Health board discusses viability of homemaker services

MARENGO — In fiscal year 2025, Iowa County Public Health provided homemaker services to 27 people; 17 of those received skilled nursing as well, said Iowa County Health Department Director Lorinda Sheeler during a health board meeting July 30.

Only 10 received homemaker services only.

Homemaking services, such as doing laundry, doesn’t cost the health department as much if a nurse is there already for skilled services, said Sheeler.

But homemaking is often the way the public health department convinces residents to accept skilled care. “That’s our foot in the door,” Sheeler said. They get comfortable with the homemaker and are willing to accept more skilled care.

Iowa County Supervisor Abigail Maas, who is also on the county board of health, has suggested that the county stop providing homemaking services because they aren’t mandated by the state and the county needs to cut its budget.

Maas said, during budget discussions in January, that other agencies could provide homemaker services if the county stopped providing it.

Dr. Steven Rippentrop, chairman of the county board of health, disputed that claim in a guest column in The Cedar Rapids Gazette, in July. “Our home health team visits 25-35 of our most vulnerable residents every week,” he wrote. “Despite what our supervisor may say, most of these residents couldn’t get care anywhere else.”

Sheeler told board members about a resident who was referred for nutritional insufficiency and had no refrigerator in the home. The resident agreed to homemaker services only.

Public Health found someone to donate a refrigerator and got food from the food bank for the resident, said Sheeler.

“I know it’s money,” said Sheeler, but the service is needed. People can’t stay in their homes without it, she said.

“Is our mission to serve an individual in Iowa County or is it not?” Sheeler asked.

Rippentrop asked if the county could offer homemaker services for a limited period of time. He also asked how many of the 10 people receiving homemaker services only would accept skilled care.

“I think it would be close to an even split,” said Abbie Schaffner, clinical manager and registered nurse for Iowa County Public Health.

It might be worth making the service temporary to get them to the place where they trust public health and will move to skilled care, she said.

Sheeler wondered how to prioritize the service if its temporary. Taking clients on a first-come, first-served basis may mean denying service to someone who applies later but is worse off and has no family who could help, she said.

They can’t force people to take the additional services, said Schaffner. Some people won’t even have that discussion.

Schaffner said she doesn’t like the idea of providing homemaker services temporarily. “It’s not like these people are going to get better in six months,” she said. Maybe public health could limit homemaker services to once a month after an initial six months or so, Schaffner said.

“We’ll investigate that,” said Sheeler. But the longer interval between visits “makes much more demanding work,” she said. The tasks may take longer.

The office limits homemaking services to three hours, said Sheeler. Some people need the entire three hours, and others don’t.

Due to staffing, the public health department isn’t taking more than 10 who need homemaker services only. One person is on the waiting list right now.

“I feel for that number 11,” said Rippentrop, but there are clearly monetary concerns, he said.