Thousands of NH residents are in need of care in their homes but are unable to receive that care because of worker shortages.
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—it is a domino effect that leaves patients with few choices.
See Your Choices ↓
If you need nursing home-level care, be prepared to pay an average of $7,756 per month for a semi-private room. This presents a significant financial burden that many are simply not prepared for.
An alternative is to pay for private care in your home, which can cost hundreds of dollars a day. If that is out of reach for you, you may qualify for care through the NH Choices for Independence (CFI) program.
CFI is a New Hampshire Department of Health and Human Services program for adults 18 years or older who have nursing home level of care needs but prefer to live at home and financially eligible for long term care Medicaid.
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 is currently preventing people from receiving this type of care.
In a 2021 survey conducted by the NH Fiscal Policy Institute (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.
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 can’t provide the services. According to NHFPI, Choices for Independence has been underfunded by more than $153 million since 2011.
Organizations that provide these services have long been chronically underfunded, operating on marginal funding and insufficient reimbursement rates (primarily under Medicaid)—and saddled by limited staffing and growing challenges with recruitment and retention. In 2018, an analysis from the AARP Public Policy Institute showed that New Hampshire had the lowest percentage of Medicaid HCBS (Home and Community Based Services) spending as a percentage of LTSS (Long Term Services & Supports) expenditures for older people and adults with physical disabilities of any state except Kentucky.
New Hampshire caregiving is at a crisis point. This crisis will only get worse if these conditions are allowed to continue unchecked. As the state’s population ages, there will not be enough caregivers to assist all of the people in need of care.
What will you do when the time comes for you and your loved ones to search for assistance?
Despite the fact that caregivers do some of the most challenging work humans can be asked to do, we pay them less than nearly all other professions.
Meet Kaleb. Kaleb lives with muscular dystrophy and has required assistance with day-to-day activities since college. Low caregiver wages directly impact his ability to find quality services; he needs caregivers to be paid more so that he can survive.
Currently, Kaleb is unable to find a caregiver due to the workforce shortage.
About 599,800 openings for home health and personal care aides are projected each year, on average, over the decade.
We aim to increase the perceived value and get the pay of caregivers to a level where caregivers are paid a fair hourly wage, along with the benefits that come with high-value employment.
Median Annual Caregiver Wage in 2022 (PHI)
of Care Workers require Public Assistance Due to High Rates of Poverty (PHI)
of In-Home Care Workers are Women
Care Paradox partners acknowledge that during this year’s budget cycle, there have been constructive conversations with legislators and many appear to be listening and recognizing the significance of the home care crisis.
The addition of increased funding for “Medicaid Rates” with a look towards prioritization of in-home services is an important step forward, but there is still a journey to go in order to stabilize the CFI system, which has been struggling for too many years.
This crisis will only get worse if these conditions are allowed to continue unchecked. New Hampshire’s older adults and persons with disabilities deserve a chance to spend their last years well cared for in their own homes.
Joyce Thomas suffers from multiple sclerosis. Without her caregivers and the Choices for Independence program, she wouldn't be able to live at home with her husband and service dogs. This short video outlines why Joyce believes that caregivers should be paid the money...
Ella is a former home health caregiver who made the difficult decision to leave a profession she loves for financial reasons - the wages simply were not enough to survive on. Funding for home health caregiver support comes through the state-run Choices for...
Ella is a former home health caregiver who made the difficult decision to leave a profession she loves for financial reasons - the wages simply were not enough to survive on. Funding for home health caregiver support comes through the state-run Choices for...
Like so many across the country, Lainie was a caregiver to some of her family members for years. Over time, she grew confident in her work and decided she wanted to help and care for others. As a personal care service provider (PCSP) Lainie spends her day...