By RICK MILLER
Olean Star
OLEAN — It’s been six months since the 2026 Cattaraugus County budget was passed with a nearly $1 million cut in wages for the health department’s home care program.
What’s the current status of the county’s home care program and what does it say about the future?
Before a patient is discharged from a hospital, their physician orders a discharge plan for home care — nursing, physical, occupational and speech therapy.
Last year, the county health department had a staff of 21 including 17 nurses. Today there are seven people in the home care program including four nurses. Other rehabilitation services are contracted out.
Last November, the home care reported serving 225 patients. In December, there were 193 patients. In February, the number of patients had dropped to 135. It was back to 140 in March, then 128 in April, 104 in May and on Tuesday, there were 88 patients in the program.
The 2026 county budget cut the payroll from $1.9 million that was spent in 2025 to $1.3 million in the 2026 budget. The department had requested $2.2 million.
The total spent on the program in 2025 was $5.4 million. The department had requested a total of $6.8 million in the 2026 budget, which was cut to $5.2 million by the budget officer.
In an interview earlier this week with the Olean Star, Cattaraugus County Public Health Director Dr. Kevin D. Watkins said the budget cuts were due to the “downsizing of the agency” and was not unlike what is happening across New York state where “we are experiencing challenges in healthcare.”
The biggest challenge is that reimbursements for some patients do not meet the costs of providing those services, Watkins said. The home care program received $3.8 million in revenue in 2024 and $2.2 million in 2025. The 2026 budget includes $3.7 million in revenue from nursing home charges and Medicare.
The deficit, or gap between the cost of the home care program and the revenues the county was receiving was close to $2 million, Watkins said. “The budget was made in the context of fiscal considerations.”
When the downsizing started, nurses were given an option to go to another county department. There were no layoffs. “No nurses were laid off,” Watkins said. Some nurses left as they looked for opportunities outside the county.
Has the program been downsized far enough to erase the deficits?
Of the seven nurses remaining in the program, four are those who go out in the field and help patients after their discharge from a hospital, Watkins said. “I don’t expect it will go lower. I can’t forecast it will go lower — unless they want to leave,” he added.
Staffing is one of several factors to consider, Watkins said.
The county is also evaluating whether the home care services need to be continued in light of Kaleida Health’s Visiting Nurse Association home care program, according to the public health director.
In past years, the county health department used to complain that VNA was poaching patients being discharged from Buffalo-area hospitals for example, were not being given the option of choosing the health department’s home care agency, but were instead steered to VNA, which is now owned by Kaleida.
Watkins said health officials believe VNA, the other certified home health care agency in the county, has been able to successfully pick up the increased number of patients.
The reduction in patients comes as someone is discharged from the program at the end of their treatment program or goes into a hospital, Watkins explained. They are not being readmitted to the county home care program.
With seven nurses available, do they need to go lower than 88 patients?
Watkins said the no readmission policy would continue until the county’s home care census “reaches a level that we can begin to accept patients back into the program.”
He did not say what level that would be, but for the time being, any referrals to the health department’s home care agency are being told no new patients are being accepted and patients are not being readmitted after a hosiptal stay.
Is the health department’s long-running home care program going to continue not to take new patients and eventually close up shop?
“That is to be determined by the legislature and the board of health,” Watkins said.
