Medicaid investment is needed

As New Hampshire long-term care providers struggle with one of the nation’s worst Medicaid payment shortfalls, Massachusetts and Maine are rolling out the red carpet for our caregivers who want to cross the border.

In Maine, legislators overrode a gubernatorial veto and, in overwhelming bipartisanship, agreed on a bill to immediately provide funding for 10 percent wage increases for those providing direct care in long-term care facilities. In Massachusetts, where the legislative session has been typically never-ending, the budget conference committee report provides that “not less than $38,300,000 shall be expended to fund a rate add-on for wages, shift differentials, bonuses, benefits and related employee costs paid to direct care staff of nursing homes[.]”

Most front-line caregivers are women – 90 percent of nursing home nursing assistants and 88 percent of home care workers, nationally. As The Telegraph has documented, rental housing is already at a premium in Nashua. If the average price of renting a two-bedroom apartment is $1,400 a month, and you’re a single mom working as a nursing assistant for around $14 an hour, how can you make ends meet?

This is a problem across all of long-term care. New Hampshire has the nation’s third-lowest unemployment rate and its second-oldest population. Low unemployment is making it very hard for providers to recruit, and retain, staff given the competing service sector. Medicaid reimbursement depresses wages here, as it does nationally. The last federal report to Congress showed the average nursing home had just a .7 percent margin in 2016 – a recipe for disaster in an aging society. Home health agencies in our state also struggle with a staffing crisis.

By 2030, the Census tells us there will be 3 million more Americans who are 85 and older than there were in 2012. Nationally, Professor Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management has conservatively estimated that by 2030 there will be a shortage of 151,000 paid direct care workers and 3.8 million unpaid family caregivers. The time to focus on this issue is now.

New Hampshire cannot pretend it operates in a vacuum. The most recent data from the New Hampshire Employment Security, from 2015, showed a net migration of 6,725 New Hampshire residents employed in health care and social assistance in other states. I suspect when this data is updated, matters will have gotten much worse.

If you’re a young person considering your options, why go through 100 hours of training to become a New Hampshire licensed nursing assistant when you could get paid more elsewhere? For that matter, in a state that puts a higher value on toll attendants than it does on those providing vital senior care, you could just avoid the rigors of clinical education and go work in a toll booth.

New Hampshire voters will soon be besieged with political messages. They’ll hear it argued that some candidates want to spend too much, and others too little. Debate over the opioid crisis may crowd out all other healthcare issues. The one message voters can send back to all candidates is to step up on funding senior care in our aging state. A modest Medicaid investment would go a long way toward improving the lives of dedicated caregivers.

Brendan Williams is the president/CEO of the New Hampshire Health Care Association.