During recent budget discussions, the Island County commissioners questioned the county’s role in home nurse visits currently provided through public health’s maternal child health program.
Through this program, a nurse visits the home of new mothers who are having trouble with breast feeding, have behavioral issues or are experiencing other circumstances that warrant a referral from a pediatrician or the hospital.
The nurse previously fulfilling these services left the job over two months ago, and while the position is vacant the commissioners discussed whether or not the program should continue.
“I don’t question the value of the program,” said Commissioner Rick Hannold. “I question what part county government is responsible for.”
No other organization is currently fulfilling these types of services, said Keith Higman, health services director. To avoid a significant lapse in services, the commissioners gave approval to fill the position. However, Commissioner Jill Johnson said that the new employee should be aware the position might be changing.
The commissioners expressed interest in WhidbeyHealth playing a bigger role, either by delivering the services, or paying for their delivery.
“A majority of this board feels the hospital needs to step up and do what they need to do,” said Johnson at the meeting.
The commissioners directed Higman to approach the hospital with ideas for either co-sharing costs or having one of its personnel do home visits instead.
Geri Forbes, CEO of WhidbeyHealth, said the types of home-visit services provided are typically fulfilled by pubic health departments in counties across the country.
“That’s outside the hospital’s scope of practice for pediatrics,” she said. “We don’t even employ pediatricians.”
Forbes said the hospital would potentially work with the county and other health care providers to identify possible gaps in care.
“We are always willing to come with other providers of care on the island and talk about what we as a group can do to improve things,” she said.
Long-term studies of children in families who receive these services have found that, in addition to having improved health outcomes as infants, later in life they are less likely to drop out of school or end up in a juvenile detention center.
“They were much more likely to be productive members of society than be less productive members of society,” said Higman.
The county spends $99,000 annually on this position, with $54,000 going toward salary. Higman plans to give a presentation to the board outlining the research around the cost-effectiveness of this type of prevention. He said because benefits occur so long after the service is provided, it can be difficult to measure how effective it is.
“When we’re preventing bad things from happening, in many conversations it’s difficult to count or see the benefit,” he said. “It doesn’t mean that prevention isn’t a worthy investment of resources.”