If You Or a Loved One Required Care, What Would You Do?

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 ↓


Nursing Home-Level Care

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.


Private In-Home Care

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.


Choices for Independence

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?

Caregivers are Underpaid and Undervalued.

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. 

Here’s What Caregivers Had to Say When Asked About the State of Caregiving

“Caregiving is extremely important for people who are in need of it. There is no doubt that they [the state] save a tremendous amount of money because they are not paying for stays at facilities such as rehab centers or nursing homes and that it is so much better and effective for the patient to be able to have a caregiver. A bond is formed and there is gratification on both sides of the spectrum. Also, there is continuity of care, which in my opinion is very important.”


“I personally feel like we have alot of great individuals who truly care and want to help those in need. We do our best to take care of as many people as we possibly can but there just isn’t enough of us. The sacrifices we face is we try to take on more responsibility and clients and we burn ourselves out. We really need to be able to meet the demand for care, the ones needing care deserve it.”

Sandra, Ascentria In-Home Care

“I work in NH and the pay is not great. It is a shame that we are not shown more respect for our hard work and the importance of helping our elderly. I know a lot of others doing this work and all the agencies are short-staffed and overworked. They can’t hire due to low pay.”

Kathleen, Ascentria In-Home Care

“I am seeing that there is an enormous disconnect between the government and the population that requires services such as this. Though my particular agency spends much time trying to validate our worth by finding ways to increase our wages, it is, unfortunately, a field that seems to not to be valued by lawmakers.

Karen, Ascentria In-Home Care

“The need, the shortages, low gas mileage reimbursement, the payscale being less for a licensed caregiver than a fast food company, a grocery bagger, or the person that chooses to be on a street corner.
Caregivers love their job but we need a wage and benefits that we can support a family on. We work in a field where we shouldn’t have to ask for assistance for ourselves.”

Sandy, Ascentria In-Home Care

“Invest more into it. Better pay will attract more caregivers because higher pay tends to make people feel that they are valued. It benefits everyone and a community to keep people in their homes who can still be part of the community; going to restaurants, community events like church suppers and parades, patronizing businesses in the community and living as fulfilling a life as possible.”

Christine, Ascentria In-Home Care

“Caregivers are important and we should be paid accordingly. They [the government] need to remember that the elderly are to be respected, not forgotten because they are old. They should think of how they would like to be treated and valued as they age, or what kind of care would they want for their own family.”

Kathleen, Ascentria In-Home Care

“We are all affected by this dilemma, we all have or know someone who is directly suffering because they are sick, disabled, physically or mentally unstable or any other illness that causes them to need our assistance as human beings. We, ourselves are not immune from one day having to depend on this system to care for us, is this how you would want to be cared for?”

Sandra, Ascentria In-Home Care

“All avenues of caregiving need to be compensated to make this a viable career choice. From infants to the elderly, the need will never be met when the rate of pay does not measure up to the value of the work

Trish, Ascentria In-Home Care

“In my opinion, as our population’s lifespan increases, there will be more need to care for them in a safe, comfortable, and, familiar setting, giving them the respect, care, and concern they deserve. Caregiving is the most understaffed, underpaid, and overlooked of all the services that I am aware of.”

Ron, Ascentria In-Home Care

“Too many patients, not enough caregivers. We’re under-appreciated, under-staffed, over-looked, and under-paid. During the pandemic there were promotions for people on the “front lines” but it excluded caregivers who were fighting to keep people in their homes safe. Feel like a glorified housekeeper.”

Sarah, Ascentria In-Home Care

“One day they [senators] most likely will require services of some kind in order to remain in their home. If they cannot think about “the greater good” then at least think about your own personal future.”

Vanessa, Ascentria In-Home Care

“As the population grows older the need for quality caregiving will continue to rise. It should be a priority in any state or federal budget.”

Stephanie, Ascentria In-Home Care

“We need more funding to provide more caregivers and other help our clients need to continue to thrive in their homes”

Darlena, Ascentria In-Home Care

“Caregiving is vital to those of us who cannot care for ourselves. There are many elderly people out there who are not receiving any care, they deserve to be cared for!”

Linda, Ascentria In-Home Care

Read More About the People Impacted by this Crisis

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Caregivers Need a Fair Wage

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...

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Ella is a Former Home Health Caregiver

Ella is a Former Home Health Caregiver

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...

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Ella is a Former Home Health Caregiver

Ella is a Former Home Health Caregiver

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...

read more

Have You Been Impacted by the Caregiver Shortage?