(Opinion) A state of crisis: in-home care in New Hampshire

Workforce shortage creates lack of care for older adults and people with disabilities in NH

Across the state, older adults and persons with disabilities are going without meals, bathing, social contact and, tragically, they are dying alone. Why is this happening?

The root cause of this problem is that caregivers in New Hampshire are grossly underpaid resulting in a significant workforce shortage. The work that they do is critical to thousands, yet they are paid an hourly wage that is less than they could earn at Walmart or McDonalds.

Those caregivers who choose to continue this work are struggling to pay their own bills. Many are reluctantly leaving for higher paying jobs and fewer and fewer are entering this line of work. A shrinking workforce means that people go without the care they need.

The driving force that is leaving fragile Granite Staters without care is the underfunded Choices for Independence (CFI) state program. The NH Fiscal Policy Institute (NHFPI) identified a structural deficit in the program of $153 million in CFI from fiscal years 2011 to 2021. Providers cannot pay livable wages to recruit and retain workers and cover costs.

Borja Alvarez de Toledo, president/CEO of Waypoint says, “The CFI provider network is in danger of collapse as caregivers are leaving the workforce in search of higher paying jobs. Without a meaningful increase in funding, we will be forced to close our CFI program leaving hundreds without care.”

When people cannot get care in their home it has a domino effect in our healthcare system, which can impact any NH residents seeking medical attention. Because home- and community-based care is a large component of the overall system of care in NH, when hospitals and rehabilitation centers can’t discharge patients back home (because there is no care available) they become strained.

“NH’s Choices for Independence (CFI) program is a vital asset to our state to support eligible adults to stay in their own homes and live in their local communities. CFI is an important part of the health care system that means that adults can receive the right care in the right places that meets their social and medical needs. It’s critically important that programs such as CFI be adequately funded to provide assurances to those that rely on it that their needs will be met now and into the future”, said Steve Ahnen, president, New Hampshire Hospital Association.

Choices for Independence is the most feasible option for many people; it’s affordable and allows people to remain in the comfort of their homes with their loved ones. A lack of funding to pay workers a livable wage is currently preventing people from receiving this type of care.

Based on NH Department of Health and Human Services data, the entire CFI appropriation is rarely spent. This is not because the budget is too large, it’s because agencies don’t have the needed staffing and can’t provide the services.

In a 2021 survey conducted by NHFPI, every single case management agency in NH 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.

Ascentria In-Home Care, Waypoint, The Alliance for Healthy Aging Advocacy Group and Granite State Home Health and Hospice Association are working together to increase the public’s awareness of this crisis and use their voices to call on legislators to increase funding for CFI to stabilize this program.

“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. If we don’t get a substantive rate increase, we won’t be able to continue services after July 1,” says Amy Moore, director of Ascentria In-Home Care.

Amy Moore, director of Ascentria In-Home Care, can be reached at AMoore@ascentria.org.

Categories: Opinion