| [Executive director] "It was a terrible year. It was awful."
(Home health care is in trouble in McKean County, Pennsylvania.)
[E.D.] "We want to stay in business. I know that I'm pleading."
(For the Visiting Nurse Association, "trouble" means bankruptcy.)
[E.D.] "I'm being sincere when I say I can't pay $35,000 by March 31st."
(Nationwide, home health agencies are going out of business.)
[State regulator] "It's regulations, and we must follow them."
(Medicare programs have tighter reviews of reimbursement claims.)
[E.D.] "Well, (regulator), you've got me backed into a corner."
(Nurses spend more time on paperwork than on patient-care.)
[Narrator] "The financial walls of Francie Ambuskie's administrative world are relentlessly pressing in."
McKean County (Pa.) VNA is rescued from bankruptcy at almost the last moment, through merger with a larger, stronger agency; Francie Ambuskie's struggle to balance her agency's budget and continue care to her patients "succeeds" by failing. But the fundamental problem continues; other social service agencies face similar or worse problems. Tough Choices shows that hard work and good intentions are not always enough to sustain a helping agency in an increasingly harsh regulatory and economic climate. Produced by P J O’Connell for Penn State Public Broadcasting and The Rural America Documentary Project. ©1988|