The Island’s surviving home health care agency has a full plate.

The Vineyard Nursing Association is moving quickly to absorb a 50 per cent increase in patients and a 20 per cent increase in employees while expanding its services and stepping up professional training for its employees, said Robert Tonti, chief executive officer of the association.

And Mr. Tonti has started the process of finding larger space to accommodate the unexpected growth.

Last March, the Visiting Nurse Service, the home health care arm of Martha’s Vineyard Community Services, announced it was withdrawing from the home health care business.

Representatives met with the nursing association to develop a plan to transfer its patient load and at least 11 of its employees to the association. By June 30, care for 72 Visiting Nurse Service clients will be transferred to the nursing association.

“Patient care has been the first priority and the [nursing service] has been very cooperative in the transition,” Mr. Tonti said. Thirty-six elder care patients, 30 Medicare patients and six Massachusetts rehabilitation younger adult patients are being transferred.

Health care service providers have been consolidating nationwide as a result of lower insurance reimbursements, particularly in Medicare payments.

Mr. Tonti said his agency has managed to reduce its dependence on Medicare by 30 per cent over the past several years by expanding its base of private payment and non-Medicare clients.

He said the agency, with $2 million in annual revenue, is financially healthy, though he noted its dependence on giving.

“We’re in decent financial shape and we have no debt but we are in the black because of our strong donor and community base,” Mr. Tonti said.

“We are taking a look at our four or five fund raisers. We know that the July clambake and the September golf tournament will continue but we’re asking ourselves whether we wouldn’t be better off spending time and effort on grant writing,” he said, adding the depressed economy could hamper raising funds in general.

The agency is also moving aggressively to expand its base of clients, such as a successful 2008 bid for the Oak Bluffs town home health care contract formerly held by the Visiting Nurse Service.

“We plan to bid other towns,” Mr. Tonti said. Vineyard towns provide home health services to residents through contracts with organizations and individual providers, he said.

But growth has stretched Mr. Tonti’s people and resources. “We are getting this done but it is a strain on our people, particularly on the management team,” he said.

The association now employs 35 home health care professionals, 16 nurses, 10 administrators and managers and 12 part time and consulting professionals for therapy services, 20 per cent more employees than it had in March.

The association recently withdrew an application before the Martha’s Vineyard Commission to expand at its current office on State Road in Vineyard Haven.

“It wasn’t clear we were going to get permission. We can’t wait any longer. We need more space,” he said.

The agency has leased space until June 1, 2009, but Mr. Tonti wants to lease 3,000 to 3,500 square feet to replace the 1,200 square feet in its current location. For the long term, buying or building a headquarters may be the best solution, he said.

Sharon Corr-Dolby, the association’s program and service director, said: “If we have to share desks for a while, we’ll do it. The important thing is we’re set to go [on June 30.]”

As part of her expanded mission, Ms. Corr-Dolby plans to provide additional training and certification for up to 35 home health care workers in her employ, including 10 former Visiting Nurse Service employees who alsready are certified.

A training program is under way at the Windemere Nursing facility at Martha’s Vineyard Hospital to license every home health care employee at the association as a certified nursing assistant. Four more certification programs are planned this summer, she said.

“The nursing shortage affects home health care as well. We want our employees to be able to work in rehabs and in hospitals also. They need this certification to do that,” Ms. Corr-Dolby said.

“Windemere has been great to us and we are funding two $1,500 tuitions (for Windemere staff certification) to recognize their help in this project,” she said.

Dr. Eleanor Morad, a summer resident, nursing instructor and long term employee is teaching the 75 hour evening certification class. The nursing agency is funding tuition and paying its own employee students to learn.

As Visiting Nurse Service home health workers and their clients move to the Vineyard Nursing Association, the service’s parent organization, Martha’s Vineyard Community Services, is rethinking its own plans, executive director Julia Burgess said.

“I really don’t have definitive things to say at this point but expect to in June when an ongoing strategic planning exercise is expected to provide answers,” Ms. Burgess said.

She reiterated earlier statements that mental health services, particularly for the Island’s elderly population, substance abuse care and counselling are at the top of her strategic list.