What else could the board of the Vineyard Nursing Association have done? Facing anticipated increased demands for services, tightening rules for eligible services to patients, the extinguishment of certain kinds of services no longer regarded as “medically necessary,” and an expansion decision made at a moment of gathering obscurity on the national health care horizon, the VNA proved financially untenable. The decision to trade its Island independence and financial fragility to become an operating unit of the Visiting Nurse Association of Cape Cod (VNACC), itself a component of Cape Cod Healthcare, a $700 million outfit may very well have been the best choice, maybe the only choice, available. One hopes that, after a thoughtful transition and with skillful and perceptive management by nursing agency managers from the Cape, a sturdy, responsive home care agency will continue to serve the needs of Islanders.
This page has pointed to the Martha’s Vineyard Hospital’s affiliation with Partners as an example of change that has improved medical care for Islanders and helped to strengthen the Island’s medical center — long a small, outlying medical center, susceptible to the clumsiness of federal efforts to reform health care access and delivery — whose financial history has been unsettled and annually threatened.
The notion that Martha’s Vineyard Community Services might have taken on the Vineyard Nursing Association business had a misleading aroma of comfortable possibilities, as did a thought that the hospital might be the white night. Vineyarders prefer Vineyard solutions to their social problems, but such solutions do not always promise long-term security and success, and the wisdom of leaders of Vineyard nonprofits over time has not always benefited as one imagined it might by the exclusion of trends in governance, management, and finance pursued by leaders of similar services in larger, off-Island contexts. The profound confidence we vest in our superior wisdom and self-referential approaches to problem solving has not always proven well-founded. Islanders have often spurned and then sorely missed valuable advice and support available off Island.
But, this latest big and important change will requiring monitoring. And, it will require the development of communication and cooperation connections between Islanders involved in health and social services and the managers at the Visiting Nurse Association of Cape Cod. This is a promising new venture, one that is immeasurably important to a growing number of Islanders. We and Island leaders of agencies that are part of the collection of health care delivery services must track and assess the nature and quality of this new — to us — home care service.
This latter is not an easy job. What continues to be missing for Islanders, and by its absence puts Island health care in doubt, is a community plan for the health services it needs, wants, and can afford. This is not something that Cape Cod Healthcare, by its intervention, can conceive for us, though it is a need whose development will certainly require the participation of our Cape Cod partners. It’s a plan and a responsibility for Islanders.