HEALTH CARE
By: Brendan Williams
For all the ways in which New Hampshire is economically competitive — the vaunted “New Hampshire Advantage” — we’re falling behind in the care of our aging population.
As of the most recent Census data, New Hampshire’s proportion of those 65 and older (21.5%) is higher than our 18-and-younger population (17.7%), placing us, along with neighboring Maine and Vermont, among only 11 states with this distinction.
For a long time, long-term care advocates warned, in a manner befitting Paul Revere, that the baby boomers were coming. Well, the baby boomers are here. What we did not foresee is that their aging process into long-term care would be accompanied by an absence of new babies — a baby bust, if you will. This will inexorably worsen a demographic shortage of potential caregivers.
The current state of New Hampshire’s facility-based care economy is one of uncertainty. As of May 2025, it was estimated that long-term care facilities supported $2.32 billion in economic activity, directly employing 11,314 workers and additionally supporting about half as many positions. But big challenges lie ahead.
A House bill would remove the decades-long statutory property tax exemption for “charitable, nonprofit community housing and community health care facilities for elderly and disabled persons,” making financing for nonprofit senior housing, including continuing care retirement communities, precarious. House Bill 1295 couldn’t come at a worse time, demographically.
There is a bed moratorium for nursing homes, which has allowed home- and community-based long-term care options to grow, but it’s not a lack of beds that explains why New Hampshire nursing homes cannot meet demand; it’s a lack of staff. This jams up hospitals trying to discharge patients and, paradoxically, makes it more likely that those in the community who can’t obtain a nursing home placement will end up in a hospital.
In the near term, my hope is that federal funds deployed by the Governor’s Office of New Opportunities and Rural Transformational Health will grow the ranks of caregivers willing to work on the front lines of care, even though Medicaid will make it hard for nursing homes to recruit them.
Our Medicaid payment rates continue to fall behind our neighboring states. On Jan. 1, the average nursing home rate went up only .01%, or 2 cents per resident, per day, though the costs associated with Medicaid care are hardly static. Many facilities suffered severe cuts. Among them is a Manchester nursing home serving nuns, which is poignant given how Pope Francis declared that “(h)omes for the elderly should be the ‘lungs’ of humanity in a town, a neighborhood or a parish.”
Employment temptation for Granite State caregivers lies across our borders.
Last October Massachusetts, for example, increased its nursing cost payments for nursing homes by 6.16%, and their operating cost payments by 6.31%.
In Maine, the average daily Medicaid rate is now around $78 more resident, per day, more than what New Hampshire affords through the combination of its average daily payment and a quarterly return on a provider tax mechanism. Even in Vermont the daily average rate is around $24 higher than that New Hampshire combined rate.
Despite the contributions of long-term care facilities to our state’s economy, their challenges are largely obscured. Nursing home care, for example, is hiding in plain view in 73 locations statewide, serving a resident population among the nation’s four-oldest.
Perhaps no one associated with that vital care will make the New Hampshire 200 list. But we ignore this sector at our peril. This is why a bipartisan Senate bill, Senate Bill 663, is so welcome. It would create a working group to publicly elevate reimbursement concerns for nursing home care and make recommendations for change.
New Hampshire is a great place to live, and its advantages should be available to all residents regardless of age or infirmity.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.
For nearly six decades, Paul Young has been a constant, if often understated, presence in public and government affairs, both in New Hampshire and beyond. Since founding Novus Public Affairs in 1996, Young has helped shape how businesses, nonprofits and political leaders communicate and connect with the world around them, leaving a mark on the state that is hard to measure but easy to feel.
When Emerson McCourt passed away in 2006, he left behind an extensive tool collection, meticulous instructions and a commitment to Great Bay Community College (GBCC) students that continues today.
UNH is home to the state’s largest school of nursing
New Hampshire is falling behind in the care of our aging population
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