Commissioners at Odds Over Shutdown of Medical Day Program

The Rockingham County Commissioners, in a 2-1 vote last week, decided to shut down the county’s Adult Medical Day Program. On one side of the issue, commissioners point to low use of the program and consistent funding shortfalls, and on the other side the lone dissenting commissioner notes the quality of service the program offers longtime taxpayers.

The county is supposed to provide a service, said commissioner Tom Tombarello of Sandown, who supports the program. He said the day program is providing that service to county residents who have been paying taxes their entire lives.
Tombarello often visits the program, talking with users and the staff, and it’s that personal side that had him looking prior to last week’s vote for any way to save the program.
Fewer than 20 people use the service, but each of those has a name and a history to Tombarello, and it’s that personal connection that has him up in arms over the closure.
The program’s private day rate is $73, on the high end of similar programs.
“It’s the saddest day so far for me as a commissioner,” said Tombarello on Nov. 14, the day after the vote was made.
But for fellow commissioner Kevin Coyle of Derry, the numbers just don’t add up.
“The point of government is to provide services that are not being provided in the private sector,” said Coyle, and when he cited 17 similar programs in and around Rockingham County, he said it was tough to justify the continued spending of tax dollars.
“We’re competing against the private sector and we’re losing,” said Coyle. He added that of the approximately 75,000 people he represents, only one user was from his constituent towns. Coyle added that he understood the program was conveniently located for its users, but said other options exists.
Both commissioners have received many letters of support for the program.
Katharin Pratt of Hampton is the third commissioner, and the chair, but was not contacted for this story.
Though adamant against getting into the political milieu but clearly an advocate for her program, director Helen Kolifrath said it’s not just the program’s users who benefit. A woman with decades of nursing experience and the day-to-day knowledge of her program, she thinks the work is far reaching.
Kolifrath has countless stories of praise the program has received from families who have needed a place for their elders to go during the day. While the program is good for its users, that benefit spreads to the families and communities of its users, said Kolifrath. There’s untold benefit to a family getting some time off from what can be the arduous daily care of older adults who can no longer care for themselves.
The program has never had a deficiency in the state’s regular inspections, and with nursing staff and people who care about their charges, the quality of the program has not been questioned.
Kolifrath additionally points to the uniqueness of her program and its connectedness to the county’s nursing home as a boon – the nursing home is upstairs in the same building in Brentwood. The Adult Medical Day Program has the trained staff, she said, who can spot trouble early and can guide families through caring for their elderly loved ones. Additionally the program has a fully outfitted therapy room on its floor.
The program has been running for 31 years and is used as a model for other programs. But the amount of money the program loses has to be addressed. Earlier this month the projected year-end losses were estimated at about $128,000. Average daily loss for this year amounts to $149.08. Last year the program lost $40,508.89, the year before that $111,869, and in 2009, that number was $260,230.78.
The impact of that loss is calculated differently by commissioners.
Tombarello points to $1 million in salaries already saved this term as the commissioners have worked hard to consolidate or eliminate positions. And considering that the county’s business is to provide a service to its residents, he argued that it made moral sense to keep the program and look for further ways to stem its losses.
Coyle said he understood the program was important to its users and he wasn’t winning any votes by shutting it down, but it was the right decision to make, given the facts. He said the program was given time this year to improve its balance sheet and to increase the number of users but missed two deadlines.
Coyle added that he knew firsthand the struggles that came with caring for an elderly parent, having taken care of his mother in his home in her final years.
“It was a difficult decision, but one which is justified,” said Coyle of the shutdown. “The easy thing to do would be to say ‘Leave it alone.’ Politically, closing a program which has a lot of backers who make a lot of noise is not a good move, but I do what I think is right.”
The program is set to shut down permanently on Dec. 31.

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