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Column: A silent crisis in N.H. for seniors and the infirm

To the Valley News
Published: 4/11/2019 10:30:19 PM
Modified: 4/11/2019 10:30:13 PM

New Hampshire takes pride in its fiscal conservatism. The Legislature funds government programs at bare minimums every two years and relies on New Hampshire’s good ol’ Yankees to make do. Like any family budget, it may work for a while — or until a leaky roof causes a ceiling to crash down. Long-term planning and small annual investments in home improvement could have averted the disaster.

This would seem obvious to most people, yet our Legislature continues its minimalist approach on important programs and then struggles to resolve crisis after crisis.

Here are few examples:

■ Long emergency room waits for mentally ill patients.

■ Children who are at risk of abuse and neglect because the Department of Health and Human Services is understaffed.

■ People with addictions who can’t find a treatment facility.

■ Developmentally disabled adults who are on wait lists for services.

For years, advocates warned that these programs were in trouble. The Legislature generally didn’t listen until the human toll became unbearable or the state was sued.

The latest victims are New Hampshire’s medically frail elderly and other vulnerable adults who depend on the state for help.

The Choices for Independence program, known as CFI, provides help at home or to those who need Medicaid-funded nursing home care. But many people in the program are not getting the services they need. What’s the impact? The 82-year-old woman with diabetes, severe foot pain and incontinence has no one to cook a healthy meal, change bedsheets and remind her to take her insulin. The paraplegic who needs daily help to get up, showered and dressed has help only four days a week. The veteran with Alzheimer’s disease and heart failure waits for a nursing home bed.

What are their options? They struggle to remain safe at home as their conditions worsen. Then what?

The Medicaid payment system for home care and long-term care facilities has been underfunded for two decades. New Hampshire’s payment rates are among the worst in the nation. The domino effect is this: Low payment rates lead to provider financial losses, which lead to stagnant wages for employees, which lead to worker shortages, which force home care agencies to limit services and nursing homes to close beds, which means people who need care don’t get it.

The crisis is real but silent. CFI clients are often homebound and nursing home patients are often severely ill. They can’t speak out at Statehouse hearings.

This doesn’t mean they should be ignored. They are your grandparents, your friends, your neighbors. Their plight is simply that they have serious medical conditions and no one to care for them.

The Legislature must confront this crisis in this legislative session. It should build on the governor’s CFI budget and rebase rates to stabilize the provider network, enabling home care agencies to invest in their workforce.

It should raise nursing home rates from the worst in the country to at least the national average. It should add state general funds to the long-term care appropriation, rather than rely completely on counties to fund these services.

And it should fully fund SB 308, which would increase Medicaid rates for all providers by 5 percent in 2020 and 7 percent in 2021.

Fiscal conservatism is admirable except when the public policy dominos topple into a heap. The current situation is not a game for our seniors and vulnerable adults. Their health and safety are at risk. Legislators need to resolve this silent crisis. Now.

Gina Balkus, of Nashua, is the CEO of the Granite State Home Health & Hospice Association.

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