BOONE, Iowa—Boone County Hospital (BCH) is announcing an important change to its Home Care Services and the F. William Beckwith Adult Day Services.
“After ongoing and careful evaluation of our operations, BCH has made the difficult decision to close our Home Health and Adult Day Center services due to persistently low patient volumes,” says Mikaela Kienitz, BCH CEO. “Home Health is currently serving 42 clients, versus a census of 84 just five years ago, and the average daily census of the Adult Day Center is less than three.” Both programs will close on June 30, 2026.
“As healthcare needs and delivery models continue to evolve, it is our responsibility to regularly assess our services and make thoughtful decisions that ensure we can best serve our community,” Kienitz adds. “This decision allows us to responsibly allocate resources and continue providing high-quality care where it is most needed. BCH remains in a strong financial position, and decisions like these—while difficult—are necessary to sustain a strong, resilient organization for the future.”
Several other factors have also contributed to making it increasingly difficult to continue operating these programs, including saturation of competing services within the service area, staffing shortages, and significant financial losses over the past several years. Additionally, the Centers for Medicare and Medicaid (CMS) classifies both home health and adult day programs as non-core services under the Critical Access Hospital (CAH) model, which has presented alignment challenges since BCH transitioned to CAH status after establishing these services. Consequently, BCH has incurred a penalty just for owning and operating these services which largely contributed to financial losses exceeding $1.2 million in fiscal year 2023, $900,000 in fiscal year 2024 and $700,000 in fiscal year 2025.
Kienitz shares that the hospital has explored partnerships with local organizations, but no long-term solution emerged that would allow these services to continue sustainably. “Our Board and Administration believe focusing our resources on strengthening the Public Health Department will better support the entire Boone County community and align with BCH’s mission to enhance the health and well-being of those we serve,” she says.
She also notes that the Meals on Wheels program will not be affected, as it moved under the BCH Nutrition Services Department in 2025.
BCH will no longer accept new referrals as our focus will shift to supporting our clients through a smooth and thoughtful transition. Boone County is fortunate to have multiple agencies that provide Home Health services, and we will work closely with our clients and those providers to help patients transition smoothly and with as little disruption as possible.
“We know this decision affects many people—patients, families, staff, and the broader community,” Kienitz said. “Supporting our staff through this change is a priority. Employees are encouraged to apply for open positions within the hospital or its clinics. Boone County Hospital remains committed to high-quality care and to supporting everyone impacted during this transition.”
(contributed press release, BCH)
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