As anyone who has had to provide care to a loved one can attest, being a caregiver is hard work. Making a profession out of caregiving is even harder.

Not unlike teaching, caregiving is a noble profession that one enters with no expectation of becoming rich.

Unfortunately, in New Hampshire, caring for our most fragile citizens can make you poor. Few states do worse in funding the Medicaid safety net for the aged and those with disabilities. State reimbursement for nursing home care, for example, has gone up just 4.5 percent since 2009, compared to a 12 percent increase in the Consumer Price Index over that time. The nation’s second-oldest state now ranks at the nation’s bottom when it comes to reimbursing caregiver wages. And in New Hampshire you’re never very far from another New England state that does a better job of funding caregivers’ wages.

The nonprofit 58-bed Clough Extended Health Care Facility recently closed its doors in New London after 45 years. It’s easy to see why, as Medicaid "reimbursement" covered only 43 percent of care costs for this community asset.

Any New Hampshire nursing home has at least 29.88 percent of its Medicaid care costs ignored – the state arbitrarily subtracts this portion as a "budget neutrality factor" to help balance its own books. Imagine trying to give employees pay raises – or affordable health insurance – in the face of such a contrivance. Had residents, providers, and legislators not successfully fought a proposed cut last year matters would, somehow, be even worse.

With the unemployment rate at 3 percent, you’ll find "Help Wanted" signs across New Hampshire’s autumn landscape. While that’s great for the service economy, it makes matters more challenging for health care providers. Becoming a licensed nursing assistant – in the hopes of making one’s professional future subject to the uncertainty of Medicaid reimbursement – takes 100 hours of instruction. For tuition reimbursement one must pass a test and start working. New Hampshire is uncommon in requiring criminal background checks both before, and after, this education. On top of that, these newly-minted nursing assistants cannot begin work until the results of that second background check are in, and it’s taking weeks for those checks to come back. It would be easier, obviously, to walk into almost any service business and start work immediately. It might pay more, too.

The problem isn’t confined to nursing assistants.

A recent survey found 84 percent of responding nursing homes had licensed practical nurse (LPN) positions they were unable to fill, mostly due to a lack of state educational programs. That is particularly regrettable as becoming a LPN is often a pathway to becoming a registered nurse.

The Legislature passed a bill into law subjecting the health care staffing crisis to study. The legislation, driven by two passionate moms of kids needing home care, created a commission including representatives from across the health care spectrum. The commission’s first meeting brought acknowledgment by all attending, including legislators of both parties, that reimbursement plays a role in the staffing crisis.

The commission will work to examine barriers to entering the caregiving profession; build an education infrastructure necessary to attract, and train, prospective caregivers; and find solutions to retain caregivers.

Sometimes it’s easier for policymakers to just study an issue, in the hopes it will go away. There are parallels to this year’s efforts, for example, in a 2001 law that created a committee "to address the problem created by the shortage of health care personnel and support staff in New Hampshire." Fifteen years later the problem has not gone away. It has only grown worse, and it is time to solve it.

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

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