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

As of December 15 data, 59.2% of New Hampshire nursing homes were experiencing a nursing staff shortage, the nation’ second-worst crisis. Compare that to Massachusetts, doing 5th best among states with just 9.3% of facilities reporting such a shortage.

Massachusetts has invested very significant resources into its long-term care workforce since the COVID-19 pandemic began, which has lured even more Granite Staters to cross the border for work. It was a wise move by the Bay State, as the pandemic has contributed to a workforce realignment referred to as the “Great Resignation,” which has hit the care economy (including childcare) hardest.

In its preliminary figures last month, Bureau of Labor Statistics’ data found over 300,000 fewer workers nationally in “nursing and residential care facilities” than in March 2020, when the pandemic began to fully unleash its cruelty upon long-term care. The inability to add back staff is not for lack of trying on providers’ part.

An accounting firm’s survey found average wage costs for New Hampshire nursing homes rose 19.53% from 2019-2021 excluding contract labor, or 23.66% including contract labor, and wages have gone up considerably since. Nursing homes that never used staffing agencies to fill nursing slots are now forced too, and it’s a race-to-the-bottom as those agencies then recruit away a nursing home’s own staff.

A recent study reported by Becker’s Hospital Review found that in New Hampshire the cost of a registered nurse, for example, is 220% higher for a provider using a “traveling nurse” agency, a hostage rate hospitals and nursing homes alike must pay. Even the state-run New Hampshire Veteran’s Home in Tilton has a multi-million-dollar contract with a California staffing agency.

This is a national phenomenon. In Tennessee providers pushed a law requiring the state government to study the cost of temporary staffing in long-term care facilities. That study, reported last month, found those costs had exploded 535% annually from 2019, the year prior to the pandemic, to 2021. For 2022, they were on track to be over 1,000% higher than in 2019.

Here in New Hampshire, as is true elsewhere, the result of these extraordinary costs for too many nursing homes has been that simply staffing to care for their existing residents is bankrupting, while adding staff to admit new residents is impossible. Thus, hospitals are jammed up with those who could otherwise be discharged into nursing home care.

There are good staffing agencies, including ones with offices in our state, but the Legislature would be wise to pass legislation, as so many other states have, to bring some transparency to the pricing of such agencies and curtail overtly predatory practices. After all, almost three-fifths of New Hampshire nursing home residents are on Medicaid, and the dynamics that affect their care are of special state interest.

The Legislature also must embrace the type of aggressive workforce investment that other New England states, and states nationally, have made to allow nursing home providers to recruit, and retain, staff. Last year, Wisconsin raised its Medicaid rates 23%, Nebraska by 20%, and Pennsylvania by 17.5 %. This is not a partisan issue. In all three states, Republicans have legislative control, as they do here.

An existential crisis requires a response that will meet its gravity. Our long-term care system, including home and community-based settings also struggling with workforce needs, is on the brink of disaster if we continue unchecked on this trajectory.

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