||| FROM BOB THOMAS |||
USE OF LEVY LIFT FUNDS
As with all Orcas commissions, once funding is established the Commissioners have authority for the legal use of the funds. Notwithstanding goals stated in Levy List meetings, correspondence and presentations are just goals and subject to change at the discretion of commissioners.
During the 4/9 Town hall Meeting an information package was made available online. The information provided broke the proposed 10-year budget into to three basic groups: Maintain Current Operations 44%; Modernize and Expand Facilities 44% and New Primary Care Services12%.
On top of our current levy of about $2 million the new Levy Lift will provide an additional $1.3 million/yr, a total of about $3.3 million/yr or about $33 million over the life of the Levy. The three basic groups were broken into a representative distribution on three dates over the 10-year life:
- 2026-Facilities 56%; Current Operations 29%; New Primary Care Services15%.
- 2030-Facilities 49%; Current Operations 35%; New Primary Care Services16%.
- 2035-Facilities 33%; Current Operations 59%; New Primary Care Services 8%.
Note that the Facilities category is front end loaded, that is, the funds flow to it at a high rate at the beginning of the 10 years and taper to the end. Yet planning is already underway, and a consultant has been chosen (not yet under contract) to advise the District on the use of these funds.
HOUSING FOR NEW HIRES AND VISITORS
Currently the District is offering a one-time housing/moving allowance to new hire providers. There have been two of these to date of $50,000 and $35,000 with two more anticipated of $25,000 and $4,000 for a new MD and nurse. These can be “clawed back” if the recipient leaves prior to completing an agreed commitment. Island Health pays half of this allowance and the District pays half.
As noted above “Facilities” are front end loaded in District planning. This gives a larger “pot” of funds up front for projects. One thought is an apartment for new hires for up to a year while they are looking for a permanent residence and extended as appropriate. Another is overnight accommodation for visiting Island Health specialists or others with business with the District.
The District has listed $500,000 for a temporary housing unit. How many will be needed? No indication of ongoing costs. Is it better to continue with the new hire allowance and one day rather than multiple day visits by specialists or incur up front construction costs and ongoing maintenance and service costs for housing?
DENTAL CLINIC
Information about the clinic operation and funding is confusing. Through several meetings and reading District literature I’ve come to understand the following:
The current dental clinic is in a rented space with three staff. The staff flies from the mainland; it appears flights are currently donated. The current Clinic funding is a composite of partners including several agencies, donors and the District. Best I can tell the District has about $28,000 invested to date, however some of the current funding is thought to be drying up.
Without this funding it’s questionable if the clinic is sustainable. Yet the District is planning to add a permanent two chair dental unit to the health clinic at an estimated cost of about $900,000. Even if some current funding ends, with almost $1,000,000 invested in a new dental office, would the inclination be to continue supporting the clinic using District funds making up the shortfall?
Orcas Dental Clinic accepts anyone regardless of where they live or inability or ability to pay. The application doesn’t require income verification.
- Lopez Dental Clinic open 2 days per month
- San Juan Dental clinic open 4 days per year
- Orcas Dental Clinic open 94 days per year.
If you live on San Juan, Lopez, Shaw or the outer islands with expensive and limited dental access where will you choose to go? Will Orcas Dental become “San Juan County Dental Clinic” paid for by Orcas residents with free dental for all?
ON ISLAND SPECIALIST VISITS
My understanding is visits by IH specialists are a monthly event and appointments must be scheduled. Best I can determine appointments are scheduled through the specialist’s office. If not enough patients schedule IH will cancel the visit. It seems like this is hit or miss and islanders will still have to schedule any critical medical activities off island.
We schedule monthly ferry trips for “resupply” trips to the mainland. Typical trips may also include medical appointments. We have been able to schedule up to three medical appointments with one typical off island visit and still accomplish our “resupply” activities.
Notwithstanding all this, the need for personal medical flight insurance remains for emergencies. Nothing the District can do will change this.
RESEARCH LEVY LIFT DOCUMENTS, DECIDE FOR YOURSELF AND VOTE ON APRIL 22
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The community dental clinic provided over $270,000 in care in 2024. Seems to me that is a good return on a $28,000 investment. Access to dental care was cited as the number one issue for folks living at or below the poverty level in the last survey conducted by the Opportunity Council. Poor dental hygiene can lead to serious heart ailments, poor nutrition (hard to chew with no teeth) and a marked increase in unemployment. Thanks to investments by local donors, and partnerships with the San Juan Health Department, the Orcas Island Community Foundation, the Orcas Community Resource Center and Mercy Flight volunteer pilots, we have been able to provide far more care this past year than ever before. It is my understanding that there is a local dentist on San Juan who is providing free clinics on a regular basis as well. Dr Dubek and her DentAll team provide amazing care to so many who would otherwise go without. I am delighted that we are piloting this project and developing a sustainable plan going forward. It will help spread dental care access to rural communities throughout the state and beyond. Thanks to all who make it possible.
$500,000 for a “temporary housing unit.” Only on Orcas Island.
You could purchase and set up a couple of brand new 36-foot bunkhouse trailers on the existing clinic grounds for 1/5 that amount. Each sleep 4 with shared bath. One for guys and one for gals. Set up a nice awning for a shaded area, put out a nice gas grill and some picnic tables, and make it a social center. Does the clinic have a shower facility already?
But, no, that wouldn’t work on Orcas for the same reason we cannot implement affordable housing. Our local taste mavens won’t accept manufactured housing.
Why not explore two tiny houses instead. The Oak Creek Homes “Sparrow Model”, or the West Coast Homes “Birchbay Tiny” at about $100,000 are tasteful and perfect for the temporary needs of a provider on call .
I am all for having a provider be on the premises should a patient need to be seen after hours. Minutes count in emergencies so a $200,000 expense is reasonable.
I also believe “tiny houses” are a good fit for island needs and the OIHC could set an example.
To date the Dental Clinic has been successful. The Dental Clinic is a separate entity from the Medical Clinic which is operated by Island Hospital. OIHCD is the sole operator of the Dental clinic. A substantial private donation (amongst others) enabled the creation of the Dental Clinic and Medicaid is a part of the ongoing support of the clinic operation.
How much in private donations can be expected going forward? And, as noted by the Commission, Medicaid is facing cutbacks. Purging the Medicaid roles of able-bodied but unemployed patients is expected. These patients would still be provided service but the clinic would lose the Medicaid cost subsidy.
It has been noted on several occasions by OIHCD that at some point the Dental clinic may reach a point of being financially unsustainable.