suspended that rule and made it so that programs could adjust their hours without state approval and operate anywhere within the county in which they were certified. The rule change also allowed them to mail supplies.

Mills’ executive order acknowledged that the public health emergency posed “substantial barriers” for clients to access syringe service programs and cited a desire to maintain a continuity of services during the COVID-19 pandemic.

The change was hailed by the American Medical Association, which urged other states to adopt similar policies. At the time Maine had 11 certified programs operating in 10 cities — Portland, Ellsworth, Bangor, Machias, Belfast, Calais, Augusta, Waterville, Sanford and Lewiston. Most programs quickly relaxed their rules. Maine Access Points, which at the time operated programs in Sanford and Calais, started a mail-order program. But Portland doubled down on the 1-for-1 policy and refused to loosen its rules for more than a year.

In September 2022, shortly after Mills’ order expired, the Maine Department of Health and Human Services adopted a 1-for-100 rule that allows programs to distribute up to 100 more needles than a person turns in. If someone turns in 20 used needles, for example, they can get 120 sterile needles. If someone doesn’t have any used needles, they can still get up to 100 sterile needles. 

But in the past few weeks Portland Mayor Mark Dion and Sanford city manager Steve Buck called for a return to the 1-for-1 rule.

In a Sept. 12 op-ed in the Portland Press Herald, Dion said “needle waste is a public safety hazard of our making” and that he would introduce a resolution to the city council next month to go back to 1-for-1. (Dion previously supported loosening restrictions on The Exchange in 2021.)

Over the past decade, enrollment in a syringe service program has almost doubled. Last year nearly 8,400 people were enrolled in a program, a 25 percent increase from the previous year. Accompanying this boom was a dramatic increase in the volume of syringes that the programs distribute and collect every year.

In 2023, the 13 programs distributed nearly 3.7 million sterile syringes — four times the amount they distributed in 2019 and seven times the 2013 amount. They collected about 3.2 million used syringes, or 86 percent of what they distributed. Before the pandemic and the rule change, programs typically collected the same number of syringes they gave out every year, or more.

Dion and Buck said the high volume of syringes that programs distributed and the discrepancy between the number collected explains the uptick in needle waste on city streets.

Portland’s two programs, The Exchange and commonspace, distributed nearly 1.4 million syringes last year. That was more than double the next-highest total distributed in a single city, though the number of people enrolled in either Portland program accounts for 43 percent of the enrollees statewide.

Together, The Exchange and commonplace collected about 294,000 fewer syringes than they gave out.

Residents have complained about improperly discarded syringes in public spaces for years, even before the city loosened its 1-for-1 rule. At a March 2021 health and human services committee workshop, Marie L. Gray wrote, “As a longtime resident of the Parkside neighborhood and an avid walker, the issue of randomly discarded needles is a major concern. Unfortunately it is almost impossible to take a walk through the neighborhood and not see several discarded needles.”

At a West End Neighborhood Association meeting earlier this month, Rich Bianculli, echoing complaints from other residents, said the situation is, “kind of a nightmare,” the Press Herald reported.

Buck, the Sanford manager, in a memo to the city council earlier this month, estimated that after the city sweeped a homeless encampment in mid-June, workers collected about 14,700 used syringes. The encampment, which had been there for about a year, was located next to the syringe service program operated by Maine Access Points.

Last year, MAP distributed 460,720 sterile syringes and collected 441,998 — a difference of roughly 20,000. Buck claimed most of those missing needles were found in the encampment clean-up.

He attached several photos taken in August that showed needles strewn about at public parks around the city.

“The City recognizes a public health crisis exists due to the extraordinary number of inappropriately discarded contaminated needs that puts people at risk of becoming infected by the very pathogens the program seeks to reduce,” Buck wrote.

But some advocates say the problem shows there’s not enough access to syringe service programs.

“To me, what that says is there is not enough access,” to programs, where people can hand in their used syringes and learn more about safe disposal techniques, said Zoe Brokos, Church of Safe Injection’s executive director.

“It doesn’t mean reduce access to syringe service programs or cut off somebody’s safe supply of sterile equipment because the only thing that does is increase disease transmission.”

A 2019 study found that improperly disposed needles in publicly accessible areas of Miami decreased by 49 percent after a syringe service program was established there — in part, researchers suggested, because people injecting drugs had a safe place to dispose of used needles. Several other studies linked syringe service programs to less needle litter and a higher inclination to practice safe disposal among the people who use the programs.

According to the U.S. Centers for Disease Control and Prevention, new users enrolling in these programs are also far more likely to enter treatment and stop using drugs altogether compared to those who don’t enroll. Last year, syringe service programs in Maine made more than 26,100 referrals to various services, such as primary care and housing assistance, more than double the amount in 2022.

Gregg Gonsalves, a Yale University epidemiologist and public health policy expert, suggested approaching needle waste as its own issue, rather than as a symptom of syringe service programs.

“The cost of instituting a clean-up program in these jurisdictions, in these cities and these towns, is far, far less expensive than paying for the lifetime medical costs for somebody who is HIV positive or HCV positive,” he said. “The economic argument is just unequivocal.”

“The point is that (needle waste) is a resolvable issue. We can resolve it in a pretty simple way by enhancing sanitation efforts.”

The executive directors of Maine Access Points, Church of Safe Injection and Wabanaki Public Health and Wellness all told The Monitor that their staff regularly does syringe clean-up in their communities.

There are no sharps containers — metal boxes where people can drop used syringes — in Sanford, said Anna McDonnell, MAP’s co-founder and interim executive director. That’s why MAP is installing its own sharps container that is accessible 24/7.

Closing or restricting syringe service programs only means more infections at a time when infectious diseases, particularly among people who inject drugs, is at an all-time high in Maine and around the nation, advocates say. Maine had the highest rates of new hepatitis A and C cases in the country in 2022, the latest year federal data is available. It had the third-highest rate of new hepatitis B cases, according to the U.S. CDC.

There is an historic cluster of HIV infections in Penobscot County that was first identified last October. Two of the three initial people diagnosed in the cluster reported they were unhoused and shared or reused equipment to inject drugs. As of Sept. 21, a total of 13 people were diagnosed with HIV; all of them were also diagnosed with hepatitis C and all of them reported recent injection drug use. Eleven were currently or recently unhoused.

“I think one of the things that really gets confused is the conversation around syringe litter. It’s really a conversation about housing, about housing access and about supporting people who are unhoused,” McDonnell said.

“We serve a lot of folks who are housed and who don’t have an issue with safely disposing of their syringes. And so the conversation really shouldn’t be about the efficacy of the syringe service programs or how well we’re able to do our job. It’s really about the conversation around people who are homeless, being displaced and not having anywhere to kind of have their belongings or deal with their waste safely.”

Over the past five years, Penobscot County averaged two new HIV diagnoses per year, one of which was a person who uses drugs, according to the Maine CDC.

As the number of cases grew earlier this year, a third syringe service program in Bangor, Needlepoint Sanctuary, was certified to operate up to three sites in the city, as well as one each in Waterville and Milo, according to the executive director, Willie Hurley.

But the city has repeatedly rejected the organization’s proposed locations, most close to homeless encampments, or in or near public parks. They have yet to reach a solution and the program is limited to doing mobile outreach within the city’s homeless encampments, which it has already been doing for years, Hurley said.

“The last thing you want to do is restrict” syringe service programs while in the midst of an HIV outbreak, said Pollini, the West Virginia epidemiologist. Limiting the number of syringes a program can distribute is “virtually ensuring that people are going to share or reuse syringes, and that doesn’t serve any of us.”

Although more and more people visit Maine programs, the number a person typically makes has stayed roughly the same for 15 years, at three to four times per year.

In 2023, enrollees in a Maine program exchanged an average of 102 used needles for 118 sterile ones at each visit. Ten years ago, people exchanged an average of 38 needles.

Dion, in his op-ed, suggested that providing 100 needles simply provides multiple “changes for addicts to taunt the finality of their own lives.”

But experts — including from the U.S. CDC — say a needs-based program is best practice, especially since fentanyl has proliferated the state’s drug supply.

“Fentanyl has a very short half-life and people are injecting a hell of a lot more than they ever used to,” said Whitney Parrish-Perry, MAP’s former operations director. One person could easily go through five to 10 needles in one day.

“People assume that if you don’t give people who inject syringes, they won’t inject drugs. And that’s patently false. People are going to inject whether you give them sterile syringes or not,” Pollini said.

“The question is not, will they inject or not inject? The question is, will they inject with a sterile syringe or a used syringe?”

Providing people with sterile syringes has not been shown to increase overdose risk. And each time a syringe is reused or shared, the risk of acquiring blood-borne infections increases, as does the potential to develop serious and life-threatening bacterial infections, Pollini added. Xylazine, an animal tranquilizer that has been growing in prevalence in Maine’s drug supply, is also known to cause necrotic wounds, which can lead to infections.

Advocates say these programs also help by reducing health care costs: nationwide, hospitalizations and lifetime medical costs for infections associated with injection drug use cost hundreds of millions of dollars annually.

Those deaths — “where someone sits in the hospital for three months and slowly dies of sepsis,” Brokos said, “those get completely forgotten in these conversations.”

Seven years after a Maine Cancer Foundation study identified transportation as a major barrier to treatment for cancer patients in the state’s most rural areas, the same communities are still struggling with long travel times to treatments. 

Since 2017, Maine has lost several cancer treatment centers, including the closure of the oncology practice at St. Mary’s Regional Medical Center in Lewiston in July 2023. The state has just a handful of radiation treatment sites, mostly in southern Maine.

The number of practicing oncologists has stayed roughly steady, with 76 practicing in 2017 and around 71 in 2024, according to state licensing data, and services are still concentrated in the southern region.

Aroostook and Washington county patients must travel on average more than 100 miles for inpatient cancer care, and two of the counties with the highest rates of deaths from cancer — Washington and Somerset — are without a single oncology practice. 

“You’re fighting just to survive to get to your treatment,” said Angela Fochesato, the director of the Beth C. Wright Cancer Resource Center in Ellsworth.

Mainers are at a significantly higher risk of developing and dying from cancer than the national average, with rural residents most at risk, according to a recent report on cancer in Maine. 

While the rate of Mainers dying from cancer decreased over the past decade, from 170 deaths per 100,000 people in 2014 to 161 in 2024, according to the Centers for Disease Control and Prevention, rates are still higher than the national average and anywhere else in New England.

There are many factors, including obesity, alcohol, tobacco use and exposure to environmental hazards such as ultraviolet rays, radon and arsenic.

Longer travel times to care can delay early detection of the disease, which has been linked to a higher likelihood of death. 

Traditional treatment plans often require therapies like radiation once a day, several times per week.

For those farther from care locations, these barriers translate to hundreds of dollars in transportation costs and hours of driving. Patients who don’t have access to a vehicle, or those too sick to drive, face additional hardships.

That was the case for Kathleen Bell, who was diagnosed with stage three breast cancer in February 2013 after a mammogram screening following a skiing accident. 

Bell’s husband had passed away two years earlier. She was alone and without the finances to make various appointments in Bangor from her home in Lincoln, a roughly two-hour drive round trip. 

Bell underwent four rounds of chemotherapy every three weeks, lasting 5 1/2 hours each time, and received 36 radiation treatments by the end of the year. 

“My keys were always in the nightstand next to me,” said Bell. “But I was so sick, I knew I couldn’t even move.”

Friends from a local book club drove her for a while. Eventually she was connected with Penquis Transportation Services, an agency with an office in Bangor contracted with the state to provide rides for certain patients with insurance through MaineCare.

“I would not have survived without Penquis,” Bell said. “Without them I would have died.” 

Penquis, one of the primary transportation providers for MaineCare beneficiaries in northern and eastern Maine, made 672,339 trips last year, according to the Bangor Daily News.

More than half – around 350,000 — were part of Penquis’ Accessing Cancer Care program, according to figures provided by Steven Richard, the nonprofit’s director of transportation. 

Penquis spent more than $25 million on transportation services last year alone, roughly 33 percent of its $75 million annual budget. 

“Every pot of money that we manage to find, we’re able to spend pretty quickly,” said Richard. 

Many rides require specialized equipment because the organization works with patients who have mobility issues or require certain medical aids.

“Sometimes they need wheelchair accessibility, sometimes they need us to actually be able to secure additional bottles of oxygen if they’re on a high consumption rate for it,” said Richard. “So those are some of the concerns (we consider).”

The Maine Cancer Foundation provides a large portion of funding for such initiatives. The director of programming, Katelyn Michaud, said the requests for grants have not slowed in her 10 years there.

“We have been investing a significant portion of funds toward transportation for cancer patients,” said Michaud, adding that Mainers would benefit from a more cohesive, statewide approach, particularly for patients who need to leave the state for care. 

“It’s one thing to get a patient from Washington County to Brewer, but then it’s another to get a patient from Washington County to Portland, perhaps, or to Boston,” she said.

Staffing issues at rural hospitals also have posed challenges.

In 2022, Northern Light Cancer Care announced it would not accept new patients at its oncology and treatment center due to staffing shortages. The center, in Brewer, is a vital resource for cancer patients in eastern and northern Maine.

Northern Light Health officials said it’s back at full capacity for oncology services and recently added three medical and two pediatric oncologists.

“We’ve been very successful so that we can support and offer the (cancer) programs and additional capacity,” said Ava Collins, the vice president of oncology services for Northern Light Health. Collins directly oversees the center and cancer care programs. 

“We continue to evaluate the need to strengthen our services and the care we provide to ensure we meet our mission of caring for our community,” Collins said in an email.

But the hospital system still faces deep financial challenges, with the Northern Light Eastern Maine Medical Center president, Gregory LaFrancois, telling employees in an email last month that it is “headed into very choppy waters,” according to the Bangor Daily News. Northern Light has cut back on services in rural areas in recent years, including closing a clinic in Southwest Harbor and shutting down a primary care practice in Orono. 

Advanced trials and collaboration pioneer possible solutions 

Advancements in cancer treatment options have also paved the way for patients to receive care closer to home — or even at home — by increasing access to clinical trials, which can offer expert medical care and cutting-edge treatments.

All of the state’s oncology practices receive guidance from the Maine Cancer Genomics Initiative (MCGI), a collaborative network of providers led by the Jackson Laboratory, a nonprofit medical research center in Bar Harbor.

The initiative, which began in 2017, aims to provide highly targeted cancer therapies to patients statewide. 

“The biggest goal of MCGI is really to help patients get the best care as close to home as possible,” said the program director, Leah Graham.

While the initiative does not replace the need for cancer treatment centers, where patients work with oncologists to create a plan, the matchmaking process can allow some to receive treatments from home. 

“The drugs that target a certain gene mutation that’s found in the cancer are oral therapies,” Graham said. “A lot of the treatments are new. Some physicians have never prescribed them before.”

An observational study by MCGI found that patients who received matched treatment through the initiative were nearly a third more likely to survive the following year than those who did not.

“The great thing about targeted therapy is there tends to be less terrible responses,” Graham said. “They’re less toxic in some ways.”

The American Cancer Society’s Road to Recovery transportation program, which has operated for over 40 years and is another option for cancer patients needing transportation to appointments, has been slow to return to normal capacity and regain lost volunteers after the pandemic.

There are also places like the Beth C. Wright Cancer Resource Center, which recently opened a second location in the small town of Baileyville in Washington County, that coordinates rides to and from appointments. The new center, which does not provide treatment but does offer wraparound services, is aimed at reaching people in the far eastern part of the state, which has some of the highest rates of cancer diagnosis and deaths. 

“That is a hot spot. That’s where a lot of our patient population comes from,” said Fochesato. 

Many, she added, will skip treatment if they think they can’t afford to make it. 

“Some (people) will go without eating to pay for their medication … it’s not pretty,” Fochesato said. 

Despite the closure of treatment centers, Cora Fahy, a breast cancer survivor and MCGI board member, said she feels more optimistic about the future of cancer survivors because of the number of local organizations working to pull together different resources across the state.

“In the nine years, even since I was diagnosed, there’s so much more offered out there,” Fahy said. “I’m very, very, very optimistic about survivorship.”

This article is part of U.S. Democracy Day, a nationwide collaborative on Sept. 15, the International Day of Democracy, in which news organizations cover how democracy works and the threats it faces. To learn more, visit usdemocracyday.org.

As the notion that elections are rigged has taken hold among a subset of Americans, spurred in large part by former president Donald Trump’s refusal to admit he lost in 2020, the processes that have long been central to U.S. democracy have come under scrutiny, and the work done by local government officials responsible for administering elections has become increasingly fraught. 

More than a third of local election officials across the United States have been threatened, harassed or abused for doing their jobs, according to a survey conducted by the Brennan Center for Justice earlier this year.

“I think we’re in a really troubling moment, an inflection point in our nation’s history because there is — and make no mistake, it’s a minority — but it is a small, well-funded, well-organized, very loud faction of individuals seeking to leverage threats of violence and stoking fears to try to upend our democracy,” Maine Secretary of State Shenna Bellows said in a podcast with the Bipartisan Policy Center this summer.

In 2022, following an uptick in threats against election officials across the country, the Maine legislature passed a law that strengthened protections for election workers and mandated that threats be reported. 

“Maine’s elections are some of the best run in the country, and that’s true in no small part because of the hard work and dedication of our local election clerks,” Bellows said at the time. “Protecting our town and city clerks from intimidation or violence protects our elections.”

The secretary of state’s office now offers regular training sessions to teach town clerks de-escalation techniques, something that would have been “unfathomable just a decade ago,” Bellows noted in the podcast.

The increasingly polarized climate has made it harder for election administrators to do their jobs and has even pushed some out of the field. 

“Unfortunately, what you see is it’s led across the country to retirements of some clerks. People have left the field. It’s made it harder, in some circumstances, to recruit people to want to run our elections. And it’s definitely added another element of stress on a job that quite frankly is very rewarding, but also can be pretty high stress,” Bellows said. 

In Maine, municipal clerks play a critical role in administering elections. This summer, between the June state primary and the November general election, The Maine Monitor sat with town clerks across the state — from York to Caribou — to ask about their work safeguarding the right to vote in a changing political climate.

YORK — To Lynn Osgood, an eleventh-generation Mainer, working as the town clerk and tax collector in York is “not a job, it’s a life.” 

Wherever she goes, she expects to get questions: about car registrations, dog licenses, beach permits — and increasingly, elections.

“I don’t go to Hannaford in my pajamas,” she said, letting out a laugh.

Before starting in the clerk’s office, Osgood didn’t realize how many responsibilities there were.

“I had no idea what it entailed,” she said. “I don’t think anyone does.”

And a big part of that is preparing for elections.

This summer, Osgood joined municipal clerks from across the state for a training session at the Augusta Civic Center, in which the Cybersecurity and Infrastructure Security Agency led them through hypothetical scenarios. 

“It was very eye-opening for me about how ill-prepared I am for an emergency at the polls,” she said. “I’ve been so focused on procedure and law, and making sure that, you know, I have the right signatures, I have the right forms, I’ve done the right process in the order that the secretary of state gives me to open the polls, to close the polls, to tally the (votes) — that it never even occurred to me that in an emergency the election must go on.”

Since then she has worked to put together an emergency plan that covers everything from a foreign substance in an absentee ballot to an active shooter, and has designated a secondary location should a fire or other disaster occur. 

“I have a plan in place,” she said. “The training was amazing.”

While Osgood doesn’t think the political climate in York has become as polarized as elsewhere in the country, she thinks she gets asked more about the voting process than her predecessor did. 

“I pride myself on being completely transparent with the whole process. I welcome anyone to come in and ask questions, to see how we do things, why we do things, how we assure the integrity of the election,” she said.

Earlier this year, Osgood said she was invited to speak on the subject at a local Republican committee meeting.

“It was a wonderful opportunity for me to be able to answer questions because they had questions, and they asked the questions, and I answered the questions the best I could. And I was just very honored that they gave me that opportunity,” she said.

One question was about signatures on absentee ballot envelopes and how they are verified, particularly if someone requests an absentee ballot over the phone. She explained that in the software she uses, there’s a “display signature” button to check what’s on the absentee ballot envelope against what’s in the state’s system.

Attendees also asked about voting machines and whether they were at risk of being hacked. She explained the tabulators are not connected to the internet, and are running on software the Secretary of State’s office provides via thumb drive. 

Another question was about whether the ballot box outside the town hall was secure.

“And I explained to them, you know, it’s on video surveillance from the police department 24/7. I’m the only one with the key, and when we go out to get ballots it’s two people at all times. There’s a ballot log that we fill out every time we open that box: who took the ballots out, who witnessed the ballots being taken out,” she said. “So that reassured them there.”

Osgood said it was a long presentation, and the attendees seemed largely mollified.

“I felt listened to,” she said. “And I feel like they got the answers they were looking for.”

GREENVILLE — When voters approach Greenville’s town clerk with sensitive questions, like how to navigate Maine’s new semi-open primary law, they’re likely to hear a reassuring phrase. 

“Tammy Firman is Switzerland,” said Firman, who’s held the position for two years now. “I’m neutral.”

The law that went into effect ahead of primaries this past June allows Maine voters who are unenrolled to select either a Republican, Democratic or Green Independent ballot, voting only in whichever primary they choose. 

That process has election officials like Firman more intimately involved in the partisan side of politics, which, paired with growing mistrust in election officials, has some people on edge, Firman said. 

She sees it as her obligation to reassure them of her objectivity and independence.

“I respect whatever you believe,” Firman said. “We want you to be able to exercise those things without feeling any pressure from us one way or the other.”

Firman and her husband visited the Greenville area for decades, traveling from their home near Virginia’s Blue Ridge Mountains. Shortly after the couple retired in 2022 and moved to Greenville permanently, Firman saw a sign in the town office advertising for the town clerk position.

Firman, who spent her career as a registered nurse, didn’t expect to get as far as an interview but applied because she wanted to give back to a community she’s long admired.

“They must have been desperate because they hired me,” Firman joked.

This November will be Firman’s first presidential election, but she feels confident because she has the guidance of the town’s longtime deputy clerk, Bethany Young, and a capable cast of experienced poll workers.

More than anything, Firman is looking forward to seeing the increased voter turnout that typically comes with presidential elections.

It’s that type of civic engagement that drew Firman to the position in the first place, and she’s excited to see it reciprocated, even if there’s added stress in making sure the tabulation process is followed precisely.

“We really, really go the extra mile to make sure we’re doing everything exactly as we’re supposed to because I don’t want there to be any question in anybody’s mind that we’re doing anything malicious or not right,” Firman said.

“At the end of the day, I know we have done the best we can, and I feel good about that.”

TURNER — For the better part of the past two decades, Rebecca Allaire has helped run Turner’s town business as town clerk, tax collector and treasurer, overseeing everything from elections to tax liens and foreclosures to town payroll.

A lot of work goes into making sure  elections are secure and everyone’s vote is counted properly, Allaire said. But distrust in elections has grown, something she sees as perpetrated by the media.

“People just don’t know the process,” she said.

A few years ago, for example, a person came into the town offices every day during early voting. It’s well within their rights to observe the voting process, Allaire said, but this person kept berating election clerks for not telling voters one thing or another. (At least two election clerks — one from each of the major political parties — are appointed to serve at each voting place, and provide checks and balances during the process.)

Allaire said that once a ballot is handed to a voter, an election clerk cannot answer any questions about the candidates because that could be seen as swaying a voter’s choice.

The same person called the Secretary of State’s office multiple times about the ballot drop box outside town offices. The office investigated and found the ballot box was properly mounted to the wall, locked and tamper-proof. It was deemed secure.

“We were doing everything that we were supposed to do,” Allaire said. “It’s gotten out of control, honestly.”

Making sure elections are secure and everyone’s vote is counted properly all starts far in advance of election day, when Allaire hands out nomination papers for local candidates and confirms that every signature on the returned petitions belongs to a registered voter in town.

Clerks must account for every ballot sent out for absentee voting. Returned ballots are kept in a sealed box in a vault.

Counting absentee ballots takes three or four people — one person checks off the name on the envelope on voter rolls, another opens the envelope and the last person feeds the ballot into the voting machine — so everyone’s vote is kept confidential.

Allaire must end election day with the same amount of ballots as the start.

The tenor of the election usually depends on who the candidates are, Allaire said. She’s worried this upcoming election will be the worst when it comes to rigged election conspiracies.

“It’s very, very difficult — almost impossible to (rig elections) in the state of Maine because of all the precautions that the secretary of state has in place,” said Allaire.

Allaire said she treats everyone with the same respect. Their feelings are valid, she said, so when someone comes in with a question about election security, she takes the time to explain it to them. Most of the time, that quells their concerns.

“I get it. I can understand, you know, (with an) absentee ballot how do they know that I’m not opening it up here in the office and reading it to the girls and saying, ‘Oh look who Suzie voted for, can you believe that?’” she said. “I mean, I understand why they would think that until they know, you know, I’m accountable for those.”

HALLOWELL — Lisa Gilliam, the Hallowell city clerk, said she first noticed a shift in attitude toward elections eight years ago, in the run-up to the 2016 presidential election.

Gilliam, now in her 30th year serving in municipal government, was just 24 when she began her career as a deputy clerk in Winthrop. It was September, she remembers, and the 1994 gubernatorial election was just a couple of months away.

“I was so stressed out,” said Gilliam,  now the clerk for Hallowell, a city of about 2,600 in Kennebec County.

She took the required election training from the secretary of state’s office. The deputy secretary of state even gave Gilliam her personal phone number.

“They made sure that I got through it and survived,” she said.

About two years later, Gilliam was promoted to town clerk in Winthrop, where she spent nearly 18 years. For many years, elections were relatively “laid back,” and even fun, a chance to see people from around town that maybe she hadn’t seen in a couple of years, and work with election clerks, some of whom had been volunteering for years.

But that all changed in the run-up to the 2016 presidential election, Gilliam said. At the time she was city clerk in Gardiner and that was the first time she said she noticed any tension surrounding elections.

“It was completely different,” before 2016, Gilliam said. “Now you feel like all eyes are on you.”

Clerks are the backbone of municipal government, and paramount among their responsibilities are running elections. Gilliam used to do it mostly without questions from residents. But over the past eight years, she said she’s been on the receiving end of a lot of anger from people “expressing their doubt” over the process.

COVID especially brought a lot of tension. Gilliam was working in Winslow in 2020, and one resident kept telling her he thought there was election fraud going on. So Gilliam asked him to be an election clerk.

“He was fantastic,” Gilliam said. “He was one of the best workers I had.”

At the end of the day, he came up to Gilliam and said, “I want you to know that I trust the process a lot more now that I’ve worked here.”

“That’s something that I will tell people, people that question it,” Gilliam said. “I encourage them to come and work with us on election day, and see what we do.”

CARIBOU — Danielle Brissette became a clerk after going into the Caribou municipal office to register a dog and a snowmobile. 

That was five years ago, but Brissette said she still feels like a newbie. There have been eight other city clerks since Caribou was founded 214 years ago — including Brissette, that’s an average tenure of 24 years.

Her first presidential election as a city clerk was in 2020 when the pandemic was raging. Brissette said the focus then was much more on preventing the spread of disease. She had people assigned only to wiping down voting machines after each voter. 

This year, Brissette said she’s more concerned about safety and security. Talking to The Maine Monitor shortly after an assassination attempt on former president and current candidate Donald Trump, Brissette said she was thinking about having a permanent police presence during election day, rather than occasional visits throughout the day.

“We didn’t have a lot of big talks about that (in 2020),” Brissette said. “Maybe it was just because I was so new and we were in the middle of a pandemic. That could be why I just didn’t recognize the danger of elections.”

Since then, Brissette has attended de-escalation trainings and done walkthroughs of the voting location (the town’s wellness center) to identify risks, and has established a second location where voters could move if necessary.

An active shooter is the worst-case scenario, she said, but it’s her duty to prepare for it. She has a readiness plan, which also accounts for the possibility of natural disasters or power outages. (Caribou’s voting location has a generator.)

While prepared for the risk of political violence, Brissette said she’s encountered very little animosity from her community regarding the election. Tensions may rise closer to November, she acknowledged, but so far she hasn’t felt a dramatic shift in the attitude of people coming into city hall.

If someone does try to confront her, Brissette said she refuses to engage in political discussions because of the importance of her nonpartisan position.

“If people question the process or anything, at the end of the night when the polls are closed, people are welcome to stay and watch,” she said. “It helps you to see the process and to learn it. And that’s the way it is across the state.”

The most common concern she hears is whether the voting machines are hooked up to the internet. Brissette answers that there is no way to hook them to the internet; the machines are programmed by the secretary of state’s office; and all machines are tested before the election.

Brissette anticipated a high turnout this year and thinks there is about the same amount of interest as in 2020. She predicts about 65 to 70 percent of Caribou’s 6,500 registered voters will go to the polls.

She said it’s important to remember it’s not only a presidential election. There are also referendum questions and local races.

“Election day: It’s safe, it’s secure,” she said. “And we’d love to see them come out and vote because their voice matters.”

PORTLAND, Maine (AP) — The lawsuit is one of two in Maine that focus on the collision between the 2022 U.S. Supreme Court ruling and the state law requiring that schools participating in the tuition program abide by the Maine Human Rights Act, which includes protections for LGBTQ students and faculty.

The post Maine law thwarts impact of school choice decision, lawsuit says appeared first on Religion News Service.

A working group looking into ways to bring healthcare to Maine’s island communities is considering “ambulance vessels” as a possible solution.

Rob McGraw, executive director of Atlantic Partners EMS, an agency charged with appointing representatives to the Maine EMS Board, said that a regional stakeholder group of lawmakers and community members have begun discussions about emergency boats that could take critical-condition patients to the mainland. 

Martin Grimnes, president of Arcadia Alliance, which partners with international manufacturing companies to provide fast ferries for U.S. operators, said such vessels are common in his home country of Norway. They are stationed along the country’s coastline and act as mini floating hospitals.

“[Norwegians] have 60 vessels up and down the coast, doing this kind of service. And in the U.S., there’s not a single one,” Grimnes said.

Getting medical care to Maine’s islands has long been an informal arrangement for patient transport that relies heavily on the Maine Ferry Service, lobstermen, the Coast Guard, the Maine Marine Patrol, and LifeFlight.

But Grimnes has been in conversation with island authorities for a more comprehensive arrangement since 2017 — in part, he said, to preserve life on island communities.

“[The] elderly do not want to live on an island where there are uncertainties of access to medical help. Young people do not want to start a family, or God forbid, [deliver] a baby on a lobster boat,” said Grimnes, a frequent visitor to Vinalhaven.

“It would be [the Maine Department of Transportation’s] preference to get out of the patient transport business completely,” said Rick Petrie, the special projects advisor for Atlantic Partners EMS and chief operations officer for NorthEast Mobile Health Service. “We do have legislators who are willing to put in legislation to fund the operation.”

Petrie estimates the 24-hour, year-round emergency boat service to cost roughly $2.5 million in operating costs each year, plus an estimated $5 million in initial investment in the vessel.

The goal, said Petrie in a meeting in July, would be to have a funded boat transport system without relying on reimbursement. Medicare and Medicaid, the primary payers in Maine, don’t provide special reimbursement for boats.

“When you start to look at the number of calls and the reimbursement that is there we would never be able to bring in enough money for the operation of the boat.”

The group has made significant progress in the last year. The team is creating a draft to be shared with island community stakeholders for review and approval before moving forward; the group aims to establish or partner with a non-profit to be tasked with operations under the Maine Department of Transportation.

“The ferry service should be treated like any other state highway,” said Grimnes. “It is the state’s responsibility to maintain that.”

Proposal comes as rural medical care, EMS falter

The ambulance vessel proposal comes as rural care providers struggle to stay afloat. One of the state’s largest healthcare conglomerates, Northern Light, announced last week that it plans to close an internal medicine facility in Dexter, after failing to find a new location for the practice. A rural care clinic in Southwest Harbor, also owned by Northern Light, will close at the end of August. 

Rural providers say they are struggling with critical staffing shortages, funding and finding housing for employees in one of the tightest housing markets in decades. 

Maine’s EMS system is also widely considered to be in crisis. Last year, lawmakers approving $31 million in grants to help shore it up, although none of the money had been allocated as of January.

The problem is particularly acute on Maine’s islands. On Vinalhaven, for instance, the town has two ambulances and 14 individuals on the roster to assist in EMT calls. The three advanced EMTs, including Director Ryan Nizolek, are on call to work every weeknight and on weekends. 

“We do great work, we try very hard, but a lot of us are wearing a lot of different hats on any given day,” Nizolek said. “We are having to ask more and more of volunteer time that they aren’t necessarily getting compensated for.”

In addition, the nature of transient seasonal communities offers few opportunities for licensed staff to maintain their skills.

“There are examples like that in many communities where … keeping the EMS service alive is a challenge unto itself, and much less keeping the people who work in it skilled enough,” said Dr. Katherine Simmonds, the Associate Director of Health Programs and a clinical professor at Northeastern University’s Roux Institute.

The vessels could ease the demand for other emergency transportation options, including LifeFlight.

“If we’re putting more resources on the coast, that allows LifeFlight to possibly go to some of those islands that don’t have that resource possibility,” McGraw said. 

LifeFlight has seen a rise in critical transportations this summer. In the first two weeks of July, they responded to 178 calls for general emergencies, compared to less than half of that amount last year in the same period.

Maine’s only emergency air transportation service, LifeFlight, has also prepared to handle more obstetrics emergencies with the closure of maternity units throughout the state. 

“We’ve been working on this for years and in anticipation, sadly, of more and more obstetrical services being abridged in the state,” said LifeFlight Executive Director Dr. Norm Dinerman. 

Of LifeFlight’s 3,000 transfers last year, 191 were for pregnancy-related care.

“We’re trying to stay ahead of the curve,” Dinerman said. 

Nizolek, one of the few advanced EMTs on Vinalhaven, saw firsthand the challenges women face if they are pregnant on the island. One of his friends returned to the mainland towards the end of their term to avoid pregnancy complications on the island.

“That was the better option than staying here and kind of taking a gamble about what may or may not happen,” Nizolek said. “But a large portion of our population doesn’t necessarily have that ability.”

Small islands worry they’ll be left behind

Some people who work on smaller islands have concerns about the vessel service. Donna Weigle is an EMT on Swan’s Island and also ran the island’s medical center for 16 years before retiring in 2023.

She worries that smaller, more remote destinations such as Swan’s and the Cranberry Islands would not benefit from the service if only one boat is available for all of Maine’s islands.

“In theory, it sounds really great,” Weigle said. To ensure the resources are available for all islanders, she added that “you’re going to need more than one boat.”

Weigle would support the service if it is established under a state agency supported by state or federal funding. But she wants the draft to include language that allows for  expansion and for the addition of more vessels.

“I feel really good about the fact that we may be able to get this in place,” Petrie said. “This will serve all of the islands, not just the islands served by the ferry service.”

The group has discussed hosting the boat on Vinalhaven, said Nizolek, an idea the town’s Select Board is open to but cautious about, given the housing crunch on the island.

But Weigle hopes the service will ultimately live up to its intended mission.

“If I’m an EMT and I called you 10 times and I was told nine times, ‘Oh, sorry, we’re on another route’ … I think I’d be very disappointed,” Weigle said. “I think the bigger islands down in Casco Bay and down in Penobscot Bay are going to be utilizing that boat, and it’s not going to be available to us.”

A nearly $5 million federal grant recently awarded to the University of New England will be put toward efforts to improve Maine’s workforce supporting geriatric care over the next five years.

Efforts will focus on rural regions and the Wabanaki Nations, and include “dream sessions” with tribal health centers.

Maine is the oldest state in the country, and the number of Mainers with Alzheimer’s is projected to increase 20 percent between 2020 and 2025. But as of 2021, there were only 46 geriatricians practicing in the state. The need is particularly acute for underserved populations in rural and tribal communities.

The Health Resources and Services Administration awarded the grant to the UNE College of Osteopathic Medicine and Center for Excellence in Public Health. It will build on a previous five-year grant to support the work of AgingME, a geriatrics workforce program at UNE.

Dr. Susan Wehry, director of AgingME, said the grant will allow the group to develop big-picture brainstorming sessions, support hands-on rural clinical rotations and offer a microcredential for nursing students and certified nursing assistants to get additional expertise in geriatric care.

Wehry said she met with Wabanaki Public Health and Wellness — a nonprofit that provides the four federally recognized tribal nations in Maine with culturally sensitive health services — early on about how best to collaborate. They ended up having a conversation that was “transformational” for Wehry, encouraging her to think more broadly about aging care without being constrained by rigid boundaries, previous disappointments or notions of what may or may not be realistic. 

This resulted in the idea to put some of the funds toward what they’re calling “dream sessions,” brainstorming conversations with tribal health centers that consider questions such as: “What does a community look like that centers its elders? What does a community look like where tribal elders are visible, heard and empowered? What does a community look like when it is led by elder voices?”

Lisa Sockabasin, co-CEO of Wabanaki Public Health and Wellness, said her organization uses this approach for most of the work they do.

“Our work at Wabanaki Public Health and Wellness has always been how do we develop programs, systems, services that serve our people without a scarcity mindset,” she said. “Knowing that financial resources will always be limited but we don’t have to limit our minds in terms of what our people deserve to heal.”

It’s an opportunity to stop thinking small, Wehry said. 

“This isn’t about parsing out our resources and making sure that older people get their share,” she said. “It’s a different way of looking at it: If you could dream into being a community that had the condition in which all members could thrive, what would it look like?”

The grant will also be put toward ongoing geriatric training for health professionals, as well as education for students, residents, interns and fellows, with an emphasis on dementia-friendly care. AgingME also trains and supports older adults, family members, caregivers and support workers in the community like case managers with Area Agencies on Aging or community health workers, Wehry said.

To support nursing students and certified nursing assistants, some funds will go toward a geriatrics microcredential program that includes three badges: age-friendly, dementia-friendly and resilience.

Another focus of the grant will be to bolster clinical rotations in rural areas. Students will be encouraged to be more hands-on in the community at a range of rural primary care sites, including rural nursing homes. They will take a public health approach to looking at how factors like food insecurity or access to clean water can have just as much impact on someone’s health as medication, Wehry said. 

“This grant creates a mechanism for community volunteers to reach out to medical students and invite them to participate in the life of the community,” Wehry said. “We’re trying to help students see the connection between community and individual health.”

Days before winter break ended in December 2022, Bill Hansen was relieved to learn that Jordan-Small Middle School in Raymond had no traces of ‘forever chemicals’ in tests of the school’s water system.

Hansen, the Windham Raymond School District’s facilities director, was on vacation in Rockland at the time, visiting venues for his daughter’s wedding, as test results for the harmful chemicals called PFAS began rolling in for schools statewide. 

He initially thought if Jordan-Small was in the clear, then so was Raymond Elementary, just down the road. It was a promising start for the district east of Sebago Lake and its six schools. 

“We’re doing good,” Hansen said at the time. “This is awesome.”

But a couple of days later, on Dec. 30, Hansen received a bombshell. Raymond Elementary’s well water tested nearly 50 times higher than the state limit for PFAS levels. Just three days before students returned, the school learned it had the most contaminated public water system in the state. 

School and district staff members were in a bind, and they had to get to work right away. 

“There wasn’t a lot of time to turn that around,” Hansen recalled.

Raymond Elementary is one of dozens of schools, mobile home parks, local water districts and other community water systems that tested above the state’s limits for PFAS in 2022, data from the Maine Department of Health and Human Services shows. 

As some of those schools close in on the two-year mark of when their PFAS issues were diagnosed, each is in a uniquely different situation, reflecting the complexities of ridding public water sources of the tiny ubiquitous chemicals that earn their ‘forever’ moniker from the thousands of years they take to break down in the environment. 

Raymond Elementary, for example, is close to securing a new safe drinking water source around the start of the upcoming school year. But others, like Deer Isle-Stonington High School in Hancock County, are further away, delayed by funding complications or the prolonged process of planning and installing complex PFAS filtration systems.

These efforts will only grow in Maine as other water systems face newer, more stringent federal rules with deadlines unfurling over the next few years, requiring dozens more owners and operators to expunge their water systems of even smaller concentrations of PFAS. 

And although much of the current costs for public PFAS filtration systems are covered by state and federal grant money, some local officials The Maine Monitor spoke with are concerned that systems will have trouble sustaining the operations costs of their filters, and installation grant money could run out — leaving schools, communities and homeowners in a race for whatever piece of the pie remains.

DHHS, tasked with distributing funds to public water systems for PFAS filtration, doesn’t expect to have enough funds to help all the state’s public water systems meet the new federal standards, according to Lindsay Hammes, an agency spokesperson. 

“It is anticipated that the available funding will not be sufficient to meet the needs of all Public Water Systems that will exceed the federal (PFAS limits),” Hammes wrote. 

Legislative origins

School districts and other public water systems (which have varying definitions, but mostly include those that serve more than 25 people for more than two months a year) began testing for PFAS in 2022 after the Maine legislature passed a landmark law regulating the harmful class of compounds in public drinking water a year prior.

The legislation required owners and operators of public systems to notify users if their results showed combined levels of six state-regulated PFAS above 20 parts per trillion, one of the more stringent action levels in the U.S. at the time. 

The law also requires owners to pursue filtration to rid the water of the chemicals, but the state Department of Health and Human Services has not had to take any enforcement actions to date, according to a department spokesperson. But the department has sent violation letters for public water systems that have missed deadlines for submitting PFAS test results.

After receiving test results for Raymond Elementary, Hansen contacted Superintendent Chris Howell, who notified students' families. Hansen and Mike Duffy, the district’s safety support specialist, then shut off the school’s water fountains and worked to get enough bottled water to support the school’s more than 250 students and staff members.  

Principal Elisabeth Peavey handled more direct communication with parents. She said they had relatively measured reactions, likely because of all the other PFAS news swirling at the time.

“I think news (outlets) putting out that information made it so people were somewhat aware that there's potential for schools to have (PFAS) in their system,” Peavey said. 

Stories of PFAS contamination in Maine have been inescapable. The class of compounds, per- and polyfluoroalkyl substances, has been used in a wide variety of products like rain jackets, non-stick frying pans and carpets. Their use in firefighting foams have led to widespread contaminations on military bases, including in Maine. 

The effects of PFAS on human health are still being discovered, but the U.S. Centers for Disease Controls have linked the chemicals to weakened immune responses, kidney and testicular cancer, and pregnancy-induced blood pressure disorders. 

The U.S. Environmental Protection Agency and the federal standard it set for PFAS in April is supposed to account for this risk, according to the agency.

Its rules will require public water systems to limit two more common and harmful PFAS compounds to 4 parts per trillion. Though it is far lower than Maine’s 20 parts per trillion standard, the state is in the process of updating its standard to align with the EPA’s.

In pursuit of solutions

The difficulties of managing the school’s PFAS contamination set in rather quickly. Raymond Elementary’s facility staff were suddenly tasked with lugging five-gallon water jugs up and down the school’s halls, and cafeteria employees were hoisting them to prepare meals.

“The bottles are so heavy,” Peavey said, “and it was causing some physical back pain for our kitchen staff.” 

Eventually the district hired temporary employees just for transporting water — an added cost to the water itself. After initially relying on a donated supply from nearby Poland Spring, the school began paying around $350 per week for water from Gorham-based supplier H2o7.

In the background, Hansen, Superintendent Howell and other district officials worked to acquire federal money from the Small Public Water System Emerging Contaminant Grant, funding managed at the state level by DHHS’s Drinking Water Program, and made available to schools and smaller water systems. 

With $60,000 in grant funding secured, the district hired Portland-based hydrogeology firm Drumlin Environmental to begin analyzing the extent of Raymond Elementary’s PFAS contamination, testing groundwater, soils on the school grounds, and mapping the aquifer used by the school’s well.

Much of Maine’s most severe PFAS contaminations originated from the wastewater sludge once used as fertilizer and spread on the state’s farmland, especially around Fairfield and central Maine.

The source of Raymond Elementary’s contamination was not so clear-cut. Though Drumlin Environmental found traces of PFAS in the soils near the school’s wellhead, Hansen said the use of PFAS-laden fertilizer was unlikely because the school is in a wellhead protection zone and fertilizer use is restricted. 

Hansen only had flimsy guesses where the school’s high levels — 950 parts per trillion — originated. Officials with other districts afflicted by PFAS contaminations were similarly perplexed by their origins, which complicated how they came up with solutions. 

Raymond’s solution, for example, was eased by the location of the suspected source: the soils surrounding the wellhead. 

Hansen said it was likely the well’s lack of reinforced piping led to the PFAS seeping in near the surface, so Drumlin dug boreholes until identifying another area to tap into the school’s aquifer, upslope of the current well, that repeatedly tested negative for PFAS.

The district drilled a new well a few hundred feet from the original, reinforcing it with additional steel casing. But what the new well lacked in PFAS it made up for in high levels of radon, a naturally occurring radioactive gas commonly found in areas composed of granite, like Raymond and the Sebago Lake area. 

That meant the district had to purchase a special radon removal system, which Hansen predicts will be installed by the start of the school year. The cost of the planning, engineering, construction and equipment totaled around $100,000, according to Howell, with the state covering 60 percent. 

PFAS filtration systems have cost around $50,000 for smaller schools, but Raymond’s new system won’t require the routine maintenance and upkeep required of PFAS filtration systems.

Complications elsewhere

The paths for some other school districts have not been as straightforward. For Regional School Unit 76 in southern Hancock County, Superintendent Daniel Ross said he’s not sure when the district’s two schools with elevated PFAS levels — Deer Isle-Stonington High and the Brooklin School — will finish their PFAS filtration systems. 

Like at Windham-Raymond, Ross said he and his district immediately began applying for public funding after receiving test results in December 2022 that put the Brooklin School and Deer Isle-Stonington as the systems with the fourth- and fifth-highest PFAS levels in the state.

The district received a grant through the state Drinking Water Program, but because of stipulations that required domestically sourced materials and an environmental impact study, the initial estimates for the PFAS filtration systems that met those requirements was around $550,000.

State funding would cover 90 percent of the estimated cost of installing a filtration system, but that would still leave local taxpayers on the hook for around $55,000 in project costs, a steep amount for a school district of its size, Ross said. 

After a year undergoing the planning process for that system, Ross said the Drinking Water Program changed its tune and allowed the district to pursue a cheaper solution from a different company, which would cut the cost to around $60,000 per school. The entire project would be funded by the grant.

Ross welcomed the news and praised the DWP for its attentive assistance throughout the process, but didn’t understand why it took so long for the DWP to make that judgment. 

“When you are dealing with large amounts of money, it takes time to get everything through,” Ross said. “Even though (the recent update is) welcome, it would have been nice to know this a year ago so that we don't get so far into this thing only to backpedal and delay finding a solution even further.”

The DWP is not involved in the design process of public water systems’ PFAS filtration solutions, said Hammes, though it recommended a less costly but still effective design that would take less time to install.

In the meantime, the district has been paying around $1,000 per month to purchase bottled water from Poland Spring and is back to square one in planning for the PFAS filtration systems. The Brooklin and Deer Isle-Stonington school boards only recently received initial quotes for the new systems, which they are comparing before selecting a contractor.  

“We want them all to have clean water to drink, but if we’re going to have to bring in bottled water, at least having a smaller school population causes that not to cost quite as much” as larger school districts, Ross said.

Ross’ district, and Deer Isle-Stonington High in particular, are in a deeper dilemma because of the area’s fragile hydrogeology.

While Raymond Elementary had the option to dig a new well in an uncontaminated area, the archipelago that includes Deer Isle and Stonington has especially fragile freshwater sources nestled under a thin layer of granite, according to Annaleis Hafford, vice president for Olver Associates. (Olver Associates was initially consulted for RSU 76 PFAS filtration systems and is contracted by Stonington to run the Stonington Water Company, where Hafford is the operator.)

“I think that the concern is if they drill another well, it may not have any productivity and it also may still have PFAS in it,” Hafford said, as well as the elevated levels of radon that accompany granite.  

Hafford and the town of Stonington face similar difficulties in securing its drinking water system. Although the town does not have elevated PFAS levels, it is highly susceptible to drought and leaks in connections to residences.

“In the summer, every day we tend to lose water,” Hafford said. “The water tank is dropping now and it's only the beginning of July.”

The Stonington Water Company is trying to increase the system’s resilience by building a new water storage tank and identifying every leak, but that hasn’t stopped Hafford’s consistent worries over her eight years of leadership.

“Every gallon is important to us,” Hafford said.

More common solutions

While Windham-Raymond and RSU 76 may be outliers in the intricate process for schools to mitigate PFAS, the more common and streamlined approaches to filtration have still operated on relatively lengthy timelines.

By the Canadian border in Hodgdon, the town’s high school and elementary school are also looking at August completion dates after more than a year and a half on bottled water. Hodgdon’s district, Maine School Administrative District 70, received $60,000 for each school to install granular activated carbon filtration systems, according to Superintendent Tyler Putnam.

One of the more common and less expensive systems, they work by slowly pumping groundwater through a carbon media which then captures PFAS passing through, like flies in a spider web. 

Though effective, some water officials say the system also has weaknesses. The extraction process results in the filter filling up over a year or two. Unless it’s replaced, a clogged filter will hit a threshold called “breakthrough,” and begin releasing concentrated amounts of PFAS back into the filtered water. 

The Hodgdon schools’ filtration systems will have three redundant filters to account for this, according to Sienna Faessler, the Haley Ward engineer overseeing the systems’ designs. 

Schools and other public water systems are also required to test quarterly for PFAS, Faessler said, so the odds a breakthrough would go unnoticed is unlikely.

Nevertheless, breakthroughs and the upkeep of carbon filtration systems are a couple of the concerns that Sanford Water District Superintendent David Parent has with how people statewide are addressing PFAS contaminations.

Parent was introduced to PFAS relatively early when one of the water district’s wells first tested for PFAS in 2013, around the time the EPA began monitoring for the chemicals. The contamination subsided while the well was shut down after a few years, but came back at higher levels almost a decade later.

Three wells in Sanford Water District have tested for elevated PFAS levels in the past year, with the initial well of concern exceeding the state’s limit at roughly 30 ppt, even though the district hadn’t drawn from it over the years because of its manganese content. 

“We weren't putting the water in the system anyway, but then we got this hit of PFAS that was fairly high,” Parent told The Monitor. “We thought, ‘Oh boy, what is this?’”

Since then, Parent has been navigating the solutions available to him and the district, which comes at a much larger cost and scale than those of public water systems such as schools. 

As he’s seen granular activated carbon become the favored solution, Parent said he’s grown concerned that the long-term care of the systems isn’t being planned for — especially for residences, where homeowners may not be prepared for the cost of replacing the filters and the complexities of disposing of their PFAS-filled contents, which are finding their way into Maine landfills and incinerators.

“The maintenance of these systems is just very, very important,” Parent said. “For both residential and municipal systems, it’s a very expensive part of maintaining that treatment.”

Operation and maintenance costs for carbon filters contributed to one school district’s decision to pursue a different type of system, one with higher upfront costs but lower maintenance costs. 

Maine School Administrative District 6, encompassing Buxton, Standish and parts of both York and Cumberland counties, was one of the first school districts in the state to test for PFAS after the legislature’s 2021 law passed.

Adam Thibodeau, the facilities director, said he wanted to be sure the district would have its water tested before labs were backed up with samples from other public water systems rushing to test before the Dec. 31, 2022 deadline. 

Before Raymond Elementary got its results a few months later, it was MSAD 6 and Bonny Eagle Middle School that had some of the highest PFAS levels in Maine, between 600 and 800 ppt. The middle school and three other schools in the district tested above the state’s limit, with a fourth just below it.

Again, Thibodeau didn’t want to waste time, so the district authorized a study to analyze each school’s PFAS situation, and the strengths and weaknesses of each filtration system. The district not only looked for the most effective system, but one that would cost the least to maintain because operation and maintenance costs are excluded from state grants.

It eventually chose FLUORO-SORB, a proprietary filtration system that uses a clay-based media to absorb PFAS compounds, not adhere to them like carbon filters.

Altogether, planning and installation costs for all five schools’ filtration systems totaled around $700,000, far more than the other districts, though MSAD 6 is one of the largest in the state.

With $1 million provided by the Drinking Water Program, the district has about $300,000 left, Thibodeau said, which will help with Buxton Center Elementary School’s system costs — the last on the district’s list. 

The price may be high now but each system’s annual cost will be limited to between $8,000 to $20,000 for as long as the systems operate, lower than the cost of most carbon systems, according to Thibodeau.

“I plan to be here a while,” Thibodeau said. “I’m picking the best solution over time, and what that study told me is that carbon is not the way to go.”  

The FLUORO-SORB systems have been in place at two of the schools for almost a year, and Thibodeau said the district hasn’t had any problems. With a carbon system, the schools’ relatively high PFAS levels may have clogged up the filters by now, requiring replacement and disposal.

Faessler, who’s worked with other public water systems on installing PFAS filtration equipment, is less concerned about the maintenance requirements of carbon filtration systems — at least for the schools Haley Ward has consulted for.

“Most schools have a maintenance person (who is) trained or at least knowledgeable on how to operate the systems,” Faessler said. “But we're available as well, and they know that we're happy to answer any questions as they come up.”

Where Faessler and Parent’s PFAS-related worries overlap involves how the state plans to fund future PFAS mitigation projects. They suspect those fiscal needs will grow as the EPA begins enforcing its new limits for public water systems in 2029 or as more homeowners test their wells and find high PFAS levels.

Parent, specifically, questioned whether the state’s regulatory approach for public water systems like his was the most effective. 

Even though the district had relatively low PFAS levels (around 10-30 ppt) compared to Raymond Elementary, Sanford acquired grant funding for its more expensive filtration systems, which could cost up to $16 million. He thinks that money may have been better spent elsewhere, for private wells with high levels or future PFAS problems in other water systems.

“I think Maine's timing was good,” Parent said of its legislation. “But it bothers me a little bit” that Sanford Water District and its low PFAS levels receive lots of support, while the state is “buying people a system to start out with, but they're not funding the maintenance of those systems.”

There’s also the $250-$500 price of PFAS tests themselves, which aren’t always covered by the Maine Department of Environmental Protection and its program to help homeowners affected by the state’s spreading of sludge.

More than half of Mainers get their water from a private well, and the state mostly relies on homeowners to have their wells tested.

Funding also was the overarching concern from other officials The Monitor spoke with. Since the state is mandating compliance with this standard from public entities like school systems, they should pay for ongoing costs. 

Faessler, for example, had public funding questions similar to Parent’s. From her perspective, securing that funding is as pertinent as the process of removing PFAS from the sources leaking the chemicals into the environment. 

When funding becomes scarce, the state will prioritize disadvantaged communities and public water systems with the highest PFAS levels, Hammes of DHHS said.

That was one of Faessler’s primary concerns: how Mainers already stretched thin are going to afford these systems and their upkeep, especially when the funding runs out.

“Who is going to help pay for some of these installation systems?” Faessler asked.

Along the sea-smoke-covered shores of Great Wass Island Preserve in Beals, the swelter of an unusually hot June day melted away. The preserve’s ever-present maritime winds carried the chill of salt spray over granite ledges, verdant heaths and jack pine woodlands. 

A mere 13 miles away on the mainland, something less pleasant wafted through the air: the toxic pesticide imidacloprid. It is one of several popular neonicotinoids, a class of pesticides designed to mimic nicotine, whose use is banned in the European Union and restricted in 10 U.S. states.

On June 10, the Columbia Falls-based Worcester Holdings — the company behind the scrapped Flagpole of Freedom project — notified nearby Addison residents that the company would use drones to spray imidacloprid over 190 acres of its pine forest this summer.

The pesticide is being used to control balsam gall midge and woolly adelgid in the fir trees that supply balsam branch tips for Worcester Wreath, one of the company’s holdings. 

The news caused a furor on social media, with residents alarmed about the potential threat to wildlife, humans and the environment. 

But the Worcesters aren’t the only ones applying pesticides. The practice is common in forestry and agriculture. 

A recent push to ban aerial pesticide application in the state was vetoed by Gov. Janet Mills, but environmental advocates continue to push for more regulations.

“We’ve long been concerned about the impacts of pesticides,” said Heather Spalding, deputy director of the Maine Organic Farmers and Gardeners Association. “There are so many studies, peer-reviewed studies — every week more and more information comes out about the impact on human health and the environment.” 

In 2022, the U.S. Environmental Protection Agency concluded that imidacloprid and other neonicotinoids were “likely to adversely affect” endangered or threatened species, and critical habitats.  

In addition to imidacloprid, many of the more than 11,000 pesticides registered for legal use in Maine have been identified as potentially harmful.

The state sets regulations for their application via the Board of Pesticides Control (BPC), including by requiring training and licensing for applicators. In the commercial category, there are 1,648 registered and certified pesticide applicators working for 573 companies or organizations. Eleven of them hold aerial application licenses.

Despite Worcester Holdings’ track record of violations, the company appears to be following protocol. Worcester Holdings gave proper notice and is duly registered.

Surprisingly, so are five of the state’s leading conservation organizations — including The Nature Conservancy in Maine, stewards of the Great Wass Island Preserve. 

According to a Maine Monitor review of state data, The Maine Coast Heritage Trust, Friends of Acadia, Mount Desert Land & Garden Preserve, and the Kennebec Estuary Land Trust also have licensed commercial pesticide applicators on staff. 

‘Crushingly disappointing’

Among them, the five conservation groups have 17 pesticide applicators helping to manage a combined 2.6 million-plus acres, mostly along the coast.

None hold aerial application licenses, instead manually applying the chemicals from “pesticide backpacks” as part of what is called an integrated pest management approach. It Involves using pesticides to augment hand-pulling and other natural means of eradicating invasive pests and plants.

All of the conservation groups interviewed for this story blistered at the idea of using aerial application, saying their methods are much safer.

A spokesperson for The Nature Conservancy in Maine — a group founded with the help of esteemed biologist Rachel Carson — said it has several licensed applicators on staff who occasionally need to use very targeted herbicide applications to control invasive plants. TNC has conserved roughly 2.4 million acres over 193 preserves.

The other conservation groups that responded to questions from The Monitor had similar responses: They reluctantly use pesticides as part of a comprehensive approach to control invasive plants and vegetation from consuming entire habitats.

“It would be irresponsible if we called ourselves conservation landowners to let invasive plants kind of spread unchecked over the lands we’ve conserved because they greatly diminish ecological value. That’s not something we’re willing to stand by and let happen,” said Amanda Devine, director of stewardship for the Maine Coast Heritage Trust, which oversees 180,000 acres from Kittery to Calais. 

Devine, as well as Dillon Mulhern, the preserve’s manager for the Kennebec Estuary Land Trust, described their groups’ use of pesticides as “surgical.”

But some environmental advocates, like Spalding from MOFGA, say there are better, non-chemical methods to manage even extensive acreage. Spalding called the news that some conservation groups are using glyphosate and other pesticides “crushingly disappointing.”

The question of aerial application

In 2021, the legislature passed L.D. 125, An Act to Prohibit Aerial Spraying of Glyphosate and Other Synthetic Herbicides for the Purpose of Silviculture. Despite broad support, Mills vetoed the bill and lawmakers failed to override the veto. 

The governor subsequently ordered the BPC and Maine Forest Service to review the rules related to aerial pesticide application for the purpose of silviculture, the science of managing woodland. 

The agencies hired a consultant named Harold Thistle, a retired expert in forest meteorology, and paid him $30,000 to conduct a study. An additional $98,436 in federal and other funding was used for water quality monitoring. 

The 175-page report, released in 2022, draws on a number of studies that consider the impact of buffer zones, droplet size, height of pesticide release, weather and wind drift.  

Thistle found that aerial herbicide treatments produced the highest internal rate of return for the forestry industry, and alternative methods would be too costly. 

Many of the concerns about aerial application have to do with the degree to which droplets of pesticide drift through the air, potentially catching a breeze and landing outside the intended area. 

“Though aerial herbicide application as practiced in Maine is very low risk, it is impossible to assert that ‘no drift’ of herbicide occurs,” Thistle concluded in the report. “It is demonstrated that drift amounts at long ranges are minute when present.”

While drones have seen significant usage in pesticide applications in the South, they remain an emerging technology in the Northeast.

Patrick Strauch, the Maine Forest Products Council executive director, and other industry professionals believe drones can help reduce drift because they can fly close to the ground, more precisely spraying targeted invasive plants and insects. 

“The technology may offer precision treatment of browntail moth outbreaks in areas of high sensitivity,” Strauch said in an email.

‘This needs to be stopped’

Though the statewide ban failed, at least seven Maine municipalities have passed ordinances prohibiting or restricting the aerial application of pesticides. A total of 32 municipalities have ordinances that ban or limit pesticide application.

Some Addison residents are calling for town officials to enact such a measure.

“The town selectmen need to do a moratorium on aerial spraying until an ordinance can be passed,” posted one Addison resident, later adding, “We do not want spraying anywhere near our property. This needs to be stopped!!!”

One particular concern is the effect on local pollinators. Cornell University biologist Thomas Dyer Seeley, who lives in Downeast Maine part of the year and is an expert on honeybees, said although pine forests are not a honeybee habitat, aphids live among the trees and honeybees are attracted to the excrement aphids leave behind.

“Honeybees can go to those aphids and drink what’s called honeydew,” Seeley said. “So even though they’re just spraying in coniferous places… these pesticides could get into honeybees.”

Alex Cammen, a licensed forester and pesticide applicator for Worcester Holdings, said the company is abiding by the laws governing safe pesticide use, and also wants to be good stewards of the land.

“(We) are members of the communities … and care deeply about the health of our neighbors, forests, wildlife, waters and ourselves,” Cammen said. 

There are no legislative or advocacy group efforts to mount a new fight for a statewide aerial pesticide ban, according to Spalding. She said her focus is now on issues such as the clear-cutting of forests. 

Her group has also advocated against an exemption for agricultural pesticides during recent legislative discussions about banning the sale of products containing PFAS. There are at least 55 PFAS-related chemicals present in more than 1,400 pesticides registered for use in Maine, according to Spalding’s testimony.

“When you’re laying down fungicides and herbicides, insecticides, larvicides, you’re really adversely impacting the health of the soil microbiome,” Spalding said. “We need to be moving away from dousing agricultural lands and forest lands with chemicals.”

Regulators were up to their ears in trash talk on Thursday morning as they deliberated over a draft of rules intended to increase recycling, reduce the amount of material going to landfills and ultimately reduce the amount of packaging that’s coming into the state. 

It’s been five years since Gov. Janet Mills signed a resolve directing the Maine Department of Environmental Protection to come up with the rules. I remember the first meeting I sat in on where they were explained, on a chilly January afternoon at a community center in Ellsworth.

The room was packed, and then-state Rep. Nicole Grohoski, who had long been championing the concept, was trying to get residents on board.

Ellsworth was a particularly interesting place to be reporting on trash at the start of 2020. The long-awaited waste-to-fuel plant in Hampden, where Ellsworth and more than a hundred other municipalities were planning to take their waste, had finally opened after more than a year of delays (it lasted less than a year before shutting down).

The nearby incinerator in Orrington, where trash was burned to generate electricity, was still operating, but at reduced capacity, having lost many of its contracts when it raised rates and the Hampden plant came on the scene.

Meanwhile, it had been two years since China implemented its National Sword program, which banned many recyclables and put a contamination limit on others, throwing recycling markets in the United States into chaos. 

Before the implementation of the program, the Environmental Protection Agency estimated that our plastics recycling rate was roughly 9 percent, in part because we sent a lot of it to China.

After National Sword, according to research from an environmental group affiliated with Bennington College, that figure dropped by half, to around 5 percent. That means 95 percent of the plastics generated that year were put in a landfill or burned for energy. 

Meanwhile, the per capita generation of plastic waste has gone up 263 percent since 1980. 

Hancock County exemplifies many of the challenges of recycling and waste management across the state. It’s both urban — the town of Ellsworth is the service provider for the area and the gateway to Acadia National Park, which saw more than 4 million visitors last year — and decidedly rural. 

It’s also seasonal, with the volume of waste exploding in the summer and dropping off significantly in the winter. The rural nature of the region means transportation costs are higher than they are in more densely populated areas, and the seasonality makes it tough to maintain infrastructure that must handle fluctuating volumes. 

In 2019, The Ellsworth American, where I was a beat reporter at the time, chronicled the situation as town after town cut back on recycling or stopped their recycling programs entirely, citing skyrocketing tipping fees and a lack of end markets. 

“We just don’t get enough material anymore to make it worth it to keep operating,” Joyce Levesque, manager at Coastal Recycling, which served five towns before it closed in 2019, told The American. “Recycling isn’t cheap, so it’s either everybody or nobody doing it.”

The draft rules presented at the meeting of the Board of Environmental Protection on Thursday are intended to get everybody to do it. But some board members were skeptical that they would have the desired effect, at least as currently written.

“It’s not going to incentivize anybody to move their solid waste,” said board chair Susan Lessard, who also serves as town manager in Bucksport.

Under the proposed rules, communities would be reimbursed for both recycling packaging and for diverting it from landfills by choosing options higher up on the solid waste management hierarchy. 

If a municipality sends packaging material that isn’t readily recyclable to a landfill when an incinerator is closer, they’re not eligible for reimbursement, explained DEP staff on Thursday.

What if there isn’t an incineration option, wondered board members — say an incinerator is full, and can’t take any more, or it isn’t currently operational, as is the case in Orrington.

Would the municipality be dinged for an option it doesn’t have? Yes, as currently proposed, said Elena Bertocci of the DEP. 

“That is something we thought about a lot and tried to figure out if there was a good way to do something different. In many cases it’s not going there because the municipality doesn’t want to pay for it at the end of the day.”

Bertocci said it also became complicated to try and “put lines around” what not having access to an incinerator looks like.

The rules would also reimburse communities at a higher rate for incinerating over landfilling, which some board members argued meant communities in southern Maine with more options and access would get reimbursed at a higher rate than rural areas. 

Municipalities that choose incineration, for instance, would be reimbursed at two-thirds the average cost of recycling readily recyclable packaging material. Those that send it to landfills (if that’s the closest option) would be reimbursed at a one-third rate.

“Our cost is not the same as someone in southern Maine,” said Lessard. “For those of us with no option close enough… you only get one-third just because there’s nothing closer. But communities within proximity that can do that get two-thirds.”

Reimbursement at the higher rate likely won’t offset the cost of trucking packaging that isn’t easily recycled to places like the ecomaine incinerator in Portland, said Lessard. “Transportation cost alone is the killer.”

The rules are still being drafted, and there’s room for change. They’re intended to incentivize infrastructure development that will make it easier and more financially attractive for rural communities to divert from landfills, DEP staff said Thursday. But that will take time.

“I see this as good, in terms of trying to put the materials in the place they need to be over the long term,” said Steven Pelletier, a board member from Topsham. “But I see this proximity thing as being something that could really kind of shake up this particular industry… what we’re seeing on the ground now — in terms of facilities we can bring things to — in 10 years would be totally different, I would think, because of this.”

After qualifying for home care services, Pauline Kane sat on a waitlist for more than a year. In the meantime her daughter, Ann Marie Kane, who goes by her initials A.M.K., had moved in with her and was caring for her around the clock — without getting paid.

Pauline Kane, who is 86, has a neurological disorder that makes it difficult to walk or stand on her own, so A.M.K. helps with everything from making meals to showering. She’s concerned about her mom falling if left on her own in their Scarborough home, so A.M.K. brings her when running errands.

“She doesn’t go anywhere without me,” Pauline Kane said. If she didn’t have her daughter caring for her, Kane said, “I’d have to go into a nursing home. I don’t think I’d like it because there would be nobody around to talk to or for me to go out with.”

When Kane finally got off the waitlist in 2022, she was approved for about 24 to 32 hours through a state-funded waiver called Section 63, for people whose medical needs qualify for additional assistance but who have too much income to qualify for Medicaid. “I honestly don’t even know what (the number of approved hours) is right now because no matter what it is, I will do the same job every day,” A.M.K. said.

Kane now uses the funds to pay A.M.K., and realizes she is lucky to have someone who can work well beyond the number of hours she’s being paid. A.M.K. was hired by a staffing agency in her area to work as her mom’s caregiver full-time.

There are multiple home care waivers that allow Mainers who medically qualify for additional assistance (like care in a nursing home or assisted living) to opt instead to receive that level of care in their homes. But for those who do want care at home, many have been unable to find caregivers to work for all the hours they’ve been approved for.

A recent state report showed that 71 percent of around 1,500 people receiving the Section 63 voucher were not receiving all the personal support services or nursing hours they’d been approved for. 

However, the Department of Health and Human Services said there is no mechanism to know the scale of these deficits — it is unclear whether someone in this group is receiving, for instance, 30 of their 32 hours or a much smaller amount. 

The percentage of people receiving fewer hours than approved for under MaineCare or state-funded programs has increased markedly over the prior year — a problem advocates say underscores workforce shortages and increasing demand.

Gov. Janet Mills’ administration has dedicated significant resources to bolster the healthcare workforce, but advocates worry that attention to the problem is waning.

The number of people who qualify for waiver Section 19, which is for older people and adults with disabilities who qualify for MaineCare (the state’s version of Medicaid) stayed roughly the same but the proportion who are not receiving all of the hours they’ve been authorized increased from 33 percent in November 2022 to 50 percent in December 2023.

For waiver Section 96, which funds private duty nursing and personal care services, the share of people who are “partially staffed” went from 47 percent in November 2022 to 62 percent in December 2023. The number of enrollees was about the same.

Lindsay Hammes, a DHHS spokesperson, said there are a couple of explanations, including the fact that the latest report combines the home care hours that are partially and fully unstaffed, whereas this data was broken into separate categories in previous reports. She added that a nursing agency in 2022 stopped providing nursing services that supported these programs.

“As more people become eligible for the service, providers continue to struggle to hire qualified staff,” Hammes said.

Jess Maurer, executive director of the Maine Council on Aging, said the problem stems from a strapped labor market and low reimbursement rates for providers. She said DHHS and the Department of Labor have worked to attract people to direct care jobs, including by increasing wages for all essential care workers to 125 percent of minimum wage, or about $17.70 hourly.

“That’s great but it hasn’t helped,” she said. “The reality is that at some point we’re going to have to pay a market-driven rate.”

Maurer said the home care deficit could result in someone who is entitled but not receiving home-based care having an avoidable health crisis and ending up in the hospital, only to sit there for days or weeks instead of being discharged because there’s no home care nor available beds in nursing homes.

Hammes said an ongoing rate study is reviewing similar services across MaineCare sections, including home- and community-based clinical, therapy, care coordination, supportive skills building, and assistive technology services. She said the study is part of the department’s goal to address “severe state labor shortages for nurses,” which has contributed to a decline in people accessing these services.

“This effort may also help to address rate disparities across other relevant positions which are also experiencing labor shortages,” Hammes said.

How it works

To qualify for home care, a client must be assessed to see whether their medical needs qualify for additional assistance. If they do and the person opts for home care, they are connected with a care coordination agency, such as SeniorsPlus.

Betsy Sawyer-Manter, president and CEO of SeniorsPlus, said her agency serves about 3,000 people who have been approved for some level of in-home help. As a coordination agency, the group helps clients get connected with someone to provide care. But they also conduct an assessment to look at what else they might need, and connect them with the appropriate services.

While their numbers can fluctuate daily, Sawyer-Manter said SeniorsPlus has 756 completely unstaffed clients, which is slightly lower than past years. She said the demand for services is high and she expects it to only grow, especially as Maine nursing homes continue to close.

More than 23 nursing homes in Maine have closed in the last decade, with the most recent closure of Narraguagus Bay Health Care Facility reported last month.

“There is a significant amount of demand,” said Tracy Smith, the long-term services and support director for SeniorsPlus. “There are many clients who are living in areas where they don’t have family support, so this is essentially the only way they can get their needs met.”

The rural nature of the state could also be why someone has difficulty finding a caregiver, because fewer home care providers are nearby. Sawyer-Manter added that a lot of immigrants work in the field and clients are sometimes reluctant to have someone who isn’t as fluent in English provide their care. Sawyer-Manter noted that she’s seen this attitude improve recently.

Another part of the problem, Sawyer-Manter said, is the work itself is “not glamorous,” the pay is low and hours aren’t reliable. Home care workers help with bathing, dressing, cooking and transporting clients — tasks that should be valued, she said.

Sawyer-Manter said there’s been progress, including increasing the reimbursement rate to 125 percent of minimum wage and efforts to “destigmatize” the work. 

Undivided attention

Ashlee Reynolds, a certified nursing assistant who provides home care services through Allmed Staffing of New England, said she chose the work because she likes the flexibility and chance to work one-on-one with a client. When she worked in a nursing home, she sometimes had to care for as many as 12 residents in one day. In home care, she can focus all her attention on one person.

She currently works with three clients, dividing her hours with each of them into two- or three-hour shifts each day. Her services range from helping with bathing and dressing, to providing transportation and running errands.

One of Reynolds’ clients has caregivers from two agencies because the original caregiver couldn’t add more hours. 

Nate Charles, the home care manager with Allmed Staffing of New England, said his agency gets referrals for people seeking home care through waivers from care coordination agencies like SeniorsPlus. A mass email will go out to all 160 staffing agencies anytime there’s a new client.

Allmed Staffing provides personal support specialists and nonmedical staff that assist with basic house cleaning, groceries and meal preparation. If a client requires nursing care they would typically have a team of people that includes a registered nurse, he said.

Contrary to data that suggests a workforce shortage, Charles said he’s noticed a lot of demand among staffing agencies to sign new clients.

He said he has to respond within minutes to referrals for new clients or someone else will snap them up. He said this varies greatly based on where the client is located. His agency is based in Augusta and many of his care staff want to work with clients nearby. Someone in Aroostook County may have more difficulty finding a caregiver.

He’s also seen people opt not to use all the hours they’ve been allocated. This may be because they don’t want someone in their home that long or because their health deteriorates and they are approved for more hours, but want to stay with a particular caregiver who is unable to add hours.

What needs to be done

In response to the growing waitlist for Section 63, lawmakers in 2022 allocated about $6 million to get people off the waitlist so they can start receiving care. As a result, recipients such as Pauline Kane were finally able to access the funding.

As of February, there was no one on the waitlist. The number of enrollees in the program nearly doubled but the percentage of people receiving fewer than all their hours also increased from 53 to 71 percent. 

Since then, however, a waitlist was reinstituted April 1 because “current funding cannot support additional participants at this time,” according to Hammes. There are currently 280 people on the waitlist.

Eliminating the waitlist — even temporarily — is still progress, according to Arthur Phillips, the economic policy analyst with the Maine Center for Economic Policy. 

“It represents an investment in the program and that is something that we should commend,” he said.

However, Phillips said the available data offers an incomplete snapshot. Unlike previous versions of the report, DHHS did not release information on how many people have no caregiver whatsoever. And for those partially staffed, it’s unclear how many hours they are short.

“This once-annual snapshot is helpful but not nearly sufficient to measure the scale of the problem,” Phillips said.

While he applauded efforts to increase wages, and the governor’s allocation in 2022 of $120 million in recruitment and retention bonuses for home care workers, Phillips said the state has not gone far enough. He is working on a report that will look into the question of what range of wages could sufficiently draw new people into these careers.

He added that the caregiver shortages impact not only those who need the services but also their family members — like A.M.K. — who are left to pick up the slack.

“Care work should be thought of as infrastructure to allow other people to participate in the economy,” he said. “It’s really the backbone. If you don’t have access to the care a loved one needs, you can’t stay in your career.”

A.M.K. said the system has made it “next to impossible” for family caregivers because they aren’t paid like a full-time job with benefits. She has cared for her mom around-the-clock for more than 1,000 days, she said, but hasn’t made nearly what she would in another full-time career. 

To incentivize a system where older Mainers can stay at home longer, A.M.K. argues that family caregivers should be paid directly as state employees, eliminating the costs of assessments, case managers and staffing agencies. 

“People think long-term care is just if you’re an institution,” A.M.K. said. “They separate it: ‘An institution is eligible for this kind of money because they’re an institution, but if you are going to care for a loved one, oh well; we will give you a couple bucks an hour.’ ”

Hammes, the DHHS spokesperson, said the department is also starting a process to implement reimbursement for home health aide services provided by qualified parents to minor children. A state plan amendment will be submitted next month and there will be opportunities for interested parties to inform future rulemaking, she said. 

Maurer said she’s worried attention to the problem is starting to wane. She was disappointed to see a workforce bill fail during the recent legislative session. The measure would have created tuition reimbursement for a direct care worker providing in-home or community support services and could be transferred to family members, which she said would make the jobs more attractive.

Sawyer-Manter echoed her sentiment, saying she hopes there isn’t fatigue around workforce initiatives.

“There are lots of things we could certainly invest in but this is one that isn’t going to go away,” she said. “We need to take care of our older people and people with disabilities. It’s a Maine value that we take care of our people.”