The NH Commission is looking at ways to strengthen direct care staff

New Hampshire is already facing shortages of nursing assistants, home nurses and other direct care workers. But a state commission says thousands more will be needed as the population ages.

The New Hampshire Commission on Aging says empowering that workforce — which helps people with disabilities and older adults handle daily chores like meals, housekeeping and bathing — should be a top priority. Local lawyers and an outside expert who recently testified before the commission say higher wages and increased government funding will be required.

Direct caregivers were already a problem before the COVID-19 pandemic, when “the growing number of older adults, increasing longevity, unsustainably low wages for caregivers, and the shrinking number of people of ‘working age’ made this a storm ” the advisory commission warned in its annual report, published on November 1.

Burnout and other issues during the pandemic have put additional strain on direct care staff. According to the Commission’s report, many older adults are not receiving the care they need and are suffering worse health outcomes because of a labor shortage.

“People think if something happens to their loved one, they’re going to make a few calls and there are going to be people there to help them,” said Amy Moore, who runs a home care program for New Hampshire at Ascentria, according to the Alliance of Care. “And that’s not the case at the moment.”

The median line-up caregiver in New Hampshire made $21,500 in 2020; A third of direct carers depended on some form of public support.

According to PHI, a national political organization focused on elder care and disability services

While staffing has been a problem for years, she said the pandemic has “made it a million times worse”.

Almost all of her employees are now people who already know a customer, like a neighbor or loved one, and are willing to take care of them, she said. That often means quitting another job. She said other clients are being forced to wait for the help they need because agencies like hers are unable to hire enough caregivers, putting their health and safety at risk.

On Monday, the commission heard about strategies other states have been using to build up their workforces.

Amy Robins, director of advocacy at PHI, a national policy organization focused on elder care and disability services, said many solutions depended on more funding. Low wages, poor benefits and limited avenues for career advancement are driving many people out of the field, she said.

“They work extremely hard, long hours and still have trouble paying their bills,” said Robins.

According to PHI, the median line-up caregiver in New Hampshire made $21,500 in 2020; A third of direct carers depended on some form of public support. Robins said these jobs are disproportionately filled by women, people of color and immigrants in New Hampshire and nationally.

Robins said some states have raised minimum wages for direct caregivers, required facilities to spend a percentage of earnings on caregiving, or invested in workforce training.

She said it’s also critical that states adequately fund Medicaid, which pays for a large portion of long-term care in the United States, so healthcare organizations have the resources to raise wages.

New Hampshire Health Care Association President and CEO Brendan Williams, whose organization represents long-term care facilities, is hoping for a significant increase in Medicaid in the next state budget. He said some nursing homes are leaving beds or entire wings empty because they can’t staff them, resulting in county nursing homes with waiting lists of over 100 people.

“If there were actual facility closures, I think that would make some headlines,” Williams told NHPR. “But what we have seen amounts to the closure of several facilities.”

Moore said the rates the state pays for home support through a Medicaid-funded program called Choices for Independence are also too low. That makes it difficult for agencies like theirs to pay enough to attract and retain employees.

“There are actually a lot of people who want to do this work. As much as it’s challenging, it’s also super rewarding,” she said. “…But no surprise, the pay is terrible.”

The Aging Commission plans to make recommendations to the governor and the legislature in the upcoming legislative session. It has identified areas of focus, including raising home care rates, expanding student grants and training opportunities, and better marketing direct care as a career.