Facing the triple whammy of growing demands because of the sick economy, budget cuts and the possibility of pandemic swine flu, public health officials say their agencies are being pushed to the limit like never before.
“Today, it all seems a little overwhelming given the surveillance we’re doing with the swine flu,” said Heather Henke, administrator for the Barber County Health Department in Medicine Lodge.
Henke runs the five-person agency but also works as one of its three nurses. The other two positions are support staff.
Even without the possibility of H1N1 flu spreading to her county, the health agency there was being stretched thin, Henke said.
Layoffs in the oil patch are creating new demands. The school district was facing state budget cuts and had to lay off the school nurse and several other people. The health agency will now take on what it can of the school nurse’s chores.
“A lot of times (in rural Kansas), public health is one of the only face-to-face agencies in the community,” Henke said. “So we have a lot of clients that use to be SRS clients coming to us for the same services. We actually have one employee who does just that, foodstamp outreach. We handle HealthWave applications a lot.”
HealthWave is the state’s health insurance program for children from low- and moderate-income homes.
State payments to counties are expected to decrease. And Barber County, which like most provides much of the funding for the local health agency, faces a declining tax base.
“We’re expecting a decrease in our (county property tax) valuations,” Henke said. “We’re planning on a funding decrease. I only hope to be able to employ the five we have here so they can provide their families with insurance and good health care, so we don’t fall into the trap of being users of the services instead of providers.”
The problems aren’t confined to rural counties.
“There’s a lot more being put on the plate of public health and the funding is not increasing to meet the need, ” said Eldonna Chestnut, president-elect of the Kansas Public Health Association and the director of Adult and Child Care Facilities with the Johnson County Health Department. “We’re concerned about unfunded mandates, if you will — ‘Here, public health, you need to address this issue, and meet growing demands of our population.’ As our economy gets worse, our needs increase, but the funding isn’t there to match it. It’s like an unfunded mandate, if you will. You’re expected to do more, but you’re not given the money to do it. Counties are making cuts, looking for what they can do without, yet, at the same time, we’re working with the population that has the highest needs at this point.”
The concern is widespread.
“This experience that we’re undergoing creates great concern for me,” said Roderick Bremby, secretary of the Kansas Department of Health and Environment. “As we go through these budget reductions in the public health sector, it undermines and harms the infrastructure.
“We don’t have the redundancies that other sectors may have to get other people involved to do this work,” he said. “Oftentimes, people don’t understand the value of this work and they may think of it as another social service. But as we think about public safety — police and fire — we really need to get into the public mindset that public health is also part of that public safety spectrum.”
Backstops weakening
State government and other local units such as counties and school districts are all reeling from the same problems besetting the health departments – growing demands and ailing budgets.
State legislators currently are trying to cure an estimated $328 million budget deficit. The House on Friday rejected a budget plan that would have meant 5 percent, across-the-board cuts for most programs and 3.3 percent in additional cuts for public schools.
They’ve been warned that all sorts of services will suffer: Maybe fewer meals for the elderly, fewer mentally ill persons treated, disabled persons waiting longer or not receiving services that help them remain independent.
“The situation keeps getting worse,” said Rep. Pat Maloney, D-Kingman, whose district includes Medicine Lodge.
“There are a number of school districts in my district,” Maloney said. “Kingman is the largest and probably the wealthiest and it is faring better than the others. But you take the Havilands, the Coldwaters, the Medicine Lodges, the South Barbers, in those districts, their budgets are maybe $3 million and you go taking 10 percent out of that district, they don’t have a lot to work with.”
Medicine Lodge school district officials a couple of weeks ago decided to lay off 12 people, including the school nurse.
“That’s happening all across my district,” Maloney said.
Even the wealthiest school district within his legislative boundaries is paring staff.
“My wife is a teacher and at Kingman they had two teachers at the high school level retire and they’re not going to replace them. Does that mean you bring someone in who isn’t a math teacher to teach math in the high schools? That starts creating problems for education.”
Maloney said he’s heard from seniors, school superintendents, public health officials and others worried about strained budgets.
School cuts
“The Legislature talks about cutting $100 from the state base aid per pupil, but for small rural school districts like us — because of how the formula and all the different weightings work — we’re looking at a $150 cut in base state aid,” said Jerry Cullen, superintendent of the Medicine Lodge school district.
“There was only one reason we laid her off (the school nurse) and that’s because we can’t afford the position,” Cullen said. “We let her go and we’re going to rely on health department services and contracted services to fill the gap.
“Was it a popular decision?” Cullen said. “Was it a something I wanted to do, to let our school nurse go? No, I would love to keep her, she does a fantastic job, but that would also describe some of the (teacher) aides I had to let go, some of the teachers I had to let go, some of custodians I had to let go. This is all about money. The state’s got to find a way to balance its budget. I’ve got to find a way to balance my budget.”
-Mike Shields and Dave Ranney are staff writers for KHI News Service, which specializes in coverage of health issues facing Kansans. They can be reached at mshields@khi.org and dranney@khi.org or at 785-233-5443.