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Most NH nursing homes won’t meet new federal staffing rule and doubt they can

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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.”

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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.

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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.”

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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.

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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.



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New Hampshire

City Of Concord Library: Christmas Eve Early Closure

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City Of Concord Library: Christmas Eve Early Closure


The library will be closing early on Tuesday, December 24, at 12pm. We will be closed Wednesday, December 25th, and will resume of normal hours on Thursday, December 26th. The CPL wishes you a happy holiday!


This press release was produced by the City of Concord. The views expressed here are the author’s own.



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Hypothermic hiker rescued after stranded in waist-deep snow amid wind chills near zero

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Hypothermic hiker rescued after stranded in waist-deep snow amid wind chills near zero


MOUNT LAFAYETTE, N.H. – A hiker was rescued on Thursday after becoming lost and suffering from hypothermia during a solo hike in central New Hampshire.

Patrick Bittman, 28, of Portland, Maine, had embarked on a hike to see the sunrise from Mount Lafayette on Wednesday night.

Officials said Bittman came upon deep blowing snow near the summit of Little Haystack on Franconia Ridge, forcing him to come back down the mountain.

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On his return, however, he became lost and ended up moving into the Dry Brook drainage, where temperatures dropped to around 20 with wind chills near zero.

After spending the night lost on the mountain, Bittman called 911 on Thursday morning. He said that his limbs were frozen, he was experiencing hypothermia and that he was no longer able to move through the snow, which was several feet deep.

HOW TO WATCH FOX WEATHER

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Ground crews with the New Hampshire Fish and Game Department and Pemi Valley Search and Rescue Team, along with an aerial crew with the Army National Guard, responded to his call.

However, they faced poor visibility from cloud cover and intermittent snow squalls over the steep terrain and thick vegetation, forcing them to adjust their approach to rescuing Bittman.

The first ground rescuers had to spend an hour bushwhacking 1,000 feet of vegetation off the trail to reach Bittman by early Thursday afternoon. By then, he was found suffering severe hypothermia and was placed in an emergency sleeping bag for shelter and given warm, dry clothes and warm fluids.

Two hours later, weather conditions allowed for the Army National Guard to reach Bittman with a medic. They hoisted the young man into the helicopter and then was flown to a local hospital for treatment. 

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“This aerial rescue saved a multi-hour carry out thru rugged terrain and is a testament as to how search and rescue works in New Hampshire with several different groups working together for a common goal,” New Hampshire Fish & Game officials said.



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Distant Dome: Christmas Comes for Some in New Hampshire

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Distant Dome: Christmas Comes for Some in New Hampshire


By GARRY RAYNO, Distant Dome

Christmas in New Hampshire is upside down if you are the Granite State’s government.

New Hampshire lawmakers have decreed that most of the “gifts” from the state do not go to the needy, but to those on the other end of the economic spectrum.

With Republicans again firmly in charge of the legislature and governor’s office, the “mandate” according to House Majority Leader Jason Osborne, R-Auburn, will focus on “lowering taxes, cutting wasteful spending, growing our economy, empowering parents with the Parents Bill of Rights and expanding the wildly successful Education Freedom Account program.”

The question is who benefits the most from “lowering taxes” and “cutting wasteful spending,” and what is “wasteful spending,” services for poor women who go to Planned Parenthood clinics because they cannot afford to go to a private practice physician?

For the better part of a decade now, Republicans have voted to cut the rates of the state’s two business taxes, the business profits tax and the business enterprise tax.

The larger collector, the business profits tax, receives the vast majority of its revenue from multinational corporations not based in New Hampshire, but who do business here.

The business enterprise tax is a value added tax on every business in New Hampshire although many very small businesses are exempt from paying.

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Now you might think lowering the rate of the business enterprise tax would benefit local businesses more than cutting the rate of the business profits tax and that would be a no brainer for lawmakers, but no, they lowered the rate for the business profits tax more frequently and far greater than they did the tax rate of the business enterprise tax.

Who did that help more? Large multinational corporations received the bulk of that benefit not your local business owners who do not reach across continents and cultures to soften the blow of taxes.

And in a little over a week, the one state tax that actually taxes wealth will be eliminated although it produced $185 million in revenue last fiscal year. Can you imagine what $185 million would do spread across the university and community college systems to reduce tuition for New Hampshire students?

Who pays the interest and dividends tax? About 90 percent of the revenue comes from the top five percent of wealth holders in the state. That is not most of us or our neighbors.

Well you might say, what about property taxes which every home, building and land owner pays in the state, surely they too should have a lower tax rate.

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Have you checked the tax bill you are about to pay in a little over a week? I don’t know about your tax bill, but mine had a hefty increase this year, and I suspect yours did too.

And with the state facing a budget crisis not seen in two decades, you are likely to see it go up even more after the lawmakers are finished crafting the next two-year budget this spring as more state costs are likely to be downshifted to local property tax payers as they were two decades ago when the state stopped paying its share of the retirement system costs for municipal, school and county workers as they had since the unified system was created during the last century.

That sifted tens of millions of costs to local property taxes that the state once paid.

There are two Christmas presents the majority of local property taxpayers sort of received in the last year, two superior court decisions declaring the state’s education funding system unconstitutional, inequitable and too meager to cover the cost of an adequate education, which is every child’s fundamental, constitutional right.

Those two decisions in the ConVal and Rand cases — if acted on by lawmakers — could have lowered the property taxes of the poorer communities hit hardest by the state’s education funding system like Claremont, Berlin, Franklin, Newport, Pittsfield and others.

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But that change would increase the property taxes in communities with the lowest rates in the state with the greatest property wealth, so in New Hampshire’s upside down Christmas world, lawmakers did not take the bait and instead did nothing keeping the current system in place.

We don’t want the taxpayers in those property wealthy communities saying “Bah Humbug” this time of year lawmakers might as well have said.

Elementary and secondary education is not the only place New Hampshire lawmakers traditionally shortchange the poorer residents, they do so in post-secondary education as well with tuition costs that are second only to Vermont for in-state students in the country.

Is it any wonder New Hampshire students have the highest debt load of any in the country when they graduate from college?

While the university and community college systems have held tuition costs near steady for in-state students for the last few years, they cannot do that forever with shrinking enrollments, reduced programs and fewer full-time faculty members.

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There is a Christmas flavored program that began four years ago, the Education Freedom Account program that was sold by Education Commissioner Frank Edelblut and others as an alternative for poor families whose children have trouble in the public school environment.

However 70 to 75 percent of the students were not in public schools when they joined the program, they were in private or religious schools or homeschooled.

In other words, parents already sending their children to private or religious schools or homeschooling have been able to gain a state taxpayer-funded subsidy to cover the costs the parents were paying.

The program is currently capped at 350 percent of poverty, which is a salary of $71,540 for a family of two and $109,200 for a family of four.

The legislature defeated an attempt to raise the rate higher last session to 425 percent of poverty level, or up to $133,600 annually for a family of four and $86,870 for a two-member family.

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The federal government estimates the median income in New Hampshire for a family of four is $133,447.

One bill in the upcoming session would do away with any income cap which would allow anyone with school-age children to apply for a grant of about $5,200 per student, a provision that is bankrupting Arizona, North Carolina and several other states with no cap.

But the program has gifted many religious and small private schools struggling to survive with a great deal of state money, money that once was forbidden for religious schools.

And another beneficiary of the program, the single biggest vendor for the parents using state money, is Amazon.

Does Jeff Bozos really need any more of your state tax dollars? I doubt it, especially at Christmas time.

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Merry Christmas and to all a good night.

Garry Rayno may be reached at garry.rayno@yahoo.com.

Distant Dome by veteran journalist Garry Rayno explores a broader perspective on the State House and state happenings for InDepthNH.org. Over his three-decade career, Rayno covered the NH State House for the New Hampshire Union Leader and Foster’s Daily Democrat. During his career, his coverage spanned the news spectrum, from local planning, school and select boards, to national issues such as electric industry deregulation and Presidential primaries. Rayno lives with his wife Carolyn in New London



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