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

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2 years ago

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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.”

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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

Bill to outlaw using student IDs to vote clears NH Legislature

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4 hours ago

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March 9, 2026

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Bill to outlaw using student IDs to vote clears NH Legislature





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New Hampshire

NH cold case solved 40 years after police found man’s skull in woods

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16 hours ago

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March 8, 2026

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NH cold case solved 40 years after police found man’s skull in woods


Local News

Investigators partnered with a nonprofit genetic genealogy analysis organization to identify the man who the remains belonged to.

Warren Kuchinsky was born in 1952 and last known to be alive in the mid-1970s. New Hampshire Department of Justice

By Darin Zullo

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2 minutes to read

After nearly four decades, a man whose skull was discovered in the New Hampshire woods has been identified.

Warren Kuchinsky was born in 1952 and was last known to be alive in the mid-1970s, New Hampshire Attorney General John Formella and New Hampshire State Police Colonel Mark Hall said in a statement. In 1986, his skull was found in a wooded area in the town of Bristol.

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At the time, investigators weren’t able to identify whose skull it was, according to officials. Last year, however, the Office of the Chief Medical Examiner partnered with the DNA Doe Project, a nonprofit organization, to solve the case using forensic genetic genealogy techniques.

Kuchinsky’s identity was confirmed through DNA testing of a surviving family member, according to officials. There is no evidence that his death was caused by foul play, according to the statement.

Founded in 2017, the DNA Doe Project partners with law enforcement, medical examiners, and volunteer genealogists to apply investigative genealogy to John and Jane Doe cases. By analyzing DNA profiles and building family trees from publicly available genetic databases and historical records, the organization has helped solve more than 250 cases nationwide.

“We are honored to have partnered with the State of New Hampshire on this case,” DNA Doe Project Team Leader Lisa Ivany said in the statement. “Through the power of investigative genetic genealogy and the dedication of our volunteer genealogists, we were able to develop a critical lead in less than 24 hours. We truly hope that this identification brings long-awaited answers to Mr. Kuchinsky’s family.”

Initial DNA testing turned up only distant matches, so the DNA Doe Project selected the case to be worked on at a virtual retreat in May 2025, according to the organization’s case profile. Over the course of a weekend, more than 40 genealogists from the U.S., Canada, England, and Scotland collaborated virtually to work on the case.

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Within hours, the team discovered that the unidentified man had roots in New Hampshire and Quebec, according to the profile. They later zeroed in on Kuchinsky, who had attended school in Plymouth, N.H., but had no official proof of life past 1970.

“This identification reflects the power of partnership and scientific advancement,” Formella said in the statement. “The dedication of the Office of the Chief Medical Examiner, the investigative support of the New Hampshire State Police, and the extraordinary work of the DNA Doe Project have restored a name to an individual who had been unidentified for nearly 40 years. We are grateful for their professionalism and commitment.”

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New Hampshire

New Hampshire House Advances One of The Nation’s Most Extreme Transgender Bathroom Bans

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1 day ago

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March 8, 2026

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New Hampshire House Advances One of The Nation’s Most Extreme Transgender Bathroom Bans


The proposal would fine transgender people up to $5,000 for using bathrooms aligned with their gender identity.

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Bathroom bans targeting transgender people have been spreading rapidly across the United States. In previous years, adult bathroom bans in public buildings were limited to a handful of states with extreme laws. This year, they have become one of the primary vehicles for anti-trans legislation nationwide. Kansas was the first to act, passing a bathroom bounty hunter system and invalidating transgender people’s IDs. Idaho and Missouri began advancing their own bills. Now, the New Hampshire House of Representatives has passed its own version — one of the most extreme in the United States, which states that a trans person using the bathroom of their gender identity is a crime under the state civil rights act, violations of which carries hefty penalties. The bill passed 181-164 on Wednesday night, just weeks after Governor Kelly Ayotte vetoed a separate bathroom ban. Republicans are now sending her something far more aggressive — raising the question of whether they are trying to move the goalposts or simply daring her to veto again.

“Notwithstanding any other provision of law, with the exception of RSA 21:3, RSA 21:54, and paragraph II below, all multi-user facilities, including bathrooms, restrooms, and locker rooms located in buildings owned, leased, or operated by any municipality shall be used based on the individual’s biological sex,” reads the new bill. This prohibition is expansive: it applies to parks, rest stops, airports, civic buildings, and more, and could leave transgender people struggling to find a public place to use the restroom across the state.

The bill contains a novel enforcement mechanism not seen in any other state. It declares that a transgender person “asserting” that their gender identity allows them to use the bathroom is against the law under the state civil rights act, turning civil rights protections that were meant to be protective of transgender people into a weapon against them. “It shall be unlawful for any person to assert that their gender identity is a sex other than that defined in RSA 21:3 for the purposes of accessing places or services restricted on the basis of sex,” reads the bill. Such violations could result in fines of up to $5,000 per incident and even jail time if a person violates a resulting court injunction by continuing to use the restroom.

The bill also contains provisions for private businesses. It permits any owner or operator of a “place of public accommodation” — a category that under New Hampshire law includes hotels, restaurants, theaters, retail stores, bars, and concert venues — to restrict bathrooms by assigned sex at birth. The bill then immunizes those businesses from discrimination claims: “Adoption or enforcement of a policy pursuant to this section shall not be deemed discrimination under RSA 354-A or any other state law,” it reads.

A separate bill, HB 1217, also passed on Wednesday. That bill permits governmental buildings and businesses to classify bathrooms and locker rooms by assigned sex at birth — similar to the bathroom bans Ayotte has already vetoed. It passed by an even wider margin, 187-163. It contains no enforcement mechanism, but rather, states that bathroom bans and sports bans are not discriminatory towards transgender people under New Hampshire law.

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The bills are part of a larger movement towards bathroom bans for transgender people. Just last month, Kansas passed a bathroom ban that allows every citizen in the state to become a bounty hunter, where reporting transgender people in bathrooms can net them $1,000 per trans person caught. This law also invalidated trans people’s drivers licenses in the state. Meanwhile, Idaho and Missouri are both advancing extreme anti-trans bathroom bans of their own, with Idaho’s ban even applying to private businesses, making it against the law for a private business to allow a trans person to use the bathroom that matches their gender identity.

The bills are substantially more extreme than the one vetoed by Governor Ayotte just weeks ago. In a veto statement of a bathroom ban last month, Ayotte stated, “I believe there are important and legitimate privacy and safety concerns raised by biological males using places such as female locker rooms and being placed in female correctional facilities… At the same time, I see that House Bill 148 is overly broad and impractical to enforce, potentially creating an exclusionary environment for some of our citizens.”

It remains unclear why Republicans are pushing an even more extreme version of a bill their own governor has already vetoed three times. The bill still needs to pass the New Hampshire Senate and be signed by Ayotte to become law. One possibility is that the more extreme HB 1442 is designed as cover for HB 1217 — making that bill appear moderate by comparison and improving its chances of earning a signature. Another is that Republicans believe they can pressure Ayotte into signing, or are simply laying the groundwork for an override attempt down the line. Regardless, HB 1442 is one of the most extreme bathroom bans moving through any state legislature in the country, and transgender people across New England will be watching closely as it advances to the Senate.

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