The Domino Effect of Bad Public Policy: A Silent Crisis for Seniors and the Infirm

by Gina Balkus, CEO

New Hampshire takes pride in its fiscal conservatism.  The Legislature funds government programs at bare minimums every two years and relies on New Hampshire’s good ol’ Yankees to make do.  Like any family budget, it may work for a while – or until a leaky roof causes a ceiling to crash down.  Long-term planning and small annual investments in home improvement could have averted the disaster.  This would seem obvious to most people, yet our Legislature continues its minimalist approach on important programs and then struggles to resolve crisis after crisis.

Here are few examples:  long emergency room waits for mentally ill patients; children who are at risk of abuse and neglect because the Department of Health and Human Services is understaffed; people with addictions who can’t find a treatment facility; developmentally-disabled adults who are on wait lists for services.  For years, advocates warned that these programs were in trouble.  The Legislature generally didn’t listen until the human toll became unbearable or the State was sued.

The latest victims are New Hampshire’s medically frail elderly and other vulnerable adults who depend on the State for help. Many people in the Choices for Independence (CFI) program, which provides help at home, or who need Medicaid-funded nursing home care, are not getting the services they need.   What’s the impact? The 82-year-old women with diabetes, severe foot pain and incontinence has no one to cook a healthy meal, change bed sheets and remind her to take her insulin.  The paraplegic who needs daily help to get up, showered and dressed has help only four days a week.  The veteran with Alzheimer’s and heart failure waits for a nursing home bed. What are their options?  They struggle to remain safe at home as their conditions worsen.  Then what?

The Medicaid payment system for home care and long-term care facilities has been underfunded for two decades.  New Hampshire’s payment rates are among the worst in the nation. The domino effect is this: low payment rates lead to provider financial losses, which lead to stagnant wages for employees, which lead to worker shortages, which force home care agencies to limit services and nursing homes to close beds, which means people who need care don’t receive it.

The crisis is real but silent.  CFI clients are often homebound and nursing home patients are severely ill.  They can’t speak out at State House hearings.  This doesn’t mean they should be ignored.  They are your grandparents, your friends and your neighbors.  Their plight is simply that they have serious medical conditions and no one else able to care for them.

The Legislature must confront this crisis in this legislative session.  It should build upon the Governor’s CFI budget and rebase rates to stabilize the provider network, enabling home care agencies to invest in workforce.  It should raise nursing home rates from the worst in the country to (heaven forbid!) the national average.  It should add state general funds to the long-term care appropriation, rather than rely completely on Counties to fund these services.  And it should fully fund SB 308, which would increase Medicaid rates for all providers by 5% in 2020 and 7% in 2021. 

Fiscal conservatism is admirable except when the public policy dominoes topple into a heap.   The current situation is not a game for our seniors and vulnerable adults.  Their health and safety are at risk.  Legislators need to resolve this silent crisis.  Now.

Gina Balkus lives in Nashua and is the CEO of the Granite State Home Health & Hospice Association, which advocates for home health providers and the patients they serve.

This Op Ed appeared in several media outlets including the Concord Monitor, Conway Daily Sun, Keene Sentinel, Eagle Times, Valley News, and World News.