The Rev. Dan Osgood was serving as chaplain at the Crotched Mountain Rehabilitation Center in Greenfield several years ago when a client there, also a member of his Greenfield church, wound up homeless.
Osgood said he didn’t know until then that Hundred Nights’ emergency shelter in Keene — where the man stayed that winter — is open to guests only at night. It made an impression.
With financial help from a family at Greenfield Congregational Covenant Church, Osgood helped turn space at the church’s ministry center — where it organizes social-service activities — into a single-unit apartment for people in housing emergencies. Many people have stayed there over the years, he said, often for three to four months at a time while they look for a more stable place to live.
“It seems to me, as a Christian faith community, that’s just some of the things we’re called to do,” he said. “Jesus is pretty clear: Feed the hungry, clothe the naked, give shelter to those who need shelter, and so on.”
Osgood’s congregation is one of many faith groups in the Monadnock Region taking action, in ways large and small, to reduce housing insecurity.
To bolster those efforts, the Greenfield church has joined the Eastern Monadnock Housing Security Coalition, a recently formed entity comprising public officials, social-service providers and religious groups. The coalition encourages local congregations to provide emergency shelter, pairing them with housing case managers who can then help people find a permanent place to live, Osgood said.
Another umbrella organization, the Monadnock Interfaith Project (MIP), has taken on a broad mission to make housing in the region more affordable.
MIP, which is made up of faith leaders and people from a wide range of religious beliefs, was established in 2016 to play an active role in community issues, according to Tom Julius, a Gilsum resident who serves as the group’s chairman.
For its first advocacy campaign, Julius said, the nonprofit pushed Keene officials to add public restrooms downtown. A proposal to reopen the transportation hub bathrooms on Gilbo Avenue, which have been closed for 10 years, is now in the city’s Capital Improvement Program.
Julius, a member of the Keene Unitarian Universalist Church on Washington Street, said MIP members have heard about housing insecurity from others in their congregations as well as people getting help from local shelters and food pantries. Faith-based organizing, he said, “doesn’t start with a point of view or a political agenda.
“It starts with listening to people in the local community about what are their concerns,” he said. “… There is this tier of people who maybe have housing right now but are just one paycheck or one car accident away from not being able to pay rent.”
The median monthly rent for a two-bedroom apartment in New Hampshire, including utilities, has risen by more than $400 over the past decade, to $1,500, according to the independent state agency N.H. Housing. Meanwhile, the rental vacancy rate has dropped to 0.9 percent — much lower than the 4 percent to 5 percent rate experts consider healthy.
For MIP, housing insecurity “seemed like an area that we could contribute to,” Julius said.
The group showed its commitment to that cause late last year, when it hired Angela Pape, a veteran faith-based community organizer, to a part-time role leading its push for greater housing affordability. Pape, of Peterborough, said that issue is critical because while other organizations, such as Hundred Nights, help people experiencing homelessness, very few address the root causes of the problem.
“We try to look at the larger systems and say, ‘Can our community be better?’ ” she said.
From speaking with housing experts and reviewing research on the topic, Pape said it became clear to MIP there is a substantial lack of affordable units in the region — noting that people spend years waiting to qualify for a subsidized apartment through Keene Housing.
The group has recently been discussing one possible solution: help create an affordable housing trust fund that would back the construction and rehabilitation of low-cost units, she said. With federal money coming into the state from a pandemic-relief bill Congress passed earlier this year, Pape said MIP hopes to convince local officials to put some of those resources toward a new housing trust fund.
“Public monies need to be spent on the common good,” she said. “Housing is a huge need for people, and it’s really foundational for a strong economic climate, for stable communities, for families.”
The idea would be to keep replenishing those funds to establish a sustainable resource that can drive residential development, Pape said. MIP members are scheduled to discuss the proposal with Cheshire County commissioners next month.
MIP has taken up other efforts, too, with volunteers canvassing area communities to tell residents about available sources of rent assistance, Julius said. Housing affordability won’t be achieved with a single policy, he said, but the interfaith group wants to chip away at the problem.
“We know that there’s no silver bullet,” he said. “… We’re looking around to see what’s something that could happen now that could help.”
A similar campaign for more affordable housing is underway across the river, with Vermont Interfaith Action (VIA), a coalition of faith groups across the state, leading that push.
Those efforts are needed because new development has not risen to meet demand, according to Rev. Scott Couper of Centre Congregational Church in Brattleboro.
Couper, whose congregation is part of VIA, said he lived on Main Street after arriving in July 2018 and saw firsthand that homelessness is a real problem in town. As a faith leader, he said he feels responsible for getting involved in community work, even as nonprofits have largely taken over from religious groups as the primary social-service providers.
“I’m really sort of dedicated to beyond the walls, in addition to within the walls,” he said.
VIA, which also includes St. Michael’s Episcopal Church in Brattleboro, has in the past couple years lobbied state lawmakers to fund new affordable housing and to extend a pandemic-era initiative in Vermont that offered motel rooms to unhoused people, Couper said.
“I was very, very attracted to VIA because it’s politically savvy,” he said. “They know what they’re doing.”
Getting involved in the community means sometimes dealing with unsavory situations, according to Osgood, who said people living at Greenfield Congregational Covenant Church’s apartment unit aren’t allowed alcohol, drugs or unapproved guests. But those challenges come with the territory, he said.
“If a church is going to do ministry, it’s going to deal with some messy stuff,” he said. “And if you don’t want to deal with that, then meet for an hour on Sunday morning.”
For Laura Tobin, a Keene resident who had to leave her old apartment last summer when her monthly rent rose by $400, that experience inspired her to help others dealing with housing insecurity. A member of Elm City Church on Railroad Street who’s gotten involved with MIP, Tobin said because of her faith, she feels it’s important to make sure everyone has access to basic resources, including housing.
“I don’t feel like that should be a big ask,” she said.
This article has been changed to correct that Crotched Mountain Rehabilitation Center was in Greenfield.
New Hampshire’s new voucher-like program for students, the Education Freedom Accounts, is shaping up to take center stage in education policy debates again in 2022.
Education Freedom Accounts give taxpayer dollars to low and moderate-income families to pay for private school or other non-public school expenses. About 1,600 students enrolled in the program this school year, 70 percent of whom had not been attending public school in the last two years.
The state expects to spend more than $8 million on the program this year, about one percent of what it spends on education in total.
New Hampshire’s Education Freedom Accounts program is one of the most expansive of its kind in the country. Republicans have hailed it as a win for families dissatisfied with their public schools, and it’s garnered support from national conservative foundations and lobbyists. Proponents say the high interest this year is a reason to expand it in 2022.
One bill, HB 1298, would raise income eligibility to 500 percent of the federal income guidelines (when originally introduced last year, the program had no income threshold).
The Education Freedom Account is currently paid for by New Hampshire’s Education Trust Fund, originally established to fund public schools with revenue from taxes on individuals and businesses. When families enroll in the Education Freedom Account program, they receive the state “adequacy aid” that would have gone to a public school district to help cover the cost of educating their child. This averages about $4,600.
But another Republican-sponsored bill, HB 607, would tap into local funds to expand Education Freedom Accounts. Under the proposal, residents could vote for their school district to set up a version of education freedom accounts, paid for by locally raised taxes that currently fund the public school.
HB 607 would dramatically increase the amount of money available to freedom account participants. That’s because local taxpayers spend far more than the state on public schools. So instead of receiving about $4,600 in state aid, participants would get an estimated $5,000 to $20,000 in their accounts, paid for by local taxpayers.
As Republican lawmakers seek to grow Education Freedom Accounts, Democratic lawmakers have introduced over 15 bills to clarify, limit or repeal them. These come amidst criticism from public school advocates and Democrats that the program lacks sufficient oversight and is siphoning money away from traditional public schools.
One bill, HB 1135, would require an audit of the program by the legislative budget assistant, including public reporting of student outcomes and expenditures. Another, HB 1120, increases oversight and restrictions on the kinds of education service providers eligible for payment through the Education Freedom Accounts.
Under the current law, if a family’s income surpasses the threshold they had to meet to first enroll, they can continue participating in the program. The logic, supporters say, is to give students continuity in their education even if family income grows.
But critics say it could leave the state on the hook for funding higher-income families’ private school tuition and other expenses. SB 237 cuts this clause allowing families to continue participating in the program even when their income increases.
Lawmakers will begin to debate some of these bills in early January.
SPRINGFIELD, Vt. — Dr. Marvin Malek, a hospitalist at Springfield Hospital, tries not to smile.
“Usually I try to put patients at ease by saying something funny,” he said in a recent interview. “Now I have to make sure I don’t laugh.”
He tries to keep a flat expression so as not to disturb the fit of his N95 mask, which filters most, but not all, airborne particles. Protecting himself from COVID-19 is one of the many things on Malek’s mind as the 69-year-old physician cares for patients amid the largest surge of COVID-19 the Upper Valley has seen since the pandemic began two years ago.
Health officials in both Vermont and New Hampshire expect that cases and hospitalizations are likely to increase even more in the coming weeks following holiday gatherings and due to the increasing presence of omicron, a more infectious variant of the virus that causes COVID-19. Deaths also continue to mount, with the highest rate of death among those who are not vaccinated. Last week, New Hampshire announced its first pediatric death due to COVID-19.
The ongoing COVID-19 pandemic, and the associated worsening of a shortage of health care workers and critical care beds is placing additional demands on health care workers in the Upper Valley at a time when they are already worn out from having worked and lived in a pandemic for nearly two years.
“It is really tough, definitely,” Trevor Swan, nursing director of the emergency department at New London Hospital, said in a recent phone interview.
The job of managing nursing staff in the emergency department of the 25-bed critical access hospital has become 24/7, he said.
“It’s nothing for me to get phone calls at midnight; 1 a.m.,” he said.
Amid the surge, which is currently affecting much of the U.S., President Joe Biden last week announced he would be sending medical personal and FEMA teams to areas hard hit by the winter surge, including Vermont and New Hampshire, with the aim of expanding hospital bed capacity.
One such team is on site at Springfield Hospital helping with pediatric vaccination clinics and preparing to open a new COVID-19 treatment clinic, the hospital announced last week. The team is slated to stay through Jan. 15.
New Hampshire also has activated the National Guard, which is providing some staff to help out with tasks such as food service and clerical work. While these efforts may relieve some of the strain on Upper Valley hospitals, health care workers are still under extreme pressure.
Mt. Ascutney Hospital and Health Center declined FEMA resources offered to the help with a monoclonal antibody clinic on Christmas Day because the hospital lacked the staff to operate the clinic, said Dr. Joseph Perras, Mt. Ascutney’s CEO.
“With the rapid spread of omicron in the state, and the known lack of efficacy of available monoclonal antibodies against omicron, we have requested FEMA personnel to help staff vaccine booster clinics in January,” Perras said in a Wednesday email. “We are awaiting their response to this request.”
Due to staffing issues, New London Hospital has had to limit the number of inpatient beds that are open for patients to as few as 16 at a time, Swan said. In turn, that means that patients who otherwise would be admitted to the hospital from the emergency room sometimes have to spend the night in the ED, he said. That ties up beds in the emergency department for other people who are seeking emergency care.
It’s “kind of a domino effect,” Swan said.
In normal times, New London aims to get people in and out of the emergency department in about half an hour. These days, however, patients are sometimes waiting two hours.
“That is a drastic change for us,” he said.
The wait for critical care beds can be even longer, with some patients having to travel to Rhode Island or New York to find a bed with the appropriate level of care. Sometimes no such bed can be found as hospitalizations across the Northeast also are seeing high numbers of patients with COVID-19.
“Nobody has beds anymore,” he said. It’s a “rarity if we find a bed outside of New Hampshire that can take a critical care patient.”
As a result, Swan said New London and other small hospitals are preparing to hold more seriously ill patients in their facilities, as models estimate the number of patients hospitalized with COVID-19 in New Hampshire could balloon from a peak of nearly 500 earlier this month to as many as 700 in mid-January.
As it is, New London Hospital’s emergency department, which has three trauma beds and five exam rooms, has at times had as many as six patients with COVID-19.
Caring for a patient with COVID is more difficult and time-consuming than caring for patients with other ailments, Swan said. Nurses have to garb up with protective gear before entering a room where a COVID-19 patient is being treated. Then they go in and try to get as much done as possible in one visit, check on the patient’s oxygen levels and make sure they have the medication they need, so as to avoid gowning up multiple times.
Doing all this takes a nurse off the floor, away from other patients, for as many as 45 minutes. That leaves one other nurse and just one or two physicians to care for the remaining patients, he said. Nurses are spread very thin.
“They really are tired,” he said.
In an effort to open up additional beds on the inpatient side, New London is competing with many other hospitals for traveling nurses, Swan said. Speaking in mid-December, Swan said he hoped that three new traveling nurses would help the inpatient side to open more beds. But, he said all it takes is one nurse calling out due to illness or other issue to trigger bed reductions once again.
We are “starting to see staff come down with COVID,” he said. “Then you have them out for 10 days.”
Caring for patients with COVID-19 also is straining resources at Dartmouth-Hitchcock Medical Center, which like New London Hospital is a member of the Dartmouth-Hitchcock Health system.
Some patients at DHMC, the state’s only academic medical center, are so sick that a ventilator isn’t doing enough to get oxygen into their bodies. In such cases, patients are sometimes put on an extracorporeal membrane oxygenation, or ECMO, machine, which serves as an artificial lung by taking blood from the body, oxygenating it and removing carbon dioxide, before returning it to the patient.
Patients on ECMO are deeply sedated and require that someone attend to them at all times. They can be on the machine for anywhere from 10 days to months, said Brian Heybyrne, a DHMC respiratory therapist. Patients on ECMO are so dependent on the machine that they can have a heart attack within 90 seconds if there’s a problem with the machine.
It’s “important to point out how resource intense these therapies are,” he said.
Patients who are very sick with COVID also benefit by being moved into a prone position, which requires that they be turned over from their back to their stomach. That can take five people working together to avoid detaching important lines.
It’s “extremely risky,” Heybyrne said.
As with patients on ECMO, patients in a prone position need to be continuously monitored for safety, he said.
The growing workload takes its toll on hospital workers, Heybyrne said.
“We were burnt out last year,” Heybyrne said. “Now we’re just numb going through the process.”
There have been some staff departures amid the pandemic workload.
“Anybody who was eligible for retirement has retired,” he said.
Heybyrne said one of DHMC’s early ECMO patients has recovered and gone home. The patient occasionally sends along an update. Because patients on ECMO have a high rate of death, “it doesn’t always turn out great.”
But the updates from the former patient “reminds us why we’re doing it,” he said.
In addition to fatigue, health care workers also are feeling frustrated that many people continue to refuse to be vaccinated against COVID-19 and won’t wear a mask in public places.
Dr. Bill Palmer, a hospitalist at Mt. Ascutney Hospital and Health Center in Windsor, said he recently stopped at a Windsor gas station, but had to leave because no one else inside the store had a mask on.
“Basically, I was furious,” said Palmer, who also is the New Hampshire chapter governor of the American College of Physicians.
Palmer said the group has tried to lobby Gov. Chris Sununu to encourage him to enact a statewide mask mandate.
He said he supports mask requirements in public places and employers’ vaccine mandates, both of which Sununu opposes.
“I think the thing is what it boils down to: People need to do something,” Palmer said. They “can’t go around with no vaccine, no mask.”
Palmer said he wishes that people who are going about their business without a vaccine and without a mask would think about the hospital staff who are pulling extra shifts to care for the sick.
Palmer said he’s uncertain how many of those who have not yet been vaccinated are strongly opposed to the vaccines and how many simply haven’t gotten around to getting the shots. He’s seen some of the latter in the hospital at times.
“I’m hoping there are enough of those people it’ll make a difference,” he said.
The current surge, which is being driven largely by those who are unvaccinated, is hitting the Twin States hard, in part, because it comes amid a health care workforce shortage that pre-dated the pandemic and affects all areas of the industry.
In addition to struggling to meet the needs of COVID-19 patients, hospitals also are continuing to struggle to find inpatient beds for people experiencing mental health crises, and to find beds at nursing homes and rehabilitation facilities once patients are no longer in need of hospital-level care.
Prior to COVID-19, Malek said he would get a no when seeking to transfer a patient to DHMC 30 percent of the time. Now it’s 80 percent of the time, he said.
On the DHMC side, Heybyrne said they have gotten transfer requests from as far as Texas, Florida and the Dakotas.
“We didn’t have a bed for them,” Heybyrne said. “That’s telling me that if you’re looking to transfer someone thousands of miles away, that’s desperation.”
Matt Bouteiller, a certified physician assistant in the emergency department at Gifford Medical Center in Randolph, said the inability to transfer patients means that in some cases patients aren’t able to get the care they need in the time they need it. A heart attack patient who arrives in Gifford’s emergency department typically needs to be transferred to a catheterization laboratory within a short period of time, but that isn’t always possible these days, he said.
That results in providers taking a different approach to treating the patient that is “proven not to be as good for the patient,” he said.
After an experience like that, Bouteiller said, “you get the feeling that you didn’t give great care.”
Amid the stress and burnout of the pandemic, the future of the health care workforce in the Twin States remains in doubt.
Palmer, who is 65, has already scaled back his clinical work as he had planned to before the pandemic.
While Mt. Ascutney has some young, energetic providers, Palmer said he worries that the additional stress of the pandemic will burn them out early.
“I don’t want them to go: I’ve got to get out of medicine,” he said.
In the face of burnout, fatigue and frustration, Upper Valley health care workers say that their co-workers are key to their resiliency in these difficult times.
“We have a great group of people in our department that work as a team,” said Alexa Swift, a DHMC respiratory therapist. “That’s what gets us through every day.”
They check in on each other and cover shifts when others are sick. They give each other breaks when they are the ones sitting with a patient on an ECMO machine, she said.
Nurses in New London also cover for each other when someone is out, said Swan, the director of nursing in New London Hospital’s ED.
In addition to giving to each other, hospital employees are finding hope by giving to the community. They are donating items to the Turning Points Network, the Sullivan County nonprofit that serves survivors of domestic and sexual violence. Workers in the emergency department are purchasing gifts for five children they’ve “adopted” from Turning Point’s shelter, Swan said.
When he spoke earlier this month, he said the staff breakroom was “jam-packed with items for these families.”
“This is their way of celebrating,” he said of the hospital staff.
Even as Upper Valley health care workers seek space and staff to cover the anticipated additional surge of COVID-19 patients in January, Swan said he hasn’t lost his optimism for the future: “I’m crossing my fingers for 2022.”
LEBANON — In an effort to quickly identify cases of COVID-19 to prevent its spread during an ongoing winter surge, state and federal health officials are working to distribute rapid tests.
But, for now at least, supplies are tight. By 10 a.m. on Thursday, most of the 25,000 rapid tests that had been allocated to the Vermont distribution sites for the day had already been picked up, according to the state’s Department of Health. The state plans to release more tests in the coming days for a total of 96,000 to be distributed by the end of the year.
“The Scott Administration is continuing work to acquire more rapid antigen tests for broad distribution, but like other states, we are constrained by the realities of the supply at the federal level,” the Department of Health said in a Thursday news release.
In Vermont, people can visit distribution sites to pick up a limited number of tests over the course of the week, while in New Hampshire, residents can order tests online while supplies last. The Biden Administration has announced plans to distribute half a billion such tests starting next month.
New Hampshire on Thursday opened up a second round of signups for residents to order rapid tests. This round is slated to distribute 750,000 tests to about 180,000 households and is open to those who did not get tests in a previous round that distributed 1 million of them.
But four kits of two tests each don’t go very far, Anne Sosin, a policy fellow and public health expert at Dartmouth College, said earlier this month. Officials “should be talking about 40,” she said.
The Vermont distribution sites are limiting people to two kits per household, according to the Department of Health’s website.
The short turnaround time of the rapid tests allows those who receive a positive result to begin isolation immediately, said Dr. Jose Mercado, a hospitalist and the associate hospital epidemiologist at Dartmouth-Hitchcock Medical Center.
But he urged those with symptoms who get a negative result to seek out the “gold standard” PCR test, or to repeat the rapid test serially, while taking other precautions.
“If you have symptoms, even if you tested negative, don’t heavily rely on that negative test,” Mercado warned.
Dr. Benjamin Chan, New Hampshire’s state epidemiologist, said during a Wednesday news conference that the rapid tests are about 70 percent accurate.
Gov. Chris Sununu, during the news conference, acknowledged that the PCR tests are more accurate than the rapid tests and urged those with symptoms who test negative to seek a PCR test, but he said the rapid tests still have a role to play.
“They’re still good tests to have, especially if you’re symptomatic and positive,” he said.
Mercado said that using the rapid tests serially — more than once over a period of time — can help to avoid false negative results. The website of the Say Yes! COVID Test program, which is the program New Hampshire is using to distribute the tests, recommends that those without symptoms use rapid tests twice a week at least one day apart if they’ve been in close contact with a person with COVID-19. That program uses Quidel QuickVue tests.
Some Vermont schools also are relying on rapid tests as part of a “test-to-stay” protocol that tests students who are close contacts of a positive case but don’t have symptoms of the disease. The tests are administered at the beginning of the school day during what otherwise would be a quarantine period for the student. The tests also are used in schools when students develop symptoms during the school day.
“Test to Stay, and response testing more generally, is going very well, keeping kids in school while lowering risk of virus spread,” said Katie Warchut, a spokeswoman at the Vermont Department of Health.
Mercado encouraged the use of the tests in conjunction with other efforts to mitigate transmission of the virus. He urged those who are not yet vaccinated against COVID-19 to avoid gathering. For those who are vaccinated and boosted, he encouraged people to wear masks while indoors with people from outside their household.
This article is being shared by a partner in The Granite State News Collaborative. For more information visit collaborativenh.org.