A stabilizing move


The board of the Vineyard Nursing Association has made the sensible choice 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. There is every reason to think 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.

The lesson of the Martha’s Vineyard Hospital’s affiliation with Partners is that it 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. Vineyarders always prefer Vineyard solutions to their social problems, but such solutions do not always promise long term security and success. Plus, despite their profound confidence in their superior wisdom and their complacent, self-referential approach to problem solving, Islanders have often spurned and then sorely missed valuable advice and support available off-Island.

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.

The Vineyard needs a plan that is financially sound and one that is conceived in honest bargaining among providers, insurers, and the community, taking each and all into account. The Martha’s Vineyard Hospital and Windemere, thanks to their affiliation with Partners, have become a stable, capable centerpiece of Island health care. The state’s expansion of insurance access, when and if it gets over its mangled beginning, will put health care within reach for almost the entire Massachusetts population, though rising costs for coverage and services, untamed, may yet compromise that valuable mechanism.

What remains unresolved is the question of how to organize and fund the range of quasi- and non-medical services that an aging Island population requires. The struggle facing the Vineyard Nursing Association, and soon its successor, the Visiting Nurse Association of Cape Cod, is the chaos that uncoordinated, inadequately supported providers face. The decades-old question remains. What shall we do about it? The familiar obstacles rooted in fragmentation, diminishing sources of dependable and increasing revenues, and territoriality remain. But, these services we need must be economically integrated and supportable over the long term.

This smart move by Vineyard Nursing Association, selling itself to a larger, more able home care organization, will ultimately play a role in creating – once and for all, one hopes – this smoothly functioning, well financed Island organization for health care. Islanders have a new partner in this work.