HB1179

As an aging state, we must take good care of those individuals who took good care of us. Not supporting this bill will only cost our state in the long run.

I live in Northern New Hampshire and throughout the years I have had many family members not only work at, but also live at St Vincent de Paul Nursing and Rehab Facility in Berlin. I have seen all sides of the Staffing issues. My mother, a retired nurse who worked at St Vincent's for almost 30 years, now resides there. She is 80 and still with it. Between my sister and I, there is someone visiting her at least four times a week. We all consistently see short staffing, if not on the same floor as my mom, on other floors. I understand how budgets affect things, as well as how few applicants there may be to cover these positions. That is where the nursing homes need to be held accountable. They need to pay a living wage so that staff retention happens. Without having specific requirements of resident to staff ratios, many facilities will slide by with as little Staffing as possible. Then resident care suffers. The elderly deserve proper time, attention, and care.

I am a resident of a nursing home in New Hampshire and I feel like I wait for help a lot and often times my LNA will leave the room to get supplies and get pulled in another direction to help another LNA which leaves me waiting longer. There are not enough LNAs assigned to the units for the amount of residents they are responsible for.

Support for HB 1179 An Act Relative to Minimum Staffing Services for Nursing Homes On December 2, 2025, the US Department of Health & Human Services, Centers for Medicare and Medicaid (CMS), repealed Federal regulation that established baseline staffing for RNs, LPNs and certified nurse aides in nursing homes. Previously a nationwide upgrade for nursing home staffing ratios had been in place. This was initiated 2024 to improve infection control in response to the COVID epidemic and establish full-time equivalent staffing requirements for RN, LPN and nurse aide staffing. The quality controls established in 2024 are now cut short as the White House advances an executive order to “unleash prosperity through deregulation.” As a retired RN health care executive with many decades experience in program development and compliance, I appreciate the importance of regulation as an effective tool for quality control. This is especially true for government funded health care. Moreover, now is not the time to promote profit incentives (i.e., “prosperity through deregulation”) for long term care to our most vulnerable patient population. The best way to ensure healthcare quality for government funded programs is to establish measurable Quality Controls by Regulation. Staffing ratios reflecting reasonable staff to patient care plan needs can be an appropriate guideline for regulation. A requirement for 24-hour RN coverage should absolutely be the standard to ensure ready access for assessment concerns as they may arise. Page 2 Support for HB 1179 An Act Relative to Minimum Staffing Services for Nursing Homes The Feds (CMS) dropped the ball on nurse staffing requirements in long term care. The State of New Hampshire now needs to pick-up the ball and carry it for our aged and disabled citizens. HB 1179 provides a much-needed mandate and guidelines for development of well-coordinated, well-qualified staffing in New Hampshire’s nursing homes. Established ratios can be evaluated over time to determine effectiveness and level of coverage needed for ongoing quality assurance. Thank you for your consideration. Respectfully submitted by: Kathleen Scribner, RN, BSN, MPH and Health Care Agent for my brother now living in LTC residence

To whom it may concern, I am writing to urge you to support HB 1179, which establishes mandatory nursing standards for residents in nursing homes. This legislation is critically important to ensure that some of our most vulnerable residents receive care that truly meets their needs. My father currently lives in a nursing home in Carroll County following a debilitating stroke. He is no longer able to speak or walk and is completely dependent on nursing staff for his daily care, comfort, and safety. When nursing homes are understaffed, residents like my father are the most affected because they cannot advocate for themselves or communicate when their needs are not being met. Carroll County is a low-income county, and many residents living in nursing homes rely on Medicaid-funded facilities. These residents and their families depend on the state to ensure that adequate nursing care is available. Without mandatory staffing requirements, shortages in nursing staff disproportionately harm low-income residents who already face limited options for care. Adequate nursing staffing is not optional—it is essential to protect residents’ health, dignity, and quality of life. Mandatory nurse-to-resident standards would help ensure that residents receive timely assistance with basic needs, medical care, hygiene, and safety, regardless of their income or ability to advocate for themselves. HB 1179 is a necessary step to protect nursing home residents across New Hampshire and to support the nurses and caregivers who work hard under challenging conditions. I respectfully urge you to support this bill and help ensure that all nursing home residents receive the care they deserve and that the nursing staff are safely able to provide that care without being understaffed. Thank you for your time and consideration. Sincerely, Marcella Shackford

The expectations of the owners and nursing department is for staff to listen to residents concerns,provide emotional support to residents and families and provide physical care with nursing skills, and to provide activities that enhance emotional wellbeing. In order to accomplish this the number of hours per resident and the number of staff present need to be significant in order to give appropriate care. Anything less puts the patient and staff at risk for unfortunate outcomes. Ann Marie Murphy. Concerned Family member

I visit residents in Long Term Care Facilities in several counties and often the theme residents are about staffing. Residents express their care is often delayed including assistance to use the bathroom, not receiving showers, receiving medications, and medical treatments. Resident added when they ring for assistance staff often saying they would return to their room but often don't. I hope you will take this bill into consideration.

I am in favor of this bill. I am a retired RN who worked in long term care for several years. I see many deficiencies at Mineral Springs especially with low staffing. This is very dangerous healthwise for LNA's and in patients not getting the care they deserve. A dear friend of mine is resident there and I see him often and notice many questionable things along with low staffing.

My husband is a resident of Mineral Springs in North Conway NH. More nurses are needed. The shortage affects the care and concerns of the caregivers and staff! Please consider the health and welfare of the residents who deserve the added number of nursing staff.

My mother lived in a nursing home for 6 months at the end of her life. I visited her at the home every day. Although the staff were caring and hard working I could see the toll it can take on the residents and staff when there are not enough caregivers. I. am writing to urge the State to require that nursing home staffing levels be based on the actual needs of the residents rather than on fixed minimum ratios alone. Residents in nursing homes have widely varying levels of medical complexity, mobility limitations, cognitive impairment, and personal care needs. Facilities that rely solely on minimum staffing requirements often fail to provide adequate care for residents who require extensive assistance. This can result in delayed care, increased falls, preventable injuries, medication errors, declining hygiene, and diminished quality of life. Staffing should be determined by resident acuity, including physical health conditions, dementia or behavioral needs, assistance with activities of daily living, and supervision requirements. Adequate staffing allows caregivers the time necessary to provide safe, dignified, and compassionate care while also reducing burnout and turnover among staff.

My concerns are the following: not enough staff for the dementia floor resident safety not enough supervision facility cleanliness (bathroom) staff and patient relationship On December 28 2025 i went to visit my mom. When I got off the elevator there was no one around, walked toward my 'mom's room and heard someone yelling for help, the 2 aids were in the sunroom at the other end of the hall with most of the residents having lunch, there was on one "on the floor. I quickly ran to find someone to help that person needing help. The second issue, residents in the activity room, wheelchairs, walkers in the way. Someone could fall, again no supervision. This happens a lot. Not enough staff The cleanliness is poor; bathroom is not cleaned every day. Floor is sticky and toilet and sink are not clean. The staff is not familiar with the residents. The D.O.N was rotating staff on different floors, residents" dementia patients need a familiar face. Staff needs to know their residents and build a relationship and trust with them. Dementia patients need consistency. Dementia floor has had a lot of staff turn around; they cannot keep help.

My mother has lived in a nursing home the past year and I witness on a regular basis the toll it can take on the residents and staff when there is not enough caregivers. The staff is burned out and exhausted. The residents do not get the care they need in a timely manner such as when asking to use the bathroom or getting moved into a different position therefore putting the residents at increased risk of infections or pressure sores.

Im so sorry i checked off i oppose the bill in error. I support this bill 100%. My mother has been at St Vincent's for over 2 years now. There have been issues since she got there and they continue to get worse. She recently had a stroke and needs additional care which is impossible because there isn't enough staff. She certainly doesn't feel like this is her home instead she feels like she is bothering the staff because they are running around trying to take care off all the residents. Here are some of the issues we have run into: 1. She needs someone to feed her as swallowing is an issue and she could choke due to Parkinson's. 2. Medication has been missed or given much later than scheduled. 3. She rarely has anything to drink and needs to drink more. 4. She has fallen a few times and has had to stay on the floor as she is unable to scream loud enough for anyone to hear. 5. She needs help getting dressed and undressed. Most times, when I go visit at dinner time, she is still in her PJ's 6. She has gone 2 and 1/2 weeks without a bath. 7. She needs 2 staff members to help her go to the bathroom as she is unable to get out of bed herself. She has had to wait a very long time many times as there isn't enough staff. 8. The follow through on so many things just falls through the cracks. 9. The communication is terrible. The staff cant even keep up with recording things on behalf of the residents. I had received a phone call one morning because her blood pressure was high. When I got there at dinner time and asked how her BP had been all day they didn't know. 9. There is rarely anyone at the nurses stations as there just isn't enough staff. I can go on and on and give specifics if you woukd like. I would like to mention that members of the staff are doing all they can and have been reprimanded in the past and quite frankly I would image they are frustrated as they are running around doing all they can and still it isn't enough. I know things have changed in the past few years but the residents are not feeling like this is their home. They are left feeling like they are a burden. Shame on you for making them feel this way! Thay need to be pampered sometimes. Putting lotion on them, back rubs, helping with make up, curling their hair, painting their nails etc. Not every day but a couple times a week. Something for them to look forward to. Please, please I beg of you to increase the staff to show our loved ones tgat they matter. It shouldnt be this way for the remaining time they have left on earth. Please help our elderly in nursing homes as one day it could be you or your loved ones left to be treated this way. Thank you for listening. I can only hope that I touched your hearts. Sometimes it's not all about the money.

No nurse/resident ratio documented that I could find on the website. There should be at least three preferably, four on the floor and one medication nurse there should be a charge nurse on the third floor and not one that floats throughout the building. staff nurses are floated throughout the facility Dementia patients need continuity of care for safety (several falls on unit) Staff reports to me that most of them were un witnessed. My mom has fractured both hips, her pelvis and she had to go back to the OR to have one of the hips redone one day I went to visit her. Her arms were extremely bruised with skin tears. No one knew what happened so again was it unwitnessed at that time she had a uterine prolapse, which was reduced by one of the staffed is more damage Ukraine individuals. The procedure was documented as it went well.??? Medication’s are not given in timely manner, residence refusing medication, medication errors or they’re not giving them at all. (my mom will not take medication from nurses that she does not know She has advanced dementia and if she doesn’t recognize the staff she out right refuses. Staff on the third floor rarely get their lunch/dinner break. Several residents need to be fed. at least 4 & several need much guidance. The distance from one sunroom to the other is quite far. On several occasions (someone in our family are at the facility daily. We hear and see things that makes the environment unsafe for both the nursing staff and the residence. Rarely do we see mid level administration One member of the staff called mid-level Administration and told them they were drowning on the floor(3). No one came up from Administration to help them. The facility is dirty. I was up there today and my mom‘s bathroom was disgusting. I would be more than happy to meet with any representative Ombudsman Catholic charities, administrator at the facility,& state representatives

I support this bill because it mandates a higher level of medical staff to be on-site at medical facilities such as nursing homes, Long Term Care facilities, and other medical facilities in New Hampshire. Even with the current regulations requiring fewer medical staff the requirements are not being met in many facilities. I am hopeful with the more stringent requirements in HB1179 there will be more medical staff attending the patients/residents in medical facilities. The excuse always given for lack of employees is that there are not enough nurses and LNA's seeking this type of employment but I believe that there are enough but the pay and working conditions need to be addressed.

Having spent a good part of the past 8 years caring for a loved one in a Nursing Home I can say without doubt that the "lack" of help and the non "rule" regarding a ratio is a dangerous and all around careless practice. When I starting going to the Nursing Home 8 years ago the staff on the floor consisted of 4 LNA's and 2 Medcart employees. After COVID hit upon returning to daily visits it became clear that the new NORMAL was 2 LNA's and 1 Medcart employees. We have cut the staffing in half and expect the same level of care. There is just not nearly enough time for the staff to complete adequate care for there very deserving residents. Due to a lack of help our residents are left with less then good care. I have always supported the LNA's because for the most part it is the lack of time and not the lack of effort that prevents good care. We need to hold Nursing Homes to higher standards by requiring better staff ratios. There is no price for providing care for residents that deserve better then what they are getting. Making some rules to the number of staff required would greatly help with the current problems that we are seeing in Nursing Homes.

I support this bill. My husband is living in a nursing home and I see the toll it can take on the residents and staff when there is not enough caregivers. I am at the nursing home 7 days a week/3-4 hours a day and observe a lot. There is not enough staff to get residents up, feed them (most need feeding) 3 times a day, change/toilet them regularly, shower them weekly, pass out meds and get them into bed. Not counting the activities and drinks, snacks during the day. There is always someone on vacation or calling out sick. There is a staff member who goes to work at 5:00 a.m. and doesn't leave till 7:00 p.m. because of shortages and she will not leave a coworker on a shift alone. It's not safe for resident or stafff. This bill should include a higher ratio of staff to residents to keep our elders safe and in good care even with the increase. As it is is a disservice to the elderly, and less fortunate physically and mentally. Thank you for voting for this bill.

I work in long term care facilities as an advocate. I speak with individual residents, , resident councils, family members and staff who report staffing issues. I have received numerous complaints over the years of resident care not being provided as a direct result of low staffing levels.

As a physician in New Hampshire that specializes in the treatment of older adults here in New Hampshire I know how important it is for nursing homes to have adequate staffing. Staffing is the best predictor of quality of care and more staff keep all our older adult loved ones safer. A daily hours per person per day minimum of 4.1 is precisely where it should be to protect New Hampshire residents from harm - pressure ulcers, medication errors, basic hygiene care and abuse and neglect- and especially from nursing home owners whose priority is profit over patients. My analysis of the most recent medicare data demonstrates that 12 out of 12 of the state and county run nursing homes meet this standard, 16 of the 17 Non-profit homes meet this standard and only 7 of the 45 for profit nursing homes meet this standard. Clearly if our state and county homes can do it and our non-profit facilities can do it too, what is stopping the profit based nursing homes? This 4.1 standard is not overly burdensome yet 15 out of 16 of the nursing home owned by the Genesis corporation do not meet this standard, We can do better, this legislation will help us.

Dear Chair and Members of the Committee, My name is Kim Lawrence, and I am writing in support of HB 1179, an act relative to minimum nursing home staffing standards. HB 1179 addresses one of the most urgent and unavoidable issues impacting nursing home residents across New Hampshire: unsafe staffing levels. When nursing homes are understaffed, residents do not receive the timely care they need and deserve. This is not merely an inconvenience — it can lead to serious outcomes including falls, preventable injuries, medication errors, missed hygiene care, dehydration, pressure ulcers, and delayed responses to medical emergencies. This bill establishes clear minimum staffing standards, including the important requirement that nursing homes have a registered nurse (RN) available 24 hours per day. Skilled nursing coverage should not disappear overnight. Residents do not stop needing care at 9 p.m., and families should not have to worry that their loved ones are living without adequate medical oversight simply because it is outside normal business hours. HB 1179 also provides measurable staffing minimums in hours per resident per day for RNs, LPNs, and overall nursing care. These clear standards create accountability. Without defined minimums, staffing becomes a budget decision rather than a care decision — and residents pay the price. I understand concerns about workforce shortages. However, staffing shortages should not be used as justification for operating facilities in conditions that are unsafe for residents or impossible for staff. In fact, establishing staffing standards can help improve retention by reducing burnout, injury risk, and moral distress among caregivers who are routinely asked to do more than is humanly possible. New Hampshire has a responsibility to ensure that nursing home residents — some of our most vulnerable community members — receive dignified, safe, and humane care. HB 1179 is a necessary step toward that goal. For these reasons, I respectfully urge the Committee to vote Ought to Pass on HB 1179. Thank you for your time and consideration. Sincerely, Kim Lawrence Resident of New Hampshire

Residents of nursing homes are vulnerable, physically and/or mentally, and at risk of needing medical care at any hour of the day and night. Requiring that one RN be on site at all times, as this bill does, is the least our state can do to provide for their well-being while in care. It merits unanimous support.

Position recorded without written comment.

Position recorded without written comment.