Assisted Living in New Hampshire
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Families looking for assisted living in New Hampshire (NH) have a wide array of communities to choose from, since estimated that there are more than 30,000 assisted living communities serving seniors across the U.S., and over 72 statewide. The state is also home to a rapidly growing number of senior citizens, with adults over 65 making up an estimated 17.6 percent of the population. A resident in an assisted living community in New Hampshire will pay $4,855 per month on average.
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What you should know about assisted living in New Hampshire
adult residential care services include things such as meal and homemaker service, personal care, nursing care, socialization, transportation and other licensed facilities.
Many assisted living communities are located throughout the state – from busier areas around Nashua and Manchester to farther north in more rural communities near Concord, Laconia and the Lakes Region. Some assisted living communities offer specialized memory care services for individuals with dementia or Alzheimer's. New Hampshire offers an online resource center for seniors called ServiceLink, a resource that helps seniors and other individuals make connections to long-term service and support systems throughout the state.
Financial Assistance for Assisted Living in New Hampshire
In New Hampshire, low-income seniors can apply for financial assistance through the Old Age Assistance program.
Old Age Assistance (OAA)
This is a statewide program funded by the Department of Health and Human Services that provides cash assistance to residents age 65 or older.
Who Is Eligible?
Eligibility for OAA depends on a number of different factors, including income, resources and living arrangements. It's available for residents of New Hampshire age 65 or over who are also U.S. citizens.
How to Apply
Eligible seniors can apply for OAA in three ways:
- Visit a Department of Health and Human Services district office and speak with a DHHS worker who can assist you through the interview and application process
- Apply online at https://nheasy.nh.gov/
For more information on applying for financial assistance in New Hampshire, visit the How to Apply for Assistance page on the DHHS website.
Medicaid is a joint federal and state public assistance program for financing health-care for low-income people. The largest public payer of long-term care services, Medicaid pays for health services for those with low incomes or very high medical bills.
Who is Eligible?
In some areas, Medicaid may be available to help offset the costs of assisted living. Medicaid benefits and eligibility requirements also vary by state. To qualify in New Hampshire, your income has to fall below a certain level. For more information about Medicaid benefits in New Hampshire, you can consult NHCarePath.
How to Apply
In New Hampshire, to apply for Medicaid benefits, you can download an application form at the Department of Health and Human Service's Family Assistance division. You'll want to look for Form 800 specifically to apply for Medicaid benefits.
IMPORTANT NOTE: Not all assisted living residences accept payment from these programs. Always check with the assisted living community you're interested in about which forms of payment they will accept, as well as any reduced rates offered for low-income residences. Individual communities may offer their own forms of financial assistance.
More Ways to Finance Assisted Living
While many families use their own funds or personal assets to pay for assisted living, there are plenty of additional options to cover these costs. Visit our 9 Ways to Pay for Assisted Living page for more information.
Free Assisted Living Resources in New Hampshire
There are a number of government-funded agencies and nonprofit organizations in New Hampshire that offer free assistance to older adults and their loved ones searching for long-term senior care.
These organizations can help you better understand the different types of senior care available, any financing options and what your senior loved one may qualify for, especially if they are disabled, a U.S. veteran, low-income or the spouse of a veteran.
New Hampshire Area Agencies on Aging
Area Agencies on Aging (AAA) is a network of more than 600 organizations throughout the United States providing federally funded services to adults in local areas. Depending on which area of New Hampshire you live, there are numerous services available that provide information about long-term senior care options, case management, health insurance counseling and help with low-cost meals and transportation.
129 Pleasant Street, Brown Building, Concord, NH 03301
As in every state in the United States, VA centers can be found in New Hampshire and can assist military veterans and their spouses with finding and financing assisted living care. They can also help you and your loved ones understand what types of care options are covered under any VA benefits they currently receive or might be eligible to receive based on their military service.
Another federally operated source for seniors is within New Hampshire's social security offices. At one of many locations throughout the state, seniors can get assistance with understanding their social security benefits, which some seniors may be able to use to help pay for assisted living.
70 Commercial St, Concord, NH 03301
1-888-397-9798 or TTY: 1-603-225-8475
9 Elm Street, Keene, NH 03431
1-877-405-3651 or TTY: 1-603-357-2034
177 Main St, Littleton, NH 03561
1-877-405-7658 or TTY: 1-603-444-4028
1100 Elm St, Manchester, NH 03101
1-866-814-5408 or TTY: 1-800-325-0778
175 Amherst St, Nashua, NH 03064
1-877-444-0134 or TTY: 1-800-325-0778
80 Daniel St, Portsmouth, NH 03801
1-888-397-9796 or TTY: 1-603-436-3086
New Hampshire's Bureau of Elderly and Adult Services (BEAS) provides a variety of social and long-term supports to adults aged 60 and older. A variety of long-term services and supports can be accessed through ServiceLink resource centers and the NH DHHS District Offices. They are intended to assist elderly people to live as independently as possible in safety and with dignity. Local NH DHHS district offices are listed below:
650 Main Street, Suite 200, Berlin, NH 03570
17 Water Street, Suite 301, Claremont ,NH 03743
40 Terrill Park Drive, Concord, NH 03301
73 Hobbs Street, Conway, NH 03818
111 Key Road, Keene, NH 03431
65 Beacon Street West, Laconia, NH 03246
80 North Littleton Road, Littleton, NH 03561
1050 Perimeter Rd, Suite 501, Manchester, NH 03103
150 Wakefield Street, Suite 22, Rochester, NH 03867
50 International Drive, Portsmouth, NH 03801
26 Whipple Street, Nashua, NH 03060
Assisted Living Laws and Regulations in New Hampshire
New Hampshire Department of Health and Human Services licenses two categories of assisted living residences (ALRs):
- Supported residential health care facilities (SRHCF) that may house nursing-home eligible residents if appropriate care and services are provided
- Residential care facilities (RCF) that provide a lower level of care.
Assisted Living Service Plan Requirements
In New Hampshire, both assisted living categories require that residents be assessed by a trained assessor with a DHHS-approved assessment tool. Assessments must be repeated twice a year or when there is a change in the resident’s condition.
Sometimes at the outcome of a resident assessment, a nursing assessment needs to be completed. This assessment typically addresses:
- Medication use
- Clinical services
- Vital signs
- Cognitive, behavioral and mental status
These assessments are used to help develop the resident's care plan.
Assisted Living Admission Requirements
There are no statewide requirements in place for admission. Admission guidelines vary by assisted living community type, whether SRHCFs or RCFs.
For ALR-supported residential health care communities, facilities may only admit and retain individuals whose needs they can meet and who can evacuate in accordance with the state fire code. Assisted living residencies with the appropriate staff may admit or retain individuals who require medical assistance to transfer. Those who require 24-hour nursing care or monitoring for less than 21 days may be admitted as well to an assisted living community, as well as those individuals receiving hospice care.
For ALR-residential care communities, they may only admit and retain individuals whose needs they can meet. For instance, in these assisted living communities, residents must be capable of evacuation without assistance. Residents requiring rehabilitation or nursing care longer than 21 days must be discharged to another facility (or hospital) that can meet their medical needs. The one exception are those residents receiving hospice care.
Assisted Living Scope of Care
The scope of care for individual assisted living residents in New Hampshire varies based on the community type.
ALR-SRHCFs' services include the supervision of residents with cognitive deficits, health and safety services, personal care (including grooming, bathing, bathroom assistance), emergency response and crisis intervention, medication management and social/recreational activities. There also may be assistance with arranging medical and dental appointments off-site. These types of assisted living communities typically provide access to nursing services as well.
ALR-RCFs, on the other hand, provide a lower level of care for residents with less acute conditions or who need less assistance from staff. Services may include the supervision of residents with cognitive limitations, arrangement of appointments, crisis intervention, supervising activities of daily living, medication services, provision or arrangement for transient medical care with licensed home health providers, and assistance with accessing community services.
Assisted Living Medicaid Policy
Some assisted living communities accept Medicaid as a form of payment from prospective residents. Some assisted living communities in New Hampshire may accept Medicaid to cover individual services, but may not cover the cost of room and board expenses.
The Old Age Assistance (OAA) benefit may also help offset some assisted living costs. It's important to check with individual assisted living communities to find out about what forms of financial assistance they do accept.
Medication Management Regulations
In New Hampshire, unlicensed staff can administer medication to assisted living residents, but they have to undergo specific classroom training so they can learn the correct ways to administer medication. New Hampshire requires them to be trained by an on-site health care professional.
Regulations vary by facility type and are explained below:
In assisted living residences-supported residential health care communities:
- residents can self-direct medication administration if their physical condition prevents them from self-administering, and they can verbally direct staff members to assist them.
- Staff can supervise this self-administration in the following ways:
- Remind residents to take their medication
- Place containers within reach
- Observe, record and document observed or reported side effects
It's important to note that in these types of facilities, staff may not physically handle the medication. However, unlicensed staff may administer oral medications if they've been delegated to do so by a licensed nurse.
In assisted living residences-residential care communities, residents may give themselves medication with or without staff supervision or may self-direct medication administration. Medications must be administered by a licensed nurse, a medication nursing assistant or any other individuals authorized by law.
In New Hampshire, ALR-supported residential health care communities must employ the following staff types:
- A full-time administrator, who is responsible for day-to-day operations
- Direct care personnel, who provide personal care assistance to residents
- A licensed nurse, to provide or delegate medication administration, assist with medical assessments of residents and to oversee health services
There are no minimum staff to resident ratios in New Hampshire. The administrator of the assisted living community is responsible for determining appropriate levels of personnel based on the facility's size and the service needs of its residents.
NH law does state that at least one awake staff must be on duty at all times, except for facilities with eight or fewer beds that are equipped with an electronic communication system, an installed wandering prevention system (for facilities that serve residents with dementia) and the ability to meet residents' needs at all times.
The same staff requirements listed above apply to ALR-RCFs as well – they require a full-time administrator, direct care personnel and a licensed nurse. However, the full-time administrator must be employed at least 35 hours per week.
There are no minimum staff-to-resident ratios in ALR-RCFs. In assisted living communities with 16 or fewer beds, an awake member of personnel is not required during the night if the following conditions are met:
- There is a communication system that allows a resident to contact and awaken the sleeping personnel member via an intercom or something similar
- There is an installed wandering prevention system if there are residents with dementia that will awaken a sleeping personnel member if activated
- Residents require nothing more than occasional reminding, cueing or verbal prompting for mobility and evacuation situations
- Residents have no acute medical needs or ongoing nursing needs
- The facility meets the needs of the residents at all times, as described in resident care plans
Staff Training Requirements
Both types of assisted living communities in New Hampshire require that administrators complete 12 hours of continued education each year that includes assisted living-related topics such as the resident plan of care, characteristics of different disabilities residents may have, nutrition, basic hygiene, dental care, first aid, medication management, dementia and aging, among others.
Before starting work, personnel must receive orientation and training within a week of hire that covers topics such as residents' rights, complaint procedures, duties and responsibilities, emergency and evacuation procedures, infection control, mandatory reporting requirements. Continuing education must be provided annually for personnel that reviews the topics of residents' rights, infection control and emergency procedures.
Background Checks for Assisted Living Staff
Both licensed assisted living types require that each staff member go through a criminal records check, obtained from the New Hampshire Department of Safety for all applicants for employment. Their qualifications must be reviewed prior to employment.
Under New Hampshire law, assisted living communities may not offer employment if the individual has been convicted of:
- Sexual assault
- Violent crime
- Abuse or neglect
- Anything that otherwise poses a threat to the safety and well-being of assisted living residents.
Requirements for Reporting Abuse
The New Hampshire Department of Justice has a comprehensive resource for administrators and assisted living personnel to report signs of elder abuse, and they supply many resources for recognizing the signs. All assisted living staff members are trained to recognize and report cases of abuse or neglect.
Assisted Living Facilities in New Hampshire
Top-Rated Caring Stars Winners in New Hampshire
Caring.com’s Caring Stars award program recognizes the best assisted living facilities across the U.S. based on reviews from family caregivers and older adults. This award is meant to help older adults and their loved ones find the best assisted living or in-home care option in their area. The list below shows up to 10 listings that have won the most Caring Stars annual awards in their state, sorted by their current overall average rating. For a complete list of Caring Stars winners for each year, please visit our Caring Stars info center.