In 2004, the Northwest Colorado Visiting Nurse Association will see patients fighting cancer, children who need immunizations, upped protection against West Nile virus and more.
But whether the VNA's budget will allow the agency to maintain the quantity and quality of services it has provided in the past remains to be seen.
The organization's 2004 budget includes a nearly $250,000 deficit, which exists after all possible cuts have been made, VNA Director Sue Birch told Routt County commissioners last week.
"We are absolutely bare bones," Birch said. "We are absolutely bare bones (in terms of) staff."
The cuts from the agency's $2.7 million budget leave the agency with expenditures that are almost $350,000 less than 2002, and about $100,000 less than what was budgeted for 2003.
The 2004 budget that Birch and VNA consultant Ed Townsend presented last week has not been approved by the VNA Board of Directors. That approval likely will take place Monday.
Though the budget Birch presented looked grim, she said she was optimistic that grants and individual donations would get the association through the tight year.
"We do a tremendous amount with very little, and we're optimistic that we'll really get through these tough times," she said.
Why a tough year
The tight budget is a result of several factors, Birch said.
First is the downward trend in federal funding that has taken place since the Balanced Budget Act of 1997, Birch said. Federal payment methods also hurt low-volume providers such as VNA, she said.
More recently, state funding sources have been shrinking. Along with that, some funding sources have become unstable with the state stopping and starting programs abruptly, making the VNA's budget process more challenging.
Such budget woes may mean little to the growing number of people who are seeking VNA services as they struggle to make ends meet in a difficult economy. But, many will find themselves without help because the tight state and federal budgets mean only very low-income families can qualify for many assistance programs, Birch said.
And finally, because the cost of living in the area has risen and because nurses are in high demand, nurse salaries need to increase dramatically
"Visiting Nurses would love to be operating at about a $3.5 million budget, and we feel like that would really be in the community's best interest," Birch said. "But our federal and state funders aren't able to afford us that opportunity, so we're put in the position of having to continually look to foundations and individuals and the community to keep us moving forward."
One example of a program that is challenged by federal and state funding cuts is the VNA's immunization program, which protects children from measles, mumps, polio and other illnesses. That program is expected to cost the agency about $63,000 in 2004 -- $26,000 more than what the VNA can afford to budget.
A few years ago, the state and federal governments provided between $50,000 and $60,000 for immunizations. Now, they provide $5,000 for the entire region.
"It's absolutely outrageous to me that we don't have base immunization funding from the state and the feds," Birch said.
The VNA serves mostly Routt and Moffat counties, with some services extended to Rio Blanco, Jackson and Grand counties.
Among the most expensive programs it provides are home-care services, the nurse family partnership program, which connects nurses with young families, Routt County school district services and general public health services. General public health services include home visitations, new mother services and communicable disease control.
One of the association's roles is to provide public health services to Routt County, which is a county responsibility. Because of those services, Routt County contributes about $175,000 to the program, County Manager Tom Sullivan said.
The VNA is not alone in the difficult year it's facing; local governments and organizations across the state and nation are being forced to make cuts, he said.
But the services the agency provides are ones that would be very difficult to cut.
"If we can't provide an adequate level of service for everything on that list, what gets cut out?" Sullivan said. "It's a tough decision. We're providing for folks who basically have no other options."
The list of important programs includes prenatal services the agency offers to pregnant women with limited needs. The program aims to decrease infant mortality and expenses of poor pregnancy outcomes by advising mothers to live in healthy environments, to stop smoking and to get out of difficult situations.
The services, she said, are cost effective. Providing a woman with prenatal care that may prevent a problem birth costs about $2,000, including delivery. But if a baby is born with problems, the average cost is $25,000. Despite the return on investments, state legislatures won't cover the program's full cost, she said.
"Our government has to come to grips with some of these preventative programs and somehow start capturing the long-term impacts of prevention, and they're not willing to do that," she said.
The story is the same for many of the agency's other programs, which help children and the elderly stay healthy, assist children with special needs, provide for family planning as well as periodic screening and diagnosis services, and more.
The workforce challenge
One of the bigger challenges the VNA faces is with its workforce. Not only has the association had to cut staff, but it also has been unable to pay its nurses competitive wages.
Over the past few years, the agency has reduced its staff to 40.8 full-time equivalents. That means the agency went from 98 employees a few years ago to 60 this year -- what Birch called "a huge work-force decrease for what we need to do."
More work-force cuts, she said, are out of the question.
"We've held the line over the years by decreasing our work force, but we can't continue to do that and run safely," Birch said.
But keeping employees presents a challenge of its own.
In the past year, the agency had a 33 percent turnover rate.
Competitive starting salaries for nurses range from $25 to $30 an hour, with attractive benefits and increased pay plans on top of that. VNA pays $20 an hour.
Cuts have been made to save money wherever possible, Birch said.
For instance, the VNA recently switched to Pacificare to save on employee health insurance. Though that means the agency is not competitive for the quality of health insurance it provides, it has allowed the VNA to continue to provide insurance for employees.
One suggestion for saving on funds would be to bring VNA under the umbrella of the county's health insurance. Birch said that any way the county can assist, whether letting a nurse borrow a county van if one of the agency's breaks down or continuing to write letters of support for grant applications, would go a long way.
The nonprofit agency is constantly submitting grants to fund its programs. Already, about $150,000 in grant requests for 2004 have been sent out, Birch said.
It relies heavily on help from key donors such as Routt County United Way and the Yampa Valley Community Foundation.
But overall, decreased revenues could mean less quality service or just less service.
"What we will look to next, if we have to, is to eliminate whole programs," Birch said. "We don't think that's in the community's best interest, but we do have back-up plans if we were to take further cuts."
Birch said that in the past, the agency has seen waves of no-frills budgets that are followed by recovery periods. But now, she said, she's not sure when or if that recovery will come.
"I don't see a lot of recovery here in sight," Birch said. "I'm just worried that the recovery may not be for quite some time."
To make a contribution to the Northwest Colorado Visiting Nurse Association, call Sue Birch or Jennifer Fritz at 879-1632.