New Hampshire

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

Published

2 years ago

June 1, 2024

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

Annmarie Timmins
| New Hampshire Bulletin

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.

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New Hampshire

NH National Guard activated in connection with Iran war

Published

4 hours ago

March 6, 2026

Press Room

NH National Guard activated in connection with Iran war

The federal government has activated the New Hampshire National Guard’s 157th Air Refueling Wing in connection with the war with Iran.

“I’ve had a briefing myself, a classified briefing, but it’s really important on the messaging on this that we really coordinate with the Pentagon,” Gov. Kelly Ayotte told reporters during a press briefing following Wednesday’s Executive Council meeting.

Ayotte said she was unable to share additional details about the nature of the New Hampshire National Guard’s activity related to the conflict, including how many guard members have been activated or what role they are playing.

“We’re going to respect what messaging comes out of the Pentagon just to make sure that our men and women in uniform are fully protected and that we aren’t providing any information that could be used in a way that would be harmful to them,” Ayotte said.

In a statement Thursday, Ayotte said the unit had been deployed in late February to the U.S. Central Command area of responsibility in support of the operation.

Pease Air National Guard KC-46 Pegasus air refueling aircraft in June 2023.

Earlier this week, Pentagon officials confirmed that members of the Vermont National Guard were involved in attacks against Iran over the weekend, though our news partners at Vermont Public were not able to confirm additional details on the nature of the operation.

During the briefing with local reporters, Ayotte also stressed her support for servicemembers and those close to them.

“I have such respect for our men and women in uniform,” Ayotte said. “As you know, I come from a military family, and they have our full support, and we appreciate them and their families, and obviously anyone who is serving right now, and my thoughts and prayers go out to those who have lost someone that they love.”

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New Hampshire

NH Senate Votes To Hike Turnpike Tolls for Out-of-State Vehicles

Published

16 hours ago

March 5, 2026

Press Room

NH Senate Votes To Hike Turnpike Tolls for Out-of-State Vehicles

By PAULA TRACY, InDepthNH.org

CONCORD – While Republican Gov. Kelly Ayotte has said she opposes increasing highway toll rates across the state, the Senate voted Thursday to increase rates for out-of-state license plate holders.

It now goes to the House for consideration.

This would be a $1 increase for those who have out of state plates going through the tolls at Hooksett, Hampton and Bedford for out-of-state plates, a 75 cent hike for those taking Hampton’s Exit 2 and on the Spaulding turnpike at Rochester, and a 50 cent hike for those taking the exit off I-93 to Hooksett.

An analysis in the bill shows that this would increase toll revenue by $53.3 million in fiscal year 2027 and go up each year to generate $81.4 million a year in 2036.

Senate Bill 627 passed on a voice vote with two Republicans, Senators Regina Birdsell of Hampstead and William Gannon of Sandown opposing.

Senator Mark E. McConkey, R-Freedom, moved to take the bill off the table and offered an amendment.
He said the last time there was a systemwide increase to the turnpike toll was 19 years ago.

“I am sure we could all agree the cost of operations…has continued to escalate when revenue is not rising with it,” and he noted that with an enterprise fund, the state can only spend what it takes in.

The state has just completed a 10-year highway plan and there was a $400 million shortfall in projects that could not be paid for under the current income.

McConkey said the measure would not increase tolls for New Hampshire drivers with a state license plate.

“Why don’t we ask our neighbors,” to pay a toll increase. “We are getting the best of all worlds,” by passing the bill, he said, including “protecting our residents” and having resources for improvements to the turnpike system.

Sen. Gannon, R-Sandown, asked McConkey if there are any studies on impacts near the border on businesses.

If implemented, McConkey said the state will be the 27th lowest in per mile cost still. McConkey said the bill would also increase from seven to 14 days the amount of time for those with NH license plates to pay for a toll adding there are other states that also have different rates for out-of-state users.

The Hampton toll cost would go from $2 to $3, while Hooksett and Bedford would rise from $1 to $2 for out-of-state plates.

New Hampshire currently has the lowest rate per mile among states with tolls roads.
The governor said she does not support a toll increase.