Assisted Living in New Hampshire

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.

Directory of Assisted Living Facilities in New Hampshire

There are many factors to consider when searching for an assisted living facility for yourself or a loved one, including your finances, level of care needed, and personal preferences. The tool below is a great place to start. Use the directory to learn about facility amenities, size, pricing, and more.

How to Pay for Assisted Living in New Hampshire

Determining how to finance assisted living often starts with the question, “What’s the cost?” In today’s economy, where inflation plays a significant role, having current data is crucial for senior living financial planning. AssistedLiving.org has gathered cost information from its expansive network of over 75,000 senior living providers. This data offers a glimpse into the average expenses for assisted living in New Hampshire and 10 additional cities within New Hampshire.

How Inflation Has Impacted the Cost of Assisted Living in New Hampshire

Inflation caused assisted living prices to rise throughout the U.S. from 2022 to 2023, with New Hampshire following the trend. In the state, costs rose 20% from $5,191 to $6,217, double the national average rate. Neighboring state Connecticut saw a 16% increase in assisted living rates in the same period.

Prices are expected to rise 10% to $6,827 in New Hampshire by 2024, compared to 14% in Massachusetts, 4% in Maine and Connecticut, and 8% nationally. By examining inflation trends in different regions, seniors can make more informed decisions when making arrangements for senior care.

Assisted Living Costs in New Hampshire's Top Cities

Seniors exploring assisted living options in New Hampshire can expect to find a high degree of price variance between cities. In the capital city Concord, assisted living costs an average of $5,295, $922 less than the state average. Nashua offers even more affordable assisted living at $3,683 per month. Closer to the coast, Dover and Salem are more consistent with the average price for New Hampshire at $6,346 and $6,446 respectively.

The Cost of Other Types of Senior Living

The costs associated with senior living depend on the level and type of senior care required. At $7,169, memory care offers specialized treatment and programming to seniors with dementia. Independent living is the most affordable option, and provides community amenities for seniors who are fully self-sufficient or require minimal care. Assisted living offers a balance between independent living and more specialized care, with a variety of floor plans and additional services.

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

Seniors can apply for assistance online or mail in a paper application. For more information, visit the Department of Health and Human Services website.

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 and Low-Cost Resources for Seniors in New Hampshire

There are many resources in New Hampshire that assist seniors in their retirement. Assistedliving.org has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.

Area Agency on Aging

Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.

Cash Assistance Programs

Cash assistance programs in New Hampshire provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.

Financial Assistance for Senior Care and Senior Living

Whether living in their own home or in a senior living community, New Hampshire seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.

Food Assistance Programs

Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help New Hampshire seniors afford the nutritious food they need.

Free Used Medical Equipment

Due to the high cost of purchasing new medical equipment, several organizations in New Hampshire collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.

Health Insurance & Prescription Drug Coverage for Seniors

New Hampshire seniors who meet certain income criteria can apply to local resources to help them pay for prescription drugs. Eligible residents can also receive assistance through health insurance and other programs to access free or discounted medical services.

Home Repair and Modifications

Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in New Hampshire have different eligibility criteria and often assist retirees by providing grants or loans.

Legal Resources

Many organizations offer free or low-cost legal services to New Hampshire seniors. Older adults can access advice on issues such as estate planning, living wills and power of attorney. Some firms also act as long-term care ombudsmen, advocating for the rights of seniors in senior living communities.

Senior Centers

Senior centers in New Hampshire bring together residents through recreational activities and events. Many also offer advice and support on senior issues, run wellness and nutrition programs, and connect older adults with other resources in the local area.

Social Security Offices

Social Security offices in New Hampshire help seniors and disabled people access the benefits they’re entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.

Tax Assistance

Seniors can apply for tax assistance from several New Hampshire resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.

Utility & Energy Bill Assistance

Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. New Hampshire retirees could also qualify for emergency funding programs if they’re in danger of losing utility services due to unpaid invoices.

Veteran’s Services

New Hampshire retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they’re eligible for and provide advice and information on a variety of issues.

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.

Staffing Requirements

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.

New Hampshire COVID-19 Rules for Assisted Living Facilities

Note: The following information was compiled and most recently updated on 2/10/22. Since COVID-19 is a rapidly evolving crisis, be sure to contact your assisted living facility or local Area Agency on Aging for the most up-to-date information.

Sources: www.covid19.nh.gov www.cms.gov