STATE BUDGET time is always a spectacle and — if one looks closely enough at the numbers — all Granite Staters can see a picture emerge of who we are and what we value by virtue of what we fund and what we don’t.
This year’s question has a $10 million dollar answer.
New Hampshire is one of the most rapidly aging states in the nation. Oddly, we are 50th in the nation based on what we spend on home and community-based services. And the funding trend line continues pointing downward. Here’s what doesn’t add up: nearly all — 95 percent of New Hampshire residents 50 and older — say they want to age at home.
However, a recent AARP study “Across the States” shows that New Hampshire still ranks 49th out of 50 states (50 including the District of Columbia) regarding the amount of Medicaid dollars that are spent on home and community-based services for older and disabled adults. These people matter.
What’s this money for? It’s for long-term care. Also called long-term services and supports, this is a diverse set of services designed to help older people and those with disabilities.
Yes, it costs money, but much less than other alternatives. Such services can be provided in a person’s home, in a community setting such as an adult daycare center, or in a group residential facility like a nursing home. The vast majority of older Granite Staters want to live independently at home as they age, most with the help of unpaid family caregivers.
Recognizing this critical need to improve access to home and community-based services for our most vulnerable residents, the New Hampshire Department of Health and Human Services included a $10 million rate increase in its budget for providers who care for older and disabled adults in the community. And Governor Sununu, in turn, included this increase in his budget proposal.
Without adequate funding, vulnerable residents aren’t getting the services they need stay in their homes and communities and live healthy lives. This leads to more expensive settings for care and greater burdens on the 173,000 New Hampshire family caregivers who provide more than $2 billion dollars in unpaid care annually.
The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. Unfortunately, New Hampshire ranks 50th --the bottom of the pack — in the percentage of Medicaid long-term care dollars for older people and adults with physical disabilities that support care provided at home and in the community, the care setting most residents prefer.
Even facing tight budgets, most states have made clear progress in helping older residents achieve that goal. It’s time for New Hampshire to pick up the pace and invest more into our home- and community-based system. Especially as our population ages.
There’s justifiably a good deal of focus on the opioid crisis, education, and all variants of taxes and mechanisms for raising revenue. We value health, favor education, and generally dislike taxes. We’re a proudly small business state with near record low unemployment and we see ourselves as a capable contributor to (if not the engine of) northern New England’s economy.
Good for us. And, we’re also a place that many older residents call home. Our aging family, friends, and neighbors are — by the way — most of the same people who through their labors, time, treasure, volunteerism and talents contributed to the state’s growth and status over the years. As many of us live longer lives, the great majority of us plan and hope to age in the communities we’ve built and supported.
Ironically, given the funding choices New Hampshire leaders have made every two years for the past decade, our choices and options aren’t quite as free and unfettered as many Granite Staters might like.
Viewed graphically, our funding choices don’t paint a picture of Granite Staters peacefully aging in place with adequate supports. Far from it.
It’s rather a fade into gray. And while graying may be inevitable, devaluing aging is a deliberate choice.
All people — from our youngest to our oldest — matter. So, as our elected officials gather in Concord to decide whether funding and spending trends will resemble sinkholes (with little return on investment), the Seacoast (with level funding), the foothills or the mountains (with needed and upward funding trends), the contours and the image of who we are and what we value will again be drawn by funding choices we make.
Sometimes, some areas just need more money — like summer in New Hampshire needs lifeguards and winter here needs plows and road salt.
Our home- and community-based system needs more money. About $10 million of it — a tiny fraction of the overall budget and a good start.
Please call your legislators and help them connect the dots so the final budget picture we see will resemble who we are, and who we can become.