Guide to Assisted Living in New Hampshire

There’s a lot to know and learn when choosing an assisted living facility. Use our thorough and highly informative guide to help you make important decisions about your needs, what assisted living facilities in New Hampshire offer and how to decide which one is right for you. After all, the more you know about senior housing NH and assisted living facilities the better off you will be. Read through our Guide below or download the PDF here:



Assisted Living Overview

Senior assisted living facilities are designed to help individuals who need assistance with normal activities of daily living (ADL) in such a way that promotes maximum independence.  Individuals commonly move into assisted living residences following a significant health or memory-related event/concern or for more social interaction, to reduce responsibilities, to increase their safety or security, and/or for activities, including physical fitness.  The following data from the National Center for Assisted Living profiles the target customers:

Residents of nursing assisted living facilities are typically

  • 86.9 years old
  • Moved to assisted living at the age of 84.6 years old
  • Female (74%)
  • Chose a residence within 10 miles of their previous home (62%)

Residents moved from the following previous locations:

  • Private home or apartment (70%)
  • Retirement home/independent living (9%)
  • Skilled Nursing Facility (9%)
  • Family residence (7%)
  • Another assisted living residence or group home (5%)

Residents chose to move into an assisted living residence for the following reasons:

  • Require assistance with medication management (80%)
    – Residents on average take 7.6 prescription medications and 2.3 over-the-counter medications per day
  • Have health conditions
    – 66% Hypertension/High Blood Pressure
    – 42% Arthritis
    – 38% Alzheimer’s/Dementia
    – 33% Coronary Artery Disease
    – 30% Depression
    – 27% Osteoporosis
    – 19% Macular Degeneration/Glaucoma
    – 17% Diabetes
    – 14% Stroke
  • Require assistance with ADL (bathing, eating, dressing)
    – 64% Bathing
    – 39% Dressing
    – 12% Eating
  • Require assistance with Instrumental Activities of Daily Living (IADL)
    – Housework
    – Laundry
    – Meal Preparation
    – Telephone Management
    – Medication Management
    – Transportation

Aging Population

The need for assisted living in NH and senior housing is expected to increase significantly over the next decade and remain in high demand for the next four to five decades due to the aging of the “Baby Boomers”. Based on the 2010 US Census, the population has been growing at a faster rate in the older ages than in the younger ages. Specifically, the population aged 65 years and over, accounting for 13% of the population (40.3 million people), grew at a rate of 15.1 % between 2000 and 2010.  The Baby Boom population which is currently aged 45 to 65 years and represents 26.4% of the population grew at a rate of 31.5%.  Comparatively, the population under age 18 grew at only 2.6% and the population aged 25 to 44 years had a growth rate of        -3.4% (Age and Sex Composition: 2010).

The Centers for Medicare and Medicaid reported that as of January 1, 2011, 10,000 Americans become eligible a day for Medicare, marking the beginning of the Baby Boom generation turning 65 years old.   The median age has increased due to the aging of the Baby Boom population.  Specifically, New Hampshire is currently ranked #4 in the nation with respect to median age (41.1 years).  New Hampshire’s total population is ~1.3 million with 13.5% aged 65 years and over and 30.7% aged 45 to 64 years, indicating the need for assisted living residences will continue for several decades (Age and Sex Composition: 2010).

Growing Need

According to a 2007 report published by the U.S. Department of Health and Human Services, there were ~38,000 assisted living residences in the United States (Assisted Living Facility Profile – National Center for Assisted Living).   A March 2011 report from the National Center for Assisted Living reported that there were roughly one million Americans residing in assisted living facilities, including 131,000 receiving assistance through Medicaid (Assisted Living State Regulatory Review 2011).  With the population over age 65 years at 40.3 million, there will be a significant need for additional assisted living facilities within the next few years.

Service Providers

Assisted living facilities are owned and operated by individuals as well as larger corporations, range significantly in the number of residents, and are housed in homes to larger dedicated facilities.  All facilities are licensed by the applicable state’s Department of Health and Human Services.  Licensing requirements vary by state but typically address both clinical and facility requirements.  Facilities are typically subject to initial as well as annual licensing requirements and are subject to unannounced inspections to ensure the safety and security of residents as well as continual compliance with regulatory requirements.  In New Hampshire, the Department of Health and Human Services does require initial and annual licensing, which require on-site inspection, as well as performs unannounced inspections.

How To Choose The Right Assisted Living Facility For You Or Your Loved One.

There are many factors to consider when choosing an assisted living New Hampshire residence. The right choice is the one that is the best fit for what is important to you or your loved one for your next home. This guide is not intended to direct you to any specific senior housing NH facility but rather to assist you in asking relevant personal and facility questions to best narrow down that choice to the one that will best meet your needs or those of your loved one.

Personal Questions

It is often most helpful to clearly define why you or your loved one is considering moving into an assisted living residence as this will guide the questions that are most important to ask of the specific facilities you tour.

Why are you considering an assisted living residence at this time?  Or in the future?

  • Health needs?
  • Medication management concerns?
  • Assistance with activities of daily living (eating, bathing, dressing)?
  • Assistance with instrumental activities of daily living (housework, laundry, cooking, transportation, etc.)?
  • Lack of socialization?
  • Depression?
  • Fall risk?

What factors are important to you about the type of residence you choose?

  • Type of setting?  Small, large, home-like, larger setting with extensive amenities?
  • Private or shared bedroom? Private or shared bathroom?  Dedicated apartment?
  • Ability to provide required services?
  • Availability of nursing staff?  Number of staff per resident?
  • Type of amenities and activities provided?  Frequency of activities?
  • Proximity to loved ones?
  • Proximity to medical care providers?
  • Cost? Pricing model (all inclusive or fee-based for specific services)?
  • Transparency of pricing and costs?
  • Availability of transportation?  Ability to keep a personal vehicle on site?
  • Ability to keep a pet?
  • Other factors?

Facility Questions

  • Is the facility currently accepting residents?  Is there a wait list and if so, what is the process of notification?
  • How many residents?
  • Does the residence offer apartments and/or private or shared rooms?  Are bathrooms private or shared?
  • What is the policy for assigning roommates if a shared room?
  • Under what circumstances is a resident asked to change rooms?
  • Are rooms furnished or unfurnished?
  • Are linens provided?
  • What is the composition of staffing and the staffing ratio?  Day/night?
  • How many staff in total work at the facility?  Will the resident see the same staff routinely?  What is the typical staff turnover at the facility?
  • Is nursing staff on site?  How many hours per day?  On call?  How many hours per day?
  • Is staff available to assist with medication administration?  How many hours per day?
  • What services are provided?  (see Financial Questions below as well)
  • Are there additional services that are provided at additional cost? (see Financial Questions below as well)
  • What amenities are available/provided?  Are any at additional cost? (see Financial Questions below as well)
  • What types of activities are provided?  Frequency of activities?  Additional cost?
  • Are transportation services available for medical and dental appointments?  Additional cost?
  • Are staff-attended medical appointment services available?  Additional cost?
  • Are laundry services provided?  Additional cost?  May residents do their own laundry?
  • Is cable television, phone and Internet service provided/available?  Additional cost?
  • How many meals are provided daily?  Is the menu posted in advance and are more than one option available per meal?  Are there special dietary staff?  Can special dietary requirements be met?  Are snacks available and if so, how many/how often?
  • Are family and guests allowed to eat at the residence?  Additional cost?
  • Is there a hydration program?  Additional cost?
  • Is there a private dining room for private family functions?  How is it reserved?  Additional cost?  Can a special menu be requested for functions?
  • Are pets allowed?  Are there any restrictions?  Additional cost?
  • How often are housekeeping services provided?
  • What is the smoking policy?
  • What outdoor space is available?  Are there any outdoor amenities (gardens, walking paths, etc.)?
  • Is storage available on site?  Are there any restrictions?  Additional cost?
  • Is there parking for resident vehicles?  Any restrictions?  Additional cost?
  • Is there sufficient parking for family and guests?
  • Are family and guests allowed?  Are there specific visiting hours?  Is there a Guest Policy?
  • Are residents required to have renters insurance?
  • Are third party service providers allowed on site (i.e. physical therapy, podiatry, social workers, etc.)?  Is there proof of their licensure?  How are services billed?
  • Is there an on-site salon?  Additional cost?  How are services billed?
  • Will the facility hold a resident’s room in the event of hospitalization or other therapeutic care outside of the facility?  For how long?  Are there any restrictions?
  • What is the facility’s medical emergency plan?
  • How close are emergency services?  Medical care?  Hospital?
  • Does the facility have a generator?
  • What is the emergency back-up plan?
  • Do residents participate in routine fire drills?  What is the fire evacuation plan?
  • Does the facility offer any religious services?
  • What are the Rules of the Residence?
  • What are the Residents’ Rights and Responsibilities?
  • Has the facility ever been reported for any of the following:
    – Resident abuse
    – Fire or safety code violations
  • Who owns the facility?
  • Does the facility have any cultural or religious affiliations?
  • What are the grounds for voluntary and involuntary termination of residency?
  • Overall, what is the condition and appearance of the facility?
  • Overall, do the residents appear well groomed, well cared for and involved in activities?

Medical Questions

  • What is the licensure level of the facility?  Note: This pertains mostly to whether there are RNs on site.
  • Are there any medical restrictions that affect whether the facility is appropriate for the level of care required and/or that would be grounds for termination of residency?  Note: This can include such issues as incontinence, swallowing protocols, insulin-dependent diabetics, etc. as not all facilities are staffed and/or equipped to accept residents with these requirements.
  • Can the residence meets all of your care needs, 24/7, based on the above?
  • How are applicant care needs assessed for residency?
  • How often are care needs reviewed?
  • Does the residence develop individual nursing care plans?  If so, how often are they reviewed?
  • Does the facility offer case management?
  • Does the facility allow on-site hospice care?
  • Does the facility require/request Advance Directives, a Living Will and/or Durable Power of Healthcare Attorney?

Financial Questions

  • Does the facility require financial information to be provided as part of its application process?
  • How is the pricing structured?
  • What is included in the basic rate?  What is not included and subject to additional cost?  Note: Specifically inquire about supplies, laundry, transportation, housekeeping, community fees and activity fees, as these can often be at additional cost and not clearly identified.
  • How often are fees increased?  How far in advance and how are rate increases communicated to a resident?
  • Does the facility accept third party payment (i.e. Medicaid) both upon residency and/or if a resident is no longer able to pay privately after admission?

Final Thoughts

Above all, an assisted living residence is a home. When touring, pay attention to the feeling you get and what you observe. Does it feel like a place where you would feel at home? Does it feel like a place for mom? How did the staff interact with you and your family members during the tour? Did you feel welcomed and treated as a person? Was management present and involved? Did the residents appear happy, cared for and engaged in activities and did they speak positively of the residence? Despite the long list of questions presented in this guide, our hope is that these last questions above will be the critical ones that help you best make a decision about where your or your loved one’s next home should be.