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The Impact: NH caregiver rates

May 18, 2021

My Turn: New Hampshire is neglecting its most vulnerable citizens

May 18, 2021 The Concord Monitor

Two years ago my friend Paul Scott and I wrote an op-ed urging our legislators to invest in the Choices for Independence (CFI) waiver. Paul was one of thousands of medically vulnerable people in New Hampshire, ages 18 to over 100, who qualify for nursing homes but choose to remain in their own homes.

Paul suffered a catastrophic injury many years ago and it was through the CFI waiver that he was able to remain at home. Despite our plea, CFI is currently failing people like Paul.

Home and community-based care cost a fraction of what a nursing home does. Unfortunately, these programs have been underfunded for over a decade, so badly that New Hampshire ranks 50th in the amount of Medicaid funding it spends on home and community-based care.


CFI rates are so low that providers cannot hire the workers they need to care for individuals. CFI rates do not cover the full cost of training, supervision, caregiving, background checks, TB tests, workers’ compensation, health benefits, payroll taxes, communications or billing. 

CFI caregivers can go to work at Market Basket, McDonald’s or Walmart and receive a much higher wage. My 13-year-old daughter can make more babysitting for our next door neighbor. We hail these caregivers, these healthcare professionals as heroes during this pandemic and yet we can’t pay them a livable wage.

Providers and advocates have been warning of this crisis for years. As someone who spent many years in this field, I can tell you that I have never seen anything like this.

A 90-year-old woman who fell a few months ago was on the floor for 14 hours before someone found her. A 62-year-old veteran who is not getting showers on a regular basis, so much so that it is affecting his health. A 39-year-old woman with Cerebral Palsy who is supposed to receive 30 hours a week of care but is only receiving 12 hours. She has intentionally overdosed twice in the last two months. I could go on, but the list is too long.

Paul passed away in February. He was smart, he was brave, he had the best sense of humor and always made me laugh. He was an incredible advocate and even while he was hospitalized he was speaking out for those who could not. He was a fighter and someone I will never forget.

Granite Staters like Paul who need long-term care should be able to remain in their homes and community and not be subject to unwanted and unnecessary institutionalization. New Hampshire is already the second oldest state in the country and our population continues to age. Legislators must strengthen our home and community-based care system now by directing the NH Department of Health and Human Services to raise CFI rates to levels realistic to deliver care.

Contact your state legislators today and urge them to take action. You can find their contact info here: http://gencourt.state.nh.us/house/members/default.aspx

(Amy Moore is the Director of Ascentria In-Home Care. She also serves on the board of the NH Home Care, Hospice and Palliative Care Alliance.) 

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