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How New Hampshire's housing crisis is making it hard to hold onto essential health workers

Even with a master’s degree, Barbara Hutchinson makes around $40,000 a year working full time as a child therapist in Peterborough. She's struggled to find housing that can accommodate her family on that budget.
Paul Cuno-Booth
Even with a master’s degree, Barbara Hutchinson makes around $40,000 a year working full time as a child therapist in Peterborough. She's struggled to find housing that can accommodate her family on that budget.

Barbara Hutchinson loves her job. As a child therapist, she makes a difference in young people’s lives — and has a lot of fun. Sometimes they bring her new toys to play with. One day, she got to have a Nerf battle with a kid.

“My job is probably one of the best jobs in the world,” she said. “I mean, I get to play and help someone.”

Hutchinson works at the Peterborough office of Monadnock Family Services, the local community mental health center. She grew up in the area and still has family nearby. She’d like to stay if she could. But she can’t find a place to live.

For months now, she’s been staying with her sister in Antrim, sharing a room with her 12-year-old son and their two corgis. She’s scoured home listings and rentals, gotten leads from coworkers, visited property in Maine, even thought about tiny homes and yurts.

“I honestly feel like since April of last year, that's all I've done is look,” Hutchinson said. “Every day, sometimes twice a day.”

Even with a master’s degree, Hutchinson makes around $40,000 a year working full time. She says the rentals she’s found that are big enough for her family would cost $1,800 to $1,900 per month. According to a 2022 report from New Hampshire Housing, a household would need an annual income of around $74,000 to afford a two-bedroom unit at those rates.

Buying doesn’t seem to be an option either. She says houses in the area are selling for much more than she can afford. At this point, she’s pretty sure she’ll have to leave the state.

“Everything is so far out of my price range,” she said.

New Hampshire needs people like Hutchinson, especially as the state’s understaffed mental health system struggles to meet demand. As of March, New Hampshire’s 10 community mental health centers had about 350 unfilled clinical positions — including therapists, psychiatrists, case managers and mobile crisis responders.

It’s part of a broader staffing crisis affecting nearly every corner of New Hampshire’s health system, from major hospitals to agencies that care for seniors and people with disabilities in their homes. Some nursing homes have closed entire wings because they don’t have enough workers.

As employers try to fill those vacancies, they say the state’s tough housing market — with its high costs and limited options — is standing in the way.

“Over the last few years, we've had people accepting jobs, start the relocation process — and then actually withdraw their acceptance because they just don't feel it's feasible,” said Carolyn Isabelle, who oversees workforce development for Dartmouth Health, the state’s largest hospital system.

To hold onto staff, some hospitals and other employers are expanding into real estate

Dan Tuohy
The connection between housing and health care has been especially noticeable in places like the Upper Valley, where Dartmouth Health is based. The median rent for a two-bedroom apartment in Lebanon and the surrounding area was nearly $2,400 last year — up 70% in just five years — while the vacancy rate for all units hovered below 0.2%.

To address the scarcity of homes for employees, some major health care organizations have jumped into the real estate market themselves. But others are constrained by limited state funding that makes it hard to pay workers enough to keep up with rising rents and home prices.

“The cost of housing has risen so dramatically during the COVID experience, and even continues to rise, and there's no corresponding increase in compensation,” said Lisa Madden, the president and CEO of Riverbend Community Mental Health Center in Concord.

Rental costs in New Hampshire have shot up over the past decade, as the supply of available housing has tightened. Last year, less than 1% of apartments were open at any given time — well below the 5% vacancy rate that experts consider a balanced market, according to New Hampshire Housing.

That’s been especially noticeable in places like the Upper Valley, where Dartmouth Health is based. The median rent for a two-bedroom apartment in Lebanon and the surrounding area was nearly $2,400 last year — up 70% in just five years — while the vacancy rate for all units hovered below 0.2%.

Karen Teixeira, a nurse who moved to New Hampshire early in the pandemic, said she pays nearly $2,000 for a one-bedroom apartment in Lebanon. She owns land in the area and wants to put down roots — but the cost of living has gotten in the way.

“Paying $2,000 a month in rent doesn't give me a lot of money to put towards building or buying a house,” she said. “So I'm kind of in this tough spot right now.”

And Teixeira can at least afford rent. As a nurse with two decades of experience, she said, she earns a decent salary.

“I don't know how nurses coming out of school, or other professions who make less than nurses do, are surviving in the area,” she said.

In an effort to ease the housing search for new hires, Dartmouth Health has started leasing blocks of apartments from landlords, and subleasing them to employees. Isabelle said that’s helped to retain some candidates who might have otherwise had trouble transplanting.

Dartmouth Health isn’t the only employer becoming more active in real estate. The owners of Harmony Homes, a pair of assisted living facilities in Durham, built seven new apartments nearby so their workers would have somewhere affordable to live. Some smaller hospitals are also buying or leasing homes, to make sure key out-of-state hires can actually move to the area.

“We've decided when we're recruiting folks that we need to have a place for them to reside in, for six months,” said Michael Lee, president and CEO of Weeks Medical Center in Lancaster.

That’s become especially important as the hospital has had to recruit more people from farther away, he said. As of late February, Lee said the hospital was renting a handful of apartments and condos, as well as a house that it intends to purchase at the end of the year. Lee has contacted developers who are building new housing, telling them to keep him in mind when they’re looking for tenants.

“I didn't really ever want to get into the real estate market,” he said. “But, you know, at one point, we were renting 10 locations.”

Officials at Monadnock Community Hospital in Peterborough say they’re also prioritizing housing as a recruitment strategy. Last year, for instance, as they prepared to add some key hires to their medical staff, hospital executives knew they couldn’t afford to delay those employees’ start dates — or lose them altogether — if they couldn’t find housing.

“We did actually end up purchasing a condo, a home, and we're renting a large four-bedroom house to support clinicians, physicians and other staff that are coming into our community,” said Cynthia McGuire, the hospital’s president and CEO.

For some organizations, it's hard to raise wages to keep up with cost of living

Paul Cuno-Booth
Barbara Hutchinson works in Peterborough and has been staying with her sister in Antrim, pictured here, while looking for a place of her own. Both communities are located in Hillsborough County. In order to afford a median two-bedroom apartment in that region, a household would need to earn $74,000 per year, according to a 2022 report from New Hampshire Housing.

For some employers, like community mental health centers, it can be hard enough to scrape together a budget for staff salaries — let alone a place for staff to stay.

Those centers serve mostly patients with Medicaid, which reimburses health care providers at much lower rates than other forms of insurance. One recent study calculated New Hampshire’s Medicaid program pays less than 60% of what Medicare does for the same mental health care — the eighth lowest rate in the country.

Madden, of Riverbend in Concord, said low Medicaid funding makes it hard for organizations like hers to raise wages — and workers struggle to keep up with rising housing costs as a result.

Madden and other community mental health leaders are hoping for a significant rate increase in the next state budget, which is still taking shape in the New Hampshire Senate.

“If we're not able to compensate people a little bit better, they're not able to stay in the community and provide this care, simply because they can't make their ends meet,” Madden said.

In Antrim, Barbara Hutchinson struggles with the thought of leaving her job. Depression and anxiety among youth surged during the pandemic. And whenever a therapist leaves, it has an impact on clients.

“As it is, so many agencies are struggling to bring people in,” she said. “So then to turn around and have to leave makes me go, how long is it going to be before they can fill my position?”

But she does need a place to live. Nothing fancy, she says — just a comfortable home with room for her family, and maybe a little space for the dogs to run around outside. She’s looked at states like Maryland, Georgia and North Carolina, where housing seems to be much cheaper.

“We don't make great money in community mental health,” she said. “It's just not there. But we don't do it for the money, right? But you still have to be able to live.”

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Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at pcuno-booth@nhpr.org.
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