New initiative addresses NH’s lingering in-home caregiver workforce shortage

Four New Hampshire nonprofit agencies have united to launch The Care Paradox, an initiative aimed at addressing the state’s chronic caregiver workforce shortage.

The organizations – Ascentria In-Home Care, Waypoint, The Alliance for Healthy Aging Advocacy Group and Granite State Home Health and Hospice Association – said the initiative will address what they see as the underfunding of the state’s Choices for Independence program, a Medicaid-funded program that provides a wide range of service choices that enable eligible adults to stay in their own homes and communities.

According to the NH Fiscal Policy Institute, the Choices for Independence program has had a structural deficit of $153 million from fiscal years 2011 to 2021. The underfunding has resulted in a “grossly underpaid” caregiver workforce, the nonprofits argue, making it both more difficult to attract new workers as well as maintain the current caregiver workforce, who are leaving for higher-paying jobs.

In fact, according to NH Department of Health and Human Services data, the entire CFI appropriation is rarely spent – not because the budget is too large but because agencies don’t have the needed staffing and can’t provide the services.

In a 2021 survey conducted by NHFPI, every case management agency in New Hampshire indicated that an individual might not receive CFI services because there are not enough available workers to meet the overall need for services or available workers at the times when services are needed.

“While the system serving highly vulnerable people has been profoundly struggling for many years due to low reimbursement rates impacting caregiver wages, we are at a critical crossroads,” said Amy Moore, director of Ascentria In-Home Care.

She said additional funding requested in the state’s 2024-25 budget “is the minimum increase needed to just keep our doors open beyond July 1st. It is not nearly enough to increase wages to attract a larger workforce and solve the caregiver shortage crisis.”

According to Borja Alvarez de Toledo, president and CEO of Waypoint, the CFI provider network “is in danger of collapse. Without a meaningful increase in funding, we will be forced to end those services leaving hundreds without care. It is an impossible and heart-breaking situation.”

While Choices for Independence is the most feasible option for many people because it is affordable and enables people to remain at homes with their loved ones, when they can’t receive the care at home, it creates a domino effect throughout the state’s healthcare system.

“New Hampshire’s Choices for Independence program is a vital asset to our state [as it helps] people to stay in their own homes and live in their local communities. It’s critically important that programs such as CFI be adequately funded to provide assurances to those who rely on it that their needs will be met now and into the future,” said Steve Ahnen, president, New Hampshire Hospital Association.

Care Paradox partners acknowledge that during this year’s budget cycle there have been constructive conversations with legislators who recognize the significance of the home care crisis. The addition of increased funding for Medicaid rates with a look towards prioritization of in-home services is an important step forward, but there is still a long way to go in order to stabilize the decade of deficits in the CFI system.

“This crisis will only get worse if these conditions are allowed to continue unchecked,” says Amy Moore, Director of Ascentria In-Home Care. “New Hampshire’s older adults and persons with disabilities deserve a chance to spend their last years well cared for in their own homes.

The Care Paradox effort is aimed at what organizers said is to put “human faces to the problem” and call upon legislators to increase funding for CFI in order to stabilize the program.

The Care Paradox site provides a platform for people to share their stories about how the system is failing them, and features a 60-second advocacy tool for emailing legislators to demand an increase in caregiver pay. Visitors can also learn about the plight of caregivers who struggle economically while they provide care to clients.