Nursing Homes in New Hampshire

New Hampshire is an aging state with a growing population of older adults. Senior citizens aged 65 and older already account for more than 18.7% of the state’s 1,359,711 residents, and this number is expected to increase as more baby boomers enter their golden years.

It’s estimated that 70% of older adults will require long-term services and supports, and nearly half will require paid care during their lifetimes. Many older adults receive personal care and medical services from assisted living centers or home health agencies. Individuals with more significant needs can choose from 74 licensed nursing homes that provide skilled 24-hour care for subacute medical conditions.

The average cost of skilled nursing in New Hampshire is $10,646 for a semiprivate room or $11,315 for a private room, which is higher than the national average and most neighboring states. This guide explores long-term care costs in New Hampshire as well as financial assistance programs, such as Medicaid. It also includes helpful information about state regulations, nonprofit resources and free services that are available to seniors and caregivers.

The Cost of Nursing Home Care in New Hampshire

Nursing homes in New Hampshire typically charge $10,646 per month according to provider responses collected in the Genworth Cost of Care Survey 2020. Average rates are $2,890 higher than the U.S. median of $7,756, which represents an increase of 37%. New Hampshire is also more expensive than most neighboring states with the exception of Massachusetts, where seniors pay $12,623 per month for skilled nursing. In other parts of New England, rates are more competitive. Seniors in Vermont pay $9,779 per month, or $867 less, and rates in Maine are about $1,000 lower at $9,642. Rhode Island is also more affordable. Seniors in the nation’s smallest state pay $1,977 less per month of skilled care than their counterparts in New Hampshire.

Manchester is one of 440 metropolitan areas included in Genworth Financial’s long-running Cost of Care Survey. Most of the state’s largest cities, including Nashua, Concord and Derry, fall within this geographic region. In these communities, seniors can expect to pay $11,330 per month for skilled nursing, which is $686 more than the state median. New Hampshire compares favorably to cities in Massachusetts, including Worcester and Boston where seniors pay $12,486 and $13,383 per month, respectively. Burlington, Vermont, is slightly more affordable than Manchester at $10,737, and nursing homes in Maine provide a more competitive value. Seniors in Portland pay $10,220 per month, and average rates in Lewiston are $1,521 lower than the New Hampshire median at $9,125.

Long-term care prices vary significantly depending on the type of services provided. In New Hampshire, adult day health care is the most affordable option. Programs that provide recreational activities and daytime care in a group setting cost $1,842 per month on average. In-home care costs $5,434 per month or $5,577 with added medical support. Assisted living facilities in New Hampshire cost $6,650 per month, which is significantly higher than the U.S. median of $4,300. At $10,646 per month, nursing homes charge almost $4,000 more due to the level of skilled care they provide 24 hours a day.

Financial Assistance for Nursing Home Care in New Hampshire

Most people do not pay for skilled nursing care entirely out-of-pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in New Hampshire.

New Hampshire’s Medicaid Program

Medicaid provides health insurance to 201,813 adults and children in New Hampshire. Although the state has adopted strict targeted enrollment strategies, these programs cover approximately 14% of the state’s population, and enrollment has increased by 58% since the Healthcare Marketplace opened in 2013. For many low-income individuals, Medicaid provides a full array of medical services, including hospital and doctor care and dental, vision and prescription drug coverage. Medicaid also pays for skilled nursing, personal care attendants and home and community-based services for the elderly.

Long-term care accounts for more than one-third of the state’s $2.2 billion in Medicaid spending, and the program covers more than 66% of the state’s 6,400 nursing home residents. Medicaid pays for room and board, skilled nursing, rehabilitative therapy, medical services and protective care provided by nursing homes. New Hampshire also offers a home and community-based services waiver known as Choices For Independence that lets disabled adults receive similar services in a community-based setting. Individuals must meet medical and financial criteria to qualify for long-term care benefits.

Medicaid Eligibility in New Hampshire

Medicaid long-term care benefits are available to New Hampshire residents who require nursing home care and meet certain income and asset limits. Applicants can earn up to $2,382 per month and retain up to $2,500 in nonexempt cash assets. However, beneficiaries must use all of their monthly income for nursing home care with some exemptions. New Hampshire permits individuals to retain a $70 personal needs allowance, and some funds may be allocated for spouse care. Applicants must be a U.S. citizen or qualified alien. You can learn more or apply for benefits through the NH EASY Gateway to Services or by calling (800) 852-3345 ext. 9700.

Alternative Financial Assistance Options

• Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
• Aid and Attendance: Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care.
• Reverse Mortgages: If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home’s equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
• Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in New Hampshire

If you’re looking for information about long-term care, a variety of government agencies and nonprofits are standing by to assist you. Learn more about some of the programs that can help older adults and their families.

Resource	Contact	Service
New Hampshire Bureau of Elderly & Adult Services	(603) 271-9203	The BEAS funds a long list of programs and services that benefit seniors, caregivers and disabled adults. It provides informational services and assistance with home and community-based waivers, such as the Choices For Independence Program. It also helps residents access long-term care and Medicaid benefits that may pay for skilled nursing.
New Hampshire ServiceLink	(866) 634-9412	ServiceLink is the state’s Aging and Disability Resource Center, a government–sponsored nonprofit that directs New Hampshire seniors to local resources in their area. It’s home to the Senior Medicare Patrol, the State Health Insurance Assistance Program and the National Family Caregiver Support Program. It offers long-term care options counseling and referrals to help residents access the support they need.
Office of the Long-Term Care Ombudsman	(603) 271-4375	The long-term care ombudsman is a federally mandated program that uses a network of specially trained volunteers to protect the interests of nursing home and long-term care residents statewide. Volunteers provide general information, one-on-one assistance and confidential advice. They visit nursing homes, empower residents and resolve disputes regarding specific providers and their policies.
New Hampshire Legal Assistance	(888) 353-9944	New Hampshire Legal Assistance operates the state’s Senior Law Project, which provides advice, self-help resources and comprehensive legal representation to adults aged 60 or older. Attorney and paralegal staff members can assist with Medicaid, Social Security and government benefits as well as taxes, debt collection practices, elder abuse, financial exploitation, housing and health care access among other issues. Services are available to seniors regardless of income or assets.
New Hampshire Endowment for Health	(603) 228-2448	The Endowment for Health sponsors the New Hampshire Alliance for Healthy Aging and several other statewide and interstate programs that are designed to assess and enhance the state’s age-related services. These programs combine the resources of more than 300 stakeholders to make New Hampshire a more age-friendly state. It offers grants, and it works to strengthen home and community-based service networks that give residents an alternative to intermediate and skilled nursing facilities.

Nursing Home Laws and Regulations in New Hampshire

Licensing	Nursing homes and residential care facilities in New Hampshire are licensed and overseen by the Department of Health and Human Services, Health Facility Licensing Unit.
Staffing	Facilities must maintain sufficient staff to meet residents’ needs during all hours of operation. Licensed nursing staff must be on-site 24 hours a day, and an RN must be available for at least eight hours during every 24-hour period.
Staff Training	All personnel, including nurses, clinical staff, administrators and food service employees, must be adequately trained and have demonstrated their ability to perform assigned tasks adequately. Additionally, facilities must conduct annual in-service training to instruct members on the facility’s policies and procedures. Certified nursing assistants in New Hampshire must complete at least 100 hours of training through a state-approved program.
Admission Restrictions	Nursing homes may not admit residents under 18 unless the facility has appropriate age- and gender-segregated accommodations.
Care Planning	At the time of admission, nursing homes must obtain orders for medication, treatment, diet and direct care from a licensed practitioner to ensure the residents’ health and safety. Individuals must undergo a comprehensive medical exam at least once every 30 days for the first 90 days and once every 60 days thereafter. Additionally, facilities must perform an initial needs assessment within 48 hours and a comprehensive needs assessment within 14 days of admission.
Dietary and Nutrition Services	Nursing homes must provide at least three daily meals to each resident, including therapeutic dietary options if ordered by a qualified medical provider. Facilities must have adequate dining facilities and food supplies, and they must follow record-keeping requirements, such as posting menus in advance and documenting residents’ nutritional intake and compliance with special diets.
Specialized Rehabilitative Services	Skilled nursing facilities may provide rehabilitative treatments and therapeutic services as part of a physician-ordered direct-care plan.
Medication and Pharmaceutical Services	Nursing homes must provide all medications, including over-the-counter drugs, as directed by a qualified practitioner. Medications must be provided within 24 hours of the order, and facilities must meet strict standards for dispensing, labeling and tracking residents’ medications.
Recreational Activities	Nursing homes must provide on-site or community-based activities that accommodate residents’ interests and promote their physical, social and emotional well-being.
Infection Control	Nursing homes must establish a comprehensive infection control program that includes provisions to prevent the spread of diseases, manage residents who have contagious illnesses and monitor the health of employees who provide direct care.
Medicaid Coverage	Medical Assistance, the state’s Medicaid program, pays for nursing home care, including room and board. Individuals must meet income and asset limits to qualify, and they must use the majority of their income to pay for nursing home care before benefits become available.