The Dubois County Health Department has had to cut a nursing position and slightly increase its fees to make sure its income can cover the department’s expenses.
“We are still a very top-notch department, even with having to curtail some of the services,” said Donna Oeding, administrative director for the health department. “It will never go all the way away. Those things are still happening. They just aren’t happening with as much time and personal resources focused at them.”
The biggest change has been the elimination of a nursing position from the department. That nurse was the primary immunizer and was at the health department every weekday to do immunizations. Now that the position has been eliminated, “we’ve had to shift those responsibilities amongst the rest of the staff,” Oeding said.
The nurse also did the community outreach activities. She served on mental health and aging committees. She did the Community Connect after-school program in Huntingburg and was the department’s representative on a local Latino collaboration group. She worked with a lot of local businesses and staffed a booth at different businesses’ health fairs.
“We’re trying to keep that going, so a lot of that will fall back on me,” Oeding said.
With that elimination, job duties had to be shuffled around, and some outreach services had to be scaled back or stopped. One such program was a family outreach service in which a nurse would go to Memorial Family Care one day a week to work with pregnant moms who were at risk due to their poverty level and limited access to health care. The nurse would talk to the moms about services that are available to them.
“We don’t go to Memorial Family Care a whole day a week,” Oeding said. “We will go if the hospital or schools call us with someone that they are concerned about and believe needs extra attention. But we are not going one day a week anymore.”
Another job that has been put on the sideline is the work needed to complete the department’s voluntary accreditation status each year. The department still does update its policies for the department, but it does not actively pursue the voluntary accreditation.
The number of days a nurse goes to the Dubois County Security Center to care for inmates has also decreased from every weekday to three days a week.
“The staff changes are heartbreaking,” Oeding said. “But the only way to make significant budget changes is in the personnel category.”
Fees for vital records, permits and immunizations have increased some. For instance, the cost to get a copy of a birth certificate increased from $10 to $15; the cost for a death certificate increased from $12 to $15. The cost of vaccines also increased a little, by varying numbers. But vaccine costs are usually covered by insurance, so the average person will not notice a change, Oeding said. She expects all the changes to bring an increase of $40,000 in income.
Oeding has been able to negotiate with the department’s vaccine billing provider, VaxCare, to receive an additional $2 per vaccine dose administered, which will generate and additional $15,000.
In 2018, the health department will receive about $72,000 from the American Cancer Society from an anonymous donor. The funding is to address HPV immunization rates in the county (HPV infection can cause cervical, vaginal, and vulvar cancers in women and penile cancer in men). So long as the department keeps up its work on this matter, it will get the funding for the next four years. Oeding plans to use the money to cover the salary and benefits of one of the department’s existing nursing positions, a $57,000 cost.
The department’s financial problem has been creeping up over the last few years. Expenses have steadily increased while the amount of revenue coming in has been decreasing; that decrease includes a reduction in tax revenue the department receives from the state each year. Tax funding has steadily decreased, from $520,000 in 2012 to $360,000 in 2016.
“With the (property) tax caps, that isn’t going to change,” Oeding said.
The first year the revenue didn’t cover the expenses was in 2015, when the shortage was $158,000. In 2016, the shortage totaled $180,000. And the department’s bank balance is starting to decrease as well. Back in 2014, the balance was at $964,000. In 2016, it’s at $625,000.
“We have a healthy balance,” Oeding said, “but it won’t last if we use it to cover yearly expenses that our incoming revenue doesn’t cover. These kinds of deficits would erase that balance in a matter of a few years.”
Using the money in the bank balance to cover yearly expenses will eventually deplete that balance, and there won’t be anything left to cover emergencies, like a sudden outbreak, she said.
“The only way I can adjust that is to adjust what my income is, and reduce my expenditures,” Oeding said.
So far, Oeding said, she has not received any complaints about the changes, most of which went into effect a couple of months ago.
Oeding expects her department’s expenses to be about $57,000 more than its income by the end of this year, which is a big improvement from $180,000. By the end next year, she is hoping that her income and expenses will be just about even.