New Hampshire
Most NH nursing homes won’t meet new federal staffing rule and doubt they can
A new analysis from one of the country’s leading health policy research organizations confirms what the state’s long-term health care providers have warned: The state’s nursing homes don’t have nearly enough staff to meet the Biden administration’s new staffing rule.
According to KFF’s analysis released last week, just 26 percent of New Hampshire’s long-term care nursing facilities, 19 of 73, could meet a new rule from the Centers for Medicare and Medicaid Services with current staffing. KFF noted that CMS has estimated that closing the staffing gap will be costly for the country’s nursing homes: $43 billion in the 10 years after the final rule takes effect.
“It’s just impossible, especially in a rural state like New Hampshire,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association. “You just can’t find those people. You can’t find the licensed nursing assistants. You can’t find the registered nurses.”
Patients and their families have told CMS they support the rule as a means to improve patient care. A Milford clergyperson was among those who submitted nearly 50,000 comments on the rule after it was first proposed in 2023.
“I have witnessed first hand the difficult conditions in various nursing homes due to inadequate staffing levels,” wrote the Rev. Hays Junkin. “This is tragic; our seniors and those who care for them deserve a safe and well staffed residence. I urge you to push for adequate staffing and ignore the nursing home industry’s opposition.”
The Centers for Medicare and Medicaid Services’ current staffing rule requires 24-hour clinical staffing and sets standards for patient care but leaves facilities discretion on staffing specifics. For example, in most cases a facility must employ a registered nurse for at least eight consecutive hours a day, 7 days a week.
The new rule, which is set to take effect in 2026 for urban facilities and 2027 in rural sites, requires a nurse to be on duty 24 hours a day, seven days a week. Each patient must receive 33 minutes of care a day from a registered nurse and 147 minutes of care from a nurse aide. Facilities could request “hardship” exemptions if they met several requirements.
The KFF analysis found that New Hampshire is closest to meeting the registered nurse staffing requirement with 79 percent of facilities able to provide each patient 33 minutes of care from a registered nurse each day. Only 30 percent of facilities meet the requirement for nurses’ aides, it found.
Williams said CMS’s new “one-size-fits-all” staffing rule ignores New Hampshire’s “hellscape of a workforce crisis” and the scarcity of affordable housing and child care that makes recruiting new workers difficult. Added to that, the state’s unemployment rate is low, and Medicaid reimbursement rates fail to cover the cost of providing care, he said.
Nursing facilities across the state are already limiting admissions because they don’t have the staff to fill all their beds. Williams said meeting the new staffing rule will leave long-term care facilities with no good options. The state and counties would have to increase taxes. Private facilities would have to charge more. Or, facilities will close.
The rule’s critics include U.S. Rep. Chris Pappas, who joined a number of other members of Congress in voicing concerns to CMS twice in 2023, before the rule was finalized, about the impact to nursing facilities.
“We believe the rule as proposed is overly burdensome and will result in additional closures and decreased access to care,” he wrote. It continued: “We recognize CMS as a crucial partner in identifying, mitigating, and preventing future health and safety problems in nursing homes. We stand ready to work with your agency on proposals to improve long-term care for patients.”
In an email last week, Pappas said he continues to have concerns and is disappointed CMS did not incorporate the feedback he passed on from worried health care providers in New Hampshire.
“I have the utmost faith and confidence in the health care workers of New Hampshire who do incredible work to keep our communities healthy, and I remain committed to supporting access to high quality care for individuals residing in nursing home facilities,” Pappas said.
He added: “Without additional support from Congress and CMS for our long-term care facilities and seniors, these new regulations have the potential to seriously impact a long-term care system already under tremendous strain. We must provide long-term care facilities with the resources and funding to stay open, recruit and retain a strong workforce, and provide residents with the best care possible.”
Gov. Chris Sununu has raised concerns, too, and joined 14 other governors in 2023 in calling on the Biden administration to abandon the rule.
Sens. Jeanne Shaheen and Maggie Hassan were two of three Democrats to join nearly 20 Republicans and independents that year in urging CMS to pause and rethink the rule.
A spokesperson for Hassan’s office said she and Shaheen are evaluating changes to the rule CMS has made since first introducing it.
Those include a phased-in approach to give facilities more time to complete initial staffing assessments; a new exemption for facilities that would not be able to fulfill the registered nurse requirement; and clarification that physician assistants, physicians, and other supervisory clinical staff can play a role in fulfilling staffing requirements.
A message to U.S. Rep. Annie Kuster’s office was not returned.
The Bulletin could not reach the state’s long-term care ombudsman. Jake Leon, spokesperson for the Department of Health and Human Services, said the agency has not heard much from the public about the new rule. He said the department’s Bureau of Health Facilities will monitor facilities for compliance once the rule is in place.
New Hampshire
Bank Robber, Sexual Assaulter, With 40-Plus Year Criminal History, Wanted On Parole Violation: NH DOC
CONCORD, NH — The New Hampshire Department of Corrections is asking for the public’s help in finding a sex offender and robbery convict, with “violent tendencies,” who is wanted on a parole violation.
Michael J. Wells is 60, white, about 5 feet, 6 inches tall, and weighs around 150 lbs. He has dirty blond hair and hazel eyes. Officials said Wells sometimes uses the following aliases: “Michael Morris,” “Michael Morse,” and “Michael Kirby.” He has Tasmanian devil, star, moon, and skull tattoos on his right arm and a cross over a skull with a spider web on his left arm.
The warrant against Wells was issued by the New Hampshire Parole Board as well as Manchester police for duty to report, after accusing him of absconding from parole and failing to register as a sex offender.
“In December 1994,” an alert stated, “Wells was convicted of aggravated felonious sexual assault and as a result, is required to register as a Tier III sex offender for the remainder of his life. Wells is currently on Parole Supervision for robbery.”
In December 2018, Wells robbed the Citizens Bank in Manchester, passing a note stating, “I have a gun. No tracking. No dye bag. $20-$50 quickly. No alarm.” In August 2021, he committed the same offense under similar circumstances, officials said, after he was placed on escape status from the Calumet Transitional Housing Unit. He was arrested in Massachusetts a few weeks later.
Wells is known to frequent both Concord and Manchester.
Editor’s note: This post was derived from information supplied by the New Hampshire Department of Corrections and does not indicate a conviction. This link explains how to request the removal of a name from New Hampshire Patch police reports.
Wells criminal history dates back more than four decades, according to superior court records, after he was accused of forgery in Nashua in August 1985. In June 1988, he was convicted on one forgery charge.
Wells was accused of theft in 1990 and he pleaded guilty to the charge a month later.
Wells was accused of bail jumping in February 1989.
In 1994, Wells was accused of aggravated felonious sexual assault, sexual assault, and second-degree assault charges in Nashua. In December 1994, he pleaded guilty to the second-degree assault charge. Wells was found guilty by the court on one aggravated felonious sexual assault charge in January 1996.
Wells was also accused of escape in December 1998.
In 2005 and 2006, more charges were racked up, including four acts prohibited counts in Nashua, a false report to law enforcement, receiving stolen property, two acts prohibited counts in Salem, and forgery in Manchester. Wells was found guilty on two of the drug charges in Salem and the Manchester forgery charge, while the others were nolle prossed.
In April 2019, Wells was convicted on the December 2018 bank robbery charges. He was given a three-and-a-half-to-10-year sentence with 136 days of time served credit and a 10-to-20-year sentence, suspended for 10 years.
New Hampshire
N.H. lawmakers to vote on increasing tolls, civil rights, and k-12 education – The Boston Globe
One proposal (Senate Bill 627) would generate more than $53 million per year in estimated revenue for turnpike projects by essentially doubling what certain cars pay on the state’s toll roads.
The cash fare for Hampton’s main toll booth on Interstate 95, for example, would jump from $2 to $4 for cars and pickup trucks. The toll wouldn’t increase at all for motorists who use New Hampshire’s E-ZPass transponders.
“Surrounding states already have the same in-state discount structure in place,” Democratic Representative Martin Jack of Nashua wrote on behalf of a House committee that unanimously recommended the bill.
A potential hitch: Governor Kelly Ayotte. She’s expressed opposition to the whole toll-hiking idea, and proven she’s not afraid to use her veto pen.
Modifying civil rights standard
Another proposal (Senate Bill 464) would add a few words to the state’s Civil Rights Act. Instead of addressing conduct that is merely “motivated by” a legally protected characteristic, the proposed revision would address conduct that is “substantially motivated by hostility towards the victim’s” protected characteristic (such as their race, color, religion, national origin, ancestry, sexual orientation, sex, gender identity, or disability).
The prime sponsor, Republican Senator Daryl Abbas, an attorney, testified the change was small and aligned with the law’s intent. But the attorney who oversees the Civil Rights Unit at the New Hampshire Department of Justice, Sean Locke, testified in opposition, saying the proposal could reduce protections, especially since the meaning of “substantially” is somewhat vague.
The House is also weighing a proposed amendment that would add a few more words than Abbas’s version, potentially narrowing the Civil Rights Act’s applicability a bit further.
Open enrollment for K-12 schools
A third proposal up for a vote on Thursday (Senate Bill 101) would make every K-12 public school in New Hampshire an “open enrollment” school. That way, students could freely choose to transfer to a district other than the one where they live.
The proposed policy is controversial, partly because of how schools are funded. Districts rely mostly on local property taxes to cover their costs, as the state government chips in relatively little, and property tax rates vary widely from one community to the next. That generates concern about who will foot the bill when a student transfers.
In light of those concerns, Republicans are offering a compromise amendment to SB 101 that would require the state to provide more money per pupil that a district receives via open enrollment, as the New Hampshire Bulletin reported. Democrats are offering their own amendment to establish a study commission on this topic, rather than adopt the proposed policy now.
Lawmakers have until May 14 to take action on the bills that came from the other chamber, though they have until June 4 to iron out any discrepancies.
Amanda Gokee of the Globe staff contributed to this report.
This story appears in Globe NH | Morning Report, a free email newsletter focused on New Hampshire, including great coverage from the Boston Globe and links to interesting articles elsewhere. Sign up here.
Steven Porter can be reached at steven.porter@globe.com. Follow him @reporterporter.
New Hampshire
Boston MedFlight expands into NH
Boston MedFlight often touches down at the scene of some of the worst tragedies in New England – where minutes can mean life or death for a victim. The critical care transport operation is now expanding with a new base in New Hampshire.
The organization is hosting an open house at the new Manchester location on Thursday.
Boston MedFlight flies a critical care transport paramedic and nurse on every flight. Jaik Hanley-McCarthy says their helicopters and ground vehicles are equipped to handle just about any emergency medical procedure.
“Anything that can be done in the ICU,” explained Hanley-McCarthy. “We have a mobile lab so we can draw blood and run labs in real time.”
Boston MedFlight now has five bases across the region.
“Having a base in Manchester just expands this Boston-level care even further north to the more remote areas of the state,” said Hanley-McCarthy.
Boston MedFlight operates as a network of bases and some of the locations are staffed 24 hours.
Chief Executive Officer Maura Hughes says the nonprofit operation survives on public and private donations.
“We provide about $7 million in free care every year to patients,” said Hughes. “Not every hospital can be everything to every patient. We’re really the glue that keeps the health care system together.”
Heather Young says her daughter, Teighan, is still alive because she was flown for a critical assessment and procedure after falling off a truck and hitting her head.
“She should not be driving and walking and talking and all the things she’s doing as quickly as she is,” said Young.
Teighan just turned 18 and plans to go to college to study the medical field.
“I want to be a nurse and help other people,” she said.
It’s stories like this that keep the men and women who work Boston MedFlight focused on their mission.
“I think we just go call by call and try to do the best we can,” said Hanley-McCarthy. “I think when we stop and truly think about it, I think that weight is pretty heavy.”
Boston MedFlight also has a yearly reunion where patients and the team get together here in Bedford to meet and check in on their progress. It really shows you how connected they are to the people they help.
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