Without much fanfare, Dallas County’s home health nurses closed up shop Oct. 31 after 48 years of bringing skilled nursing care into the homes of county residents.
“It’s hard,” said Kelly Vellinga, director of Dallas County Public Health Nursing Services. “It’s really hard after being here for 48 years. For a long time we were it.”
But the home health field has gotten crowded in Dallas County. Twenty agencies now deliver home health services in different parts of the county, and some of them have much deeper pockets and wider networks than the county public health department.
“As a small agency trying to compete with the large companies, we just don’t have the staff or the financing to do that,” Vellinga said. “Many of the agencies have a broad base and network for documentation specialists, people that code, people that bill. They have a large infrastructure where we just don’t have that. I have one biller. If that person is out, I’m in big trouble. I have one coder. If they’re out, I’m in big trouble.”
Home nursing care was just one of a large number of essential public health duties that Vellinga and her team do — and will continue to do — for county residents, including health navigation, maternal child health home visitation, communicable disease surveillance and investigation, immunization services, emergency preparedness activities and community health needs assessment and health improvement planning.
“How do you find your niche and do it really, really well instead of trying to be everything to all people? That’s the challenging decision point we had to come to,” Vellinga said. “That was something we just had to take a hard look at. I would have rather that we could have done it all. It isn’t something that anybody wants to do, but it just became clear when I couldn’t compete with salaries. The decision was made by the board of health. It wasn’t something that was done quickly and not without a lot of thought, deliberation, research and assessment — and a lot of tears. I tell you, there’s been a lot of sleepless nights and tears. It’s been tough.”
The winding down began in August, with the county’s 55 home-health clients, virtually all Medicare patients, making a smooth transition to other agencies, Vellinga said. Most of the home health nurses have also resigned, some taking 20 years or more of experience with them, while a few were moved from the home health side to one of the public health programs.
The handoff of home-care patients was done “slowly and gradually and very thoughtfully with other agencies,” Vellinga said. “They’ve been great to work with. And we made sure that they were set up and admitted and there’s continuity of services. There’s no break in care.”
Although the change marks the end of an era for the Dallas County Public Health Department, Vellinga said there is much cause for joy and pride and remembering figures such as Margaret Felton and Ruth Oelrich, the county’s first and second public health nurses in the 1960s.
“We would love to celebrate what we have accomplished and all the lives that we have touched and made a difference in,” she said. “We’re saying, ‘We went out strong and did the right thing.’ There was a time when we were the only ones here.”
The challenge going forward is to find the best niche for the Dallas County Public Health Department. The basic question is: “Where can I do the greatest amount of good for the greatest number of people in Dallas County?” Vellinga said. “Because I work for 85,000 people. That’s why we’re here.”
One promising niche for the county public health team to fill is in health navigation services, and they have already shown excellence in that line with the 2017 Model Practice Award they won in July at the annual conference of the National Association of County and City Health Officials.
Health navigation “is something we provide that other agencies don’t, but it really enhances and improves the quality and safety of patient care,” Vellinga said.
Jennifer Walters, population health administrator with the Dallas County Public Health Nursing Services, said health navigation takes a holistic view when considering the factors affecting health.
“This service fills a critical need for residents in Dallas County,” Walters said, “by serving as an extension of the medical care received in the hospital or clinic, but we focus more on transportation, food, housing, employment, mental health services and other community resources. We expect this service to continue to grow and expand with Dallas County’s rapid population growth.”
Vellinga was similarly optimistic about health navigation as a model practice for Dallas County to excel in.
“Nowadays with public health, we see that your zip code has more to do with your health than your genetics,” she said. “So we’re looking at access to healthy food, access to healthcare, access to transportation and what we can do, as a county and as a community, to make sure everybody has an opportunity to be healthy. And that’s where public health comes in.”
While Dallas County Public Health Nursing Services might need to change their name and the department’s letterhead in light of their reorganization, their mission appears to be as fixed as ever, yet they could no more resist the force of the marketplace than could the Dallas County Care Facility, once known as the county poor farm.