Leaders of Douglas County Visiting Nurses Assn. will meet this week to make sure they’re on track for a balanced budget by the end of the year.

But if the numbers don’t add up, the agency could be forced to swallow some harsh fiscal medicine and start cutting services that dozens of uninsured, elderly and homebound people have come to rely on.

The agency’s Home Care Support Program — its client list already frozen because of dwindling funds — could be forced to pare its services without an injection of new financing, said Belinda Rehmer, secretary of the agency’s board of directors.

The home-care program, which helps people take medicine, bathe and otherwise live comfortably in their own homes regardless of ability to pay, now has 113 people enrolled. At least 84 already have been turned away, and even deeper rejections could be on the way.

“You don’t want to have to say no, but in reality we’re going to have to say no,” Rehmer said. “And that’s the plan. That’s part of one of the plans that are out there: We’re just going to have to start saying no. And that hurts. We don’t want to have to do it.”

Board members are scheduled to meet at 5:30 p.m. Wednesday to review the agency’s financial condition, nine months after Visiting Nurses stopped taking new patients for the home-care program, cut managerial salaries, eliminated employee pay raises, stopped making contributions to employee retirement funds and slashed overtime pay.

The cuts have the agency on course for a balanced budget, Rehmer said, but board members aren’t taking any chances. They want to be sure their books are in good shape before asking for more money later this year from Douglas County commissioners.

‘We want to help’

The request will come in the wake of a stinging rebuke last month from commissioners, who rejected the agency’s application for an $80,000 financing boost. Visiting Nurses had sought the money to help salve financial wounds opened by cuts in Medicare and Medicaid programs and swelling demand for home-care services.

Take a stand: VNA financially sound (7-13-04) Letter to the editor: VNA needs (7-14-04) Letter to the editor: VNA support (7-12-04) Editorial: Financial wreck? (7-5-04) Visiting Nurses bailout unlikely (6-30-04)

At the time, commissioners said they were worried that Visiting Nurses didn’t have a clear vision for making ends meet financially. The agency’s own budget request indicated that Visiting Nurses expected to fall $240,000 short of its budget needs for this year, after ending 2003 about $580,000 short of expectations.

Commissioners say they’re still concerned, but remain more than willing to help, as long as the agency can show that the financial bleeding has stopped.

“We want to help them,” Commissioner Bob Johnson said last week. “We want to give them support. …

“I have no doubt that Visiting Nurses is doing the right things, as far as serving the needs of the community. (But) you have to start doing the right things that you can afford to do.”

Such talk is both comforting and worrisome for Hilda Enoch, whose husband received care from Visiting Nurses after suffering a stroke.

While Enoch understands that commissioners support the agency and its work, she remains concerned that elected officials — at all levels of government — are failing to recognize the importance of caring for elderly people in their own homes.

‘A terrible dilemma’

Medicare and Medicaid cuts are forcing more people to seek local services, such as the home-care program offered by Visiting Nurses. And with local governments facing rising demands for everything from roads to law enforcement, Enoch worries that people unable to afford proper care no longer will be able to get the help they need to live.

“It’s a terrible dilemma,” she said.

Jan Jenkins, executive director for Visiting Nurses, said getting another $80,000 from the county would help make a positive difference. With an average visit cost of $99, the county’s money would finance 808 more trips next year.

For a program that sent nurses, therapists and care aides into homes 16,423 times last year, the investment would represent a 5 percent increase — an increase designed to provide some comfort by easing an agency’s financial pain in dealing with clients unable to pay their own way.

“We don’t want to have to stop seeing those patients, but without extra funding we’ll have to put a limit — we’ve already put a limit — on how many people we can afford to do that way,” she said. “You’re cutting people out, and that’s the part that hurts.”