County nursing homes plan major projects, propelled by federal funds

Aug. 19—The Sullivan County nursing home is set to receive $2 million in federal funds toward an anticipated renovation that will apply lessons learned during the COVID pandemic, as county nursing homes around the state are still reeling from the pandemic and workforce crisis and preparing for the future of long-term care.

Long-term care facilities were in many ways the epicenters of COVID-19, and the pandemic directed more attention and funding to long-term care. Federal dollars from the American Rescue Plan Act have catalyzed other projects in some of New Hampshire's county nursing homes, including a $10 million project to replace the HVAC system in the Hillsborough County nursing home, which will bring central air conditioning to the more than 250 residents there.

The federal government funding bill, passed in March 2022, included hundreds of "congressionally-directed spending requests," or earmarks for specific projects including some for nursing homes. The $2 million grant from the U.S. Department of Health and Human Services, announced by Sen. Jeanne Shaheen's office Thursday, is one added to the bill by New Hampshire's congressional delegation.

Parts of the campus of Sullivan County Health Care, the county nursing home located in Unity, are close to 100 years old. The plumbing leaks, the air-conditioning units are old and some are barely functional. The rooms are small, and can feel restrictive.

"There are a lot of structural problems with the current building," said Sullivan County Health Care Administrator Lewis Thibodeau Jr. "We have a lot of things that are inhibiting quality-of-life for our residents."

The renovation will keep the nursing home's current capacity of 156 beds, but Thibodeau hoped the renovation would make the spaces more comfortable.

The $2 million earmark is significant but just one piece of the funding puzzle for Sullivan County, Thibodeau said. The county delegation is set to vote Wednesday on a bond that would be the biggest piece of funding for the project.

COVID lessons

The pandemic underlined the importance of single rooms and private bathrooms, but those amenities will continue to be important. Nursing home and county leaders say they expect private rooms and a less-institutional, more home-like feel will be important to the future of long-term care.

Even during the worst of COVID-19, residents of many county nursing homes shared bedrooms and bathrooms.

Single rooms and a more up-to-date building and ventilation systems helped Carroll County's Mountain View Community manage the virus, said administrator Dee Brown.

Mountain View was rebuilt in the early 2010s, where some other county nursing homes are 50 years old or more.

Less COVID transmission has helped Mountain View maintain more staff and residents, though she said maintaining enough staff is a challenge.

Beyond controlling the spread of illnesses, Brown said private rooms afford seniors and their families a little more dignity with privacy — particularly important for end-of-life care.

"If they can have single rooms, for every reason it makes sense," Brown said. "It's just been something that has been extremely beneficial to the staff and residents."

Brown said she hoped more nursing homes would be able to capitalize on this post-pandemic moment — and the sudden availability of federal funding — to make lasting changes.

The coming 'tsunami'

Strafford County is also preparing for a major renovation of the county nursing home, but County Commissioner George Maglaris said the vision for a new-and-improved county home doesn't end with single rooms.

"I want to build a facility that people don't mind going to, instead of being forced to go to," he said.

Maglaris is advocating for a new nursing home specialized for dementia care, with public spaces mimicking a town Main Street instead of a warren of cafeteria and community rooms. He hopes for space to house resources that will help seniors age in place like a telehealth hub and a home health aide office, plus senior center-like social activities for seniors and their families.

He hopes to see the existing Riverside Rest Home building repurposed into supportive and transitional housing for people experiencing homelessness and housing insecurity, and working with the city governments in Dover, Rochester and Somersworth to change zoning codes to encourage workforce housing that will be attainable for people working in the county nursing home and supportive housing facilities.

New Hampshire's aging population is projected to grow rapidly in the next 20 years, Maglaris said, and the coming "silver tsunami" will mean nursing homes and other caregiving for older people will have to change. Strafford County now has about 7,000 residents over 65, but in the 2040s, he said the over-65 population in the county is projected to be more like 40,000.

Single rooms and updated facilities are a start, he said, but they won't be enough.

"If it's business as usual, you're going to need 4,000 nursing home beds and that's just unsustainable," Maglaris said. "We have to change the way we're doing business."