New Hampshire may not have the warm climate or low cost of living that many seniors look for when it comes time to choose a place to retire, but it does have its perks. New Hampshire’s tax policies are very retirement-friendly, and local nonprofits and governmental organizations have many helpful services in place for seniors who choose the Granite State for assisted living.
Paying For Assisted Living in New Hampshire
The Cost of Assisted Living in New Hampshire
The monthly median cost of assisted living in New Hampshire is $4,675, higher than the national average of $4,000. However, Genworth’s 2018 Cost of Care Survey indicates that assisted living communities in New Hampshire are less expensive than the median in all but two neighboring states, Vermont and Rhode Island.
The cost of assisted living falls in the middle of other long-term care options within New Hampshire. The state median monthly cost of assisted living is considerably more expensive than adult day care and independent living. However, it is marginally less expensive than in-home care, and it’s significantly cheaper than nursing home care.
Financial Assistance for Assisted Living in New Hampshire
Choices for Independence Waiver
The Choices for Independence waiver helps seniors access the services they need in their own home or a community setting, rather than be placed in a nursing home. This Medicaid Home and Community Based Waiver may be used towards assisted living, residential care homes, adult family care, and other types of supportive housing. It allows seniors to maintain more independence and autonomy, as they are able to choose their own providers.
Who Is Eligible?
Applicants must be age 65 and over, require a nursing home level of care, and meet income limitations. The monthly income limit is set at $2,250 with countable assets less than $2,500.
How to Apply
Interested seniors can apply online or call 1-866-634-9412.
Old Age Assistance Program
The Old Age Assistance program is part of a group of Cash Assistance Programs sponsored by the state government. All Cash Assistance Programs aim to aid financially needy New Hampshire residents by providing monetary assistance. Old Age Assistance specifically helps seniors, and the given resources may be used to help finance long-term care. There is a resource limit of $1,500 per person.
Who Is Eligible?
Applicants must be age 65 and over, and meet income requirements.
How to Apply
More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:
- Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.
- Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov
- Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.
- Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.
Free Assisted Living Resources in New Hampshire
Long-Term Care Ombudsman Program
New Hampshire maintains a Long-Term Care Ombudsman program. The ombudsman’s purpose is to act in the best interest of residents of ALFs and other residential care facilities. Some of the ombudsman duties include:
- Educate care staff, residents, and the public about issues that affect residents in long-term care facilities
- Catch problems before crises occur and make suggestions to facilities regarding necessary changes to policies and procedures
- Connect seniors to facilities and resources that may benefit them
- Investigate problems and complaints raised by residents of long-term care facilities or their families
- Advocate for the needs of long-term care facility residents
Area Agencies on Aging
Area Agencies on Aging (AAA) is a network of hundreds of nonprofit organizations across America that provide federally funded services to adults over 60 in their local areas.
In New Hampshire, AAA functions are carried out by ServiceLink Resource Centers. ServiceLink is a program of the Department of Health and Human Services that helps connect seniors with long-term care services and other community supports and resources.
The Bureau of Elderly and Adult Services also provides similar services for seniors in New Hampshire. Bureau staff are present in both DHHS district offices and ServiceLink Resource Centers throughout the state.
|Area Agency on Aging||Address||Phone Number|
8 Commerce Drive
650 Main Street, Suite 200
610 Sullivan Street
17 Water Street, Suite 301
224 Elm Street
40 Terrill Park Drive
2 Industrial Park Drive
73 Hobbs Street
111 Key Road
105 Castle Street
65 Beacon Street West
67 Water Street
10 Campbell Street
80 North Littleton Road
262 Cottage Street
1050 Perimeter Rd, Suite 501
555 Auburn Street
70 Temple Street
150 Wakefield Street, Suite 22
25 Old Dover Road
19 Rye Street
26 Whipple Street
72 Portsmouth Avenue
448 White Mountain Highway
The Department of Veterans Affairs provides healthcare and other useful services for military veterans and their families. Some VA programs can even be used to fund long-term care services. There are four Vet Centers located throughout New Hampshire where veterans and their families can go to access services or find out more about resources available to them. The offices can also provide guidance on finding and financing assisted living in New Hampshire.
|VA Office||Address||Phone Number|
515 Main Street
640 Marlboro Rd
1461 Hooksett Road
19 River Road
Social Security Offices
There are several Social Security offices in New Hampshire where residents can go to find out more about their benefits and what resources may be available to help pay for long-term care. These offices are a great resource if you are unsure how to make the most of Social Security benefits for yourself or a loved one.
|Social Security Office||Address||Phone Number|
70 Commercial St
9 Elm Street
177 Main St
1100 Elm St
175 Amherst St
80 Daniel St
NHCarePath is a collaborative effort between multiple organizations in New Hampshire, including the Department of Health and Human Services and ServiceLink. The initiative aims to make it easier for older adults, as well as their caregivers and families, to find services and educational resources that help them live comfortably in their communities.
NHCarePath can direct seniors to services like ServiceLink Resource Centers, Cash Assistance programs, and mental health services. If you are unsure where to turn to access necessary services, CarePath is a good place to start.
To contact NHCarePath, visit the program website or call 1 (866) 634-9412.
Commodity Supplemental Food Program
The Commodity Supplemental Food Program (CSFP) offers free meals and nutrition information for New Hampshire residents age 60 and over. Seniors enrolled in the program receive nutritious food, including fresh fruits and vegetables from farmers markets in the summer months, free of cost.
To be eligible for CSFP, seniors must meet certain income guidelines. To sign up for the program, call your local CSFP agency.
Prescription Drug Assistance
There are two programs in New Hampshire that help seniors and low-income individuals pay for prescription medications: Partnership for Prescription Assistance and Medication Bridge. Neither of these programs fund prescription medications themselves, but rather connect seniors with existing programs that provide medications at a very discounted price or free of cost.
There are certain income guidelines for each program, both of which are available on the organizations’ websites. Seniors can also visit or contact ServiceLink for more information on these programs or other means of prescription drug assistance.
Assisted Living Laws and Regulations in New Hampshire
Assisted Living Definition
In New Hampshire, there are two different types of assisted living facilities, which offer different levels of care:
- Supported Residential Health Care: These facilities are the more comprehensive of the two options. They provide social and health services to three or more residents, and may provide short-term medical care to residents who are recovering from an illness.
- Residential Care: These facilities provide assistance with personal care and provide social activities. Supervision levels are kept to a minimum.
Neither type of facility is able to care for seniors who require around-the-clock nursing care.
Assisted Living Care Plans
Residents of both types of facilities must be evaluated using an assessment tool approved by the New Hampshire DHHS. Assessments must be repeated at least twice per year, including following a change in condition. If deemed necessary during the initial assessment, a follow-up nursing assessment must be completed to evaluate medication use, vital signs, and physical and cognitive condition. These assessments are then used to develop residents’ care plans.
Assisted Living Admission Requirements
Both facilities must only admit residents whose needs they can meet with certainty.
- Supported Residential Health Care facilities may admit residents who require mechanical assistance to transfer if all direct care personnel receive training in how to properly operate such equipment. They may also admit residents who have an ulcer of Stage III or higher pressure if the facility employs a licensed nurse or contracts a healthcare professional who has specialized training in caring for persons who have ulcers.
- Residential Care facilities may only admit residents who are capable of evacuating on their own in case of an emergency.
Assisted Living Scope of Care
Supported Residential Health Care facilities provide the more comprehensive services of the two ALF options in New Hampshire. Their core services include:
- Health and safety services
- Personal care services
- Medication services
- Social and recreational programming
- Medication services
- Assistance arranging medical appointments
- Supervision of residents with cognitive impairments
- Crisis intervention
- Access to nursing services, as needed by residents
The core services provided by Residential Care facilities include:
- Supervision of activities of daily living (ADLs), like dressing and bathing
- The arrangement of medical appointments
- Assistance accessing community services
- Supervision of residents with cognitive impairments
- Crisis intervention
Both facilities may only provide 24-hour licensed nursing care to residents for periods of up to 21 days.
Assisted Living Medicaid Policy
New Hampshire Medicaid doesn’t directly pay for the cost of assisted living. However, the Medicaid Choices for Independence Waiver program may be used to help cover the cost of either type of assisted living facility. Keep in mind that the waiver program is not an “entitlement” program, meaning that not everyone who qualifies will be able to receive care as there is a participant cap.
Assisted Living Facility Requirements
Private apartments are not required in either type of residential care facility. Resident units may be single-occupancy or double-occupancy, and there must be at least one toilet, one sink, and one shower or bathtub for every six residents.
Medication Management Regulations
Residents Supported Residential Health Care facilities may self-administer medication or self-direct administration verbally to staff if they are unable to administer the medication themselves. All facility staff may remind residents to take their medication, place containers within residents’ reach, and observe and document side effects.
Unlicensed staff may administer oral medications only if they are delegated to do so by a licensed nurse, and if they have undergone a 4-hour training on infection control, the “five rights” (right dose, right resident, right medication, right time, and right route), general categories of medications, and potential side effects, precautions, and interactions.
Medication regulations for Residential Care facilities are similar to those described above, but medications must be administered by a licensed nurse, a medication nursing assistant, or another staff member authorized by law to assist.
Supported Residential Health Care facilities must employ an administrator to handle day-to-day operations, direct care personnel to provide residents with personal care services, and a licensed nurse to oversee medication administration and health services, and complete resident assessments. At least one staff member must be on duty and awake at all times, except in facilities with eight or fewer residents that have necessary electronic safety and communication systems.
Residential Care facilities must also employ an administrator, direct care personnel, and a licensed nurse to administer medications. No awake staff member is required to be present during the night in facilities of sixteen or fewer residents if the proper communication and safety systems are in place, residents are fully capable of self-evacuation, and no residents have acute medical needs or a history of being abusive.
Neither type of facility has state-mandated staff ratios. Individual facilities may set their own standards for staff-to-resident ratios.
Staff Training Requirements
Both types of facilities require administrators to complete 12 hours of continuing education per year. Topics must include nutrition, first-aid, medication management, resident assessment, and residents’ rights.
Direct care personnel must receive training within a week of hire covering topics including residents’ rights, complaint procedures, emergency and evacuation procedures, and infection control. They must also receive annual continuing education on infection prevention and control, residents’ rights, and the facility’s emergency plan.
Background Checks for Assisted Living
Both types of facilities must obtain and review a background check from the New Hampshire Department of Safety for all applicants for employment, as well as for residents. Facilities must not offer employment or grant admission if the application has been convicted of a violent crime, sexual assault, fraud, abuse, neglect, or exploitation, or may otherwise pose a threat to residents’ safety and wellbeing.
Requirements for Reporting Abuse
Any cases or suspicions of elder abuse or neglect should be reported to the DHHS Bureau of Elderly and Adult Services. The Bureau can be reached by calling (800) 949-0470 or (603) 271-7014.
If you would like to report a violation of any of the above mandates or have other concerns about a residential care facility, you should direct those messages to the office of the Long-Term Care Ombudsman. To contact the ombudsman, call (800) 442-5640 or (603) 271-4375.