Rich Crocker of Meredith is a retiree, formerly the superintendent of Laconia State School and Training Center and director of the Bureau of Elderly and Adult Services.

This year presents a great opportunity for development in New Hampshire’s long-term services and supports (LTSS) system of care that would result in a better quality of life for older adults, and in the long run, would lower governmental costs.

We have known for many years that older adults, who have spent a lifetime contributing their gifts to their families and community life, want to maintain doing so as they age. The gifts they offer all of us do not stop at a specific age but can need services and supports to continue doing so.

To achieve this will require a rebalancing of the funding in New Hampshire’s system of care, which currently focuses mainly on facility-based care, the most expensive setting for care.

According to the NH Commission on Aging 2022 Annual Report, as a state, we only spend 14% of funds on home and community-based care compared to the 45% average nationally.

In real dollars, the 2022 New Hampshire State budget for the largest payor, Medicaid for long-term services and supports, allocated about $110,000 for facility-based care per enrollee and about $20,000 for home and community-based care per enrollee.

This lopsided use of funds does nothing to promote reasonable choices for older adults.

Additionally, the Granite State is an aging population, meaning the need for more LTSS will only increase. Providing funding for more home and community-based options will help families and communities continue to benefit from engagement with older adults. People who are our grandparents, parents, other relatives, and friends, people who have helped all of us lead our lives.

Shouldn’t we ensure that choice and access to these home and community-based care options exist?

These issues have been confronted before when much of the same was true for individuals with developmental disabilities who primarily had access to facility-based care at Laconia State School and Training Center. Home and community-based services that were available at the time were mostly developed and paid for by families due to nearly all the state funding dollars supporting facility-based care. Concern for the quality-of-life issues these individuals faced led to a lawsuit that changed that system. As a result, nearly all funding now supports life in the community for individuals with developmental disabilities.

Today, with bipartisan support, we can all stand up and say, “It’s time for change” for older adults by supporting SB 36, System of Care for Healthy Aging, sponsored by Senator Gannon.

This legislation is broad in scope, addressing not only the issues raised above but many of the operational details needed to move toward making this vision a reality. SB 36 would lead to more comprehensive services like personal care, homemaker services, transportation, meal delivery, emergency response systems, adult day services, family caregiver support, and other types of LTSS that would emerge as the state invests in its future. Moving forward, the cost of LTSS would also be reduced by expanding the availability of a less costly system of care.

]]>