AN ACT relative to long-term care.

SPONSORS: Rep. Donovan, Sull 4; Rep. Pilliod, Belk 5; Rep. Emerton, Hills 7; Rep. Gagnon, Sull 4; Sen. Downing, Dist 22; Sen. Hassan, Dist 23; Sen. Gallus, Dist 1; Sen. Gatsas, Dist 16

COMMITTEE: Health, Human Services and Elderly Affairs


This bill establishes guidelines and standards for the New Hampshire long-term care policy. This bill also establishes the New Hampshire long-term care commission to assess and oversee the long-term care system in New Hampshire.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.




In the Year of Our Lord Two Thousand Nine

AN ACT relative to long-term care.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Statement of Policy on Long-Term Care.

I. The general court finds and declares that the intent for the New Hampshire long-term care system is that:

(a) A dynamic and enduring continuum of long-term care services and supports exist in order that all New Hampshire citizens may live within their community and age with respect, dignity, choice, and control throughout their lives.

(b) Each citizen has the opportunity to make informed decisions about his or her own health, care, and aging needs.

(c) There is quality and accountability in services and supports that are offered and provided.

II. It is the intent of the general court that long-term care system policies reflect the goal that New Hampshire strives to be an extended community of people who care about, value, and help one another.

III. The general court further recognizes that it is time for state leaders to evaluate and build the long-term care system capacity and infrastructure for the needs of the citizens of New Hampshire today and in the future.

2 New Chapter; Long-Term Care Guidelines; Commission Established. Amend RSA by inserting after chapter 151-G the following new chapter:



151-H:1 Long-Term Care System Design Standards.

I. The long-term care system shall support the informed choices of individuals.

II. All individuals shall be treated equally, regardless of age, ability, or needs, to engender and perpetuate dignity and respect for all, as well as to recognize that each individual is a valuable and contributing member of the community.

III. To the maximum extent possible, the long-term care system shall strive to afford each individual choice, independence, control, flexibility, and timely access to a full array of services and supports, regardless of age, abilities, needs, or payor source, as well as services and supports that are self-determined, individualized, and that complement the existing supports of the individual.

IV. Capacity of caregivers, paid and unpaid, shall be sufficient in number and these caregivers shall be trained, valued, and compensated, as appropriate.

V. Long-term care system access and transitions shall be simple, convenient, and seamless, such that the entry into all sectors shall be integrated, regardless of payor or type of long-term care provider.

VI. Long-term care system services and supports shall enable individuals to remain connected with their community.

VII. The long-term care system shall be dynamic and responsive to changes that occur over time in the community and in the needs of community members.

VIII. The long-term care system shall promote wellness and take into consideration the needs of the whole person.

IX. The long-term care system shall include a comprehensive quality assurance mechanism across the entire continuum of services, supports, and settings. Such mechanism shall:

(a) Include a focus on consumer perceptions of quality and processes, so as to ensure ongoing feedback from individuals and their families; and

(b) Enable timely identification and resolution of issues and improvement of the overall quality of the system.

151-H:2 Long-Term Care Commission Established.

I. There shall be a New Hampshire long-term care commission to respond, in an ongoing manner, to the increased demand for long-term care brought about by the aging of the state population and the long-term care workforce shortage. The commission shall consist of the following members:

(a) Two members of the house of representatives, one of whom shall be from the health, human services and elderly affairs committee and one of whom shall be from the joint legislative committee on elderly affairs, appointed by the speaker of the house of representatives.

(b) One member of the senate who shall be from the health and human services committee, appointed by the president of the senate.

(c) The commissioner of the department of health and human services, or designee.

(d) Two representatives of the New Hampshire Association of Counties, one of whom shall be an elected official, or designee, and one of whom shall be a county nursing home representative, both appointed by the association.

(e) A licensed physician, nurse, or nurse practitioner who specializes in the field of gerontology, appointed by the governor.

(f) Three consumers, as defined in paragraph II, representing 3 different regions of the state, appointed by the governor.

(g) Three consumer long-term care advocates, nominated by 2 or more organizations; provided that no more than 2 advocates shall represent one organization, appointed by the governor.

(h) Four representatives of long-term care provider entities, such as, residential care, home or community-based care, and non-medical social services entities, nominated by their respective trade association, appointed by the governor.

(i) Two representatives from institutions of higher education in the state who have experience in long-term care policy, nominated by their institutions, appointed by the governor.

(j) One direct care worker who has at least 2 years experience in long-term care and is nominated by an employer or a consumer, appointed by the governor.

II. For the purposes of this section:

(a) “Consumer” means an individual who:

(1) Is:

(a) An individual who has received long-term care services; or

(b) An adult who has provided or directed long-term care for a family member;

(2) Holds, or whose immediate family member holds, no ownership or investment interest in a long-term care provider entity in New Hampshire; and

(3) Is not an employee of or under contract with a long-term care service provider.

(b) “Immediate family member” means the spouse; civil union partner; birth or adoptive parent; stepparent; child or stepchild; sibling, stepbrother or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; spouse of a grandparent or grandchild; or any person involved in an intimate relationship and residing in the same household.

III. The members of the commission shall as much as possible represent a geographically diverse membership, to maximize representation of the various regions of the state.

IV. Each member shall serve for a term of 3 years, except the terms of the members appointed under subparagraphs I(a)-(c) shall be coterminous with their terms in office.

V. Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission. The commission shall meet at least 4 times a year. All meetings shall be at the call of the chair. At the first meeting each year, the commission shall elect from its membership a chair and vice-chair. The commission shall establish a procedure to govern its deliberations. Ten members of the commission shall constitute a quorum.

151-H:3 Long-Term Care Commission; Duties; Report.

I. The commission shall:

(a) Assess the current status of the adequacy and delivery of long-term care services.

(b) Collect current and long-range data on long-term care and the long-term care population of the state.

(c) Evaluate state expenditures for long-term care, considering efficiency, consumer choice, competition, and equal access to providers.

(d) Identify, evaluate, and make recommendations relative to gerontological, mental health, and developmental services issues in long-term care.

(e) Recommend the long-term goals for the state for providing a continuum of long-term care for older adults based on the standards in RSA 151-H:1.

(f) Evaluate and recommend financing mechanisms for long-term care.

(g) Evaluate and make recommendations relative to legislation, administrative rules, and policies on long-term care.

(h) Coordinate the commission’s activities with other activities related to long-term care services and supports, as appropriate.

(i) Recommend policies that support the participation of families and volunteers in meeting long-term care needs.

(j) Recommend goals for providing guardianship services and other representation for adults who require such assistance.

(k) Carry out other activities the commission considers necessary to perform its mandate.

II.(a) The commission may hold public hearings across the state to solicit public input with respect to long-term care in the state.

(b) The commission may appoint subcommittees to assist with its work and shall prescribe the duties of the subcommittees. A subcommittee may include non-commission members and shall include at least one commission member.

III. The commission shall annually report its findings and any recommendations to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, the commissioner of health and human services, and the state library on or before November 1 of each year.

3 Applicability.

I. Initial appointments to the commission under RSA 151-H:2, I(d)-(j) shall be staggered terms of one, 2, and 3 years.

II. The initial meeting of the commission established in section 2 of this act shall be no later than September 1, 2009 and at the call of the first-named house member.

4 Effective Date. This act shall take effect upon its passage.