Dear Commissioners,

Thank you all for your efforts and time in follow up activities (emails and phone calls) with my previous communications with you. I am impressed with your individual responsiveness. I watched the meeting last night (April 19, 2021) and also appreciate that you gave Dare County residents the opportunity to voice their opinions and concerns.

During that meeting, I heard a lot of emotional presentations from citizens who have used these services, and from those who have dedicated their professional lives to Home Healthcare. I’d like to add to their comments with the demonstration of a very concrete and practical failure mode that is built into the sale of a critical health service in any rural area to a private organization. Please see my point-by-point common scenario and explanation.

1. PREMISE: Private, for-profit healthcare provider’s first priority to provide services in a delivery and billing model that generates a profit and return for the shareholders.
2. In a for-profit Home Healthcare model, the organization needs to ensure that their workforce is producing enough revenue through services that are billable, so productivity minimums will be placed on the aids, nurses, physical and occupational therapists (PT and OT) etc.  How will this common practice affect us here in Dare County?
3. Here is a very real scenario that occurs frequently in any for-profit Home Healthcare organization.
   1. Let’s say that a private company buys Dare County Home Health Services and sets a productivity target of six patients a day (this is a typical productivity number and includes the drive time, time for the visit, charting and reporting).
   2. A Home Healthcare worker leaves Manteo to visit a patient in Stumpy Point, and when nearing the patient’s house finds the road to the village blocked by high water or an accident and has to cancel the appointment for the day (not an uncommon occurrence).
   3. The worker will be required to call into the office, and another patient will be assigned (so the worker can meet the minimum productivity).  So, the worker has invested an hour, yet has recorded no productivity, and the company will expect that productivity to be made up.
   4. The worker will be assigned another patient, let’s say in Southern Shores.
   5. She calls the patient and schedules the visit for the end of the day (workday now extended another 90 minutes).
   6. The worker returns to Manteo and sees another patient.
   7. After lunch (usually eaten while charting), the worker drives to her next patient, let’s say in Salvo, and upon arriving, is told that the patient is not feeling well, and wants to reschedule (not an uncommon occurrence with PT and OT).
   8. The worker now calls back to the office, is directed to make another appointment, and does so adding another 90 minutes (now a total of three hours) to the end of the workday… to make the minimum productivity.
   9. The worker finishes seeing patients at 6:30 PM and heads home.
   10. The worker spends two more hours charting on the two new patients and finishes (hopefully) at 8:30.
4. The consequences of this type of delivery model typically include worker burnout, high turnover, and inconsistent coverage and care.
5. This is a very typical scenario that I have seen from multiple healthcare workers, in multiple for-profit organizations.
6. I recommend you look harder at how non-profits have DEMONSTRATED ability to operate in a model not driven by profit. I am not anti-profit or business, but the reality of our corner of the world is that this service will need to be subsidized (through taxation, user fees, or other revenue generating solution) to be sustainable.

In conclusion, your job as members of the Board of Commissioners is to do what is best for the residents of our county, and especially to protect those who are most at risk. Your job is not to get the best price for selling a critical service.

Please consider this scenario as the likely future daily operational reality of the Home Healthcare workforce when deciding to move forward, and its impact on the quality and sustainability of this critical healthcare service.

Thanks for your consideration.

Respectfully,
George Haber

Southern Shores

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