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.

Lowell M. Brookbank, born 1961, of Henniker, was arrested at 10:41 p.m. on May 5 on felony possession of a controlled drug charge after an incident or investigation at the Quick Stop at 201 S. Main St.

Esther Ntumba Mbombo, 43, of Concord was arrested at 3:30 p.m. on May 3 on felony criminal threatening-deadly weapon and criminal mischief charges. She was arrested after an incident or investigation on East Side Drive.

Troy Maine, born 2000, of Concord was arrested at 10:10 a.m. on May 1 on a conduct after an accident charge and an unsafe lane violation after an incident or investigation on South State Street.

Alex R. Crowder, 35, of Concord received a summons at 10:25 p.m. on April 28 on a bench warrant after an incident or investigation at the Concord Homeless Resource Center at 238 N. Main St.

Jonathan Taylor Gagne, 23, a homeless man now located in Concord, received a summons on a bench warrant at 8:05 a.m. on April 28 after an incident or investigation at the Friendly Kitchen at 2 South Commercial St.

“A lot of people are focused on putting food on the table. A lot of people are focused on not getting fired from their job, or keeping their families together,” he said.

So even before the jury convicted Trump on 34 felony counts Thursday night, Register was confident: The trial’s outcome alone would be unlikely on its own to change the minds of many voters in New Hampshire, where analysts generally view President Biden as somewhat favored to win, though recent polling suggests he has no more than a slight edge over Trump.

“I think the people that are going to vote for Trump are going to vote for Trump,” Register said Wednesday, after a veterans roundtable hosted by the Biden campaign. “I think independents that are still undecided are going to stay undecided. I think the Democrats need to get out and vote.”

Register said he is among the undeclared voters who comprise a plurality of New Hampshire’s electorate. And, like a majority of the state’s population, he was born elsewhere. Originally from North Carolina, he moved to New Hampshire in 2021 after his military service. He said he used to vote for Republican presidential candidates, but sees Trump as a self-serving threat to American norms and the rule of law. So he’s actively supporting Biden.

Register isn’t alone in his assessment that Granite Staters — who handed Trump a victory over former South Carolina Governor Nikki Haley in the first-in-the-nation GOP primary in January — have mostly made up their minds on who they prefer in the Trump-Biden showdown. And reactions to the verdict reflect that.

“If you’re on Team Trump, this just hardens the resolve,” said Wayne Lesperance, a political science professor and the president of New England College. For those on Team Biden? “It feels good: He’s been held accountable.”

But there is also a middle group, Lesperance said. The group includes some Haley voters who are still wrestling with whether to throw their support behind the presumptive GOP nominee, as Haley has. While this segment may be fairly small, it could have an outsize influence in New Hampshire, he said.

“It’s the only segment that has the potential to move the needle for either Trump or Biden,” he added.

J.P. Marzullo, 80, of Deering, N.H., is somewhere in that middle group. He’s a former vice chairman of the New Hampshire Republican Party and a former state representative. He initially supported former New Jersey Governor Chris Christie’s bid for presidency, then turned to Haley after Christie dropped out.

Marzullo has mixed feelings about Trump’s conviction. On the one hand, he said the justice system worked and jurors did a good job. On the other, he still wants to know more details about how and why the case played out the way it did.

“Honestly, I’m still kind of sitting there, trying to figure out what I’m going to do,” he said on Friday.

Marzullo said he has lingering questions. He noted that Judge Juan Merchan made donations to Biden in 2020 ($15 to the campaign and $20 to progressive organizations, as NBC News reported). He’s also mulling Fox News commentary about Merchan’s alleged bias against Trump.

“It bothers me a little because I think the justice system worked,” Marzullo said, “but people are going to question those things, and I think rightfully so.”

Marzullo said the verdict will likely split Haley voters, with some backing Trump because they think he was “taken advantage of,” while others remain conflicted.

“I mean, to vote for a felon, for me, is going to be difficult,” he said.

Difficult, but not impossible.

Others contend the verdict will dramatically drive turnout for Trump.

“The American public is smart and they will see through this farce,” said Michael Biundo, a veteran Republican political strategist in New Hampshire who advised Trump’s campaign in 2016 and advised a political action committee that supported Vivek Ramaswamy’s candidacy in 2024. “I think it solidifies his base and moves people that just think that this whole case was done for political reasons. The Democrats have overplayed their hands.”

Recent polling of likely New Hampshire voters found that 37 percent of those who identify with the Republican Party and 14 percent of those who identify as independent said a conviction in this case would make them “much” more likely to vote for Trump, according to the University of New Hampshire Survey Center — but it’s not entirely clear how many of those respondents would cast a vote for Trump anyway. The survey found that 85 percent of likely New Hampshire voters had “definitely decided” who they will support in November.

Bobby Yoho, a construction worker who lives in Alexandria, N.H., said while enjoying a sunny Friday afternoon with his family at the Franklin Falls Dam that Trump’s conviction was “trash.” He called it an abuse of the justice system and said Trump’s other legal challenges are also part of a politically motivated witch hunt.

Yoho, a registered Republican, said he was pleased with how Trump ran the country, noting that costs went down and wages went up. He felt Trump did exactly what he said he would do, and the felony conviction won’t shake his support for the former president.

“It doesn’t change anything for me,” he said.

While many New Hampshire voters may be dead-set in their presidential selections at this point, Dante Scala, a UNH political science professor, said it would be worthwhile to keep an eye on two groups: progressives and independents.

There are progressives upset with Biden over his handling of Israel’s war with Hamas in Gaza, and Trump’s conviction might provide a basis for Democrats to reinvigorate some of that diminished support, he said. And there are casual independents who aren’t particularly plugged into the political process; the phrase “convicted felon” might make a difference for them.

Scala said it’s also important to remember where the conviction landed in the 2024 political calendar.

“This isn’t an October surprise. It’s a May surprise,” he said. “There’s an awful long time until people actually go to vote, and there’s an awful long time for this to settle in.”

Steven Porter can be reached at steven.porter@globe.com. Follow him @reporterporter. Amanda Gokee can be reached at amanda.gokee@globe.com. Follow her @amanda_gokee.