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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.
MANCHESTER, NH – A five-run second inning and an eight-run eighth powered the New Hampshire Fisher Cats (27-23) to a Wednesday night win against the Altoona Curve (23-30) at Delta Dental Stadium, 14-3. In the eighth Inning, third baseman Sean Keys, second baseman Cutter Coffey, and catcher Patrick Winkel all
New England Travel
These hikes are full of history, wildlife, and gorgeous views.
Hiking trails are full of history, beauty, and wildlife, but with so many options, it can be hard to choose your next path.
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Car camping is trending this season, according to Hipcamp
The following are 12 great hikes recommended by the Massachusetts Department of Conservation & Recreation (DCR), Mass Audubon North Shore, Berkshire Natural Resources Council (BNRC), and the Appalachian Mountain Club.
Massachusetts
Skyline Loop Trail in Blue Hills Reservation in Milton
The 2.64-mile Skyline Loop Trail in the Blue Hills Reservation in Milton gives hikers a taste of the longer, nine-mile Skyline Trail. The loop takes hikers over five hills, including Hancock Hill, which was once the farm of John Hancock of Declaration of Independence fame and the first independent governor of the Commonwealth of Massachusetts.
There is a tower built by the Civilian Corp of Engineers during the Great Depression, and hikers can look out over Boston and the Harbor Islands
Cedar Swamp Trail in Douglas State Forest in Douglas
As hikers experience the Cedar Swamp Trail, a .5-mile hike, the environment changes from a typical New England mixed hardwood forest into a cedar swamp as Atlantic white cedar and hemlock trees replace oak, maple, birch, beech, and ash.
“The thick growth of these evergreens allows little light to reach the forest floor,” according to DCR. “Keep an eye out for the unique foliage native to the swamp like sphagnum or ‘peat’ moss, skunk cabbage and cinnamon ferns, as well as the wildlife that calls the swamp home.”
Robert Frost Trail in Mount Holyoke Range State Park in Amherst
Fans of Robert Frost can experience nature through the writer’s eyes on this 4-mile hike on the Robert Frost Trail that honors the iconic poet’s Massachusetts connection. Frost spent part of his life in Massachusetts, teaching English at nearby Amherst College.
Hikers can look for a hidden pool and a fork in the road while exploring the interpretive trail, DCR noted, which is an easy to moderate hike.
Read more about these state park hikes: 3 beautiful hikes at Massachusetts State Parks
Rockery Trail at Ipswich River Wildlife Sanctuary in Topsfield
For a unique, family-friendly hike involving rocks, head to the Rockery Trail at Ispwich River Wildlife Sanctuary, according to the Mass Audubon North Shore.
The 1/2-mile trail, the most popular hike at the sanctuary, includes boardwalks and features a rockery built by Thomas Emerson Proctor in 1905. You can climb the large stone structure and also walk through the little tunnel underneath. The wide easy trail is great for all ages.
Professor Chandler’s Long Walk at Rough Meadows Wildlife Sanctuary in Rowley
Hikers enjoy panoramic views at Rough Meadows Wildlife Sanctuary, which includes the scenic Professor Chandler’s Long Walk. The .65-mile easy trail takes hikers out into the Great Marsh, the largest salt marsh in New England, and is great for bird watchers.
The trail is named after Professor Alfred D. Chandler, Jr., who donated much of the land.
Woodland Loop at Cedar Pond Wildlife Sanctuary in Wenham
The Woodland Loop trail is a universally accessible trail at Cedar Pond Wildlife Sanctuary. The .9-mile trail offers a loop through deciduous and pine forest and opens up to a small meadow at the midpoint.
These All Persons Trails are ADA compliant and include universally accessible interpretive features. Visitors can expect handrails, braille and tactile features, wildlife viewing boardwalks and platforms, audio tour stops, seating, and more, according to Mass Audubon.
Read more about these North Shore trails: 3 beautiful hikes on the North Shore
The Meadow Loop Trail in Great Barrington
Animals lovers will love the accessible half-mile Meadow Loop Trail in the 267-acre Thomas & Palmer Brook Reserve, according to the Berkshire Natural Resources Council. The path, conveniently close to downtown Great Barrington, has excellent wetland and meadow views with benches for resting and taking in the scenery. The trail is also great for beaver watching.
For those who want to keep hiking, the trail connects to the 0.6-mile Woodland Trail and 0.3-mile Whale Rock Trail, both moderate.
Mahanna Cobble Trail in Pittsfield
Those looking for a challenge can tackle the 2.8-mile roundtrip trek on the Mahanna Cobble Trail.
The trail starts at Bosquet Mountain ski area, where hikers climb a beginner-level ski slope before getting into the forest. Hikers are rewarded with views of Kennedy Park, Mass Audobon’s Pleasant Valley Wildlife Sanctuary, and Yukon Ridge.
Sunset Rock Trail in North Adams
Hikers who tackle the easy 1.6-mile roundtrip Sunset Rock Trail at Hoosic Range Reserve later in the day can take in the Taconic Ridge and Green Mountains and it’s a great place to view the sunset.
For hikers seeking even more great views in the 944-acre reserve, continue on for 3 miles along the Hoosic Range Trail. This trail is considered difficult because of its length, and the 6-mile roundtrip hike is a gradual climb.
Read more about these Berkshires hikes: 3 beautiful hikes in the Berkshires
New Hampshire
Arethusa Falls Trail in Hart’s Location
Hikers on the Arethusa Falls Trail in Crawford Notch State Park are in a for a real treat, according to the Appalachian Mountain Club: New Hampshire’s highest waterfall. It’s a 1.3-mile moderate hike to the near 200-foot waterfall. Once at the waterfall, folks can hike down to the bottom and sit and dip their feet in the water.
The falls were discovered by Edward Tuckerman in 1875, according to visitwhitemountains.com, who named it after a nymph in Greek mythology that turned into a fountain.
Zealand Trail in Bethlehem
Zealand Trail connects to the Appalachian Trail, and hikers get to experience a short section of it before it goes out to Zealand falls. It’s about 2 1/2 miles to the falls.
The Appalachian Trail, which stretches from Maine to Georgia, is the longest hiking-only footpath in the world, and the New Hampshire portion offers more miles above the treeline than any other state on the trail, according to the Appalachian Trail Conservancy.
There is also an AMC Zealand Falls Hut on the trail, where hikers can stay overnight with a reservation.
Mount Willard Trail in Hart’s Location
Mount Willard’s elevation is 2,865 feet, and the summit is located in Crawford Notch State Park. It is a 1.6-mile moderate hike up to the summit, and hikers follow an old carriage road.
Folks start out at the top of Crawford Notch and hike along forests and along a stream, and there’s a tiny waterfall and an area called the Centennial Pool. Hikers can see the southern end of the Presidential Range, Crawford Notch, Mount Tom, and Mount Willey.
Read more about these hikes in the White Mountains: 3 beautiful hikes in the White Mountains
✨ The Dip is coming back to the park!
They had you dancing last time, and they’re back to do it again. Seattle’s seven-piece soul and R&B powerhouse The Dip brings a three-piece horn section, deep grooves, and a #1 Billboard R&B album’s worth of heat to the Wilcox Main Stage. This is the kind of band that makes you want to stay out way past your bedtime.
THE DIP in The River House Concert Series on the Wilcox Main Stage
📍 Prescott Park Arts Festival, Portsmouth NH
📅 Wednesday, July 1 at 7PM
🫶 Recommended Donation
No reservations required to attend, but grab one and have your spot waiting for you!
Prescott Park Arts Festival
07:00 PM – 11:59 PM on Wed, 1 Jul 2026
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