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Doing More with Less: Maximizing Health Outcomes with Limited Funding

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Candace Sharkey, RN, MSHA, CEO

Candace Sharkey, RN, MSHA, VNS CEO

By Charlena Wynn

Offering quality healthcare services to all, regardless of ability to pay, drives Visiting Nurse Services of Newport and Bristol Counties of Rhode Island’s (VNS) commitment to healthcare access, programming, and funding. But as one might imagine, funding is scarce, and VNS, like many nonprofits, is faced with the reality of making tough decisions concerning underfunded and zero funded programming which is essential to the health of its community. VNS refuses to end critical programs such as wellness clinics, palliative care, and maternal health programs. How does an organization that is critical to its community handle budget concerns that may threaten programming? VNS’s CEO Candace Sharkey’s strategy is to explore external resources that offer comparable services to one’s target demographic and to educate the government on the importance of home care agencies.

Why Home Care

VNSRI Logo Original

Visiting Nurse Services of Newport and Bristol Counties Logo

For healthcare, the one-size-fits-all model simply does not work, as patients have many needs that must be addressed through collaboration among different specialists. A typical stroke patient, for example, may require nursing for ongoing assessment and medication management, physical therapy to regain muscle function and address mobility needs, occupational therapy to assess and treat deficits in the  ability to perform daily tasks and more to regain some semblance of life before the stroke, says Sharkey. VNS is a home care agency that specializes in collaborative practices through a diverse team  of nurses, dietitians, chaplains, bereavement coordinators, occupational, physical, and speech therapists, and hospice workers. The collaboration between the diverse staff is essential to the care VNS provides. All disciplines must coordinate with each other to ensure the Plan of Care is followed so that the patient can attain optimal goals. To keep these services at low or no cost to patients, outside funding is needed to ensure qualified staff and resources are available to care for patients.

VSNRI Nurse Helping Patient Original

VNS working with a patient

Access to quality care can be costly, particularly as community needs increase and resources decrease. According to Ms. Sharkey, insurers are incentivizing to keep patients out of in-patient facilities, and patients are being discharged “sicker and quicker.”  Where does that leave patients battling chronic and/or terminal illnesses or those not eligible for hospice? Visiting Nurse Services has honed in on many peoples’ desire to stay at home to “age in place.” By offering care in the home, in-patient care is reduced and self-directed care is increased as patients are able to collaborate with caretakers and manage their own health. As the 65 and over population increases by an estimated 71% from 2003 to 2020, Medicare will struggle more. Therefore, new ways to care for this increasing population is important to the overall health of communities across the nation. With limited funding, VNS provides important services to Newport and Bristol Counties by bringing healthcare to patients in their homes.

Bringing Tradition into the 21st Century

The tradition of Visiting Nurses began in 1890 with a simple mission to provide free care to the sick and poor and address the rising immigrant population’s needs. The bottom-up approach proved to be successful in improving the health of entire communities by ensuring access to basic healthcare. VNS of Newport and Bristol Counties was founded in 1950 and has continued the tradition of access to quality care regardless of a patient’s ability to pay.  As one of two stand-alone non-profit VNS’s  in Rhode Island, Visiting Nurses is critical to the health of Bristol and Newport Counties as they work to bring the concerns of their patients to the forefront of their programming.  To identify community needs, VNS has strong ties with its community partners, Board members who live within the community, a clinical staff that lives and works in the same neighborhoods, and an Advisory Committee with community representation.  All of these grassroots stakeholders help to shape programming and, most importantly, budgeting.

Underfunding, Zero Funding… What Can You Do?

Visiting Nurse Services knows the importance of keeping community needs as a priority and focus. Since 2000, they have expanded to include palliative care, adult community wellness clinics, specialized diabetes workshops, and maternal health and child programming for high-risk infants and mothers. Some of these programs are underfunded or not funded at all, like the maternal health program. But because there is a large need for health care and education for high-risk infants and mothers, VNS refuses to end these services. When asked why, Sharkey simply said “because it’s a part of our mission”.

It’s a difficult balancing act many nonprofits face. Budget cuts, limited resources, and staffing bring about tough decisions concerning how they can continue to be effective in their respective communities. Sharkey says that because of private donations, fundraising events, and grants, they have been able to continue these programs that the community needs. What VNS may not be able to offer, they explore external options. VNS, like many nonprofits, is careful about their spending and cuts costs where needed to maximize the impact of funding.  Involvement with state and national associations and educating Congress and the Senate on the needs of home care agencies is pivotal to policy change and legislation that supports funding for home care agencies.

Value of Home Care

“It’s never easy, but we survive. It’s the old adage of doing more with less, even though it might not seem feasible,” says Sharkey. In recent years, the VNS has not had to cancel any programs and tries to maximize every dollar that comes from fundraising events, donors, and philanthropists. Many nonprofits that are grappling with underfunding must find innovative ways to continue to provide quality services.

Visiting Nurses Staff

Visiting Nurses Staff

Budget constraints not only affect services, but also staffing. For VNS, a large staff is essential to carrying out programs and ensuring optimal health outcomes for  varying healthcare needs. How do they do it? None of their 250 workers are contract workers. Payroll is a significant part of their budget and is funded through revenue received from Medicare, Medicaid, private insurers, and grants. And of course, the volunteer staff is an important way to maximize their ability to carry out VNS work. Again, funding through policy change at the legislative level is integral to ensuring staff is adequately paid for their expertise so that they can bring quality care to patients.

Home care agencies, while not all the same, are valuable as they strive to bring quality care to each individual and positive outcomes for their communities. Ms. Sharkey says that while VNS’s future is dependent on partnering with community agencies and health care facilities, VNS should still be recognized for the independent contributions they offer on family and community health. While home care may not be the best decision for everyone, supporting low and no-cost health care services can help home care agencies everywhere continue to provide quality care to those who want self-directed and collaborative healthcare services.


Visiting Nurse Services of Newport and Bristol Counties is an independent home healthcare and hospice agency providing optimal health and quality of life for individuals and families throughout Rhode Island’s Bristol and Newport counties.

Charlena Wynn is currently pursuing her Master’s of Arts in Liberal Studies at NC State University with a concentration in examining the construction of Blackness in contemporary United States museums.

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