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Another View -- Brendan Williams: Nursing shortage threatens NH health care system

June 14. 2016 8:32PM

The Legislature is to be commended for passing Senate Bill 439 to create a commission to study the shortage of nurses and other skilled workers in long-term care settings.

Our aging country must come to grips with the fact that, increasingly, it’s hard to find caregivers for our most vulnerable citizens. By 2022, the number of direct care workers needed nationally is projected to exceed the number of K-12 teachers. And New Hampshire is aging faster than almost any other state.

Much of the growth in caregiver need will be found in home health. My nephews, both with developmental disabilities, benefited from in-home care as infants and toddlers. It was critical to their development. Yet not everyone can be cared for at home.

Indeed, the need for caregivers will also be significantly increased in facility-based settings, both in nursing homes and in assisted living. It is vital that this staffing challenge be confronted in all long-term care settings, so residents experience little, to no, change in care quality as they transition from one type of care to another.

There is, however, an elephant in the room that any study must confront.

We hear a lot of speeches about income inequality. When it comes to administering Medicaid, however, words can be quite inconsistent with deeds. Inadequate state funding for this vital safety net denies living-wage dreams for caregivers, most of whom are women, often single mothers. It makes it almost impossible to retain, let alone recruit, caregivers.

Where the state itself is responsible for influencing wages, should not a nursing assistant be at least as valued as a fast-food worker? Shouldn’t we encourage, not punish, a commitment to care?

New Hampshire nursing homes, for example, are beset by a caregiver shortage that is more pronounced in rural areas. With around 64 percent of those they care for on Medicaid, caregivers’ wages depend entirely on state funding. Yet the state budget falls millions short of paying audited wage costs. Had Sen. Jeanie Forrester, R-Meredith, and others not led the Legislature to block a $7 million cut proposed last year, a bad situation would have gotten infinitely worse. Caregiver dedication, despite adversity, is evident in the fact that, in the most recent data, New Hampshire nursing homes were second-best nationally in avoiding health deficiencies.

Meanwhile, a $49 daily Medicaid payment for assisted living facility care is entirely detached from wage considerations, threatening to severely limit choices citizens have for care in many places.

The new state commission can look to leadership in the Monadnock Region, where a work force group was formed to address these challenges. Showing the need to look at the issue holistically, meeting attendance has included representatives from local colleges, the Chamber of Commerce, a hospital and long-term care providers, both for-profit and nonprofit. Sen. Molly Kelly, D-Harrisville, was instrumental in pushing SB 439.

It is regrettable that both Forrester, who is running for governor, and Kelly are leaving the Senate, because theirs is the sort of political courage we will need going forward to truly address this crisis. Following the study will be the need for action.

Brendan Williams is president and CEO of the New Hampshire Health Care Association.

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