Closure of Lebanon home for people with disabilities highlights a support system spread thin

  • Susan McCarthy, nurse trainer at the Pathways Orford Road home in Lyme, takes Mary Ellen Sanders, 70, a former resident of the now-closed Riverdale home, for a walk around the facility on Thursday. Valley News — James M. Patterson

  • Dennis Valcourt, Pathways’ Upper Valley residential director, said Thursday that when the agency’s Riverdale residence had to close in April, “it was a blessing in disguise” for those residents because he could help find them places better suited to their needs.

  • Veronica Gray, a personal care assistant from Mississippi on a traveling contract, helps Mary Ellen Sanders settle down for a rest under a blanket of her favorite color — green — at Pathways of the River Valley’s Orford Road home in Lyme on Thursday. Frank Sanders, Mary Ellen’s brother and guardian, said she had a smooth transition to Orford Road when her former home closed in April. “They give her the quality of life she deserves,” Sanders said. James M. Patterson / Valley News

Valley News Staff Writer
Published: 6/28/2022 5:56:28 PM

LEBANON — Pathways of the River Valley closed a home for adults with disabilities in Lebanon in April, displacing three residents.

The agency was able to find alternative care for the people who had been living at Riverdale residence, but in the message posted to Facebook announcing the closing, Mark Mills, Pathways CEO, said the closing is a symptom of a much bigger problem.

“A lack of qualified direct support workers has reached a crisis point in the developmental services system in New Hampshire,” Mills wrote in April.

The organization, based in Claremont, would have about 200 workers if it were fully staffed, said Steve Warner, Pathways’ senior director of community services. But it currently has 73 vacancies, meaning it is short some 35% of the workforce necessary to care for people with disabilities in Sullivan and lower Grafton counties. It’s not alone. Pathways is one of 10 area agencies in New Hampshire and together they have about 500 vacancies for direct support workers alone.

Riverdale, which had been in operation since the late 1990s, provided full-time care to four people with acquired brain disorders. It took about 10 full-time employees to provide that care. In 2020, due to staffing issues amid the COVID-19 pandemic, in spite of having a waiting list, and becoming increasingly reliant on a staffing agency, Pathways reduced the census to just three residents. Ultimately, that wasn’t enough.

It “wasn’t a choice to close. It was a required action step,” Warner said. “We were just barely getting by and then we lost two full-time people, and that was it.”

While many of the people in the field are passionate about their work to support people with disabilities, Warner said the COVID-19 pandemic took a toll.

“Having gone through the pandemic, that takes a lot out of people,” he said.

Due to workforce issues, Pathways is sometimes providing people with fewer hours of support than they would otherwise receive; some employees are working overtime, and the agency relies on some temporary workers employed through staffing agencies.

Pathways plans to sell the Riverdale property, a ranch home on nearly one acre located at 28 Riverdale Parkway, and direct the proceeds to its 10-resident home in Lyme, which provides daily nursing care, along with other supports, to people in need of an even higher level of clinical services.

“We get requests regularly to see if there’s a bed available,” Warner said. “It’s a huge need.”

Stuck at DHMC

Janice Chase, of Concord, is well-acquainted with the difficulty finding care for adults with disabilities. She is co-guardian for 23-year-old Michael Dupuis, who has been at Dartmouth Hitchcock Medical Center since March. He was initially admitted with influenza A. He developed meningitis, and doctors found he also had Lyme disease and a blood infection, which they believe stemmed from a tooth infection. He developed encephalopathy, a change in his brain affecting his speech and his mobility. He was unconscious for a week.

Dupuis, who has a rare form of dwarfism called Russell-Silver syndrome, has since recovered medically and has been cleared to leave the facility for a lower level of care since April. But in spite of about 40 referrals so far, that care cannot be found.

The facilities are “all declining him,” Chase said. His needs, which in addition to his medical and developmental challenges also include mental health issues, are too complex for him to return to Visions for Creative Housing Solutions’ location on Green Street in Lebanon, which opened last year.

Either the rehab places, which also are facing staffing issues, don’t have a bed for him or his needs are too complex, she said. He needs occupational therapy, physical therapy, speech therapy and acute care, she said. Between the three forms of therapy, he needs three hours a day. Nursing facilities are set up to provide only one hour a day, she said.

“We’re going to have to take whichever at this point, which is really tough,” Chase said, noting that they were starting to send out requests to facilities in Massachusetts.

“That is not where we want to be,” Chase said of the prospect of sending Dupuis out of state. “What Michael needs is what we’ve got to do. He also needs his people for his mental health. He’s going to be alone down there.”

Pathways recently evaluated Dupuis at DHMC and he can have a spot at the organization’s Lyme home, but he first needs to find a place for rehab, Chase said.

“There’s just nothing there,” she said.

In the meantime while at DHMC, Dupuis is not able to receive the therapy he needs to regain his ability to speak and move. Though he has regular visits from Chase and his 87-year-old grandmother, Lois Miner, of Grafton, along with friends in the Lebanon area, he spends the days in bed often watching television. He is able to say yes and no, but other words are garbled.

Dupuis was fully functional prior to his hospital admission, Chase said. He attended the Regional Resource Center in Hartford for a time before completing his certificate of completion at Spaulding Academy & Family Services in Northfield, N.H., at age 21. Prior to his recent hospital admission, Dupuis had a job working on the janitorial staff at Walmart in West Lebanon a few days a week. The staff at Visions took him to his job and made sure he got to his doctor’s appointments, Chase said, noting that the direct support workers helping him made a lower hourly wage than Dupuis did at Walmart.

“The government or somebody’s got to step up to the plate to help them with their wages,” Chase said.

‘Waiting for families to organize’

A small part of Pathways’ loss became Visions for Creative Housing’s gain, when the nonprofit, which provides supported housing for adults with developmental disabilities at homes in Lebanon and Enfield, was able to hire one of the former employees of Riverdale residence.

“She’s wonderful,” said Sylvia Kluge Dow, Vision’s executive director.

But more broadly, Dow said she regularly hears from families who are struggling with the insufficient support for people with disabilities and their families in New Hampshire.

“It’s troubling for me because there is such a need in our state,” Dow said of Riverdale’s closing. “I keep sounding the alarm.”

Dow said families and other groups around the state are eager to set up homes like Visions’ in their communities. While she tries to offer them support and encouragement, she said it’s increasingly up to families to ensure that their loved ones receive the support they need.

“Once again, families are asked to do this really hard work,” said Dow, whose two daughters live in Visions housing. “Not everyone is equipped. Not only that, it takes so long.”

Dow said she finds it frustrating that state agencies aren’t stepping up to provide services.

“Why are they waiting for families to organize and to get the work done?” she said.

Creating a career path

The New Hampshire Department of Health and Human Services is aware of the staffing challenges. It has formed a direct support workforce committee that meets weekly, said Jake Leon, a department spokesman.

The committee is tasked with developing recommendations to grow the direct support professional workforce in New Hampshire. The committee is focused on developing a career ladder for direct support professionals; elevating the direct support profession through credentialing and specialty certification; and ensuring rate development includes livable wages and opportunities for wage increases for direct support professionals.

Additionally, DHHS has worked to help agencies temporarily expand payment for services provided by family caregivers or guardians. The state has directed some American Rescue Plan Act funds for training, recruitment and retention of the direct support workforce.

Warner, at Pathways, said the state’s efforts to support workers during the COVID-19 pandemic have helped shore up the workforce and allowed them to give employees bonuses, but they haven’t been enough. Pathways has increased the number of home providers it works with to care for people with developmental disabilities in their homes, some of whom might otherwise be cared for in a group home setting. While that has helped address some of the need, the need is still greater than Pathways can address.

Pathways simply cannot compete with area employers such as Dartmouth Hitchcock Medical Center and the Coop Food Stores, which raised starting pay to $17 an hour last fall. Pathways had worked to raise pay for direct support workers to $12 in 2018. That wage has since increased to a rate ranging from a little more than $13 an hour to over $18 for those with more experience, but it’s not sufficient to compete with other area employers in a tight labor market. The agency is constrained by budgets funded by a mix of state and federal Medicaid payments, the rate for which has only increased a couple of times in the past two decades, according to Mills, Pathways’ CEO.

Mills sits on the statewide committee that is looking at ways to bolster the direct support workforce. He said he’s encouraged by conversations about reconfiguring the rate structure.

“We haven’t finalized our recommendations yet,” Mills said. “What we all feel the issue is … (the) direct support profession really needs to become a profession — something that people can make a career in.”

Workers supporting people with disabilities need a career path they can follow, said Mills, who started out as a direct support worker in 1984.

For him, Mills said, direct support provider was both the hardest and best job he’s ever had because he knew he was “having that impact on people’s lives.”

One idea to make the field more attractive to employees is to create a credentialing program such as those in the fields of teaching and nursing that allow people to earn more money as they gain more skills.

“You have to have the funding,” Mills said. But “It’s not just the funding.” Ultimately, he said, the goal is “having people look at this very important and critical role differently.”

Nora Doyle-Burr can be reached at

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