Stacy Koeppen.

The ongoing saga that is the future of Tama County Public Health and Home Care has taken another turn as the CEO and Executive Director, Stacy Koeppen, resigned late last week. At the April 9 Public Health Board Meeting, Koeppen informed those in attendance.

“After a long discussion with my husband, and we just talked a lot about the ups and downs of everything that was going on, with everything the last couple months here. And had decided that it would be best if I accept the other job that I was offered, which, unfortunately, is me leaving here,” she said. “However, that being said, I have unlimited PTO at my new job and would be more than happy to consult as needed. If it be once a month, or anything like that, or if they just have a question and want to call me. It helps that I know these guys. I know the ins and outs, and can help guide to help meet that goal, just as an outside source.”

Koeppen went on to explain her reasons for the decision.

“But like I said, this decision was based solely on the actions of, not you Curt,” Koeppen said to Supervisor Curt Hilmer, who attended the majority of the meeting via Zoom, before continuing, “of some of the Board of Supervisors members and how they handled this unprofessionally towards my staff and how they’ve handled things unprofessionally in the community. I just had decided that, I’m a professional. I hold a professional standard, and my goals of professionalism are not the same as theirs. And I could not work under that anymore. It had nothing to do with you guys, nothing to do with the staff here, I love everybody here, but that was my deciding factor. So, I just wanted to be clear on why I chose the choice I made because I don’t want you guys to think that you guys did anything to push me one way or the other, because it was not you guys at all.”

The new budget proposal approved last week by the Board of Supervisors was also a factor in Koeppen leaving now, as she said to the News Chronicle.

“While a short-term agreement was reached, there are still long-term questions about direction and stability. After careful consideration, I felt it was the right time to make a transition that provides more certainty moving forward,” Koeppen said.

The new approved budget proposal was also a topic at the April 9 meeting, as registered nurse and Tama County Public Health and Home Care Case Manager Kelly Purk spoke against it.

“This will leave only two full-time nurses to sustain both the home health and public health operations per CMS guidelines, if we stay certified, okay? Maintaining a CMS certified home health agency with this level of staffing presents substantial operational challenges. The responsibilities required include, but are not limited to, for the nurses, managing and processing referrals, including detailed review, coding, and preparation for patient admissions, conducting admissions, discharges, recertifications, resumption of care visits, and transfers,” she said. “Completing comprehensive OASIS documentation within strict regulatory timeframes, maintaining ongoing patient caseloads, and supporting public health responsibilities. Historically, these duties have been distributed across multiple full-time nurses and a dedicated public health nurse. Consolidating these responsibilities onto two individuals is not safe or operationally feasible. Additionally, each nurse would be required to provide approximately 62.75 hours on-call coverage per week. Which is 125.5 combined hours of on-call, in addition to the full-time clinical responsibilities that we have to do, at 40 hours a week, here in the office. This equates to over 3,200 on-call hours annually per nurse.”

Purk went on to state that decertification may be the better alternative.

“The operational demands required to maintain CMS certification under these conditions exceed the capacity of the remaining staff in our building and place our agency at risk for compliance and quality concerns. How good we can do our job as a nurse with all of this that we’re being asked to do? It’s a safety issue as well. Given these factors, we believe that maintaining the CMS certification is not a viable path forward at this time,” Purk said. “We, however, we do believe, we’ve discussed, that there is a potential still to sustain the agency by transitioning to that decertified model. This would allow continued service to key populations, including veterans, the sliding fee patients, the private pay clients, and the underserved or indigenous communities, while reducing the regulatory burden and documentation requirements that we would have to maintain.”

During this stressful meeting, those in attendance discussed how they thought the supervisors didn’t fully understand all that went into public and home health. Board member Richard Arp stated at one point that he wished the supervisors could have heard all that the nurses had talked about.

The speed at which all of this has happened, and the quickness with which decisions have had to be made, was also a point of tension. It was mentioned that the supervisors said they will start on the budget earlier next year, in October.

“But it’s too late then. Once the nurses are gone, it’s too late,” Arp said.

Supervisor Curt Hilmer also spoke on the subject.

“It’s been a rollercoaster. I felt really good last Monday that we were gonna kinda still do it for at least another year like we were, we gave them a bit more funding, and then we had a meeting Thursday and the nurses didn’t feel like they could do the workload. Which they probably can’t because some have left, ya know. And ya can’t blame them,” he said. “Our Director, Stacy, is taking another job, so wish her well. She has done a great job here. I think she would’ve worked some things out if she had more time. It is what it is. It’s kinda a thing of the times. So, we are just trying to make our budget better, and get it in the right way. It is going in the right direction, but we just need to keep the belt tight. We are doing what we can. None of us want to lose it, that’s for sure. It can be us someday, our parents now, our grandparents now, and even us, so in-home care is important, especially for the people who can’t afford it. Hopefully, the county can deal with that.”

Hilmer was certain about one facet of the future regarding Tama County Home Care, saying for sure, the help for the veterans, sliding fee patients, and the Meskwaki people will remain.

When asked what she thought would become of Tama County Public Health and Home Care after she leaves, DKoeppen shared her thoughts. “That will depend on decisions made by county leadership. My hope is that the needs of patients, families, and staff remain the top priority and that a sustainable path forward is developed. There are many dedicated, long-time employees, and the services provided are important to the community,” she said. “Home health services are essential, especially in rural areas. Their future in Tama County will depend on clear direction, stable support, and long-term planning to ensure patients continue to receive the care they need.”

Koeppen said she is transitioning into a new position where she can “continue serving patients in a stable and supportive environment.” Her last day with Tama County will be May 4.