In America, large corporations gobble up small businesses every day, claiming greater operating efficiency through economies of scale. The justification has become so commonplace that hardly anyone seems to wonder when it was that efficiency started trumping all other values.
Things are different here on the Vineyard. On-Island, community-based, homegrown: these are the virtues we tend to celebrate. So it is that the decision by the Vineyard Nursing Association to sell out to an off-Island home health care group doesn’t sit easily.
We don’t doubt that Cape Cod Healthcare, which includes the Visiting Nurse Association of Cape Cod, will streamline operations here, perhaps erasing an unexpected half-million-dollar operating deficit the local VNA disclosed in November. Both the VNA of Cape Cod and its six hundred and eighty-million-dollar parent organization showed healthy operating profits in recent financial statements filed with the state. And the Cape-based organization, which serves twenty-nine towns on Cape Cod, gets high marks nationally for, among other things, quality of care.
Though the details of the merger have yet to be determined, we expect the Cape agency will seek efficiencies by combining so-called back office functions like accounting and administration, moving at least some middle-class jobs off-Island. And though the agency has pledged a seamless transition, something is always lost when decision-making is no longer locally based.
Martha’s Vineyard Hospital was not interested in taking over the Vineyard Nursing Association. Home health care is outside the scope of what the hospital does, although it depends on home health services as an integral piece of the community care network.
But we are left wondering whether a different merger, with Martha’s Vineyard Community Services, might have strengthened both organizations at a time when the Island badly needs a coordinated strategy to deal with a rapidly aging population. Community Services executive director Juliette Fay told the Gazette this week that her organization had engaged a consultant and was preparing to make a bid for VNA when the Cape Cod merger was announced.
Community Services, which shed its own Visiting Nurse Service five years ago because of competition from VNA, saw value into reabsorbing home care into its mission. A merger would have enabled the agency to integrate behavioral and medical care in a way that will be increasingly required under Obamacare and to expand services by combining both agencies’ Medicare licenses, Ms. Fay said. Moreover, the space-strapped agency could have made immediate use of VNA’s new two million-dollar office building.
Operating a financially stable home health care service is indeed complex and challenging, and continuing reductions in Medicare reimbursements have only aggravated the problem. But as the Vineyard’s elderly population grows, the question of how we provide quality in-home care for those who need it becomes central to the issue of sustainability for the Vineyard as a whole. We need to constantly look for solutions that provide jobs and care for people on-Island.