New Hampshire Assisted Living
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 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.
The typical resident population in New Hampshire's assisted living communities is 71% female. Overall, 88% of residents are ages 75 and older, with 31% of residents ages 75 to 84 and 57% ages 85 and older.
The New Hampshire Department of Health and Human Services refers to assisted living facilities as “assisted living residences” (ALR) and licenses two categories of them.
Supported Residential Health Care ALRs provide social and health services to three or more residents. The services are provided by trained or licensed personnel. Supported residential health care facilities cannot serve residents who require nursing services that are complex enough to require 24-hour supervision by a nurse. Short-term medical care is permitted for residents who are convalescing from an illness or are capable of self-evacuation.
Resident Care ALRs offer personal and social activities for residents that require very little supervision or health care.
Supported residential health care agreements must list all fees and core services provided by the residence, discharge planning responsibilities, medication management services, information on nursing and other health care services and supplies that are not part of the core services of the residence, the cost of these additional services and how the residence will help provide these services, including transportation.
Residential care residences must provide all of the above information in their agreement and include the acuity level that the facility can accommodate.
Supportive residences can only admit and retain residents who can evacuate the facility in accordance with the state fire code. These facilities may admit or retain residents requiring assistance in transferring or with Stage 3 or 4 pressure sores.
Residential care facilities can admit or retain residents whose needs they can meet. All residents must be able to self-evacuate in case of emergency. Any resident requiring rehabilitative or nursing care exceeding 21 days must be discharged, except those in hospice care.
The core services of supported residences include supervision of residents with cognitive issues, health and safety services, personal care, emergency response and crisis intervention, medication services, social and recreational activities, and assistance in arranging medical or dental appointments. These residences may provide access to nursing services, including supervision and instruction of direct care for residents, rehabilitation, and behavioral health care as needed.
Services included in residential care facilities include the supervision of residents with cognitive issues, arrangement of medical and dental appointments, crisis and emergency intervention, supervision of activities of daily living (ADLs), medication services, arrangement for transient medical care with licensed home health care providers, and assistance accessing community services.
Residents of both categories of ALR must be assessed by a trained assessor at least twice annually and following a change in their condition. If required, a nursing assessment must be completed that addresses medication use, clinical services, pain, vital signs, and the status of the resident's physical, cognitive, mental, and behavioral status.
Residents of both categories of ALR are allowed to contract with home health and hospice services.
Supported residential health care residences must provide three or more meals a day and snacks between meals and before retiring. All staff responsible for food services must know nutritional requirements and plan and prepare prescribed and therapeutic diets.
Residential care facilities must provide three meals per day and daily snacks. Therapeutic diets must be provided to residents who have had such diets prescribed by a licensed practitioner.
Supported residential health care residences must have a full-time administrator who is responsible for daily operations. They must employ direct care staff to provide personal care assistance for residents and a licensed nurse to provide or delegate medication administration, assist with resident assessments, and oversee health services for residents. Certified medication nursing assistants must be employed to administer medications. There are no minimum staff ratio requirements. The administrator determines staff levels based on the size of the residence and the needs of the resident population. One staff member must be awake and on duty at all times.
Residential care residences must employ an administrator who is responsible for daily operations. The facility must hire direct care personnel to provide personal care for the residents and a licensed nurse to administer medications. There are no minimum staff ratios; they must have sufficient staff to provide for the needs of the residents. Facilities with 16 or fewer beds do not require a staff member to be awake at all times if there is a communication system that allows residents to contact and awaken staff members, there is an installed wandering prevention system for residents with dementia if residents require little assistance, or if residents have no acute medical needs.
Private apartments are not required for either category of ALR. Resident units must be single- or double-occupancy and have one toilet, sink, and shower/bathtub for every six residents.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
In New Hampshire, ALFs 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 health care specialists and on-site services, with 63% of communities offering dental care. In addition, 67% of ALFs have hospice services.
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 screenings, and 70% offer mental health counseling. Social work programs are also found in 48% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In New Hampshire, 49% have Alzheimer's disease or another form of dementia. In addition, 51% have high blood pressure, 36% have heart disease, 27% have depression, and 16% have diabetes.
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.
Residents of supported residential health care facilities may self-administer medications if they are capable. Residents can verbally direct personnel to assist in the self-administration process. Facility staff may remind residents to take medications and place medication containers within reach; they may observe, record, and document observed or reported side effects. Staff may not handle the medication. Unlicensed staff may administer oral medications if they have been delegated to do so by a licensed nurse and have successfully completed a four-hour training course. Under a licensed nurse's direction, a licensed nursing assistant may administer medicinal shampoos and baths, glycerin suppositories and enemas, and topical products to intact skin.
Residential care residents may self-administer medications with or without staff supervision or may self-direct medication administration.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in New Hampshire’s assisted living facilities often receive help with their ADLs. In New Hampshire, 21% of residents need help eating. Other commonly used services include bed transfer (26%), toileting (41%), and walking (51%). Caregivers in ALFs help 54% of residents dress, and 65% need help bathing.
The average cost of assisted living care in New Hampshire is $6,053. This is $1,553 higher than the monthly national average of $4,500. The cost of living in New Hampshire is more than the national average by 9.9%, with health care costs more than the national average by 15.8% and housing costs more than the national average by 8.1%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living can be as high as $8,061, as it is in Portsmouth.
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 of assisted living: Maine and Vermont have average costs of $5,865 and $5,250. Massachusetts has a higher monthly average cost of $6,500.
How to Pay for Assisted Living
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.
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.
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.
This guide covers the 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.
The typical resident population in New Hampshire's assisted living communities is 71% female. Overall, 88% of residents are ages 75 and older, with 31% of residents ages 75 to 84 and 57% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The New Hampshire Department of Health and Human Services refers to assisted living facilities as “assisted living residences” (ALR) and licenses two categories of them.
Supported Residential Health Care ALRs provide social and health services to three or more residents. The services are provided by trained or licensed personnel. Supported residential health care facilities cannot serve residents who require nursing services that are complex enough to require 24-hour supervision by a nurse. Short-term medical care is permitted for residents who are convalescing from an illness or are capable of self-evacuation.
Resident Care ALRs offer personal and social activities for residents that require very little supervision or health care.
Resident Agreements and Disclosures
Supported residential health care agreements must list all fees and core services provided by the residence, discharge planning responsibilities, medication management services, information on nursing and other health care services and supplies that are not part of the core services of the residence, the cost of these additional services and how the residence will help provide these services, including transportation.
Residential care residences must provide all of the above information in their agreement and include the acuity level that the facility can accommodate.
Assisted Living Admission and Retention
Supportive residences can only admit and retain residents who can evacuate the facility in accordance with the state fire code. These facilities may admit or retain residents requiring assistance in transferring or with Stage 3 or 4 pressure sores.
Residential care facilities can admit or retain residents whose needs they can meet. All residents must be able to self-evacuate in case of emergency. Any resident requiring rehabilitative or nursing care exceeding 21 days must be discharged, except those in hospice care.
Assisted Living Services and Service Planning
The core services of supported residences include supervision of residents with cognitive issues, health and safety services, personal care, emergency response and crisis intervention, medication services, social and recreational activities, and assistance in arranging medical or dental appointments. These residences may provide access to nursing services, including supervision and instruction of direct care for residents, rehabilitation, and behavioral health care as needed.
Services included in residential care facilities include the supervision of residents with cognitive issues, arrangement of medical and dental appointments, crisis and emergency intervention, supervision of activities of daily living (ADLs), medication services, arrangement for transient medical care with licensed home health care providers, and assistance accessing community services.
Residents of both categories of ALR must be assessed by a trained assessor at least twice annually and following a change in their condition. If required, a nursing assessment must be completed that addresses medication use, clinical services, pain, vital signs, and the status of the resident's physical, cognitive, mental, and behavioral status.
Residents of both categories of ALR are allowed to contract with home health and hospice services.
Assisted Living Food and Dietary Provisions
Supported residential health care residences must provide three or more meals a day and snacks between meals and before retiring. All staff responsible for food services must know nutritional requirements and plan and prepare prescribed and therapeutic diets.
Residential care facilities must provide three meals per day and daily snacks. Therapeutic diets must be provided to residents who have had such diets prescribed by a licensed practitioner.
Assisted Living Staffing Requirements
Supported residential health care residences must have a full-time administrator who is responsible for daily operations. They must employ direct care staff to provide personal care assistance for residents and a licensed nurse to provide or delegate medication administration, assist with resident assessments, and oversee health services for residents. Certified medication nursing assistants must be employed to administer medications. There are no minimum staff ratio requirements. The administrator determines staff levels based on the size of the residence and the needs of the resident population. One staff member must be awake and on duty at all times.
Residential care residences must employ an administrator who is responsible for daily operations. The facility must hire direct care personnel to provide personal care for the residents and a licensed nurse to administer medications. There are no minimum staff ratios; they must have sufficient staff to provide for the needs of the residents. Facilities with 16 or fewer beds do not require a staff member to be awake at all times if there is a communication system that allows residents to contact and awaken staff members, there is an installed wandering prevention system for residents with dementia if residents require little assistance, or if residents have no acute medical needs.
Assisted Living Housing Requirements
Private apartments are not required for either category of ALR. Resident units must be single- or double-occupancy and have one toilet, sink, and shower/bathtub for every six residents.
What Is Included With Assisted Living Care In New Hampshire?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In New Hampshire, ALFs 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 health care specialists and on-site services, with 63% of communities offering dental care. In addition, 67% of ALFs have hospice services.
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 screenings, and 70% offer mental health counseling. Social work programs are also found in 48% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In New Hampshire, 49% have Alzheimer's disease or another form of dementia. In addition, 51% have high blood pressure, 36% have heart disease, 27% have depression, and 16% have diabetes.
Mental Health Resources
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.
Medication Provisions
Residents of supported residential health care facilities may self-administer medications if they are capable. Residents can verbally direct personnel to assist in the self-administration process. Facility staff may remind residents to take medications and place medication containers within reach; they may observe, record, and document observed or reported side effects. Staff may not handle the medication. Unlicensed staff may administer oral medications if they have been delegated to do so by a licensed nurse and have successfully completed a four-hour training course. Under a licensed nurse's direction, a licensed nursing assistant may administer medicinal shampoos and baths, glycerin suppositories and enemas, and topical products to intact skin.
Residential care residents may self-administer medications with or without staff supervision or may self-direct medication administration.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglect of household chores.
Residents in New Hampshire’s assisted living facilities often receive help with their ADLs. In New Hampshire, 21% of residents need help eating. Other commonly used services include bed transfer (26%), toileting (41%), and walking (51%). Caregivers in ALFs help 54% of residents dress, and 65% need help bathing.
Cost Of Assisted Living Care In New Hampshire
The average cost of assisted living care in New Hampshire is $6,053. This is $1,553 higher than the monthly national average of $4,500. The cost of living in New Hampshire is more than the national average by 9.9%, with health care costs more than the national average by 15.8% and housing costs more than the national average by 8.1%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living can be as high as $8,061, as it is in Portsmouth.
How Costs Compare In Nearby States
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 of assisted living: Maine and Vermont have average costs of $5,865 and $5,250. Massachusetts has a higher monthly average cost of $6,500.
How to Pay for Assisted Living
New Hampshire Assisted Living Oversight
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.
Quality and Safety of Assisted Living Facilities in New Hampshire
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.
Legal Resources
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.
