A Blog about Prosperity and Opportunity in Northern New England

Healthcare in New Hampshire and across the region faces a shortage of workers (both in health care support and health care practitioners). In fact, 29% of the state’s healthcare workers are nearing retirement, according to an assessment of the State’s workforce development needs.

Analyses of future demand for healthcare workers in New Hampshire indicate that current labor supply will be insufficient to meet future needs. For example, according the Economic and Labor Market Information Bureau:

Healthcare practitioners and healthcare support occupations, two separate major occupational groups, account for 7,725 of all new projected jobs by 2032, 18.5 percent of all new jobs in the ten-year period.

Per the state’s “high demand occupations” data from 2024, there were 2,382 job openings in health care occupations in June of 2024 and New Hampshire will need 3,461 additional workers in healthcare occupations by 2032. See also projections by industry for rural and urban areas in New Hampshire.

Filling those positions with qualified local workers will require boosting New Hampshire’s workforce development efforts generally and specifically adding to the capacity of local colleges and universities to educate and train future healthcare workers in both degree and non-degree programs. But filling these positions also requires some fundamental economic infrastructure: housing.

Focus: Critical Access Hospitals in NH

According to the New Hampshire Hospital Association, Critical Access Hospitals employ roughly 5,300 people in the state. Critical Access Hospitals are hospitals that meet certain criteria established by the Center for Medicare Services based on the size of the community, its rural status, distance from other hospitals, and limited size of the facility.

Did you know that, in New Hampshire, each dollar of hospital payroll generates an additional $0.7750 in earnings across all other industries? Each hospital job generates 0.9130 additional jobs across all other industries.

–U.S. Bureau of Economic Analysis, RIMS-II Multipliers

Several factors contribute to the financial struggles of critical access hospitals in New Hampshire and across the region. Rural patients are more likely than their urban counterparts to be on Medicare or Medicaid and are also more likely than their urban counterparts to be over age 60. Also, the cost structures of rural hospitals have higher fixed cost ratios: for example, according to one study, the median ratio of fixed costs to total costs for hospitals in metropolitan areas is 73.3%; for micropolitan areas the median ratio is 84.7%; for “noncore” areas with a town of at least 2,500 residents, the median fixed cost ratio is 90.1%; for noncore areas with no town of at least 2,500 residents, the median fixed cost ratio is  93.3%. Put simply, the more rural the hospital, the less financial flexibility the hospital has to cut costs.[1] The less financial flexibility these providers have, the more financial strain they will experience. Without the economies of scale and flexibility to increase prices or reduce costs, these providers are very much in peril.

Talent Attraction and Retention: A Common Problem for the Region’s Hospitals

Beyond the funding and regulatory environment for Critical Access Hospitals, one of the biggest challenges facing rural hospitals is talent attraction. In fact, according to a survey by AMN Healthcare, an advanced practitioner search and consulting organization, practitioners have a strong preference for mid-size and larger metropolitan areas. Many of the reasons for these preferences are difficult for local communities to address – for example, a young doctor with a spouse who is pursuing their own career may not want to live in a rural community with limited job options for the “trailing spouse.”

One increasingly common barrier to talent attraction and retention is housing availability. This is especially true in rural communities, in which there is both a general housing shortage and a specific shortage in the market for new and/or high-quality rental housing.

An increasing number of critical access hospitals have elected to address this one specific barrier to talent attraction and retention by providing employer-owned housing. One such hospital is Speare Memorial Hospital in Plymouth, NH.

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CASE STUDY: SPEARE MEMORIAL HOSPITAL PLYMOUTH, NH

Speare Memorial Hospital owns a small portfolio of five units to support their efforts to attract and retain staff in a very tight Plymouth housing market. These properties — three standalone houses and two apartments within hospital office buildings — are all easily accessible on foot from the hospital, and are directly managed by the hospital admin.

As we own all of the units, the Hospital can set a rental fee that is affordable — and as we manage the units ourselves, we can address any issues in a timely manner.

Cheryl Callnan, Director of Development, Speare Hospital

Directly owned units are the core of Speare’s workforce housing strategy.  Hospital-owned properties allow Speare to successfully house and retain staff in a market constrained by vacation rentals and college housing. However, Speare also maintains relationships with local rental property owners if excess need arises.

One house owned by Speare is shared specifically by on-call nurses, and all the units are available only to hospital staff. Since these units are typically only rented for a few weeks to months at a time, they are the most flexible, convenient, and affordable option for new hospital staff. Based on past experience, the units will likely turn over 4 times per unit per year – put differently, each unit can facilitate up to 4 new hires per year. The cost of recruiting for key positions can be substantial, so each new hire facilitated by employer-owned housing also represents significant savings when it comes to advertising, recruitment, travel reimbursements for interviewed candidates, et cetera.

Speare is now expanding its housing footprint with three more apartments – the latest units were financed in part through a $500,000 catalyst grant from the Northern Border Regional Commission. NBRC’s grant programs are among the only sources of federal grant funding that can be used to finance employer-owned housing.

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Keep an eye out for more from Northeasterly! We’ll be back on the blog in a couple of weeks.

Northeasterly is published by Harpswell Strategies, LLC, a Maine-based economic development and public policy consultancy. This content is researched and written by @Jacob Sesker (Principal), with help from two talented young analysts: @Addison Davis and @Oscar Herrera. To contact Northeasterly, e-mail jacob@harpswellstrategies.com and reference Northeasterly in the subject line.

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[1] Abigail Barker, PhD; Eliot Jost, MBA, MPH; Timothy McBride, PhD; and Keith Mueller, PhD. The Impact of High Hospital Fixed-Cost Ratios on Rural Populations. RUPRI Center for Rural Health Policy Analysis, Brief No, 2025-3.

The post NORTHEASTERLY: Spotlight on the New Hampshire Healthcare Sector appeared first on Better Future Alliance.

If you do not know of either the Precision Valley or exactly what a machine tool is, that was the problem. The Valley -separated by the Connecticut River- was a major international hub for manufacturing machines that made other machines. But it was in economic shock, as their buyers – automotive, energy and defense – were all either imploding or had sourced offshore.

Communities that were once significant players in this field were aging and emptying out. If it was a manufacturing building – and there were many – it was probably empty or soon would be.

So, my stardom would have to wait. The task of stopping the bleeding and redevelopment became my interest and on-going question: How to best help high-need, low-capacity communities recover?

Hence the Comeback Community: Where they had once been an economic leader, then for various external factors had a big drop, but were now trying to “comeback”, but differently.

Fast forward 30+ years; I’m still at it. Stardom will need to wait. But nothing beats a redeveloped site’s ribbon-cutting, and the feeling of accomplishment by the volunteers and champions that made it happen!

The Comeback Community Champion

There are many “former” vibrant communities in New England. Some remain stuck, leaking wealth, energy and people. Others seem to be heading toward a different future and comeback strategy. Why the difference?

One factor we’ve seen in the more successful communities is the leadership – and hard work performed – by residents who have also “comeback:” from out-of-region jobs, careers or educations elsewhere. They have “Comeback to give back.” Finding and supporting these community champions seems to be an essential element of progress.

We hope you’ll find the contributions by Better Future Alliance members of interest and help us identify and recognize Comeback Communities and Comeback Champions.

Thank you for your own good works in your community!

The post The Comeback Community appeared first on Better Future Alliance.

By Jacob Sesker

Our goal in launching Northeasterly is to provide a resource to economic developers, planners, leaders, legislators, lenders, and funders seeking a deeper understanding of economic trends and solutions in Northern New England. If you think that we are missing an important story about the economies of Maine, New Hampshire, or Vermont, please don’t hesitate to reach out!

Content for Northeasterly is developed by Harpswell Strategies, LLC, a Maine-based economic development and public policy consultancy. This content is researched and written by @Jacob Sesker (Principal), as well as two talented young analysts: @Addison Davis and @Oscar Herrera. To contact Northeasterly, e-mail jacob@harpswellstrategies.com and reference Northeasterly in the subject line.

Our Approach
Each month we will provide an overview of one industry or topic that is important to the economic development of the region. In one or more subsequent posts, we’ll dive in – spotlighting what is happening in that industry in Northern New England, providing relevant case studies, and exploring some best practices in economic development that relate to the industry.

Healthcare by the Numbers

It is frequently stated that healthcare is one-sixth of the national economy. If anything, that undersells the significance of healthcare in the nation’s oldest region – healthcare represents more than one-fifth of private employment in both Maine and Vermont. Hospitals alone represent approximately one-twentieth of the region’s economy.

Commercial Real Estate & Healthcare

Healthcare generally occurs “in-person.” As such, as demand for healthcare increases, it is often accompanied by development of new medical offices. This distinguishes healthcare from many of the other industries that typically occupy commercial real estate (for example, firms in professional and business services often rely on remote workforces and are contributing less to new commercial real estate development than was the case several years ago).

Constrained Supply of Practitioners, Nurses, and Technicians

Nationally, rural communities find it increasingly difficult to attract and retain talent for key positions. A healthcare provider’s ability to deliver quality care is inextricably linked to the availability of trained healthcare professionals, including physicians, nurses and technicians. Providers often struggle to maintain high standards without sufficient staff, leading to longer waits, rushed consultations and a higher risk of errors.

Specialists perform procedures that can be a significant source of revenue. As such, the problems attracting or retaining specialists can create cascading problems for the bottom line of rural hospitals.

General practitioners, such as doctors of internal medicine, can earn significantly more in urban markets than they can in rural markets. Communities that are not adequately served by general practitioners can experience declining health outcomes, higher absenteeism, and other associated health and economic problems.

Even when the healthcare practitioners are in place to provide the care that a community needs, the volume of patients that can be seen depends on the availability of nurses. Nursing positions have also been difficult to fill across the region, as many nurses left the profession due to retirement or pandemic-era burnout, and many qualified and experienced nurses have found that they can earn significantly more by working as traveling nurses rather than as employees of a particular provider or system.

Demand Factors

The number of individuals aged 65+ is a significant factor that drives demand for healthcare. While the size of that subpopulation will continue to grow, the rate of growth of the senior population is unlikely to reach current heights ever again.

The number of people with private health insurance is one factor that contributes to demand for healthcare. The aging population and current immigration policies are likely to contribute to very low population growth. It remains unclear whether the GOP can develop a healthcare plan that will lead to more individuals and households being covered by private health insurance.

Other demand factors include federal funding for Medicare and Medicaid, total health expenditure, and per capita disposable income.

Some Light Reading

With respect to federal funding, this recent explainer by the Government Accountability Office is a good place to start; similarly, this 2025 Congressional Research Service report provides an excellent overview.  Pew Research is the source covering the impact of Medicaid on state budgets. The National Rural Health Association provides resources, research, and advocacy related to rural healthcare.

Regional Economic Data Updates

The Federal Reserve Bank of Boston provides data dashboards for each state in the region:

• Maine
• New Hampshire
• Vermont

We’ll be back next week with a deeper dive on healthcare in New Hampshire!

Contact Jacob Sesker: jacob@harpswellstrategies.com

The post NORTHEASTERLY: Prosperity and Opportunity in Northern New England appeared first on Better Future Alliance.

Telling Our Stories

Success stories of our involvement in numerous projects need to be told and our message needs to reach the right people. This is where our Alliance member, Chuck Sink, comes in. Chuck’s business and teaching background lend themselves nicely to our communications efforts.

As founder and owner of the marketing agency, Chuck Sink Link, Chuck brings brand strategy, art direction, graphic design, writing, and content creation skills to the table. His CV offers an overview of business and academic experience, validating his role with us.

Better Future Credentials

Chuck Sink is a brand strategist, master content writer and adjunct teaching lecturer with a proven skills combination of creativity, excellent writing and successful marketing experience. He offers organizations and professional individuals proven insights for increasing sales and building brand equity in competitive markets.

Mr. Sink has over 30 years of sales, marketing, management and publishing experience. He led 3 printing companies to record growth and went on to implement record breaking business development programs for a national full-service advertising agency.

Since 2011, Chuck Sink has operated his own business which specializes in creating message content for websites, social media, blogs and advertising media to help businesses increase revenues and improve market positioning. Chuck Sink Link facilitates the publication of feature stories and business articles in such media as the New Hampshire Business Review, Business NH Magazine, New England Real Estate Journal and numerous online newsletters and blogs.

Chuck Sink is on the adjunct faculty at Plymouth State University where he teaches Business Writing and Presenting and formerly taught Organizational Communications.

Chuck Sink was a Charter Member of the Hopkinton Rotary Club where he served in leadership positions on numerous project committees for over 10 years to benefit local communities as well as support Rotary International. He is currently a Third Degree Knight in the Knights of Columbus, Newport, NH Council 4983, serving church and local charities though fundraising and volunteer efforts. Chuck gives back to the community through substance abuse counseling and supporting the Boys & Girls Club of Manchester, local soup kitchens, his church, and health-challenged individuals.

Chuck’s professional affiliations include:

• Greater Manchester Chamber of Commerce – Former Ambassador Committee Member
• Newport Area Chamber of Commerce – Member and Event Contributor
• Upper Valley Business Network – Member Success Advocate
• Better Future Alliance – Communications Specialist

The post The Communications Link to the Better Future Alliance appeared first on Better Future Alliance.

Bridging the Planning – Action Gap

Jared is particularly focused on bridging the gap between planning and implementation, helping communities move from feasibility and strategy to informed decisions and meaningful action.

Jared Reynolds

Before joining the University of Alaska, Jared led Do North, where he built regional and national entrepreneurial ecosystems and founded the Forest Products Accelerator, the nation’s first accelerator dedicated to commercializing products in the forest industry. “The 4-month program supports companies commercializing new products, services, or technology in the forest industry. Participating companies get expert advice and tools to build a market validated business case, model, and operating plan through a rigorous commercialization curriculum, coaching, webinars and panels, and connections to industry experts, customers, and suppliers.”

Jared has previously held roles in economic development and research at the University of New Hampshire, AECOM, the Center for Municipal Finance, and the Center for Tax and Budget Accountability. He has also founded and managed several for-profit and non-profit ventures.

Jared Reynolds holds an undergraduate degree from the University of New Hampshire and graduate degrees from the University of Chicago.

The post Economic Development from Alaska to New Hampshire appeared first on Better Future Alliance.

Meet Jacob Sesker of Harpswell Strategies

Better Future Alliance member Jacob Sesker is the Principal Consultant at Harpswell Strategies, LLC. Harpswell Strategies provides economic and public policy consulting services to real estate developers, non-profit organizations, and municipalities up and down the east coast. In Maine and New Hampshire, those clients are generally small communities or community non-profits with resource constraints and limited staff capacity.

“Those are my favorite projects,” Sesker says. “They require thinking carefully about how to do as much as possible with limited budgets and timeframes. They require working in an environment where everyone is stretched thin – the City or Town Manager might also be the Police Chief or Harbormaster, the Planning Department might be one person, the town might not even have an economic development function in-house. Those towns need amenities and services, but they need a lot of help getting from here to there.”

Experience from the Inside

And sometimes, Sesker says, towns start off looking for a specific service and eventually realize that they need general staffing support as well. “For someone like me who has worked in local government management for years, serving as an interim or fractional staffer is a good way for me to scratch that itch. And, as the workforce ages, many communities find themselves needing help to get through transitions or to get things kickstarted or re-started.”

That work comes with an extra benefit for Harpswell Strategies’ other clients as well. “The reality is, there is no better way for me to improve my understanding of the social, political, and fiscal forces affecting my client base than to spend some of my time working for them from the inside,” Sesker says. “Whether we are talking about access to care, addiction, homelessness, or transportation challenges, the best way to understand the pressure these communities are under is to talk to stakeholders and municipal management about what they face every day.. The interim staffing and fractional work that I do has made me a better consultant on all of my projects.”

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Jacob Sesker is a planner, economic developer, and public policy professional with 20 years of experience working for and with local governments. His firm, Harpswell Strategies, provides economic and fiscal impact analyses, quantifies financing gaps and identifies solutions to close them, market and feasibility analyses, and strategic planning services.

Jacob’s expertise includes:

• Analyzing local economies;
• Understanding the relationships between business climate and economic performance;
• Understanding the connections between real estate investment decisions and local tax revenues;
• Catalyzing change by identifying opportunities for strategic redevelopments that will drive prosperity and create economic opportunities; and
• Helping local communities understand how to provide the amenities and services they need to succeed without breaking the bank,

The post NORTHEASTERLY: Introduction to Harpswell Strategies’ Jacob Sesker appeared first on Better Future Alliance.