Economic challenges threaten long-term care

State-funded Medicaid payments annually fall millions of dollars short of reimbursing provider costs


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As New Hampshire considers how much money to sock away in the state’s rainy day fund, it is important to remember that storm clouds are gathering for some of New Hampshire’s most vulnerable elders.

According to the current State Plan on Aging, New Hampshire now has the nation’s third fastest growing elder population.

One-fifth of residents will be 65 and older in 2020, up from 13.5 percent in 2010. Yet, as we look to this future, inadequate funding is squeezing care providers and the Department of Health and Human Services alike. It’s unsustainable.

New Hampshire has had commendable success in developing long-term care options. As a result, today’s skilled nursing homes are not yesterday’s “rest homes.” Many residents are rehabilitated and return home or to lighter-care settings.

This trend has increased medical acuity for remaining residents. By 2014, the percentage of those needing help with at least four of five activities of daily living was higher than 15 other states. And those without the highest care needs can now obtain services in their own home or in an assisted-living facility.

Over three-fifths of nursing home residents are on state-funded Medicaid, but those funds annually fall millions short of reimbursing care costs. This deficit has painful consequences for dedicated caregivers and support staff, and exacerbates a health care workforce shortage.

Worse crises loom; last year, after a resident outcry, the Legislature rebuffed a devastating $7 million care cut proposal.

For assisted-living facility care, it’s even worse. The state pays an arbitrary $49 a day for Medicaid there. That $49 is all the state pays for 24/7 care, meals
and housing in a highly regulated setting. In contrast, a well-known budget motel chain’s rooms would
cost you $69.99 a day in Nashua or $89.99 in Portsmouth.

These paltry payments are a disincentive for assisted living facilities to accept Medicaid, and can make it hard for seniors to even find Medicaid assisted living. Many have to leave their community – leaving behind place-bound spouses and friends – thoroughly contradicting the “aging in place” notion of home- and community-based long-term care options.

In rural New Hampshire particularly, the Obama administration may worsen matters with a proposed rule disallowing assisted living where traditionally offered adjacent to nursing home care.

A Lancaster facility’s example both highlights New Hampshire long-term care’s evolution and challenges.

A Victorian mansion built in 1890 and known then as Indian Brook, it became a “nursing and rest home” in 1959 – newspaper accounts show its 1997 rebirth as assisted living was celebrated with a “bash” attended by local and state dignitaries.

Yet ever-longer lifespans strain the resources seniors have available for care, and the small facility came to see two-thirds of its residents on Medicaid. Now it’s closing, displacing residents and staff.

It is custom in politics everywhere to not look beyond the budgetary crisis du jour or the next election. Yet those receiving, and providing, long-term care cannot keep riding a roller-coaster of political uncertainty as our state so dramatically ages. A nursing assistant doesn’t have the luxury of a rainy day fund.

Citizens must ask those running for governor and the Legislature how they will honor long-term care across the entire continuum of options.

Brendan W. Williams is the president and CEO of the NH Health Care Association.

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