Considering a career in health care in New Hampshire? I cannot currently recommend it despite the level of need.
That position is against self-interest. After all, my association represents 78 long-term care facilities capable of serving over 7,100 New Hampshire residents.
Yet the current state budget impasse reveals, yet again, the tenuousness of health care in the Granite State. A state that eagerly bestows 5% pay raises on liquor commission bigwigs balks at raising Medicaid rates by 3.1%, even though those rates have suffered years of neglect. One cannot help but wonder if this is because the caregiving workforce is overwhelmingly women (91% of nursing assistants, for example, in nursing homes) predominantly caring for elderly women.
According to an analysis by Hansen Hunter and Company, an accounting firm, the gap between Medicaid payments and costs for nursing home care in New Hampshire grew from $46.70 in 2016 per resident per day to a projected $49.45 in 2018. That is easily the worst payment shortfall in New England, and our state has the nation’s second-oldest population. Because 64% of nursing home residents are on Medicaid, funding has made it nearly impossible to recruit, and retain, staff within tight resources, and facilities are simply removing beds from service.
To put our funding in perspective, Oregon, which has also developed the nation’s leading home-and-community-based long-term care system, pays a Medicaid rate for nursing home care that is well over $100 per resident per day higher than New Hampshire’s.
I cannot responsibly advise New Hampshire nursing homes considering closure to stay open based upon the possibility the budget impasse may end and result in additional funding. Businesses, whether nonprofit or for-profit, cannot budget based upon hypotheticals. And every day counts when you are losing money, especially as the law requires a facility to provide notice at least 60 days before it closes. If New Hampshire facilities close, it will be through no lack of demand, unlike some closures in other states that were at least partly based upon low occupancy.
The Medicaid sector for assisted living is even more precarious, with state rates of $50.96 a day causing even nonprofit facilities to close – including, in May, the 115-year-old Gafney Home in Rochester – and scatter residents. Poor funding has caused assisted living to effectively become nonexistent as a Medicaid option in New Hampshire, despite an assisted-living facility’s social care environment’s appeal to so many older adults.
For those who can be cared for in their own homes, help is hard to find, with one advocate describing bedridden adults lying in their own excrement waiting for the freedom, and dignity, a home care aide could provide.
As is true with nursing homes, Medicaid severely depresses home care wages. One major nonprofit hiring home care aides is offering $12 an hour. In contrast, a Toll Attendant II for the state starts at $14.95 an hour. If a budget is thought of as the ultimate policy document, it’s clear where our priorities are.
Last year, 29% of last year’s registered nurse graduates in New Hampshire left the state, mostly for Massachusetts, and the state also suffered a net loss of 567 licensed nursing assistants. Staffing agencies are feasting on providers unable to find permanent employees. Until our budget gets resolved, we are increasingly closed for health care business as a state.
With Concord paralyzed, and the compromise budget in Massachusetts providing another huge increase in Medicaid rates ($50 million for nursing homes), I wouldn’t be surprised if Massachusetts health care employers begin holding job fairs throughout New Hampshire.
(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)