How an aging state, a fraying care workforce, and soaring costs are colliding behind closed doors
By Granite State Report
New Hampshire likes to brand itself as ruggedly independent: “Live Free or Die,” shovel your own driveway, mind your own business.
That motto is killing people.
Behind tidy vinyl-sided homes and aging farmhouses, tens of thousands of older Granite Staters are living and aging alone, with no spouse, no nearby family, and increasingly thin support from overworked home-care workers and an overstretched long-term care system. Social isolation — the quiet, accumulating absence of human contact — has become a slow-motion public health emergency.
This is not just a story about hurt feelings. It’s about higher rates of heart disease, dementia, depression, falls, and early death. It’s about emergency rooms functioning as de-facto social services. And it’s about whether New Hampshire is willing to retrofit its “Live Free” identity for a future in which one in four residents will be over 65.
1. The Grey State: New Hampshire Becomes One of the Oldest in the Nation
By median age, New Hampshire is not a “graying” state; it’s a gray state.
As of July 2023, the median age in New Hampshire was 43.4 years — tying Vermont for the second-oldest state in the country, behind only Maine.(New Hampshire Fiscal Policy Institute) Roughly 20.8% of residents are over 65, and another 15.3% are between 55 and 64. Those under 18 now make up only about 18% of the population.(New Hampshire Fiscal Policy Institute)
The trend line is pointed one way: older.
- Citizens Count, a nonpartisan civic group, notes bluntly that New Hampshire has “the second-oldest population in the United States” and that one in five residents is over 60.(Citizens Count)
- The 2025 New Hampshire Healthy Aging Data Report, produced by UMass Boston researchers, projects that older adults will continue to grow as a share of the population in almost every community.(Healthy Aging Data Reports)
Within that demographic wave, one number jumps out: how many older people are alone.
A 2025 NHPR report on the Healthy Aging Data found that 25.5% of the state’s older population lives alone, with the majority in rural communities.(New Hampshire Public Radio) That’s roughly one in four older adults. In some small towns, the percentage is even higher.
Living alone is not automatically a problem; plenty of people thrive in solitude. But as health declines, driving becomes harder, and friends die or move away, those solo households turn from a choice into a trap.
2. When “Living Alone” Becomes “Being Left Alone”
New Hampshire’s own Department of Health and Human Services keeps an Index of Social Isolation Risk Factors for residents 65 and older. It combines measures like poverty, living alone, disability, and difficulty with independent living. On that index, a higher score means greater isolation risk.(NH DHHS)
The 2025 Healthy Aging Data Report and a separate study on social isolation among NH older adults, commissioned by Partners in Public Health, paint a consistent picture:
- Loneliness is common, particularly among older adults who live alone for all or part of the year and among men.(WellnessLinkNH)
- Key informants across the state identified social isolation as a “serious concern” for community-dwelling older adults.(WellnessLinkNH)
In practical terms, this looks like:
- A widowed 82-year-old in Coös County whose children live in Boston and North Carolina, relying on a once-a-week aide and Meals on Wheels.
- A retired machinist outside Claremont, no longer driving, whose only regular human contact is the grocery delivery driver and a telehealth visit every few months.
- A divorced 74-year-old in Manchester in an aging walk-up, leaving her apartment mainly for medical appointments.
These are composite examples, but they are built from the patterns service providers describe: residents scattered across rural roads and aging mill towns, proud of their independence, reluctant to admit they’re struggling — and slowly disappearing from community life.
3. The Body Keeps the Score: Health Impacts of Isolation
You don’t have to be sentimental to care about loneliness. The science is unforgiving.
The Centers for Disease Control and Prevention (CDC) draws a sharp distinction between social isolation (objective lack of contact) and loneliness (the subjective feeling of being alone). Both significantly raise the risk of serious illness.(CDC)
The U.S. Surgeon General’s 2023 advisory on social connection went further, calling loneliness and isolation a public health crisis and comparing the health impact of social disconnection to smoking up to 15 cigarettes a day.(HHS)
Across multiple large studies, isolation and loneliness in older adults are linked to:
- Cardiovascular disease and stroke
- Increased risk of dementia (roughly 50% higher risk in some studies)(HHS)
- Depression and anxiety
- Higher rates of hospitalization and emergency room use
- Premature death comparable to or greater than the risk from obesity and physical inactivity(HHS)
A 2023 analysis in JAMA reported that about 37% of older U.S. adults aged 50–80 felt lonely, and about 34% said they were socially isolated. Loneliness was more common among those with poorer physical or mental health and those living alone.(JAMA Network)
In New Hampshire, those national trends land on an older, more rural population with limited public transit and long winter months. That’s a recipe for what providers describe: older residents who may go days without speaking to another human being in person.
Mental health: Silent depression, invisible crises
Loneliness feeds depression; depression feeds isolation. Primary care practices in New Hampshire report older patients who:
- Stop taking medications consistently
- Quietly lose weight because they’re not cooking full meals
- Show subtle cognitive decline that goes unnoticed because no one is around them daily
These are not just “sad” stories — they are clinical risk factors. Chronic depression is associated with worse outcomes in heart disease, diabetes, and recovery from surgery. It also increases suicide risk, including self-neglect: refusing food, medications, or care.
4. The Home-Health Aide Who Never Shows Up
Even when older adults qualify for home-based help, that doesn’t mean the workers exist.
At a 2024 New Hampshire Long-Term Care Summit, officials and providers detailed “shortfalls in direct care and healthcare employment” across the state. The New Hampshire Commission on Aging’s workforce work highlights a chronic shortage of direct care workers — home health aides, personal care attendants, and nursing assistants — as one of the system’s most urgent problems.(NH DHHS)
Nationally, the Home Care Association of America describes the home-care workforce shortage as a crisis: the number of people needing in-home support is growing faster than the number of workers entering or staying in the field. Low wages, physically demanding work, and lack of benefits are driving high turnover.(Home Care Association of America)
For older Granite Staters living alone, this plays out in brutally concrete ways:
- Inconsistent coverage. Agencies struggle to fill all authorized hours, especially in rural areas. A senior might be deemed eligible for 20 hours a week of help and receive 8.
- High churn. A different aide shows up every few weeks, or no one shows up at all. For someone with memory issues or anxiety, this is destabilizing.
- “Invisible waitlists.” People may be technically “accepted” into a program but functionally unserved because there simply are not enough workers willing to drive 40 minutes for a two-hour shift.
When aides don’t show up, family members in other states scramble to plug the gaps by phone, neighbors do what they can, and small problems snowball: a missed shower becomes a fall risk; a skipped grocery run turns into malnutrition.
Providers across the state quietly describe a triage system: people with no one else sometimes get priority, but in practice, having no support network makes it harder to advocate, not easier.
5. The Cost Cliff: Long-Term Care in One of the Most Expensive States
When living alone is no longer viable — falls, advanced dementia, or complex medical needs — the default answer is long-term care: assisted living, memory care, or a nursing home.
In New Hampshire, that step is often financially devastating.
According to 2024 data summarized by PayingForSeniorCare, using Genworth’s Cost of Care Survey, New Hampshire’s assisted living costs average about $7,025 per month, compared to a national average of $5,350. In Manchester, assisted living averages $7,275 per month.(Paying for Senior Care)
Genworth’s New Hampshire-specific Cost of Care tables show:
- Nursing home (private room): around $12,900 per month (over $155,000 per year).(Long Term Care Brokers)
- Home health aide services are also expensive, with annualized costs often approaching or exceeding $70,000 for full-time care.(Genworth Financial, Inc.)
A 2025 Nationwide survey on long-term care found that 58% of adults incorrectly believe Medicare will pay for long-term care, including help with bathing, dressing, and daily activities. It does not. These costs are largely out-of-pocket until a person has impoverished themselves enough to qualify for Medicaid.(MarketWatch)
For an older adult living alone with modest savings, the choices look like this:
- Pay $7,000–$13,000 a month for facility care until the money runs out;
- Try to piece together home care and family help, if any family is nearby;
- Or go without, relying on occasional check-ins and sheer luck.
In other words: isolation plus poverty equals institutionalization — or neglect.
6. Winter in a Quiet House: How Isolation Actually Feels
Statistics are necessary, but they’re sterile. To understand the stakes, imagine a commonplace New Hampshire winter storyline.
Case Study (composite, not a real person):
Mary is 79, widowed, in a small town in the North Country. She has mild heart failure and arthritis, and she stopped driving after a minor accident on black ice two years ago. Her son lives in Ohio. She receives Social Security, a small pension, and qualifies for some home-care hours.The local agency can staff six hours a week: three two-hour visits. One aide recently quit to take a better-paying job at a hospital; another moved. On days without an aide, Mary doesn’t shower — she’s afraid of falling — and eats toast, canned soup, and whatever is easy. She hasn’t been to church in person in months; the livestream works when her internet doesn’t cut out.
In January, a storm knocks out power. Her cellphone is charged, but she hesitates to call 911 “just because it’s cold.” She layers blankets and waits. By the time her neighbor notices after two days and checks in, she is mildly hypothermic and delirious.
In the ER, clinicians treat the immediate crisis. But the underlying issue isn’t a one-time medical problem — it’s the fact that there is no consistent human network around her.
Multiply Mary by hundreds of households and you have the real shape of this crisis.
7. Why New Hampshire Is Especially Exposed
Plenty of states are aging. New Hampshire has a particular mix of factors that magnify isolation risk:
- Rural geography + car dependence. Many older adults live on back roads with limited or nonexistent public transit. When driving stops, social life shrinks dramatically.
- Out-migration of younger adults. New Hampshire has long exported its 18–34-year-olds to Boston, other states, or other regions. Parents age in place while children’s careers take them away; “care at a distance” becomes the norm.(New Hampshire Fiscal Policy Institute)
- High housing costs. The state’s tight housing market and high property values make it hard to downsize within the same community. Older adults may stay in isolated single-family homes because there are few smaller, accessible apartments nearby.(New Hampshire Fiscal Policy Institute)
- Limited institutional capacity. Nursing homes and assisted living communities face the same staffing shortages as hospitals and home-care agencies. Some facilities have closed beds or wings because they can’t find enough staff, not because they lack demand.(NH DHHS)
- Culture of stoicism. “I don’t want to be a burden” might as well be the unofficial state slogan for older adults. That pride can delay asking for help until the situation is acute.
None of these trends are malicious. They’re the byproducts of broader economic and demographic shifts. But together, they create a trapdoor for older residents who lack a strong family or neighborhood network.
8. What the Research Says About Fixing Isolation
The good news: we know a lot about what helps.
Social connection is as “real” a health intervention as blood pressure medication
The Surgeon General’s advisory urges health systems to treat social connection as a vital sign, as important to overall health as smoking status or BMI.(HHS)
Evidence-backed strategies include:
- Regular, structured social contact (senior centers, group meals, volunteer programs)
- Transportation access, especially flexible, door-to-door options
- Home visiting and “friendly caller” programs
- Built environments that make it easy to bump into people (walkable town centers, mixed-use zoning)
The New Hampshire study on social isolation among older adults recommended expanding services that prevent and mitigate isolation, mapping existing programs, and explicitly targeting men and people who live alone for outreach.(WellnessLinkNH)
9. What’s Already Working in New Hampshire
New Hampshire is not starting from scratch. Across the state, agencies and communities are experimenting with ways to keep older adults connected.
Healthy Aging Data as a flashlight, not a report on a shelf
The 2025 New Hampshire Healthy Aging Data Report provides town-level profiles that show rates of older adults living alone, chronic disease, falls, and more.(Healthy Aging Data Reports)
Used well, that data can:
- Help towns identify neighborhoods with high isolation risk
- Justify grants for senior transportation, housing, or community health workers
- Spur collaborations between hospitals, nonprofits, and town governments
DHHS “Social Connectedness” focus
The NH DHHS Social Connectedness initiative acknowledges that social isolation is a modifiable risk factor and highlights New Hampshire’s relatively high levels of civic engagement as an asset to build on.(NH DHHS)
That framing matters: it shifts isolation from a purely private problem (“I’m lonely”) to a shared, community-level challenge.
Local programs and “soft infrastructure”
Around the state, you’ll find:
- Senior centers in cities like Manchester, Nashua, and Concord running congregate meals, exercise classes, and tech help.
- Faith communities organizing ride networks and visitation ministries.
- “Aging in place” committees under town governments, exploring accessory dwelling units (ADUs), walkability, and intergenerational programs.(New Hampshire Fiscal Policy Institute)
These programs are often fragile — dependent on a few key volunteers or short-term grants — but they prove something important: social infrastructure can be deliberately built.
10. Where the System Is Breaking: The Workforce and the Money
Despite all that, the gap between need and support continues to widen.
- The New Hampshire Commission on Aging identifies strengthening the direct-care workforce as a top priority, recommending higher wages, better training, and career ladders to keep workers in the field.(NH DHHS)
- Nationally, reports on the home-care workforce warn that shortages are accelerating “at an unsustainable pace.”(Home Care Association of America)
If New Hampshire wants fewer older adults stranded alone at home, it will need to:
- Treat home health aides and personal care attendants as core health infrastructure, not disposable labor.
- Align Medicaid and state reimbursement rates so agencies can pay living wages without collapsing financially.
- Expand training pipelines through community colleges, apprenticeships, and immigrant workforce integration.
On the financing side, there’s a brutal mismatch between what long-term care costs and what most people can pay. A national analysis by MarketWatch found home health aides averaging about $77,792 annually, assisted living at $5,900 per month, and nursing home private rooms over $127,000 a year — and many Americans wrongly assume Medicare covers this.(MarketWatch)
For a state with New Hampshire’s high baseline cost of living, that mismatch is even more extreme.
11. Policy Ideas: From “Live Free or Die” to “Age Free and Connected”
New Hampshire doesn’t need to become Scandinavia to fix this. But it does need to update its mental model of “independence.” For an 80-year-old living alone in a farmhouse, independence is only meaningful if someone is close enough to knock on the door.
Here are pragmatic, evidence-informed directions the state and local communities could take:
1. Make social connection part of healthcare, not an afterthought
- Screen for isolation. Primary care clinics and hospitals should routinely ask about living situation, frequency of social contact, and transportation — and record it as a risk factor.
- Fund community health workers / care navigators who can do home visits and connect isolated seniors to local programs, benefits, and mental health support.
2. Invest in the direct-care workforce like it’s a bridge or a highway
- Raise reimbursement rates for Medicaid-funded home care and nursing home care, earmarked for frontline wages and benefits.
- Offer state-funded bonuses or loan forgiveness for workers committing to direct care in rural or high-need areas.
- Treat home care as a career ladder: certified roles, mentorship, and pathways into nursing and allied health fields.
3. Build housing that doesn’t isolate people by design
- Expand accessory dwelling unit (ADU) laws and encourage town zoning that allows in-law apartments, senior cottages, and small multifamily housing near town centers.
- Prioritize walkability and transit in planning: sidewalks, benches, and safe crossings make a huge difference for older adults who no longer drive.(New Hampshire Fiscal Policy Institute)
4. Support “aging in place” tech — with human backup
- Promote broadband access and easy-to-use technology for telehealth, social calls, and remote monitoring.
- Fund local “tech buddy” programs where volunteers or students help older adults use tablets, video chat, and online communities — reducing both isolation and digital exclusion.
5. Strengthen informal networks: neighbors, volunteers, churches, clubs
No state program can replicate what a good neighbor can do.
- Encourage and lightly fund “village” models — local membership-based groups where volunteers help with rides, errands, and check-ins.
- Partner with faith communities and civic groups to run friendly caller programs and regular social events, especially in winter.
This is where New Hampshire’s high civic engagement can be turned outward toward its oldest residents.(NH DHHS)
12. What Individuals Can Do Now
Policy is slow. Isolation is happening today. For readers wondering what this means in daily life, some blunt advice:
- Know your elders. Learn the names of older neighbors. Notice whose lights don’t come on after a storm. “Nosy” used to be called “being a community.”
- Normalize asking for help. If you’re older and alone, needing support is not a moral failure. It’s biology. The body slows down; the environment should adjust.
- Talk early about long-term care. Families should discuss potential needs long before a crisis hits — what level of support someone wants, what they can afford, and how siblings or friends can share responsibilities.(Investopedia)
13. Further Viewing & Listening
For readers who want to dig deeper, these videos put faces and expert voices to the data:
- “NH aging population on the rise” — WMUR-TV
Short segment on how New Hampshire’s aging demographics are reshaping communities and services.
Watch on YouTube (YouTube)
- “Loneliness and Social Isolation Among Older Adults” — academic talk
Explores research on loneliness, especially among older adults with cognitive impairment, and community-based interventions.
Watch on YouTube (YouTube)
- “US Surgeon General discusses health risks of loneliness” — PBS/NewsHour-style segment
Dr. Vivek Murthy explains why loneliness is now considered a public health epidemic.
Watch on YouTube (YouTube)
14. The Quiet Emergency, in Plain Sight
New Hampshire has spent decades marketing itself as a place for freedom: no income tax, minimal regulation, a state where you take care of your own.
What happens when you can’t?
Right now, the state’s combination of advanced age, high housing and care costs, rural isolation, and workforce shortages is pushing more older residents into a dangerous in-between zone. They are not sick enough (yet) for institutional care, not wealthy enough to privately hire comprehensive help, and not connected enough to rely on family or neighbors.
They are, in practical terms, on their own.
This is the silent crisis: not dramatic spikes in crime or visible tent encampments, but empty chairs at town meetings, darkened windows on winter evenings, and an ER that doubles as a social safety net.
New Hampshire still has time to change course. The data are clear, the health impacts are undeniable, and the solutions are not mysterious. The real question is cultural and political:
Does “Live Free or Die” include the freedom to grow old and stay connected, or are we comfortable with independence defined so narrowly that it means suffering in silence behind closed doors?
The answer will determine not just how older Granite Staters live out their final decades, but what kind of state the rest of us will age into.
References & Key Sources
- New Hampshire Fiscal Policy Institute, “More Than One Third of the State’s Population Was Over the Age of 55 in 2023.”(New Hampshire Fiscal Policy Institute)
- U.S. Census Bureau, state median age comparisons (2024).(Census.gov)
- Citizens Count, “Aging Population – NH Issue Brief.”(Citizens Count)
- New Hampshire Healthy Aging Data Report (2025) and related NHPR coverage on social isolation.(Healthy Aging Data Reports)
- JSI Research & Training Institute, “Social Isolation Among Older Adults in Community Settings in New Hampshire.”(WellnessLinkNH)
- CDC, “Health Effects of Social Isolation and Loneliness” (2024).(CDC)
- U.S. Surgeon General, Our Epidemic of Loneliness and Isolation (2023).(HHS)
- Mushtaq et al., “Social Isolation and Loneliness in Older Adults,” JAMA analysis (2023).(JAMA Network)
- NH Department of Health and Human Services, “Social Connectedness” resources and isolation risk index.(NH DHHS)
- New Hampshire State Commission on Aging, “Strengthening the Direct-Care Workforce” resources and 2024 workforce priorities.(NH DHHS)
- Home Care Association of America, “The Home Care Workforce Crisis: An Open Letter” (2023).(Home Care Association of America)
- PayingForSeniorCare & Genworth Cost of Care Survey, New Hampshire assisted living and nursing home cost data (2024).(Paying for Senior Care)
- Nationwide Retirement Institute / MarketWatch reporting on long-term care misconceptions and costs (2025).(MarketWatch)
- Additional context from NHFPI’s “Greying of the Granite State” podcast and related analysis.(New Hampshire Fiscal Policy Institute)
This crisis is measurable, solvable, and already reshaping New Hampshire. Whether it stays “silent” is up to the rest of us.
