“With the case load we had,” Stacy Koeppen,CEO and executive director of the Tama County Public Health and Home Care department, said, “We were just at the verge of breaking even, when all this started. So, and we had referrals flooding in, so we would’ve been coming in above by next year. Above what we’re asking.”

“There’s that much difference?” Supervisor David Turner asked.

“Yeah.”

“Man,” Turner exclaimed.

“Well,” Koeppen explained, “for example, the nurses put the coding in answering their OASISs, changing one answer went from bringing in $1,200 to $5,000. So, I mean, that’s a big chunk of change, and then multiply that by 60 patients.”

“So, all the brouhaha would have been gone had you been here earlier,” Turner said.

“Yep, sure would’ve,” Koeppen said.

This conversation unfolded at Monday morning’s Tama County Supervisors meeting. After dozens of meetings, which included a last-minute one at 7 a.m. Monday morning, members of public and home health presented the supervisors with another budget proposal.

This all comes after former Tama County Supervisor and Tama Police Chief Dan Wilkens enthusiastically expressed concerns about the Public and Home Health Care’s budget before being removed by the Sheriff at a February Supervisors meeting.

The new proposal has a decreased budget, which is due to, among other things, every remaining staff member having their salary cut. This proposal provides services to the most vulnerable, low-income residents of the county and those on Medicare. Medicare payments being a significant part of the department’s revenue.

The overall budget total for both Public and Home Health proposed was $1,293,808 with $649,795 going to Home Health, and $644,013 going to Public Health.

The projected revenue for the next fiscal year for the department is $991,151. When asked what guarantee there is that the revenue would come in, Koeppen stated, “The only guarantee I can give you is the fact that there’s always people that need help.”

“Well, I think looking in the past, there’s value to that, but the past is the past, we gotta let the water go under the bridge,” Supervisor Curt Hilmer said. “With the revenue coming in, and everything, I know we have to levy the 1.2, that’s what it looks like, but hopefully the revenue comes back in, and improvements have been made already, that’s obvious.”

He spoke about the frustrations he has with the lack of communication, to how for years they could have been making money from the coding change that the department didn’t make until Koeppen became director.

“I would be in favor of another year of this with this, with an underlying agreement that it’s gotta get better,” Hilmer said.

Chairman Mark Doland spoke on the subject as well.

“Communication, I think that we’ve got a good relationship with this board. We were, quite frankly, before I was on the board, I was embarrassed by the way that the previous board handled relationships with the board of health and that meeting where they brought in their attorney, and things got really nasty. I like the open communication. We want to be more transparent. We want you to be more transparent. I think we can come up with good solutions that way. And also, we thought that maybe it was a good idea, and the services could be equal. Then we find out, you know, that that’s not true,” he said. “We can’t come up with an alternative that’s going to replace the thing that’s there right now, equally. And the cost of that is good care to the people who have paid it, their residents, they’ve been paid all, you know, their property taxes have been paid every time that they were due, and they are not; this is not an entitlement. This is something that they have moved here, worked hard, and they rely on the service. So, it’s hard to take that away from somebody, and I’m not gonna be the one to do that. So, I think that a million dollars is a substantial savings, and I think if we can get close to the services that we’ve had, and next year, you know what’s on the block.”

The motion made was to accept the Public Health and Home budget as presented, with the caveat that they look into an operating line of credit or a similar system to help. The motion passed with only Supervisor Curt Kupka voting nay.

After the meeting, Koeppen provided a statement to the News Chronicle thanking the board for their decision.

“The Home Health Budget is $649,795. The estimated revenue with recent changes and training to the staff is $911,151.92. This decision is not just about budgets — it’s about people. Home Health is about the elderly neighbor who depends on a nurse to safely remain in their home. It’s about the veteran who needs care but cannot easily travel. It’s about families who are already overwhelmed and rely on these services during some of the most difficult moments of their lives,” she said. “Approving one more year is not about delaying the inevitable — it’s about giving us the opportunity to fight for a sustainable future. During that time, we will work to increase revenue, strengthen referral partnerships, improve operational efficiency, and explore new funding opportunities. Our goal is not just to extend services for a year, but to build a path that allows us to continue serving Tama County residents long term.We thank the Board of Health and the Board of Supervisors for working together to find a solution that allows us to continue caring for our patients in Tama County.”

Also during the meeting, Sheriff Casey Schmidt spoke about getting mental health physicals for the department. Schmidt talked about how trauma is something those in the Sheriff’s department and first responders in general are frequently exposed to.

All full-time employees, deputies, jailers, and dispatchers will have a mandatory visit with a mental health counselor every year. This will cost approximately $5,000 and is budgeted to come out of the health fund. The mental health physicals were approved.

The computer system Ninjaone was approved for a two year contract with six months free. The FY25 County Audit by Eide Bailly was approved.

Short-term and long-term disability were approved to start for both union and non-union county employees. Backyard Vines had their liquor license approved. Claims totaling $105,449.37 were approved.