New Hampshire Long-Term Care Analysis Published

Author: akieslich Category: Long-Term Health Care Facility Analysis

Share Page

Executive Summary

               Meeting the Demand for Long-Term Care Facilities in New Hampshire

            January 4, 2024: Kieslich Analytics published the “New Hampshire Long Term Health Care Locational Analysis“. The report was distributed to State and Federal Elected officials and State Department heads in hopes it will raise awareness and concern and prompt government action to address the mounting number of 65+ people who will need 6300 additional long-term care / mental health care beds by 2030 in New Hampshire.

This study reviews the existing New Hampshire Long-Term Health Care (LTC) Facilities and forecasts their demand for the year 2030 by Location, and Facility Type. The Facility Types are: Assisted Living/Residential Care Facility (AL/RCF), Nursing Homes (NursH), and Supported Residential Care Facility (SRCF).

The goal of this study is to present the order of magnitude numbers and inform LTC facility owners and operators, governmental, educators and other interested parties of the locational demand for Long-Term Care facilities in New Hampshire. A summary of expected costs and personnel requirements is also provided. Suggested initiatives to support the expansion and sustainability of New Hampshire’s Long-Term Care (LTC) Facilities are outlined.

Looking at the data, New Hampshire is facing a burgeoning 65+ demographic and locational challenge in LTC facilities and caring for its seniors. This study reveals that the current facility and personnel commitment to LTC bed capacity and locations needs to be expanded to meet this challenge.

Key Findings:          

  • The forecast indicates the need for 6300 additional beds in existing and 36 new service facilities by 2030. The forecast utilizes a state top-down and county bottom-up forecasting process of the facility type, and bed counts, equating to approx. 780 additional beds per year.
  • The 2022 to 2030 increase of 69,000 in the 65+ population is a result of the “Baby Boom”. The NH 65+ Population in 2022 was estimated at 262,000 with a 2030 population estimated at 331,000. The 65+ cohort wave is estimated to peak between 2035 and 2040.
  • In 2030 the 65+ Pop will constitute 24% of the NH’s total Pop, with a max of 37% of Carroll County and min of 19% of Strafford’s County’s Pop.
  • In 2022 the States Dependency Ratio is 69, consisting of 35 for 1-18 and 34 for 65+Pop. Meaning 69 people are being supported by 100 age 19-64.
  • The 2022 availability of Facilities is uneven across the State. Carroll County has 21 beds per 65+ 1000 population while Belknap County has 97 beds per 65+ 1000 population. Carroll County has no AL/RCF facilities. The State bed average is 53 beds per 1000 population 65+. (A similar 2022 study indicated Vermont’s average is 49 B/1000 65+ pop).
  • The capital cost to build the new facilities is estimated between $2.3 Billion and $3.8 Billion from 2022-2030.
  • The additional bed operating cost is estimated to be $1.3 Billion over the 2022-2030 period.
  • An additional 4570 LTC Staff members will be required by 2030, consisting of Administrative and Nursing Staff.
  • There are presently (late 2022) 217 Long Term Care Facilities with 13948 Beds. There are 89 SRCF facilities with 5279 beds, 49 AL/RCF facilities with 1257 beds, and 79 NursH facilities with7412 beds.

Meeting The Challenge – Government Action:

The building of facilities and providing the personnel required for 6300 additional Beds over 9 years can be attained through coordinated action and resolve between the State of NH, City and Towns, and the Facility Owners and Operators. Below are suggestions to support the necessary growth and sustainability of Long-Term Health Care Facilities.

Support Facility Expansion –

  • Ensure investors and operators that State compensation for services is adequate now and, continuing to cover the capital investment and operating costs.
    • Establish a State Director for Long-Term Health Care Facility Implementation. This Director will facilitate actions between Facility Owners and Operators, State and Local governments, Financing, Education, and Building Contractor members to ensure the necessary facilities are built and provide annual reports to the State Executive and Legislative branches on Facility expansion.Establish Quantifiable and measurable Long-Term Care Facility Objectives in the NH State Plan⁶ on Aging.Establish a Regional Long-Term Care Commission among the Northeastern States to foster cooperation and long-term planning in such areas as; Education, Employment, Facility requirements, Personnel requirements, Tax policy, and co-ordinate when new facilities being built near a bordering state.State to Coordinate with local Cities and Towns on zoning and building approvals.State to Co-ordinate the multiple capital funding sources. Co-ordinate State, Federal and Private funding sources to facilitate the building of the new LTCF.State/Federal Government. -Consider Underwriting/Guaranteeing Construction Loans, or partner with private sector.State to consider constructing facilities if private sector does not.
    • Technology to support data for decision making. Establish a Facility Bed Inventory Database and web site for public identification of bed availability. To Analyze and Forecast by Location, Facility Type and Service type a database needs to be established and maintained monthly.

Attract Long-Term Care Personnel –

The greatest challenge LTC providers have is attracting and keeping Health Care Professionals.

  • Offer Student tuition reimbursement with an associated work time in the State.
    • Relocation expense reimbursement for moving to NH or within NH.
    • Provide the Geographic based Living Wage (as defined by the County specific MIT Living Wage Tables, https://livingwage.mit.edu/, for workers at these facilities in lieu of the state or federal minimum wage.
    • Ensure State and Regional Health Care educational facilities/programs are coordinated and available.
    • Consider subsidized LTC workforce housing. On site or nearby walking / mass transit distance to LTC Facilities.

6-New Hampshire Commission on Aging, Annual report, November 2023

Meeting The Challenge Cont.

Support Facility Operating Cost –

  • Provide annual support to the Medicaid per diem rate to meet the provider’s cost for all types of facilities and home care services.
    • Reduce the facilities depreciation term from 37 to ex. 20 years. State and Federal governments acknowledge that the Long-Term Care facilities, built in the next 10 + years may not have sufficient 65+ population with the passing of the “Baby Boomer Cohort” to economically operate.
    • Foster Building of Multi level facility types (AL/RCF, SRCF, NursH) i.e., Continuing Care communities, for new locations and existing expansions.
    • Anticipate facility reuse in designs as baby boom population begins to decline in the 2040’s.
    • Provide 55+ Housing, Work Force Housing, etc.
    • Establish a lowered utility rate category for the LTC Facilities (Water, Elec. Gas, Oil, etc.).
    • Establish a lowered State Corp Tax category for LTC Facility companies.

Support Say at Home Programs – Stay at home programs will continue to be an alternative to moving to an assisted living or a residence care facility, can defer moving to a nursing home, reduce hospital admittances and overall Medicare and Medicaid cost.

  • Offer home improvement grants to help aging people modify and maintain their home.
  • Encourage building affordable ⁷ one level designs and features for the aging population into new housing developments.
  • Ensure at home care personnel are certified, trained and properly compensated.

Aging Effects on Other Facilities:

Although beyond the scope of this report it should be mentioned that an additional 69,000 people 65 and older in NH by 2030 will exert an impact on Hospitals, Home Care, Hospice services, Primary Care Physicians, and Nurses in and near NH.

7 Housing America’s Older Adults 2023 – Harvard Joint Center for Housing Studies November 30, 2023  Housing America’s Older Adults 2023 | Joint Center for Housing Studies (harvard.edu)