New Hampshire
The weight of caregiving in NH. Why we need SB 608: Sirrine
Recently, I met with a husband who had been caring for his wife since her Alzheimer’s diagnosis. Her needs were escalating quickly — appointments, medications, meals, personal care — and he was determined to keep her at home. But the cost to his own wellbeing was undeniable. He was sleep‑deprived, depressed, and beginning to experience cognitive decline himself.
As director of the Referral Education Assistance & Prevention (REAP) program at Seacoast Mental Health Center, which supports older adults and caregivers across New Hampshire in partnership with the CMHC’s across the state, I hear stories like his every week. And his experience is far from unique.
Across the country, 24% of adults are family caregivers. Here in New Hampshire, 281,000 adults provide this essential care, often with little preparation or support. Only 11% receive any formal training to manage personal care tasks — yet they are the backbone of our long‑term care system, helping aging parents, spouses, and loved ones remain safely at home. (AARP, 2025)
REAP provides short‑term counseling, education, and support for older adults, caregivers, and the professionals who support them. We address concerns around mental health, substance use and cognitive functioning. After 21 years working with caregivers, I have seen how inadequate support directly harms families. Caregiving takes a serious toll — emotionally, physically, socially and financially. Many experience depression, chronic stress, and increased risk of alcohol or medication misuse.
In REAP’s own data from 2024:
- 50% of caregivers reported moderate to severe depression
- 29% reported suicidal ideation in the past two weeks
- 25% screened positive for at‑risk drinking
Their responsibilities go far beyond tasks like medication management and meal preparation. They interpret moods, manage behavioral changes, ease emotional triggers, and create meaningful engagement for the person they love. Their world revolves around the care recipient — often leading to isolation, loss of identity, guilt, and ongoing grief.
The statistics reflect what I see every week. Nearly one in four caregivers feels socially isolated. Forty‑three percent experience moderate to high emotional stress. And 31% receive no outside help at all.
Compare that to healthcare workers, who work in teams, receive breaks, have coworkers who step in when overwhelmed, and are trained and compensated for their work. Even with these supports, burnout is common. Caregivers receive none of these protections yet are expected to shoulder the same level of responsibility — alone, unpaid, and unrecognized.
Senate Bill 608 in New Hampshire would finally begin to fill these gaps. The bill provides access to counseling, peer support, training, and caregiver assessment for family caregivers of individuals enrolled in two Medicaid waiver programs: Acquired Brain Disorder (ABD) and Choices for Independence (CFI). These services would address the very needs I see daily.
Professional counseling helps caregivers process the complex emotions of watching a loved one decline or manage the stress that comes with it. Peer support connects them with others navigating similar challenges. Caregiver assessment identifies individual needs before families reach crisis.
When caregivers receive the right support, everyone benefits. The care recipient receives safer, more compassionate care. The caregiver’s health stabilizes instead of deteriorating from chronic stress and neglect. And costly options, which many older adults want to avoid, are delayed or prevented.
There is a direct and measurable link between caregiver training and caregiver wellbeing. The spouse I mentioned earlier is proof. Through REAP, he received education about his wife’s diagnosis, guidance on communication and behavior, and strategies to manage his own stress. Within weeks, his depression decreased from moderate to mild without medication. He was sleeping through the night and thinking more clearly. His frustration with his wife dropped significantly because he finally understood what she was experiencing and how to respond compassionately.
The real question before lawmakers is not whether we can afford SB 608. It is whether we can afford to continue ignoring the needs of those who hold our care system together. In 1970, we had 31 caregivers for every one person needing care. By 2010, that ratio dropped to 7:1. By 2030, it is projected to be 4:1. Our caregiver supply is shrinking while needs continue to grow. Without meaningful support, our systems — healthcare, long‑term care, and community supports — cannot function. (AARP, 2013)
Caregivers don’t ask for much. They want to keep their loved ones safe, comfortable, and at home. They want to stay healthy enough to continue providing care. SB 608 gives them the tools to do exactly that.
I urge New Hampshire lawmakers to support SB 608 and stand with the 281,000 residents who are quietly holding our care system together. We cannot keep waiting until caregivers collapse to offer help. We must provide the support they need now — before the burden becomes too heavy to bear.
Anne Marie Sirrine, LICSW, CDP is a staff therapist and the director of the REAP (Referral Education Assistance & Prevention) program at Seacoast Mental Health Center.
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.
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.”
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.
“We are not going to put a burden on drivers for a toll increase,” Ayotte said. “Families are struggling.”
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