By Mari Radtke
Dennis Clark, O’Brien County Engineer opened up the October 17 regular meeting of the O’Brien County Board of Supervisors. Follow up about a potential loan to the City of Sutherland for repair work within city limits on M12 started the meeting. It’s been determined that O’Brien County can make lending arrangements with a city for more than 2 years. A 5-year payback is proposed to the City of Sutherland for the shoulder work it is required to pay for. The supervisors did approve the repaving of M12 from Highway 18 south to Highway 10. This improves the chances of this project not being bumped from the IDOT schedule.
Bridge work updates were provided. Supervisor Dennis Vanden Hull asked about how the rumble strips are coming. Clark reported that the rumble strips and stop lines at stop signs were to be deepened to better alert drivers of an upcoming stop sign.
Korrie Ewoldt, Public Health Director presented the board with information about the activity of the department and opened by telling the board she is also requesting an additional staff person. She showed in graph form, the obligations the department must meet to fulfill their public health grant.
The largest program currently is the “Best Care for Better Babies/Kids.” She noted that the department is also currently doing vaccine clinics in the schools. Public Health staff conducts screenings at WIC clinics and I-Smile. County wide vaccination audits at all the county’s schools, (1500 at Sheldon schools alone) daycares and preschools are required by the public health office.
She gave a detailed explanation of the difficulty in meeting all of its obligations throughout the county, noting when just 1 staff member is gone. She described how her being required to do nurse duties “hinders her efforts to be an administrator.” Additional demands on the department include increasing referrals for the “Best Care” program, funded by Early Childhood of Iowa. She showed 33 visits in recent months with additional requests coming in regularly. The department has 1 fulltime nurse, a 1-day a week nurse, the director and an office manager.
Ewoldt asked for an RN. She explained the part time nurse on staff is an LPN and limited in the services she can legally provide for the various programs. Ewoldt explained that the total cost for an additional RN comes to $86,296.00. This figure was reached with the Public Health Board and the County Auditor. The wage is not particularly competitive, but the fringe benefits are “amazing.”
Ewoldt responded to questions from Dan Friedrichsen about the I-Smile program administered by Cherokee County Public Health. Ewoldt expressed her view that she is glad that O’Brien County did not take on that grant. Ewoldt defended the need for the program while recognizing it is underfunded.
When asked by Vanden Hull about vaccinations at pharmacies Ewoldt explained that public health has the child dosage for vaccines and only some clinics.
Ewoldt highlighted benefits from the “Best Care” programs. Through the in-home visits the staff conducts to evaluate the health and development of children 5 and under referrals for concerns can be made early. Development concerns, autism or other health issues can be caught early.
A budget discussion followed. That led to updates on COVID vaccines. Public Health is currently not being offered for adults due to insurance reimbursement rates. RSV vaccines are also very expensive and not available through Public Health. Outreach and care for elder residents was discussed. Funding to county public health by the state for elder care is declining. Ewoldt also mentioned Sanford is doing some of that and didn’t know where the dollars would come from for those kinds of visits.
Supervisor John Steensma said about funding an additional RN, “It appears to be necessary.” Discussion of staff part time staff and staff time off benefits were discussed, noting vacations have been earned. Rohwer noted that the current budget could probably support an additional RN until “maybe March.”
Board member Nancy McDowell requested time to think about approving the needed nurse for Public Health. Tim Overmire stated, “I guess I’d like to think about it and then I’d like to kind of see where you are on your current budget.”
At the October 24 regular board meeting a deep dive into the Public Health budget provided insight into the department’s spending. Start out, Ewoldt felt there is a risk that mileage spending might go over. Operations, funding and expenses of lead testing was examined. That activity is part of a different grant administered by Cherokee County. The lead testing requirement is new. There was also discussion of the $88,000 IT grant Public Health must spend before the end of the year.
A long discussion about funding options for door locks and cameras came in context to the IT grant. The security spending has to come from Emergency Preparedness grant.
Vanden Hull stated that the requested funds for a new employee would increase the budget by more than 22%. He went on to ask about the increase limitations imposed by the state. Iowa has issued a policy that budget increases can not exceed 106% of an existing budget. That limit will be imposed in the 2025 budget year (begins July 1, 2024). According to Rohwer that they don’t know exactly how the formulas will work out. She also noted that the state is expected to impose severe growth restrictions on cities and counties. Good comparisons with other county public health departments are not an option due to the variety of local hospital involvement, population and other variables.
Friedrichsen compared Public Health staffing/demands to other offices in the court house, noting that he didn’t see other offices asking for additional help even though being busy. Ewoldt said she understood the position of the county but said, “This isn’t going to go away.” Rohwer shared comments at a conference made by Ahlers and Cooney that policies for downsizing are advisable due to actions being taken by the state legislature. Rohwer again suggested taking a new look again in 3 months. The conversation became about the legislatures goal of $0 state income taxes.
Ending the “Best Care” program would cost O’Brien County $90,000 and health care needs might not be met, according to Ewoldt. Every grant has certain obligations to be met. If the county doesn’t offer certain programs the county would have to pay a different county to provide the services.
For budget reasons, the request to hire a second fulltime nurse was declined.
The board of supervisors approved a few ARPA funding requests. The committee approved $50,000 to Public Health for an office remodel and $45,500 for additional security on the door locks.
Public Health has been asking for more space for over a year. One of their biggest concerns is that they do not have a HIPPA compliant exam room. Early in the ARPA funding process there was a big effort to identify available space outside the court house to provide proper Public Health facilities. A rumor that Public Health will be regionalized has put a stop to O’Brien County’s ARPA committee considering meeting the Public Health need.