At the end of 2021, U.S. News & World Report released its list of the top 50 best places to retire in the United States. Two New Hampshire cities made the list — Manchester and Springfield — drawing attention to the Granite State as a great place for older adults. Although the state has a high cost of living, residents love New Hampshire for its outdoor attractions, low crime rates, and lack of state income tax.
This guide covers the most common types of senior care available in New Hampshire, details about New Hampshire’s assisted living regulations, and the differences between assisted living and other types of senior housing. It concludes with a list of resources to help older adults access health care and legal assistance when needed.
New Hampshire has a variety of in-home and adult day care options for older adults interested in aging in place. New Hampshire also has several types of residential care for people who need additional support.
Assisted Living Facilities (ALFs)
When a loved one can no longer live independently, an assisted living provider can be a good option. Assisted living residences are for residents who would like to, and can, maintain some independence but need help with meals, housekeeping, and some of the activities of daily living (ADLs), such as showering, getting dressed, or personal hygiene.
Assisted living is a residential setting with staff members available to provide personal care, 24-hour supervision, and assistance with activities of daily living. An assisted living community typically offers three meals per day, help with medication self-administration, wellness programs, laundry and linen services, and recreational activities, among other services. New Hampshire assisted living facilities also offer transportation to hospitals, medical clinics, beauty parlors, and other local businesses. Assisted living minimizes moves among residential settings, maximizes residents’ dignity and autonomy, and encourages people to stay connected to their peers and communities.
New Hampshire issues licenses to two types of assisted living communities. One license is for communities that provide services and supports to accommodate residents who would otherwise require a nursing home level of care. The other license is for assisted living communities that offer residents a standard level of care. Before issuing a license, the Bureau of Health Facilities Administration requires an ALF owner to submit a floor plan, proof of authorization to operate a business in New Hampshire, an overview of the administrator’s professional qualifications, and written approvals from the local zoning officer and building inspector.
Independent living communities are a good housing option for seniors who can still live independently but want to downsize. Each resident or couple lives in a private unit, and most communities offer social programs so residents can meet their neighbors. Housekeeping, chores, and some meals may be provided, although these may incur an additional cost. Unlike the care given in an assisted living community, assistance with activities of daily living and medication management aren’t available in these communities.
Nursing homes offer the highest level of care of all senior living options. These communities provide around-the-clock supervision and skilled nursing care, and available medical help. Generally, people in nursing homes have complex medical issues or need more residential care than is offered in an assisted living facility. New Hampshire has skilled nursing facilities (SNF) for people who require 24-hour care and intermediate care facilities (ICF) for people who don’t need as much medical care. The average cost of nursing home care in the state is $10,950 for a semi-private room and $12,015 for a private room.
Many seniors prefer to choose a community that will continue to meet their needs in the future. Often, CCRCs are bigger than ACHs, as they encompass more care options. Continuing care retirement communities have independent living, assisted living, and nursing home facilities on the same property or owned by the same community. This model allows seniors to stay near their friends in familiar surroundings, even as their needs change. The care provided in the assisted living section is the same as in an assisted living community. The difference is that residents can quickly move to a skilled nursing room if required.
Supportive Housing facilities are residential facilities designed for older adults or persons with disabilities who cannot live independently with a focus on the homeless. These individuals need help with toileting, bathing, dressing, medication management and administration, assistance with meals and housekeeping, and other activities of daily living. These individuals do not need regular nursing care. Several housing options range from living in a facility to residents living in their own home or apartment, with community-based support services.
Some older adults live with family members who provide care during the evenings and weekends but may need supervision and support when caregivers are working or busy during the day. New Hampshire’s adult day programs offer services during daytime hours, ensuring older adults are safe when their regular caregivers aren’t available. Adult day program services provide at least one of the following services for up to 12 hours per day: nursing care, social and recreational activities, supervision, nutrition, and/or assistance with activities of daily living.
Although adult day programs provide some of the same services as assisted living, there is a significant difference between the two types of care. Assisted living communities offer full-time care where the adults live, adult day programs provide services during limited hours, and adults return to their homes at the end of the day. As a result, adult day care costs less than assisted living, averaging $1,842 per month in New Hampshire.
There are two types of in-home care available in New Hampshire: homemaker services and home healthcare. Homemaker services generally provide personal care and may also help with errands, chores, and housekeeping. Home healthcare can deliver these services and offer medical care such as skilled nursing and medication management. Unlike assisted living care, in-home care is provided to people in their homes, making it a good choice for those who prefer to age in place. It doesn’t give seniors access to social and recreational programming for assisted living communities. The average cost of homemaker services is $6,006, and the average cost for home health aides is $6,197 per month.
There are around 100 licensed assisted living facilities with 4,800 beds in New Hampshire. The largest provider of assisted living in the US, Brookdale, has one community in New Hampshire and Langdon Place has four communities in the state.
Two agencies play a key role in maintaining the quality and safety of assisted living communities in New Hampshire. The Bureau of Health Facilities Administration is responsible for issuing licenses, conducting inspections, and taking action against ALFs that don’t comply with state regulations regarding assisted living care. To protect older adult New Hampshire residents, the Bureau of Health Facilities Administration also requires ALFs to give prior notice of changes in ownership, physical location, or the number of beds provided.
Another agency is the Department of Health and Human Services, which operates the Long-Term Care Ombudsman program. This program aims to investigate and remedy complaints about assisted living communities and other long-term care facilities.
Before obtaining a license, an assisted living community’s owner must demonstrate that the ALF has the resources necessary to meet each resident’s unique needs. The Bureau of Health Facilities Administration requires each ALF to appoint an administrator to oversee daily operations. If selected after 2017, the administrator must have at least one of the following: a bachelor’s degree and one year of experience in the healthcare field; a New Hampshire RN license and six months of experience in the healthcare field; an associate’s degree and at least two years of experience in health care; or a New Hampshire LPN license and at least one year of health care experience.
The average cost of assisted living care in New Hampshire is $6,053 per month. This is $1,553 higher than the national average of $4,500 per month. The cost of living in New Hampshire is 5.4% higher than the national average with healthcare costs nearly 12.3% lower and housing costs 18.6% more than the national average. The exact price of care differs depending on where in the state you’re located. In the capital of Manchester, you could expect to pay more than the state average. In Manchester, the average cost of assisted living is $8,061.
If you live close to one of New Hampshire’s borders, you may find assisted living in a neighboring state is an affordable option. Two of New Hampshire’s neighbors have a lower average cost for assisted living. Maine and Vermont have average costs of $5,865 and $5,250, while Massachusetts has a lower average cost of $6,500.
The average cost of assisted living in New Hampshire is around $72,000 per year, so you or a family member may be wondering how to pay for care. A range of options is available to fund senior housing in the state.
Selling a home is a common way for seniors to raise funds for assisted living care. Income from pensions and Social Security may also pay for some care. Other examples of private funds include your retirement accounts, mutual funds, and other investments.
New Hampshire offers a state supplement to older adults who receive Supplemental Security Income (SSI), which uses state and county funds to increase the amount of an eligible recipient’s monthly SSI payment. The supplement is available to older adults living independently, in residential care facilities, and with family members or friends. Recipients can use the supplemental funds to cover some assisted living costs.
Long-term care insurance covers personal care, residential care, and other long-term support and services. Each plan is different; however, most offer a daily amount based on the policy that pays for assistance with activities of daily living. Most people buy a policy in their 50s or 60s and access it when required. If you or your family member has a policy, read it carefully to see what care it covers.
New Hampshire has one Veterans Home in the state, in Tilton. This home provides skilled nursing care to residents of New Hampshire who served in the military. The state’s Department of Military and Veterans Affairs also has offices where team members can help people obtain benefits and services. This includes the Aid and Attendance Benefit, which can help qualified veterans fund personal care.
Elderlife Financial can help you understand how to pay for assisted living.
The services provided in assisted living communities generally come under three broad categories: personal care, medical care, and amenities.
Most people move to assisted living communities because they look for easy access to personal care. These services assist with activities of daily living, such as bathing, dressing, walking, and toileting. Communities also provide supervision and can deliver care for unforeseen needs or in cases of emergencies.
In New Hampshire, ACHs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 68% of communities providing skilled nursing. Many have healthcare specialists and on-site services, with 63% of communities offering dental care. In addition, 67% of ACHs have hospice services.
ACHs may provide specialized care for people diagnosed with Alzheimer’s disease or other forms of dementia. These special care units have additional security measures to ensure residents don’t wander, a common symptom of Alzheimer’s disease. Typically, they also offer programs designed to improve cognitive function and routines that help lower stress.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In New Hampshire, 89% of communities conduct depression screening, and 70% offer mental health counseling. Social work programs are also found in 48% of ACHs. Social workers can provide counseling, conduct assessments, and help ensure residents access all their resources.
Amenities refer to other features and services of the community. ACHs offer three meals a day and coordinate activity programs to help residents stay active and connected with their families and the community. New Hampshire facilities must also provide transportation and laundry services and may offer housekeeping services.
The Bureau of Elderly and Adult Services provides several wellness-related services to adults who are at least 60 years of age, including home-delivered meals, community meals, in-home health care, and transportation to medical appointments. Individuals can also access wellness services via ServiceLink, a network of 13 resource centers that serve people with disabilities. ServiceLink provides information and referrals to help seniors maintain their quality of life.
New Hampshire has community hospitals throughout the state. Still, people in need of specialized care often go to Dartmouth Hitchcock Medical Center, which ranks as the best hospital in the Granite State. Concord Hospital and Alice Peck Day Memorial Hospital are also highly rated.
The Referral, Education, Assistance, and Prevention (REAP) Program has counselors available to help people dealing with grief, substance use, stress, and other mental health issues. Individuals should contact their local ServiceLink for more information on REAP services. The National Alliance on Mental Illness New Hampshire chapter operates an information and resource line. Those in need of mental health support should call (800) 242-6264. NAMI also offers referrals to other mental health resources in New Hampshire.
The decision to move into an assisted living community can be difficult. Generally, you’ll notice changes in your loved ones that suggest they need some assistance. Signs that this environment could be beneficial include increased isolation, loss of mobility, noticeable weight loss or gain, and signs that they’re neglecting household chores.
Your older family member may be the one to start talking about assisted living. For many seniors, moving into a home where cooking, laundry, and other chores are taken care of is appealing. For seniors who realize they need help with daily tasks, the addition of personal care may come as a relief. In New Hampshire, 12% of residents need help with eating. Other commonly used services include bed transfer (22%), toileting (28%), and walking (67%). Caregivers in ACHs help 43% of residents to dress, and 59% of residents need help bathing.
If you think your family member would benefit from assisted living, start talking about it openly. Highlight the positives of a move, such as social activities, cooked meals, and easily accessible assistance. Some ACHs provide respite care, which may allow your family member to have a trial run. Remember, this should be a conversation, not a lecture. Stay open to their opinion. If they’re not ready to transition to assisted living, talk about the care they need to stay at home.
The Bureau of Health Facilities Administration is responsible for assisted living oversight in New Hampshire. As part of its responsibilities, the agency conducts regular inspections to ensure that ALFs are following the rules outlined in the New Hampshire Administrative Code. Assisted living communities must allow department representatives to review their premises and their resident records at any time, even without prior notice.
To protect residents from unsafe conditions, the Bureau of Health Facilities Administration (BHFA) also investigates certain complaints related to assisted living. For the BHFA to investigate, a complaint must be about a violation that occurred no more than six months before a citizen reports it. The complaint must also be based on first-hand knowledge of the alleged violation. If the BHFA decides to investigate, it may inspect the ALF, review relevant records, conduct interviews with ALF residents and employees, or request additional information from the ALF’s administrator.
Many older adults need help with estate planning, advanced health care directives, power of attorney documents, and related legal issues. Unfortunately, there’s also a growing demand for legal services related to elder abuse, neglect, and exploitation.
New Hampshire has resources to help with these legal issues and provide referrals to private law firms if needed. New Hampshire Legal Assistance offers the Justice in Aging program free legal assistance to adults aged 60 and older. The Justice in Aging program is for people with limited financial resources who need help accessing public benefits, dealing with financial exploitation, resolving disputes with residential care facilities, and addressing other legal matters. Those who need referrals to local attorneys can contact the New Hampshire Bar Association for assistance.
There are 53 assisted living facilities in NH and the median cost of care is $7,214. The average rating of assisted living facilities in New Hampshire is 3 out of 5 stars and the top ranked facility is Sunapee Cove Assisted Living.
80 Lake Street, Nashua, NH, 03060
Outdoor Areas, Pool, Social Outings, Pet Friendly, Housekeeping,
1250 Route 11, Sunapee, NH, 03782
Outdoor Areas, Activity Center, Social Outings, Clubs & Communities, Beauty & Barber,
206 N River Rd, Lee, NH, 03861
Pet Friendly, Activity Center, Social Outings, Fitness Programs, Outdoor Areas,
151 Langley Parkway, Concord, NH, 03301
Outdoor Areas, Housekeeping, Pool, Activity Center, Clubs & Communities,
306 Knox Marsh Rd, Madbury, NH, 03823
Beauty & Barber, Pool, Social Outings, Activity Center, Outdoor Areas,
319 East Dunstable Road, Nashua, NH, 03062
Pet Friendly, Housekeeping, Pool, Activity Center, Clubs & Communities,
40 State Route 101, Bedford, NH, 03110
Outdoor Areas, Nearby Shopping, Parking, Pool, Social Outings,
3 Church Road, Windham, NH, 03087
Outdoor Areas, Clubs & Communities, Activity Center,
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