As outlined in the NH Long-Term Health Care Locational Facility Analysis the building of facilities and providing the personnel required for 6300 additional beds over 8 years can be attained through coordinated action and resolve between the State of New Hampshire, City and Towns, and the Facility Owners and operators.
Below are suggested actions governments can implement to support the necessary growth and continued operation of Long-Term Health Care Facilities. Additional Information for States from The National Govenor’s Assoc. are included below.
Meeting The Challenge – Government Action:
Support Facility Expansion –
- Ensure investors and operators that State compensation for services is adequate now and, continuing to cover the capital investment and operating cost.
- 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
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.
- Establish a lowered State Corp Tax category for LTC Facility companies.
- Possibly provide 55+ Housing, Work Force Housing, et
- Establish a lowered utility rate category for the LTC Facilities (Water, Elec. Gas, Oil, etc.).
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 and Personnel:
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.
Select to see full 48-page Analysis.
Supporting Research by the National Governors Association (NGA)
The NGA has published several publications and letters regarding the need to address the Health Care Industry, especially a letter on the “Health Care Workforce Shortage” that was sent to the US Senate. Listed below are several of these publications, which provide additional and expert analysis, state examples and suggestions for States to consider. The NGA has also created a Healthcare Collaborative to discuss and learn from other States.
Click on the Picture to see the full report:
“It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.” ~ Hubert H. Humphrey