This story was originally produced by the New Hampshire Bulletin, an independent local newsroom that allows NHPR and other outlets to republish its reporting.
New Hampshire ranks 24th nationwide in supports and services for older residents and people with disabilities, according to AARP’s latest analysis. Among New England states, however, it’s last.
The state scored much higher in some specific measures, such as the number of nursing home residents up to date on COVID-19 vaccinations and the employment rate among people with disabilities compared to those without disabilities, the report said.
But it scored near the bottom on Medicaid spending that allows people who qualify for nursing home care to remain home or in a home-like community setting. It also earned low rankings for the percentage of people who are hospitalized while receiving care at home or in nursing homes.
AARP’s Long-Term Services and Supports State Scorecard, updated every three years, backs up concerns raised by long-term care advocates and people who need those services.
They’ve pointed to a workforce shortage, driven in large part by low wages, that has led agencies and nursing homes to turn people away. Patients ready for discharge are languishing in hospitals for weeks or months, waiting for a nursing home bed to open.
In a release Monday, AARP New Hampshire called New Hampshire’s rankings “lackluster.”
“The pandemic reinforced the need to strengthen long-term care for countless loved ones across the country and in New Hampshire,” said AARP New Hampshire State Director Christina FitzPatrick in a statement. “New Hampshire AARP’s Scorecard shows there are many roads to meet the needs of all Granite Staters who deserve the very best care, including the 168,000 family caregivers in our state. It’s time to accelerate our efforts, for the sake of saving more lives.”
AARP’s scorecard assesses states and the District of Columbia on 50 measures in five areas: affordability and access to services; the choices people have about their care; safety and quality of care; support for family caregivers; and community integration.
New Hampshire ranked 29th or lower in all but the last category.
The analysis found that Granite Staters are spending more of their annual income on in-home or nursing home care than their counterparts in other states. New Hampshire also ranked 31st on the availability of adult day services.
“The rankings are indicative of how there is room for improvement,” FitzPatrick said.
It did not surprise her to see that New Hampshire was 49th for Medicaid spending on basic care that allows people who could be in a nursing home to remain home or in a community setting. AARP worked with the New Hampshire Fiscal Policy Institute on its 2022 analysis of Medicaid long-term care spending.
The analysis found that between 2011 and 2021, the state kept pace with inflation for Medicaid payments to nursing homes but not for the Choices for Independence Program, which provides in-home and community-based care.
If it had, the CFI program would have received an additional $153.2 million between 2011 and 2021, the report said.
FitzPatrick has prioritized addressing that discrepancy and worked with other advocates this year to pass legislation she hopes will increase the use of CFI services for those who want to remain at home or in a small community setting.
The budget includes $1.7 millionfor developing and coordinating a system of care for healthy aging. Some of that money will expand ServiceLink, the state’s resource center for people seeking options for long-term care.
The legislation also requires the state to explore improvements to its Medicaid eligibility determinations for long-term care. Providers cannot receive payment for care until a person’s eligibility is confirmed, a process that can take several weeks.
Nursing homes can afford to admit someone during that wait because their budgets are large enough to cover costs until Medicaid payments begin. Small agencies that provide in-home and community-based care do not have the same budget flexibility, FitzPatrick said. That leads some who could stay home to go into nursing homes instead in order to get care more quickly.
The state had much higher scores for the ability of older residents and people with disabilities to integrate into the community. It placed ninth and 10th for housing assistance for people with disabilities and age-friendly health systems, respectively.
It also did well on aging and disability resource access, landing in third place.
New Hampshire provides support for family caregivers in two important ways, FitzPatrick said.
People who lose their job due to an immediate family member’s illness or disability can qualify for unemployment benefits under state law. And, New Hampshire has adopted the CARE Act, legislation to help family caregivers during and after a loved one’s hospitalization that includes educating caregivers on the medical tasks they will need to perform for the patient at home.
AARP reported in March thatnearly 168,000 Granite Staterswere providing critical home-based care to older people or adults with a serious health condition in 2021. It put the value of that care at $2.8 billion in 2021, up $500 million since 2019.
The cost is based on a $17.96 hourly wage, which is calculated using the average of the state minimum wage, state home health aide median wage, and state median hourly cost of hiring a home care worker.
FitzPatrick also pointed to significant increases in Medicaid reimbursement rates that health and long-term care providers said were crucial to addressing workforce shortages.
“We are hoping that in providing this (scorecard) we are setting out some guideposts for what we can do to improve long-term care in the state,” she said. “That runs everywhere from supporting people so they can stay in the community and have what they need to age well in the community all the way up to nursing home care to make sure that care is high-quality.”
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