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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

Federal vaccination policy changes put New Hampshire’s health at risk – The Boston Globe

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Federal vaccination policy changes put New Hampshire’s health at risk – The Boston Globe


As a public health professional and state representative, I’m alarmed by recent shifts in federal vaccination policies from the US Department of Health and Human Services. These changes threaten to undermine decades of progress in protecting New Hampshire families from preventable diseases.

Vaccines remain one of the most powerful tools we have against serious illnesses, from seasonal flu to emerging infectious threats. Historically, federal agencies like the CDC have provided clear, science-based guidance and helped ensure vaccines are affordable and accessible to all Americans.

But recent moves signal a retreat from this commitment. The decision to abandon universal COVID-19 vaccine recommendations for adults is just the latest example of how federal leadership is stepping back when we need it most. Without straightforward guidance, confusion grows, and with it, vaccine hesitancy and misinformation flourish.

This shift disproportionately harms the most vulnerable Granite Staters: Those in rural areas, low-income families, and elderly residents who already face barriers to health care. Worse, the change threatens to increase out-of-pocket costs by removing insurance coverage guarantees tied to universal recommendations. This is a direct threat to equal access and public health.

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New Hampshire has fought hard to maintain vaccination rates, investing in outreach and community clinics. But state-level efforts can’t fully compensate for federal retreat. When Washington cuts funding, muddles messaging, and abdicates responsibility, it’s our communities that pay the price.

Vaccination is not a partisan issue. It is about protecting lives, reducing strain on our health care system, and safeguarding the future of our children and elders.

I call on our federal leaders to restore strong, science-driven vaccine policies, fully fund public health programs, and ensure vaccines remain affordable and accessible to all Granite Staters. The health of our communities depends on clear leadership and unwavering commitment.

Jennifer Mandelbaum is a public health expert representing Rockingham 21 in the New Hampshire House of Representatives.





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Brockton man injured after box truck crashes into tree on I-93 in New Hampshire

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Brockton man injured after box truck crashes into tree on I-93 in New Hampshire


A Brockton man is recovering after a box truck crashed into a tree in New Hampshire early yesterday morning.

Around 4:30 a.m., emergency crews responded to I-93 North at Exit 23 in New Hampton, where they found a box truck lodged in a tree.

According to state police, the driver, identified as Anilton Resende Barros, 21, lost control while navigating a curve in the road.

The box truck went straight into the median, traveling over the crossover between the north and southbound lanes, struck an embankment, and launched into a group of trees before coming to a final stop in the woods separating the opposing lanes.

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Barros suffered minor injuries in the crash and was transported to a local hospital for evaluation.

The left travel lanes of I-93 northbound and southbound were closed at Exit 23 for about four hours for the cleanup of the crash. All lanes were back open at 8:58 a.m.

The cause of the crash remains under investigation.

This is a developing story. Check back for updates as more information becomes available.

Download the FREE Boston 25 News app for breaking news alerts.

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Give Back NH: Gilford Public Library

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Give Back NH: Gilford Public Library


In this special summer series from Give Back NH, we explore how local libraries across New Hampshire strengthen communities, support lifelong learning, and build trust—through the people, programs, and stories that make them essential.

Learn more about the Gilford Public Library and all it has to offer, here.

This transcript has been lightly edited for clarity.

When you hear the word “library,” you probably think of it as the place where you can borrow books, movies, occasionally a metal detector, but what about learning how to line dance?

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Every Saturday, Bonnie Deutch teaches her beginner line dancing class in the meeting room on the lower level of the Gilford Public Library.

Bonnie Deutch: When I moved up here, I wanted people to line dance with, but I didn’t really see much. And so I kind of waited. And then one day, one of the ladies of the library said to our Tai Chi instructor, “can you do this twice a week?” And she said, “no, I can’t.” And I said, “well, Nancy, I said, I’ll do line dancing on Wednesdays.” And she goes, “well, I’ll come if you play Willie Nelson.” And there it was.

Bonnie Deutch: I never knew that there’d be so much information advocating dancing for heart health, mental health, things that just keep popping out of the woodwork about dance, dance, dance.

I’m Dan Cahill, and this is the 3rd stop on Give Back New Hampshire’s library tour.

Eugene Seymour, a guinea pig who lives at the Gilford Public Library, who Miss Linda affectionately refers to as “the Mayor.”

Also on the lower level, there’s the children’s library, and as soon as you walk in, you’re greeted with the “mayor,” Eugene Seymour — A guinea pig who lives at the library and every year, children come to the library to celebrate Eugene’s birthday, his cage surrounded by handmade cards wishing him well on his special day.

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Handmade cards from children who visit the library wishing Eugene a happy birthday.
Handmade cards from children who visit the library wishing Eugene a happy birthday.

Next to Eugene sits Miss Linda, an assistant at the children’s library, and a former teacher.

Miss Linda: Since I taught in town, what’s a real benefit for me being here, is that I can keep connections with the children I taught. I do have teenagers who come in, and it’s lovely to reconnect with them because I taught fifth grade, which is 10/11. But I also have children that I taught who now have their children and they bring them in. So not only do I get to see where “my kids” ended up, but I get to meet their children, and it’s just lovely to continue to instill the love of reading for all these generations.

The most important thing about libraries though, Linda says, is the connections they can create.

Miss Linda: We see that a lot with the children and the adults that come, they build these friendships, and then they go out into the community together and they’re pretty lasting ones. They’re really lovely. And even with the programs that are held downstairs here, where we see the adults that attend them, they’re just so happy to be able to connect with other people in meaningful ways.

For Annie, a local mother, those connections helped her family after they moved to Gilford in 2021.

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Annie: My husband is from here, and so he always talked about how wonderful the library was. And so when we moved here and we didn’t know anybody, this is where we started coming. And we’ve made lots of friends since we’ve started doing that. It’s been a real like sense of place and community here for us.

Line dancing, new connections, even some furry friends, there’s much to experience at the Gilford Public Library. I think Colden, who was visiting the library with his mother Bryanne says it best.

Miss Linda: And what did you tell me this morning when you came in? You said, “I want to go to the library…”

Colden: Every day!

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