Chisago County discontinues Home Health Care Services

Patients shifted to for-profit health care providers


When August ends, so will Home Health Care in Chisago County.

Effective August 31, the 60-plus people who receive in-home health services from county employees will need to find private companies that offer the same services.

And the county nurses, physical therapists, occupational therapists, home health aides, and independent living skills staff will need new jobs.

A Chisago County press release lists the reasons for discontinuing the services:  changes in state and federal regulations, the development of private sector service providers, declining client enrollment for a government provided service, changing needs of the population seeking care, and growing fiscal challenges.

County Administrator Bruce Messelt said the county’s move is part of a trend.  “Individuals are moving away from government-provided health care,” he said.

“Our service model is not in demand,” Messelt continued.  “Clients want service 24/7; we tend to be 9 to 5 Monday through Friday.  We’ve had only nine new referrals this year,” he said.

According to the press release, until the early 1980s almost all of Minnesota’s 87 counties offered home health care services.  Today only about 15 counties do.

Winona County recently decided to discontinue service, Messelt said.  He predicted that in the future, only the most rural areas, where there are no private services, will continue to offer home health care through the county.

Money is a big reason, he explained.  Leaner local governments can’t afford to subsidize home health care.  The client pays the same whether using public or private service.  The government reimbursement money is limited and goes with the client.

Private providers typically have three levels of service, Messelt said:  skilled nursing, health aides, and basic caretaking.  The county has only the top two levels.

In addition to lower average salaries, Messelt said, private providers can have a more flexible work force, with employees paid on call or by the visit.  “We do full-time with benefits or part-time with paid hours,” he said.  “We have nurses who have been here for many years, at the top of the pay scale.”

For about three months now the county has been working to ease the transition for current clients.  A case manager is assigned to each client, Messelt said.  When a new provider is found, the county nurse and private nurse talk to assure “a clean hand-off.”

The county is absorbing as many staff as possible in new roles, Messelt said.  Some are eligible for early retirement.  Job information from private companies is being provided to the rest.


Chisago County Health and Human Services Director Nancy Dahlin wrote, “When the Home Health Care program was developed in 1966, it was the right program at the right time.  Over the years, our delivery of quality service helped the citizens of Chisago County accept Home Health Care as a valuable resource for persons choosing and able to live in their own homes as they age or become disabled.”

Since 1966, Chisago County Public Health has been a Medicare Certified home care agency and a licensed Class A Professional Home Care Agency under the auspices of the Minnesota Department of Health.

When first established, Chisago County was the county’s only available Medicare Certified/Class A provider.  In recent years, an increasing number of private Medicare Certified home care agencies, now about 11, are providing home health care services in Chisago County.

Since 2007, the number of clients served by Chisago County has declined by over 40 percent and the number of client visits by over 30 percent.

That, plus changes in regulations and reimbursement, has caused the program to lose money.  If the situation were to continue, 2012 program expenditures would be $250,000 over revenues–about 10 percent of the $2.7 million nursing budget for 2012, Messelt said.

Washington County does not have employees who do home health care, but the county manages contracts with private providers.  Anoka County stopped offering Home Health Care Services about 10 years ago.