At a time when county-owned nursing homes across the country are struggling financially, one county-run LeadingAge member in New Hampshire is bucking that trend and expanding services. Through a state grant won by Rockingham County, funded under the American Rescue Plan Act of 2021, Rockingham County Rehabilitation and Nursing Center in Brentwood, NH, is helping older adults—some living in rural areas with transportation challenges—get financial and transportation help to enroll in adult day centers.

The innovative Rockingham Community Care Program, launched in early 2024, recruits dually eligible Rockingham County residents aged 65 and above with the goal of helping them continue living safely at home—delaying or even avoiding the need for institutional care.

Rockingham County and the New Hampshire Department of Health & Human Services (DHHS) see greater use of home and community-based services as a way to improve outcomes for residents while saving funds that would otherwise be needed for institutional care. “All of the counties in New Hampshire have their own nursing homes, supported by taxpayer dollars,” explains Jeseca Wendel, public relations & community outreach manager for the Rockingham County Rehabilitation and Nursing Center. “By enrolling people in adult day programs, we can actually defer them from having to come into a nursing home.” Another goal, she says, is to drive more business to the adult day centers: “It’s a model that we’re seeing diminished throughout the state, and to keep those programs going is an added benefit.”

Program managers identify adult day programs for participants, paying their fees and arranging transportation if necessary. Once enrolled, the older adults can enjoy recreation therapy, assistance with activities of daily living, meals, personal care such as haircuts and nail trims, and more.

A $578,000 grant to the county covers operating costs. Remunerations, according to Wendel, have not been interrupted by the Trump administration’s review of federal programs.

Meeting the first participants (18 as of the end of January), says Christine Bobek, one of several rehab and nursing center staff at Rockingham County Rehabilitation and Nursing Center who are implementing the program, has been eye-opening.

“For maybe half of these folks, it’s not the adult children who are doing all the care, it’s the spouse,” Bobek says. “They are barely holding it together, and they’re amazing. There is an 89-year-old man being transported [to the day center] by his 87-year-old wife, and she told me, ‘I can’t drive in the snow and ice.’ So that means he would [have to] stay home if it weren’t for the transportation we provide.”

To meet the needs of all enrollees, Bobek is creating partnerships with adult day programs around the county. The first 18 participants attend Silverthorne Adult Medical Day Center in Salem. A similar partnership is being forged with Easterseals NH Adult Day Manchester, a large day program with room for more participants and empty slots to fill. Bobek will then expand her outreach to more adult day programs.

The collaborations help solve some common barriers to attendance. Transportation, Bobek has learned, is the major obstacle for many. Silverthorne has a bus, but no funds for a driver; Rockingham County Center has funds, but no bus. “We have a subcontract where we pay for the driver using grant funds, and we’re reimbursing them for mileage,” says Wendel.

Comments from family caregivers about the program’s impact, says Bobek, are moving:

• “On the days my wife goes to [the adult day], I notice a big difference in her mood and affect … I am doing all the care and some days I don’t know how much longer I can do this. It’s a Godsend to have someone pick her up and bring her home. I now can take care of myself, get to my own doctor appointments, and just get some rest.”
• “She’s so much better when she goes to the adult day program. There she has activities and interactions with a lot of others. The stimulation really helps.”
• “The transportation has been really helpful. Before it started, I had to take a lot more time off work, bringing her in the mornings and getting her home in the afternoons. If she wasn’t at Silverthorne, we would have to look into long-term care. She’s happy when she goes there and for me it has been a lifesaver. I can focus on my own health as a caregiver.”

Wendel is actively exploring options to continue the initiative, scheduled to end at the end of 2025 (after a six-month extension). If federal funding ends, she says, Rockingham County would continue to appropriate a budget line to help support county residents in attending adult day programs, although the funds available would likely not be as great as the state grant.

She also notes that DHHS wants to do a needs-based study on home and community-based services, and data from the Community Care program can help to prove the efficacy of HCBS.

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