{"id":48670,"date":"2026-02-23T16:05:04","date_gmt":"2026-02-23T23:05:04","guid":{"rendered":"https:\/\/www.newmexicopbs.org\/productions\/newmexicoinfocus\/?p=48670"},"modified":"2026-02-23T16:05:53","modified_gmt":"2026-02-23T23:05:53","slug":"an-alarm-bell-los-alamos-visiting-nurse-service-shutters-amid-turmoil-for-home-health-care","status":"publish","type":"post","link":"https:\/\/www.newmexicopbs.org\/productions\/newmexicoinfocus\/an-alarm-bell-los-alamos-visiting-nurse-service-shutters-amid-turmoil-for-home-health-care\/","title":{"rendered":"\u2018An alarm bell\u2019: Los Alamos Visiting Nurse Service shutters amid turmoil for home health care"},"content":{"rendered":"\n

by Margaret O’Hara<\/p>\n\n\n\n

This story<\/a> was originally published at Searchlight New Mexico<\/a>, a NMPBS partner.<\/strong><\/em><\/p>\n\n\n\n

\"A
Susie Edwards, left, clinical manager with Los Alamos Visiting Nurse Service, watches with patient Gordon McDonough as the last of the fluid of an infusion passes through the IV tubing during a home visit in Los Alamos on Wednesday. Matt Dahlseid\/The New Mexican<\/figcaption><\/figure>\n\n\n\n
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<\/div>\n<\/div>\n\n\n\n

A home health and hospice agency that has been serving Los Alamos and Rio Arriba counties for more than 50 years will shutter later this month, a closure agency officials attributed to decreasing revenue from patient insurance and sharply rising health care costs.<\/p>\n\n\n\n

Los Alamos Visiting Nurse Service will halt operations Friday.<\/p>\n\n\n\n

The loss should serve as a warning, said Meggin Lorino, executive director of the New Mexico Association for Home and Hospice Care. Chronic underfunding poses a threat to all home health and personal care service providers, she said, and policy changes at the state and federal level are needed to stabilize the industry.<\/p>\n\n\n\n

\u201cThe closure of Los Alamos Visiting Nurses is an alarm bell that all of these underinvestments in care in the home are coming to roost,\u201d Lorino said.<\/p>\n\n\n\n

\"A
Susie Edwards, left, clinical manager with Los Alamos Visiting Nurse Service, prepares for an infusion Wednesday for patient Gordon McDonough during a home visit in Los Alamos. Matt Dahlseid\/The New Mexican<\/figcaption><\/figure>\n\n\n\n

The decision to shutter Los Alamos Visiting Nurses comes as rural health care providers grapple with an abundance of challenges, which range from operating on razor-thin financial margins<\/a> to impending cuts<\/a> to Medicaid to the added pressures of the state\u2019s aging population<\/a>. Bolstering the state\u2019s health care system has turned into a central issue<\/a> of this year\u2019s regular session of the New Mexico Legislature, which concludes Thursday.<\/p>\n\n\n\n

Lorino argued investments in home health care now can save costs in the long term by preventing patients from cycling through expensive hospital stays.<\/p>\n\n\n\n

\u201cWe know that, in the long run, we help save health care delivery dollars, but \u2026 we are not in a reality where that kind of long-term thinking and forward-thinking is really embraced,\u201d Lorino said.<\/p>\n\n\n\n

\u2018Can\u2019t keep up\u2019<\/h2>\n\n\n\n

In Santa Fe, a home health care provider might be able to visit seven patients within an eight-hour shift, driving from one in-town appointment to another.<\/p>\n\n\n\n

For Los Alamos Visiting Nurse Service \u2014 which until next week will serve locations throughout a 32-mile radius of its Los Alamos office \u2014 that\u2019s not the case, said clinical manager Susie Edwards. One patient might live in White Rock, the next in Chimay\u00f3, the next in San Ildefonso Pueblo.<\/p>\n\n\n\n

The demand was there. New Mexico is home to a growing number of seniors: The state\u2019s over-65 population grew nearly 40% between 2010 and 2019, outpacing the rest of the nation, and the trend will continue. Demand for health care services \u2014 including home-based care, since many seniors live in rural areas and want to age in place \u2014 is expected to rise with the demographic shift known as a \u201csilver tsunami.\u201d<\/p>\n\n\n\n

Los Alamos Visiting Nurse Service often operated with a wait list for physical therapy services.<\/p>\n\n\n\n

\"An
Gordon McDonough finishes up with an infusion procedure administered by Susie Edwards, right, clinical manager with Los Alamos Visiting Nurse Service, during a home visit in Los Alamos on Wednesday. Matt Dahlseid\/The New Mexican<\/figcaption><\/figure>\n\n\n\n

After accounting for drive time, however, providers with Los Alamos Visiting Nurse Service couldn\u2019t see the volume of patients that counterparts in more urban areas could, Edwards said.<\/p>\n\n\n\n

\u201cYou just can\u2019t keep up,\u201d she said.<\/p>\n\n\n\n

Maintaining the right volume of patients is critical to the financial solvency of any health care venture. Insurance \u2014 including Medicare and Medicaid, which together cover nearly half of New Mexico residents, according to data from the health research and polling organization KFF \u2014 reimburses providers per patient served.<\/p>\n\n\n\n

Crucially, Lorino said, those reimbursement rates don\u2019t pay for drive time between appointments \u2014 which leave rural providers traveling long distances at a disadvantage.<\/p>\n\n\n\n

\u201cThe universal pay model that a lot of these companies have do not take into consideration what it is like to provide care in a rural setting. And so, I think that\u2019s really what put us at a disadvantage,\u201d Edwards said.<\/p>\n\n\n\n

While Los Alamos Visiting Nurse Service grappled with limitations on revenue, costs \u2014 for staffing, supplies, insurance, technology and other necessities \u2014 increased, Edwards said. After factoring in inflation and rising costs, she estimated the agency has seen a 20% decrease in reimbursement since the early 2000s.<\/p>\n\n\n\n

The New Mexico Association for Home and Hospice Care estimates over half of agencies providing that care in the state are not profitable, which Lorino attributed to unfavorable reimbursement models at the federal level.<\/p>\n\n\n\n

Providers, she said, are \u201cjust getting squeezed at every single angle, and so there\u2019s fewer and fewer dollars there.\u201d<\/p>\n\n\n\n

Especially in rural areas, those challenges compound with limited health care infrastructure<\/a> and a smaller pool<\/a> of providers in the workforce.<\/p>\n\n\n\n

\"A
Susie Edwards, clinical manager with Los Alamos Visiting Nurse Service, visits with patient Gordon McDonough while he receives an infusion during a home visit in Los Alamos on Wednesday. Matt Dahlseid\/The New Mexican<\/figcaption><\/figure>\n\n\n\n

Mounting financial pressure, combined with resignations of the agency\u2019s medical director for hospice and another registered nurse, sounded the death knell for Los Alamos Visiting Nurse Service, Edwards said.<\/p>\n\n\n\n

\u201cWhen we took another look at the financial picture, it was really time to close the entire business down,\u201d she said.<\/p>\n\n\n\n

There is a sliver of good news in all of this, Edwards said: Other agencies operating in the area have been willing to take on Los Alamos Visiting Nurse Service\u2019s patients, meaning the closure shouldn\u2019t leave them without the care they need. She said she doesn\u2019t expect a hole in home health and hospice services in the area.<\/p>\n\n\n\n

\u201cIt\u2019s really kind of beautiful to see how the home and hospice community has stepped up. \u2026 It\u2019s been absolutely terrifying to worry that you\u2019re not going to be able to discharge these patients to anyone,\u201d Edwards said.<\/p>\n\n\n\n

Ensuring patients are cared for at home is an important step to keep them from cycling through hospital stays \u2014 which are more costly to the patient, to the health care system and to taxpayers \u2014 Edwards said.<\/p>\n\n\n\n

But she argued policy change is needed to ensure New Mexico\u2019s rural residents continue to have access to home health care.<\/p>\n\n\n\n

Potential policy change<\/h2>\n\n\n\n

Making meaningful policy changes for the home health system is a matter of money, Lorino said.<\/p>\n\n\n\n

\u201cI hate when the answer is always just, \u2018We need money. We need funding,\u2019 \u201d she said. \u201cBut the answer is adequate funding for these programs, and I think that we need lawmakers and policymakers to better understand what it takes to adequately fund these programs.\u201d<\/p>\n\n\n\n

Lorino said changes at the federal level will be required to increase and stabilize Medicare reimbursement rates and ensure compensation factors in drive time for agencies that serve rural communities.<\/p>\n\n\n\n

But it can be difficult for home health agencies from small states like New Mexico to make headway at the federal level \u2014 something Lorino said makes her feel the \u201cinvisibility\u201d of the home health workforce.<\/p>\n\n\n\n

\"A
Susie Edwards, clinical manager with Los Alamos Visiting Nurse Service, prepares to administer an infusion for patient Gordon McDonough during a home visit in Los Alamos on Wednesday. Matt Dahlseid\/The New Mexican<\/figcaption><\/figure>\n\n\n\n

Recent policy changes at the federal level have also brought about grave concern for the future of rural health care in New Mexico and beyond. Medicaid cuts included in the federal budget reconciliation bill, which was signed into law by President Donald Trump in July, could result in the closure of six to eight rural New Mexico hospitals by 2028, according to estimates from the state Health Care Authority.<\/p>\n\n\n\n

An analysis by health research and polling organization KFF shows a $50 billion federal investment<\/a> in rural health care will offset just 37% of the funding providers are set to lose through Medicaid spending cuts in rural areas.<\/p>\n\n\n\n

Advocacy at the state level has proven a little more successful.<\/p>\n\n\n\n

During this year\u2019s legislative session, a bipartisan group of lawmakers introduced House Bill 83, which would have provided $51 million to increase Medicaid reimbursement rates for personal care services, or help with activities of daily living like bathing, dressing, eating and using the bathroom.<\/p>\n\n\n\n

To Rep. Rebecca Dow, a Truth or Consequences Republican and sponsor of HB 83, the reasoning behind the bill was twofold. It would keep aging and sick residents in their homes while saving taxpayer dollars in the long run.<\/p>\n\n\n\n

\u201cI believe in family first; I want to see families stay together,\u201d Dow said. \u201cFrom a fiscal conservative perspective, adequately funding a high-quality personal care provider network saves taxpayers huge amounts of money versus assisted living and long-term care.\u201d<\/p>\n\n\n\n

The bill wouldn\u2019t have affected home health care providers like Los Alamos Visiting Nurse Service, since they provide medical care \u2014 rather than personal care \u2014 to patients at home. Lorino argued, however, HB 83 is still a change at the state level that would better support providers of home-based care.<\/p>\n\n\n\n

HB 83 won\u2019t pass this year; it was halted by the House Rules and Order of Business Committee.<\/p>\n\n\n\n

Instead, lawmakers came to a compromise in the state budget bill, House Bill 2. The version of the budget that made it through the Senate Finance Committee on Sunday includes $10 million for rate increases for personal care services, after advocacy efforts by the New Mexico Association for Home and Hospice Care.<\/p>\n\n\n\n

New policy in the future won\u2019t change the present for Los Alamos Visiting Nurse Service. Lorino said she was \u201creally saddened\u201d to learn the organization will no longer be able to provide care in Los Alamos and Rio Arriba counties.<\/p>\n\n\n\n

But she said the agency\u2019s closure should serve as a warning. She hopes it raises policymakers\u2019 awareness of the consequences of underinvestment in home care for rural New Mexicans.<\/p>\n\n\n\n

For Edwards, working in home health and hospice care offered its own kind of relief.<\/p>\n\n\n\n

In her more than two decades as a registered nurse \u2014 with much of that time spent working in New Mexico emergency rooms \u2014 Edwards said she felt the burnout that often comes with the profession. The feeling dissipated when she made the switch to home care and started making authentic connections with patients.<\/p>\n\n\n\n

\u201cIt\u2019s been one of the most beautiful things that I stumbled into,\u201d Edwards said.<\/p>\n\n\n\n

This story was originally published at Searchlight New Mexico<\/a>, a NMPBS partner.<\/em><\/p>\n\n\n\n

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