Thomas Blonski: New Hampshire's fragile long-term care system is in crisis

Catholic Charities New Hampshire operates seven nursing homes, from Windham to as far north as Berlin. We are capable of serving 471 residents. In providing care, we work to be as efficient as possible, to maintain the high quality required by exacting federal standards, and do right by our caregivers and staff. The latter has become increasingly impossible under the current state Medicaid reimbursement system.
Caring for Medicaid recipients in the long-term care-arena in New Hampshire is bringing with it losses that cannot be sustained, even for non-profits with charitable missions, like Catholic Charities. New Hampshire currently has the nation’s third worst gap between state Medicaid payments and the costs nursing homes incur in providing care; the proposed state budget would actually freeze that funding for two more years.
With any nursing home, wages constitute most of the costs of providing Medicaid care. For our 120-bed Mt. Carmel Rehabilitation and Nursing Center in Manchester, for example, the state’s calculations assume that 54 percent of our costs will be in direct patient care and therapy — the cost component for caregiver wages — while another 20 percent will be in the support cost component that covers wages for dietary and housekeeping staff.
Even if wages were the only costs we had, the state’s payment rate, by itself, would fall short of covering them. The state appropriation only covers 63 percent of Mt. Carmel’s overall Medicaid care costs. Thanks to a budget artifice by which the state produces a rate that is far below the facility’s costs, and another additional cut in the rate (euphemistically called a “budget neutrality factor”), the state avoids paying an additional 27.3 percent of the costs beyond that. That leaves a payment deficit for Mt. Carmel of over $2 million a year.
A portion of this payment gap for each nursing home is lowered by federal matching funds that are produced by a fee the facilities themselves pay (the state contributes nothing to this). Yet even after these federal funds come in, this still leaves a huge deficit — more than $700,000 for Mt. Carmel alone. I can think of no better way to characterize the incredible extreme that this Medicaid funding crisis has reached than to say that, in effect, we are now providing charity to the state itself.
Our continued revenue shortfall is making it impossible for facilities to recruit, and retain caregivers. Already there are facilities turning away prospective residents simply because they cannot staff adequately, and safely, for beds that they have available. It is increasingly common for fast food restaurants and other retailers to pay more than the wages the state is willing to support for licensed nursing assistants, who must undertake 100 hours of education before working.
Shouldn’t it be possible in our state, with the nation’s second-oldest population, for long-term care workers to find adequate compensation in caring for our most vulnerable? Shouldn’t we want them to be able to make a career out of serving the elderly and those with disabilities?
The Catholic Church is the largest non-governmental provider of charitable services in New Hampshire. The mission of Catholic Charities is to respond “to those in need with programs that heal, comfort and empower.” This Medicaid funding deficit is not only threatening the long-term care services offered by Catholic Charities, but is also requiring us to divert resources from other critical areas served by Catholic Charities. We implore the New Hampshire Legislature to resolve this crisis. Failure to do so is guaranteed to result in the closure of nursing homes and the forbidding prospect of the most frail and needy elderly in our state being displaced from these homes. As Pope Francis has said, “Where there is no honor to the elderly, there is no future for the young.”
Thomas E. Blonski is president and CEO of Catholic Charities New Hampshire.