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Eyeing more community-based care, NH health officials aim to eventually make nursing homes a last resort

A woman with a microphone speaks at a conference, in front of a lectern
Paul Cuno-Booth
Cheryl Steinberg, director of the Justice in Aging Project at New Hampshire Legal Assistance, speaks Monday at a conference on long-term care.

New Hampshire’s population is getting older. But there's not enough people to take care of those who are aging — and not enough money to help.

State officials, policy experts and long term care providers gathered in Portsmouth on Monday to discuss how they're addressing those challenges and working to make New Hampshire a better place to age.

“We want our policies and programs to represent the vitality among this community,” Lori Weaver, the state’s health and human services commissioner, told attendees at the New Hampshire Long Term Care Summit. “We know older adults thrive when they are able to be in situations in which they feel supported.”

By one estimate Weaver shared, one-third of New Hampshire’s population will be over 65 by 2030. But services haven’t necessarily kept up.

The COVID-19 pandemic exacerbated staff shortages across the health care sector in New Hampshire, including at long-term care facilities.

That’s forced nursing homes to leave beds unoccupied even as demand remains high, according to Brendan Williams, who heads the New Hampshire Health Care Association, a lobbying and advocacy group representing long-term care facilities. He said at least two county nursing homes have more than a hundred people, each, waiting for a bed.

Home and community-based services are also struggling. Providers say the funding they get from the state doesn’t cover the cost of services, and they can’t pay workers enough to fill vacancies.

Some people at the one-day conference said it can also be hard to navigate those services. State Rep. Lucy Weber, a Democrat from Walpole, said even she finds it difficult to help constituents who are trying to access care.

“I have a law degree. I was a practicing elder law attorney in another state. And I served on the Health and Human Services Committee for about eight years,” she said. “I can't find this stuff.”

The conference began with a discussion of recent policy changes that target those shortcomings.

In June, as part of the state budget, lawmakers passed legislation meant to lay the groundwork for a more coordinated, comprehensive “system of care” for older adults.

The goal is “to ensure that older people and people with disabilities have a full range of care options in a setting of their choosing,” said Cheryl Steinberg, who directs the Justice in Aging project for New Hampshire Legal Assistance and helped advocate for the bill. For most people, she added, “that is being in their home, in the community.”

The legislation also includes expanding and improving the state’s ServiceLink program, which helps people access aging- and disability-related resources.

Associate Health and Human Services Commissioner Christine Santaniello outlined how the state is trying to implement that legislation, from reducing the financial paperwork required for Medicaid and helping providers with workforce development, to undertaking a study of how the state pays for in-home care.

She said New Hampshire is at the beginning of what will be a long-term process of transforming how it supports older adults.

“How do we make sure that nursing facility institutional care is really the last option for individuals, after we've developed, strengthened and supported home- and community-based services?” she said.

The newly passed state budget also includes substantially more funding for long-term care, particularly for people living at home or in other community-based settings.

New Hampshire Medicaid’s Choices For Independence program covers those services, which can help people stay in their homes rather than a nursing facility. But its funding has not kept up with the costs of that care.

The New Hampshire Fiscal Policy Institute estimates the program had a total shortfall of $153 million dollars between 2011 and 2021, compared to what would have been needed to keep pace with inflation and rising demand.

Phil Sletten, the institute’s research director, said the new budget will make tens of millions of dollars in additional funding available to home- and community-based care providers.

Amy Moore, who directs in-home care for Ascentria Care Alliance, said that money is a good start. But it will take additional investment to make sure everyone can get the care they need.

“We serve 400 individuals throughout the state,” she said. “We were at the point of having to close our doors, because we were taking on such a deficit year after year. So this really just level-sets us so that we can keep our doors open.”

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
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