Committee calls for changes to New Hampshire’s disability system

A group of New Hampshire disability rights advocates, families and care agency professionals want to see reform in the state’s disability care system.

New Hampshire’s System Review Committee finalized its recommendations for systemic reform Thursday. The committee came together in December after a Bulletin investigation last year uncovered evidence of hundreds of abuse and neglect incidents in New Hampshire’s care system for people with developmental disabilities, such as autism and cerebral palsy.

The system consists of a network of private care agencies. It’s funded by taxpayers and overseen by a collection of offices within the Department of Health and Human Services. Last year, Bulletin reporting revealed inadequate oversight and prevention measures throughout the system and told the stories of victims who were raped, beaten and died too young.

The committee members have been holding regular meetings since January, where they’ve questioned officials and discussed ways to improve safeguards meant to deter such abuse and neglect. On Thursday, the committee released its final recommendations for the state.

Stephanie Patrick, co-chair of the committee and executive director of the Disability Rights Center-New Hampshire, said they “want a system that involves all the different pieces of DHHS, all the different people who have a stake in the system, which includes providers, service coordinators, families, to understand where we are now and where we need to be, and commit to making those changes, even if they’re difficult.”

“That may be a little ‘Pollyanna,’” she continued. “But I think that’s the only way you’re gonna make this better.”

Here are some of those recommendations:

The state should create a centralized complaint intake and triage system.

Under this change, reports and investigations into abuse and neglect made to the state would be handled by one electronic system shared among all involved state agencies. This would help state officials from disparate government agencies, who are presently siloed, work seamlessly together on managing investigations. The system would relay reports to the proper agency so that the reporter does not need to keep track of what entity has jurisdiction.

DHHS should create a clear leadership structure for investigations.

The committee found that the investigation process is “disjointed and difficult to understand.” The current system could potentially involve Adult Protective Services; Licensing and Certification; Medicaid Program Quality; the Office of Client and Legal Services; the Bureau of Developmental Services; and the Health and Human Services ombudsman. The committee found that this creates confusion, and wants DHHS to establish a clear leadership structure and designate one agency or office the lead entity on investigations.

The state should create a 24/7 hotline.

The committee wants to see one main number — integrated into the aforementioned intake and triage system — that people can call if they suspect someone in the system is being abused, neglected or otherwise exploited. The phone line should have a live operator 24/7. It wants the operators to be empowered to educate callers on the process, timeline and expectations for investigating the report.

Investigators should be able to deem a report ‘inconclusive.’

Currently, state investigators looking into abuse and neglect reports determine whether a report made to the state is “founded” or “unfounded.” The committee wants state investigators to establish a new finding, “inconclusive,” for cases in which there isn’t enough evidence to support either outcome.

The state needs to encourage better reporting.

That includes launching a community education campaign on how witnesses can report abuse and neglect to the state and what obligations mandatory reporters have to make reports. The campaign should explain what constitutes suspected abuse, neglect, exploitation and rights violations, as well as the various reporting and complaint pathways. Staff at care agencies should understand, the committee says, that they’re mandatory reporters and should never be “talked out of” reporting.

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The state should implement unannounced visits to facilities.

These visits, completed by the Bureau of Developmental Services or Adult Protective Services, should be conducted in response to complaints, risk factors, significant staffing changes, and other health and safety concerns. Committee members note that abuse and neglect is much more likely to be identified during an in-person visit than a telephone call made by an investigator to the care agency.

DHHS should report more data publicly.

There’s very little data publicly available regarding abuse and neglect investigations, which leaves advocates with little ability to identify trends or suggest reforms. The committee wants DHHS, in collaboration with stakeholders, to identify categories of data that do not violate victims’ privacy that can be reported publicly. The committee also wants DHHS to complete analysis on the data to identify patterns and trends. Takeaways on how to improve gaps in the system should be shared across the network of care providers.

The state needs to overhaul its paperwork and bureaucratic systems.

The committee heard from many who work in the system about the onerous amounts of paperwork caregivers, agency officials and others are required to complete. That immense paperwork burden takes up employees’ time, which they could be spending on caring for people with disabilities. The committee wants state agencies to review the paperwork requirements and attempt to revamp them to make the system more efficient.

The Incapacitated and Vulnerable Adult Fatality Review Committee needs a revamp.

The New Hampshire Incapacitated and Vulnerable Adult Review Fatality Committee is responsible for reviewing concerning deaths among people with disabilities and other vulnerable adults, and providing recommendations to prevent future similar tragedies. In November, the Bulletin investigated the 2022 and 2019 untimely deaths of Stephen Weidlich Jr. and Christine Marie Bill, respectively. At the time — late 2025 — both co-chairs of the Fatality Review Committee said they were not even alerted about either death until hearing from the Bulletin. The System Review Committee is calling on the New Hampshire Department of Justice, where the committee is housed, to “ensure the Incapacitated and Vulnerable Adult Fatality Review Committee has the resources and expertise to examine deaths in the developmental disabilities service system.”

The system should centralize the voices of people with disabilities and their families.

The committee believes the state needs to listen more to those living within the system. It’s recommending the state “establish an independent navigation/advocacy function” to this end.

The state Legislature should better fund the system.

The committee wants state lawmakers to devote more funding to the system. The committee heard from agency officials who say the state doesn’t have enough abuse and neglect investigators. They also heard that caregivers are underpaid and that low wages make it difficult to hire and retain quality caregivers. The Legislature needs to devote more funding to increase Medicaid provider rates, which support caregiver salaries; to better fund the state’s investigative units; to provide the system with the funding to create the aforementioned centralized intake and triage system; and more.

The committee is asking DHHS to respond to its recommendations within 30 business days. In response to the Bulletin’s request for comment, DHHS spokesperson Jake Leon said in an email: “We have received the Council’s recommendations, are currently reviewing them and anticipate responding within the letter’s stated deadline.”

On the committee are Emily Manire (chair), Stephanie Patrick (co-chair), Isadora Rodríguez-Legendre, Gina Cannon, Marissa Berg, Jessica Gorton, Lisa Beaudoin, Karen Hatch, and Howard Clark.

The recommendations are not the only effort to address abuse and neglect in the disability care system in the wake of the Bulletin’s investigation. In July, Gov. Kelly Ayotte signed Senate Bill 670 into law. The new law, sponsored by state Sen. David Rochefort, created a new oversight commission for the system that is set to hold its first meeting soon; beefed up data sharing between state agencies; and required state officials to notify watchdog agencies about any deaths or serious injuries. Additionally, the Disability Rights Center-NH, a federally funded watchdog agency, launched an investigation and plans to release its own recommendations for system change soon.

Scroll down to view the committee’s full list of recommendations.