Deeds have not matched actions

After showering 5% pay raises upon New Hampshire Liquor Commission executives, is the state ready to be as generous to caregivers? A rally in front of the Statehouse in Concord on May 6 showed how energized more than 50 groups are in support of Senate Bill 308, to improve health care workforce funding. And the Granite State Poll just found 63% of New Hampshire residents would prioritize paying Medicaid care bills over socking more money into the state’s Rainy Day Fund by continuing to leave care bills unpaid.

New Hampshire’s nursing assistants, in inflation-adjusted dollars, made 4% less in 2017 than they did in 2007. That is because New England’s worst Medicaid reimbursement – combined with the nation’s lowest unemployment rate – has created a perfect storm when it comes to recruiting, and retaining, staff.

Other states are stepping up.

In neighboring Massachusetts, for example, legislators are proposing a $30 million funding increase for nursing home care, after 20 facilities closed last year.

In South Dakota, a new Republican governor, Kristi Noem, prioritized a 10% increase in nursing home after rural facilities closed.

In Nebraska, Gov. Pete Ricketts, a Republican, proposed an additional $21.4 million for nursing home care; however, the unicameral legislature’s budget leader, a fellow Republican, wants to double that increase.

Yet here in New Hampshire, with the nation’s second-oldest population, we seem content to drift toward an iceberg that would shatter our long-term care system. Facilities are taking beds offline because they cannot responsibly staff them.

Throughout the state, those wishing to access nursing home care face the same challenges that have existed with equally-underfunded in-home care – there is simply no room. In December, a system budgeted to care for 4,100 Medicaid residents cared for only 3,884. That should set off alarm bells. Funding and staffing challenges have beset every type of facility, whether for-profit or nonprofit.

Politicians tend to be reactive, not proactive. The opioid crisis is visible, and has generated a reaction – daily rates for substance misuse treatment are now roughly twice what the average nursing home rate is. The long-term care crisis isn’t as visible. It does not create social disorder. You have to go looking for it. It’s hiding behind the walls of our state’s care facilities and the private homes in which in-home care is provided. But it’s no less urgent a public policy matter.

Unless Medicaid funding is significantly improved during this legislative session in Concord a growing access-to-care crisis will spiral into full-blown bankruptcies and facility closures – a result guaranteed, in stark terms, to legislators by my board of directors. Any reaction then will be too late for displaced residents and staff. We talk a lot about honoring the “Greatest Generation” – and New Hampshire has one of the oldest nursing home populations, including the country’s second-highest proportion of elderly women residents and a remarkable number of centenarians. But do we really care? Our deeds have not matched our words.

A proactive response would be to fund the workforce investments in SB 308 308. It has been heartening to see the bipartisan support for this bill from its sponsor, Sen. Cindy Rosenwald (D., Nashua), and leading cosponsor, Sen. Jeb Bradley (R., Wolfeboro), both of whom addressed the May 6 rally.

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