Public Health director defends home health services

Public Health director defends home health services

Southeast Iowa Union offers audio versions of articles using Instaread. Some words may be mispronounced.

MARENGO — After hearing that the Iowa County Board of Supervisors discussed cutting home health services earlier this month, Iowa County Health Department Director Lorinda Sheeler defended her department to the board.

Iowa County Supervisor Abigail Maas, a member of the county Board of Health, has suggested for months that the county consider dropping home health care — which is not required by the state — to save money.

Maas suggested earlier this month that the Public Health department could cut employees if it didn’t provide home health services.

Sheeler said Friday that she wished Supervisors had talked to her before debating the issue in public. Now Sheeler’s staff is afraid of layoffs, she said.

Sheeler felt the need to explain what the health department does and why.

By law, the health department has to conduct community health assessments. Following this year’s assessment, and several suicides, the Health Department prioritized brain health and prevention of suicides.

“We founded the Brain Health Coalition of Iowa County,” Sheeler said.

The state has mandated that county health departments conduct disease surveillance, following up on animal bites and rabies prevention and following up on diseases to stop their spread.

That includes a pertussis outbreak in Iowa County schools this year, said Sheeler.

The disease is prevented by vaccine, but there is vaccine hesitancy out there, said Sheeler. Health Department staff identifies the cases and conducts interviews to find out who might have been exposed to the disease by the carrier.

Kevin Heitshusen

Kevin Heitshusen

Public Health had four confirmed pertussis cases in Iowa County, said Sheeler. And those are just known cases. Not everyone sees a doctor for it, she said.

Public Health nurses treat TB patients. “Last year we did have one case in our county,” Sheeler said.

Public Health conducts immunization audits, making sure that children in day care and in schools have valid certificates as required by state law.

Public Health works with Emergency Management. Last year the agencies were able to get a grant of $25,000 to buy eight automated external defibrillators which have been placed in several communities in the county.

Public Health has trained more than 300 school stop members in stop-the-bleed procedures and provided stop-the-bleed kits to schools. According to The American College of Surgeons, their Stop the Bleed program can save a life.

Jonathan Degen

Jonathan Degen

The number one cause of preventable death after injury is bleeding, the American College of Surgeons says.

Home health

Iowa County started home health care services in 1975, said Sheeler. It offers nursing, bathing and homemaking, but not all three to each client. It provides whichever kind of care the client needs.

Home Health served 120 people in fiscal year 2024, said Sheeler. Of those, about 38% (46 people) are on a sliding pay scale based on their income. Some pay nothing, said Sheeler. Some pay close to full fee.

Sheeler conceded that home health services are not required by the state, and some counties have chosen not to provide it.

Iowa County has 16,400 people, Sheeler said. About 20% are on Medicaid. (3,200) and 20% are over 65. Of the latter, about 12% have some degree of Alzheimer’s.

There’s a lot of caregiver stress in Iowa County, Sheeler said.

Sometimes it’s not safe for people to stay at home, Sheeler said. Then they have to do something else.

“We have 225 long-term are beds,” said Sheeler. But nursing home care is not covered by most insurances. Medicaid will pay, said Sheeler, but not until assets are liquidated. A patient would have to lose the family farm to go to a nursing home.

Home health is important for those who have no other option, Sheeler said.

Sheeler said she knows that 120 people doesn’t sound like a lot, but many clients receive services two or three days a week. Public Health staff made 5,000 home visits.

The average time a person uses home health services is 16 months, said Sheeler. That means they were able to stay in their homes for an additional year or more.

Home health care is a last-ditch effort to keep a person out of a nursing home, said Sheeler. One client has been using it for 13 years.

Home health also provides services for people who need help for a few weeks following a surgical procedure.

In fiscal year 2024, the health department had actual expenses of $762,193, and actual revenue $302,352 for a deficit of $459,841, said Sheeler.

But 18.25% of that budget is public health services which is mandated by the state. The amount saved by discontinuing home health would be less than that, Sheeler said.

Public Health is currently not at full staff. It employs two nurses aids, a half-time nurse and a nurse that works 3/4 time, said Sheeler. One nurse recently resigned.

Some of the staff is making only $14 an hour, said Sheeler. Their benefits cost the county more than their pay.

“I don’t like looking at numbers because numbers don’t look large,” said Sheeler. The state has a point system to judge how much work is done based on what task is performed and the time it takes to complete it.

Maas said she understands the emotional side of the issue. She’s known people who benefited from home health care.

But looking at the numbers, Maas doesn’t know if the county can sustain it.

Supervisor Kevin Heitshusen said he doesn’t want to see people unable to get services if they need it.

Supervisor Jon Degen noted that supervisors control the budget but they need help from county departments to keep costs down.

The county could cap the money, said Sheeler, and when the health department runs out of money it will have to stop providing services.

The decision to discontinue home health services should be up to the health board, not the Board of Supervisors, Sheeler said. In addition to Maas, the health board consists of Jodi Matthew, Tanya Powell, Dr. Steven Rippentrop and Teresa Sauerbrei.


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