The Dallas County Board of Supervisors held its regular weekly meeting on Tuesday, Dec. 5 in Adel and took time during the meeting to hold a joint conversation with members of the Dallas County Board of Health about issues they are facing, and how County leadership can help them better meet the health needs of Dallas County.
Bruce Thorsen, member of the Board of Health said that the Department of Public Health brings “significant value” to the growing population in Dallas County but that there continues to be hurdles and roadblocks in their way when it comes to their reorganization efforts.
The Iowa code provides public health departments across the state a certain degree of autonomy when it comes to staffing, as the Department of Public Health does not need to have all of its hiring requests approved by the Board of Supervisors like other departments.
The Department of Public Health decertified its home care services officially on Oct. 31 and will continue billing out until Dec. 31 of this year. Kelli Vellinga, executive director of Dallas County Public Health Nursing Services said that they want to be able to transfer the two nurses and the project assistant they have in that department to be full-time in the Public Health Program, which was voted to be done by the Board of Health.
“I would not be able to complete the work required by the State of Iowa without those staff members,” Vellinga said.
Among other things, Dallas County Public Health gives vaccines to the children in the area and since Oct. 20 alone, Dallas County Public Health nurses have administered 204 vaccines, according to Vellinga.
One of the big “roadblocks” that the Public Health Department is facing is a lack of staff due, in part, by offering low salaries to new employees. This has also, according to Board of Health members, contributed to the decertification of the Home Care services.
Before decertifying its Home Care department, the Department of Public Health attempted to hire new nurses to keep the program afloat but Vellinga said that they only received two applicants. She said that the department compared salaries of other home care nursing jobs in the area.
“Our highest range on our salary for a home health R.N. was not at the lowest starting range for our competition,” Vellinga said.
Thorsen said that the home care services were costing the County money because they only had two nurses on staff to provide those services while there are 20 competitors out there in the private sector.
Another major issue they were facing in home health care, due to a shortage of staff, was in the area of compliance. A compliance mistake in home health care could cost the County as much as $10,000 per day in fines which the department wanted to avoid.
“One of the things that bothers me is that we are very ill prepared for a pandemic flu,” Thorsen said. “We need to be thinking of things like that rather than who’s in touch with the right policy.”
Dallas County Supervisor, Kim Chapman, said he believes avoiding compliance issues was a good reason to have the home care services shut down. He stated that it didn’t bother him to have that service shut down.
“People that know me know that I’m not a big supporter of government doing functions, doing things that the private sector can and does do,” Chapman said, “and many times they do it very well.”
Board of Health Chairman, Roger Zobel said that the Dallas County Public Health currently operates on about $3 per capita.
“If you go to any other county in Iowa, you’re going to find much larger numbers. If you go to any other county in the United States you’re going to find a much larger number,” Zobel said. “We feel we’ve given much more value but we still have the same amount of income coming in on the county side that we’ve had for years and I’m not convinced we can do that much more going forward.”
After looking at the Dallas County Employee Handbook, Thorsen said that he thinks there is a need for an addendum that covers the Iowa Administrative Code, what the Public Health Department’s responsibilities are in terms of their personnel, which would create some clarity for the Department and the Board of Health.
A policy that was discussed was in regards to posting available jobs. Sometimes there are jobs available that Vellinga prefers to post internally and hire from within for, but Chapman warned that that could jeopardize State and Federal grants for the Department and possibly for the whole County, and that they should follow County policy and post those jobs internally and externally.
The Supervisors and the Board of Health plan to have further discussions at later dates.