Across the state, older adults and persons with disabilities are going without meals, bathing, social contact and, tragically, they are dying alone.
The cause of this crisis is a significant caregiver workforce shortage that is a direct result of New Hampshire’s underfunded Choices for Independence (CFI) program; New Hampshire caregivers are grossly underpaid. The work that they do is critical to thousands, yet they are paid an hourly wage less than they could earn at Walmart or Mcdonald’s. Those caregivers who choose to continue this work are struggling to pay their own bills. They are leaving for higher-paying jobs and fewer are entering this line of work.
In response, agencies Ascentria In-Home Care, Waypoint, The Alliance for Healthy Aging Advocacy Group and Granite State Home Health and Hospice Association, have formed The Care Paradox. The initiative puts human faces to the problem and calls upon legislators to increase funding for CFI in order to stabilize the program.
According to the NH Fiscal Policy Institute (NHFPI), New Hampshire’s Choices for Independence program has had a structural deficit of $153 million from fiscal years 2011 to 2021. Providers cannot recruit and retain workers and cover costs. A shrinking workforce means that more people are going without the care they need.
“While the system serving highly vulnerable people has been profoundly struggling for many years due to low reimbursement rates impacting caregiver wages – we are at a critical crossroads,” says Amy Moore, director of Ascentria In-Home Care. “The additional requested funding in the budget is the minimum increase needed to just keep our doors open beyond July 1st. It is not nearly enough to increase wages to attract a larger workforce and solve the caregiver shortage crisis.”
Borja Alvarez de Toledo, president and CEO of Waypoint, the oldest human service agency in New Hampshire, concurs: “The CFI provider network is in danger of collapse. Without a meaningful increase in funding, we will be forced to end those services leaving hundreds without care. It is an impossible and heartbreaking situation.”
Choices for Independence is the most feasible option for many people; it is affordable and enables people to remain in the comfort of their homes with their loved ones. When people cannot get the care they need at home, it creates a domino effect in the healthcare system that can impact any NH residents seeking medical attention. Because home and community-based care is a large component of the overall system of care in NH, when hospitals and rehabilitation centers can’t discharge patients back home (because there is no care available) they become strained.
Based on NH Department of Health and Human Services data, the entire CFI appropriation is rarely spent. This is not because the budget is too large, it’s because agencies don’t have the needed staffing and can’t provide the services. In a 2021 survey conducted by NHFPI, every single case management agency in NH indicated that an individual might not receive CFI services because there are not enough available workers to meet the overall need for services or available workers at the times when services are needed.
“NH’s Choices for Independence (CFI) program is a vital asset to our state [as it helps] people to stay in their own homes and live in their local communities. It’s critically important that programs such as CFI be adequately funded to provide assurances to those who rely on it that their needs will be met now and into the future,” said Steve Ahnen, president, New Hampshire Hospital Association.
For further information about the Care Paradox, visit CareParadox.org.
The site provides a platform for people to share their stories about how the system in its current state is failing them, and features a 60-second advocacy tool for emailing legislators to demand an increase in caregiver pay. Visitors will also learn about the plight of caregivers who are struggling to survive while they provide vital care to clients, many of whom they consider family. As the initiative unfolds, the site will provide updates on progress toward the goals.
Care Paradox partners acknowledge that during this year’s budget cycle there have been constructive conversations with legislators who recognize the significance of the home care crisis. The addition of increased funding for Medicaid rates with a look towards prioritization of in-home services is an important step forward, but there is still a long way to go in order to stabilize the decade of deficits in the CFI system.
“This crisis will only get worse if these conditions are allowed to continue unchecked,” says Amy Moore, Director of Ascentria In-Home Care. “New Hampshire’s older adults and persons with disabilities deserve a chance to spend their last years well cared for in their own homes.
The Care Paradox is supported by a grant from the New Hampshire Charitable Foundation for the purpose of community education and advocacy.