MADISON COUNTY, Iowa — Veterans. The elderly. The disabled. Those are some of the groups that will be impacted by the looming closure of a home health benefit in Madison County.

The Madison County Board of Health officially announced the end of its ‘Homemaker Program’ at a meeting on Feb. 12, 2025, citing budget shortfalls due to changes at the state level regarding public health funding.

There are 27 people from the most vulnerable populations that will be impacted by the end of the program. The family of one of those people, told WHO 13 that they are angry and feel as if their loved one has been left behind.

“He doesn’t go outside. He’s not allowed downstairs because we’re afraid he’s going to fall,” said Scott Sadler of Winterset.

Scott is talking about his 83-year-old father, Frank, who he likens caring for to a full-time job. He and his wife, Kristen, spend an estimated 40 hours a week between them managing Frank’s appointments, running errands for him and monitoring a batch of cameras inside his home to ensure Frank has not taken a spill. Something that has happened multiple times before.

“He has fallen in the bathroom. He has fallen in the bedroom some times,” said Scott.

Scott shared photos from several incidents, including one that showed a pale and fragile Frank surrounded by a pool of blood. He had been there for hours before anyone noticed and Paramedics were called to the home, Scott said.

It is one of the reasons that makes he and his wife so grateful for the few hours of nursing aid relief the county has provided each week for the past two years. The peace of mind is great. The help — even better.

“It has taken a lot of things off my plate,” he told reporter Katie Kaplan.

“She cleans the house. She does dishes. She gave me a bath,” said Frank. “I had a stroke and my right arm is almost numb.”

The Vietnam Veteran is cognizant, but needs a helping hand to get around his house. The nurse spends a few hours helping with laundry (the washer and dryer are located in the basement), checking vital signs, grocery shopping or even mowing the lawn.

However, all that will come to an end in just a few months. Frank and the 26 other clients of the Madison County Homemaker Program were notified of the sunsetting of the program via mailed letter in mid-November.

“A bunch of pressure just went back onto me,” said Scott, of learning the news. “It was like, ‘What am I going to do? How am I going to take care of him and take care of what needs to be done at our place with what my family needs?’”

Scott is a disabled Veteran himself and the father of two younger kids. The family lives in a home across the street from Frank and try to stop by every day to check on him.

The program is something that has helped a lot of people in the rural county maintain a sense of normalcy.

“That it’s been a great program for many of my patients,” said Dr. Kevin De Regnier.

Dr. De Regnier retired from the BOH on Jan. 1, 2025, after serving on it for more than 30 years. He spoke to WHO 13 as a private citizen and said the decision came down to the bottom line.

“That it’s been a great program for many of my patients. It’s allowed them to stay in their home,” he said. “It’s allowed them to remain independent in the community and that so it’s sad to see it go.”

But, as with a lot of things – the program costs money. Roughly, $2,500 per client according to figures presented during a BOH meeting in 2024. And, when the money is not there – it is hard to support.

“In simplest terms, it was declining revenues and increasing costs,” he said. “More complex was the fact that we had lost a key staff member to retirement.”

An overview of the 2024 BOH meeting minutes showed the issue was discussed multiple times since February of 2024 – with some disagreement over what to do. However, after several setbacks with filling an open Homemaker Supervisor position for the program, the decision to end the program went up for a vote. In May of 2024, the first vote to end the program passed unanimously. However, it was rescinded at the following BOH meeting. Ultimately, the issue persisted and a September vote by the health board to end the Homemaker Program passed unanimously with a plan promptly put into place to begin to notify impacted parties.

However, that decision has prompted some pushback from concerned citizens, including an array of people who took advantage of public comment opportunities during county Board of Supervisors meetings.

Second-term Supervisor Diane Fitch, who agreed budget cuts needed to be made, believes the strong response from the public shows residents were willing to continue to fund the program. She said there could have been an opportunity to keep it.

“I think many taxpayers have indicated they’re willing to pay taxes to keep this,” she said. “I think, I think our revenues are up. We’ve had so much building. I think we could have, we could have found the money.”

Unfortunately, during a budget work session on Mar. 3, 2025, the BOS voted to freeze the 2025 Fiscal Year budget to match the FY2024 budget, leaving little to no hope for the program moving forward. Fitch was the lone vote against the freeze.

“This is not fair for us,” said Scott, who believes the more than two dozen impacted residents have been left behind.

“I believe they’re being abandoned by the State of Iowa,” he said. “I think, statewide, could have done better on budgeting. I think the Madison County Board supervisors should have done better.”

WHO-13 had an on-camera interview scheduled with the Madison County Public Health Administrator, but it was cancelled by the administrator the night before. The following information was sent in an accompanying fact sheet:

Residents have until June 13 to figure out alternative care. The program will continue until then as long as staffing permits. The BOH provided clients with a list of contact information for private in-home health services. For those that cannot afford it, a government-funded nursing home may be the only option. Luckily, there is at least one nursing home in Winterset that is a Medicare and Medicaid approved facility.

The 27 impacted clients are comprised of 18 people from Winterset, seven Earlham residents, one client in Truro and one person in Macksburg, according to the BOH. The program employs two, full-time Home Health aides. However, Madison County is currently engaged in a 28E Agreement with Warren County, essentially paying its Pubic Health agency to provide services to Madison County residents.

The Madison County Board of Supervisors is now exploring selling the BOH building at 209 E. Madison St. in Winterset, and consolidating any remaining offices to the courthouse in order to compensate for budget loses.