- Associated Press - Saturday, March 18, 2017

CONCORD, N.H. (AP) - Pressed by parents of children with complex medical needs, New Hampshire increased Medicaid reimbursement rates for skilled in-home nurses a year ago. But while some families report improvements, the number of shifts being filled has barely budged.

Roughly 75 children and 50 adults in New Hampshire are approved for so-called private duty nursing paid for by Medicaid, but they often go without because there aren’t enough nurses to do the work. Parents who successfully lobbied for the rate increase last year argued that wages were so low that nurses wouldn’t take the jobs, forcing them to abandon their own careers and compromising their children’s health.

Staffing agency and state officials say increasing payments by up to 46 percent has helped with retention of nurses and continuity in care, though filling night and weekend shifts remains difficult. According to the Department of Health and Human Services, in the first month the new rates took effect - April 2016 - 84 percent of the hours authorized for private duty pediatric nursing were billed. But in the eight months after that, the average was just 60 percent, with a low of 53 percent in November 2016 and a high of 68 percent in August 2016.

Details for the months before the rate increase weren’t available, but agencies told the health department that the percentages were similar to those seen after the change, said department spokesman Jake Leon. He said officials will continue to explore other ways to address the problem.

“The department, nursing agencies and stakeholders understand that while pay increases have helped with retention, increased wages cannot overcome the nationwide shortage of nurses,” he said.

Sandra Poleatweich, chief operations officer at Interim HealthCare, said boosting wages has helped to a degree. But of six families identified as the top priority by the state, the agency was only able to meet the needs of three because the other half required night nursing, she said.

Audrey Gerkin, of Brentwood, one of the moms who led the lobbying effort, said she has been able to fill most of the shifts for her 15-year-old daughter, Lexi, who has epilepsy and a rare genetic disorder that requires a feeding tube. The family cycled through more than a dozen nurses in less than two years, with frequent gaps in coverage.

Some nurses were unqualified - one broke Lexi’s leg while moving her - while others left for higher-paying jobs, Gerkin said. Gerkin herself quit her job as a farmer to care for Lexi but is now working for an organization that helps people with developmental disabilities.

“We’re in a good place right now,” she said. “We have three really great, qualified nurses that are reliable and stable in our home.”

For Philip Barker, a licensed practical nurse at Interim HealthCare, getting a raise allowed him and his wife to save more money and allowed him to go back to school. He has encouraged friends who work in other nursing jobs to consider private duty nursing, and a few have sent in applications, he said.

“One of the big deterrents is that home health nurses do a lot of work for not a lot of pay,” he said.

Heather Donnell, another key player in the effort to increase the rates, said the efforts to repeal the federal Affordable Care Act and change the Medicaid system have her worried about the future. She got involved to fight for her 6-year-old son, Lucas, who has Down syndrome and required a tracheostomy tube to breathe for more than a year.

Shortly after the rate increase, he was able to have the tube removed and no longer required in-home nursing, but Donnell has remained active in the cause and now works for an advocacy group.

“We were really able to shed light on a crisis New Hampshire families were dealing with,” she said. “People are listening now.”

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