A special meeting was held by the Lafayette County Board of Supervisors on Wednesday, June 8 to discuss the future of home health care in Lafayette County.
After a moment of silence was taken to honor the memory of the late Lafayette County Board member, Bill Moody, Board of Health Chairman Bob Boyle remarked on the current status of home health care.
At the Board of Health meeting on May 23, they came up with this statement, “Although the health board believes that home health care is needed in Lafayette County, with its current financial and staffing deficits, the home care program is unsustainable.” Boyle stated that either the board spends additional money to revitalize the program or it should be terminated.
He added some concerns with continuing the program. “One, where do we find the money to a tune of at least another $100,000? We cannot levy. Secondly, can we find adequate staffing, even if the money is allocated?”
There is a nursing shortage not just with home health care but also with the manor and the hospital. Home health care only has 2.2 employees and is currently seeing only 11 patients throughout the county. The staff is stressed out and cannot continue as is. Danielle Steger, home health care nurse, stated that the program was initially started in 1973 because there wasn’t another program to serve the people of the county. Due to staffing, they have not been taking any referrals since April and have given those who were referred (about eight patients) to outside agencies.
Jennifer Theill is the manager at the Home Health United (HHU) branch in Platteville and explained what they offer. They have home care, palliative care and hospice. They have been open in Platteville for three years and serve Lafayette County completely along with 18 other counties. Kris Fleming, a social worker is HHU stated they offer services such as skilled nursing, IV infusion, wound care, therapy (speech, occupational, physical), and have a social worker on staff. They have Cardiocom, which allows a triage nurse to monitor someone’s blood pressure or blood sugars remotely. They are available 24/7, weekends, and holidays. A patient can have home care within 48 hours and they do take same day admissions. Theill explained that the patient will continue to doctor with their primary doctor and hospital. When receiving a referral, they do not base their decision to care for someone based on what they can or cannot pay for that care. They take patients from all ages. They currently have 55 patients out of their Platteville office and take all insurances in the county but do not take Cigna, which is mainly out of Dubuque, Iowa.
Katie Reuter, the director of nurses and Pat Balk, service coordinator, spoke about Homeward Bound out of Lancaster. They are a private family owned company and have been in business for 19 years in July. They cover nine counties and have around 140 patients in all counties combined. They are not only a home health agency but they are a support home care and personal care agency such as providing housekeeping to patients. They are also available 24/7, weekends and holidays. Reuter stated how Homeward Bound could do many of the same things Home Health United could do. They have a negotiated pay for people who cannot pay or do not have a lot to pay. They take all insurances except Dean TPA.
Monroe Clinic Home Care was explained by Stephanie Kleppe. The home care program has the backing of the Monroe Clinic Hospital. Kleppe said that they were not there to take away patients but try and help out in any way they are needed. They cover six counties with only part of Lafayette going to Argyle, Gratiot, South Wayne and Browntown. They would have to look at staffing and territories that need to be taken care of to consider covering all of Lafayette County if offered. They have a total of 120 clients and are expanding their hospice program in Monroe. Kleppe was not there to make promises but wanted to offer their support. They take on people that cannot pay or have no insurance because they are a not for profit organization.
Laurie Unbehaun and Karl Pustina spoke on behalf of Upland Hills Home Care & Hospice out of Dodgeville. They echoed what Kleppe had stated about how home health care done in the community is the best thing for the community not only getting the face to face relationship but for economic growth. Pustina reiterated what the other home care agencies stated: that it was a tough decision for the county and they would be there to help out and be supportive. They provide similar services to the other agencies as well. They are connected with Upland Hills Hospital in Dodgeville. Over 30 years ago they took over Iowa County’s home care services. They have a foundation to help those who are unable to pay. Unbehaun added that they do cover many parts of Lafayette County.
Mercy and Finley Hospitals out of Dubuque, Iowa were competitors in the area last year. Currently they are not taking any new referrals for this area. Finley is only taking referrals within their hospital. Both hospitals are struggling with staffing issues and will not be coming into Wisconsin.
Hospital Administrator Julie Chikowski commented about how home care is vital.
“The way of the future is home care. We have got an aging population where people want to stay home. It is vital. But we also have a huge nursing and resource shortage. If we can build relationships with other agencies that are going to come in and assist us, that’s a win-win for all of Lafayette County,” Chikowski pledged. She added that there needed to be some stability for the nurses and staff of the home care program, so they didn’t have to worry about every time they turn around, if the agency would close.
Board member Carol Korn understood the financial situation but wanted the county to do whatever it could to sustain the home care program.
Chairman Jack Sauer mentioned that he is a big supporter of the home care program, having experience with his father needing home care. He said how this issue has gone back and forth for a long time. He also had the question of where is the money coming from or how would they find the people. There are only 7 counties in Wisconsin that have their own home care program, including Lafayette and only one other county has a county owned hospital; that being Rusk County.
Bev Anderson commented that this isn’t all about home health care.
“When is Lafayette County going to say, we have to buy the services ourselves because we keep sending our money out and economics 101 says, you try to generate the money within,” Anderson stated. She also added that every time the county is sending the services other places “we are making ourselves weaker. I wish I had some solution. Nobody’s going to tell me that even in this county, you people or any of us don’t have the intestinal fortitude to bite the bullet and do something ourselves. I don’t know what’s happened to us.”
“We are struggling. It’s really, really hard. We feel a sense of failure and I don’t want anyone to think that everybody sitting here hasn’t tried,” Annie Timmerman from the Health Department said commenting on the hard work done by other members of the Health Department.
Board member Tony Ruesga commented that many of these decisions should have been taken care of a long time ago and this responsibility falls back on the county board.
“The reason we don’t have the nurses here is because we are not competitive. We are not competitive in a lot of areas. We need to keep finding ways to keep people here. We have dismantled it piece by piece. If that continues to be the trend, then someday we will divide each other up and we will be a part of Green, Iowa and Grant County where the decisions will be made.”
Boyle explained what is currently happening with the Health Department. They will be closing applications for the Health Officer position on June 17. The department has been using Grant County’s Health Department director Jeff Kindrai as an interim director. He commented on the tension and the low moral throughout the department. There is currently only seven staff members and no one to lead them. Timmerman said it would be ideal to see everything that went away: three full time RNs, a home care supervisor, and increase billing clerk back to full time. That would cost roughly $270,000 not including what it would take to have an entire revitalization plan, which would be closer to double the $270,000.
“We don’t know what we aren’t doing right now,” Timmerman explained without having a director.
Maura Trimble thanked the staff of the Health Department for all they have done.
“These guys are just absolutely exhausted. My recommendation to you as the former interim Health Officer/Director, Home Health Supervisor, is to close the program. While I understand what you are saying, at this point, we are past the ability to remold and function. Passion doesn’t always pay the bills,” Trimble said.
Boyle read resolution 16-16 “To Revitalize and Continue the Lafayette County Home Care Program”. It failed with a vote of 10-3. Korn, Ruesga and Boyle voted yes with Leon Wolfe abstaining.
Boyle then read resolution 17-16 “Phase Out and Terminate the Lafayette County Home Care Program”. Before the vote was cast, Larry Ludlum asked if there was any middle ground. Steger answered the board discussed it but at this point there is no idea of where the middle ground would be. It passed 11-2 with Korn and Ruesga voting no and Wolfe abstaining.
The phase out of the Lafayette County Home Health will be completed December 31, 2016. The audience gave the Health Department a round of applause for everything they have done for the county.