Long-term Care in Grafton County

In the context of an increasingly older population and rising medical costs, especially for the elderly population, New Hampshire policymakers have recently decided to shift the state’s resources for long-term care from institutional providers (e.g., county nursing homes) to home- and community-based care (HCBS). While national studies of HCBS show mixed results in terms of efficiency vis-à-vis institutional care, a dramatically lower per-patient cost, combined with the social benefits of remaining independent and in one’s home and community, makes HCBS attractive to policymakers. This report analyzes case studies from states that have adopted HCBS in the past and examines national studies of HCBS effectiveness to elucidate best practices for making HCBS cost-effective.