New Hampshire Long-Term Care Options: A Side-by-Side Guide for Families

The Four Main Settings

When a parent's needs exceed what occasional family help can manage, New Hampshire families typically face four categories of long-term care. Each has a different cost structure, level of supervision, and relationship to Medicaid — and picking the wrong one can lock a family into an arrangement that's either unnecessarily expensive or clinically inadequate.

Home Care

Home care keeps your parent in their own residence while professional caregivers come in for scheduled visits. Services range from companionship and light housekeeping to hands-on personal care with bathing, dressing, and transfers.

Private-duty cost: $35 to $50 per hour in New Hampshire, depending on the region and the level of care. A parent needing 4 hours of daily personal care runs roughly $4,200 to $6,000 per month out of pocket.

Medicaid coverage: The Choices for Independence (CFI) waiver covers comprehensive home care — personal care assistance, homemaker services, PERS devices, home modifications, respite, and adult day services — for residents who meet the nursing facility level of care standard (assistance needed with 2+ ADLs) and who are financially eligible (gross monthly income under $2,982, countable assets under the $8,500 effective categorical limit with New Hampshire's He-W 856.07 resource disregard).

Best for: Parents who are medically stable enough to be safe between caregiver visits, have a home that can be adapted for accessibility, and have either family support or adequate hours authorized under the CFI waiver.

Assisted Living

Assisted living facilities in New Hampshire are licensed under He-P 804 (Assisted Living Residence-Housing) and He-P 805 (Supported Residential Health Care Facility). They provide a private or semi-private room in a residential setting with meals, housekeeping, medication management, and personal care assistance available on-site.

Cost: New Hampshire assisted living averages approximately $5,000 to $7,000 per month for a private room, though memory care units run significantly higher. Unlike home care, this is an all-inclusive rate covering room, board, and basic care services.

Medicaid coverage: New Hampshire Medicaid does not directly cover the room and board component of assisted living. However, residents of qualifying facilities can receive CFI waiver-funded personal care services while living in assisted living — meaning Medicaid pays for the care portion, while the resident pays the room and board out of pocket or through other resources.

Best for: Parents who need a supervised environment with social interaction and on-site staff, but who do not require the intensive medical care of a nursing facility.

Nursing Home (Skilled Nursing Facility)

Nursing homes provide 24-hour skilled nursing care in a licensed facility under He-P 803. This is the highest level of institutional care available outside a hospital, with registered nurses on staff around the clock.

Cost: The statewide average for a semi-private room exceeds $10,000 per month. Private rooms cost more.

Medicaid coverage: Nursing home Medicaid is an open entitlement in New Hampshire — there is no waitlist and no enrollment cap, unlike the CFI waiver. If your parent meets the financial and medical eligibility criteria, Medicaid will cover the full cost of a nursing facility stay. The same income and asset thresholds apply (gross monthly income under $2,982, countable assets under $8,500 categorically), plus the same spousal impoverishment protections. The critical difference: once admitted, the resident's monthly income is applied toward the cost of care, minus a $93 Personal Needs Allowance.

Best for: Parents with complex medical needs requiring 24-hour skilled nursing supervision — advanced dementia with behavioral issues, ventilator dependence, wound care, or post-acute rehabilitation that exceeds what Medicare's short-term home health benefit covers.

Adult Day Health Services

Adult day programs provide structured daytime supervision — typically 6 to 8 hours, Monday through Friday — with meals, social activities, therapeutic services, and personal care assistance. The parent goes home at the end of each day.

Cost: Varies by program and region. Some programs charge $75 to $125 per day for private-pay clients.

Medicaid coverage: Adult day services are covered under both the CFI waiver and the Title XX Social Services Block Grant (SSBG) program. The SSBG income threshold is $1,645 per month per person — lower than CFI, but with no asset test and no medical eligibility requirement.

Best for: Parents who are safe at home overnight but need supervised activity and social engagement during the day, and families where the primary caregiver works during daytime hours.

What New Hampshire Does Not Have

No PACE program. The Program of All-Inclusive Care for the Elderly (PACE) combines medical, social, and long-term care under a single interdisciplinary team. Adjacent states like Massachusetts operate PACE sites, but there is currently no active PACE program in New Hampshire. DHHS is conducting a feasibility study for launching PACE or Dual-Eligible Special Needs Plans (D-SNPs), but there is no operational timeline.

The Decision Framework

The right setting depends on three variables: clinical need, financial eligibility, and family capacity.

If your parent needs help with 2+ ADLs and meets Medicaid financial criteria: The CFI waiver is usually the first option to pursue. Home care preserves independence, costs the state less than institutional care, and the waiver covers a comprehensive service package. The trade-off is the staffing shortage — authorized hours may go unfilled, and the application process takes 45 to 90 days.

If your parent needs 24-hour supervision: A nursing facility may be the only safe option, and nursing home Medicaid has no waitlist. For families trying to avoid institutionalization, the CFI waiver's self-directed care option (hiring a family caregiver through a fiscal management agency) can sometimes bridge the gap — but only if the family has someone willing and able to provide extensive daily care.

If your parent falls between categories: Many families combine settings — adult day services during the week plus home care in the evenings, or assisted living with CFI waiver-funded personal care layered on top. These hybrid arrangements require coordination with the care management agency but can be more sustainable than any single setting alone.

If you're trying to determine which of these options fits your parent's situation — and how to navigate the Medicaid eligibility process for the CFI waiver — the Aging in Place in New Hampshire guide maps the full application workflow from ServiceLink intake through care plan activation, including the financial thresholds, document preparation, and the medical eligibility assessment.

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