The LMAS Health Department is reducing its 100-person staff to 40 people and has jettisoned two programs in the face of decreased revenue. Home health and hospice services will no longer be offered by the health department as of Friday, July 31, but families using those services will be covered by neighboring agencies.

The program cut means the loss of 60 jobs in Luce, Mackinac, Alger, and Schoolcraft counties, including nursing, administrative, and clerical positions. Job terminations began in July and will continue through September.

Luce, Mackinac, Alger, and Schoolcraft District Health Department will discontinue home health and hospice services because providing it is crippling the agency financially, for two reasons: Patients in Mackinac County are spread out geographically, meaning more time and money must be spent for nurses to reach them, and regulations are making it more difficult for patients to receive home health care, said LMAS Health Officer Brian Schoenborn.

The Chippewa County Health Department, under the name EUP Home Health and Hospice, and VitalCare, a northern Michigan home healthcare provider affiliated with the hospitals in Petoskey and Cheboygan, will provide services to those originally covered by LMAS.

Home health and hospice services receive funding through Medicare separate from the other public health services offered by the Chippewa County Health Department, said Dave Martin, that agency's health officer. Cuts in state healthcare funding will not effect home health and hospice services in Chippewa County. One reason is the county is serving a smaller geographic area than LMAS with these services, taking on only the eastern portion of Mackinac County. Chippewa is currently providing services for more than a dozen patients of LMAS, Mr. Martin said.

VitalCare covers Mackinac and Chippewa Counties in the U.P., and 13 counties in northern lower Michigan.

An advisory board for EUP Home Health and Hospice Ser - vices will be established and will have seats available for representatives of Mackinac County. This will enable Chippewa to determine the needs of the patients of Mackinac County and serve them better, he said.

Work of hospice volunteers will continue

Home health and hospice services

are two separate services. Many hospice services are provided by volunteers, and those will remain the same for many of LMAS's patients, said Tracy Holt, executive volunteer coordinator of Chippewa County Hospice Services. In fact, Chippewa volunteers stepped in to help with LMAS patients beginning last year to help meet a Medicare requirement for the program to continue.

When LMAS made the decision to pull out of home health and hospice, Mrs. Holt said, affected hospice patients were sent letters notifying them of the change.

The volunteer component is funded entirely by donations.

"We're not leaving. We're not abandoning this community," Mrs. Holt said.

The hospice volunteer program of Chippewa County plans to build a hospice facility that will offer free room and board for patients. The building will be funded entirely by donations and will be available to anyone who needs it, and is not restricted to Eastern Upper Peninsula residents. There will be no charge for patients in financial need.

Need for hospice care is increasing, Mrs. Holt said. Chip - pewa County had 40 patients re - ceiving hospice care in 2006, she said. Today, the number has doubled to 80 patients.

Some patients in Mackinac County may be outside of Chippewa's coverage area, Mr. Martin said. Because of how expansive Mackinac County is, he said, some patients may be too far away for the department to cover them, but it will help them make other arrangements for care.

"We're not afraid to say we can't take that patient," he said.

Since LMAS's announcement of the decision in late June, Chippewa has not turned any referrals down. If a denial is made, he said, the department will work with the patient to help find a provider for their needs.

LMAS's decision to pull out of home health and hospice coverage was a result of a lack of funding. Healthcare funding has been shrinking for the past 12 years, Mr. Schoenborn said, and the state's deficit and resulting cuts added pressure on the department.

Health regulations have made it more difficult for patients to obtain home health care, reducing the overall revenue of the department. In some cases, patients are spread so far apart from each other that it would take nurses an entire day to tend to three of them, he said.

LMAS considered other op - tions, such as expanding services or selectively cutting back on others, but decided eliminating home health and hospice services would enable the department to continue providing its other services.

"The only option at this time is to scale back and focus on the basics," Mr. Schoenborn said.

LMAS will continue to provide other services such as immunization, wellness programs for parents and children, and prevention of the spread of the swine flu virus and others. The department is not mandated to provide home health and hospice services, he said.