Column: N.H. Must Act Now on Crisis in Long-Term Care

  • Medical Assistant Charina Canete, of Claremont, N.H., prepares to take the temperature of Gonzalo Franceschi, of Quechee, Vt., during an appointment in the General Internal Medicine ward of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., on Tuesday, Oct. 9, 2018. Canete is an apprentice in DHMC's Workforce Readiness Institute program and plans to go into nursing. (Valley News - August Frank) Copyright Valley News. May not be reprinted or used online without permission. Send requests to

To the Valley News
Published: 12/25/2018 10:06:02 PM
Modified: 12/25/2018 10:06:08 PM

In Maine, a record number of nursing homes have closed this year, despite the fact that Maine has the nation’s oldest population. New Hampshire, with the second-oldest population, may not be far behind in what is shaping up as a bleak holiday season.

At least Maine, after all, took a significant step this year to improve its nursing home reimbursement, recognizing that caregivers were underpaid as a result of Medicaid.

The Maine increase was, according to the law that passed over the governor’s veto, intended to allow a 10 percent wage increase.

That’s tremendous compared with the fact that New Hampshire’s Medicaid reimbursement for nursing homes will increase by an average of only .17 percent on Jan. 1.

In New Hampshire our caregiver recruitment and retention crisis is also compounded by the fact that we have the nation’s third-lowest unemployment rate.

As the Valley News has reported (“Nursing Home Beds in Short Supply in the Upper Valley,” Dec. 1), underfunding and staffing pressures are leading to an access problem in some areas.

Under exacting federal standards, a nursing home cannot serve more patients than it can responsibly staff for. Thus, many facilities effectively have beds “offline” as there are not enough staff members to serve them.

Nor are nursing homes alone in their plight — New Hampshire’s entire continuum of long-term care, including in-home care and assisted living, is underfunded.

According to a recent salary survey, one can make more as a liquor store clerk, or a restaurant dishwasher, than one can as a licensed nursing assistant at a nonprofit nursing home in New Hampshire’s largest county.

Why undertake 100 hours of training, and submit to two criminal background checks, for less money than you can make elsewhere?

Caregiving is a labor of love, and it is not for everyone.

Yet, while one may not enter into caregiving to get rich, one should not get poor caring for the state’s poor on Medicaid.

For too long the state budget has been “balanced” by leaving the budgets of nursing homes, and the family budgets of their caregivers and support staff, unbalanced.

A “budget adjustment factor” means that, effective Jan. 1, the state will fall short by 26.82 percent of paying what it recognizes (after downward adjustments) as the full cost of care.

This is not the fault of the Department of Health and Human Services. It must make do within the means appropriated to it. But payments are untenable for many providers, as even the rate paid in full would not meet their actual care costs.

Absent a sizable funding increase, facility closures are guaranteed. And it is always the rural areas that are hit hardest.

Caregivers, support staff and residents will be displaced, belying any notion of “aging in place” for the residents and forcing them into relocations where they leave place-bound, elderly spouses — and other family and friend supports — behind.

We cannot continue to defer addressing this crisis by commissioning legislative studies.

The coming legislative session, with split party control in Concord, will bring a historic opportunity to finally act to sustain a fragile safety net, and promise, to our most vulnerable citizens. It should be done without favoritism.

All who serve Medicaid clients, in whatever setting, should be able to pursue living wage dreams.

Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

Valley News

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