LITTLETON — Members of the Select Board and the Board of Health are discussing the future possibility of leaving the Nashoba Associated Boards of Health, a collective of over a dozen towns that has existed in some form since 1931.
The suggestion, coming only weeks after the group acquired its own vaccination site in Devens, was intended to become a topic of discussion for the June 12 town meeting. If the departure were to happen, the town would then need to fund and hire staff for the newly created Department of Health, including at least a sanitarian, a nurse and an administrator, and maybe also a director of public health.
Board of Health Clerk Mike Zeldin, who presented the idea to the Select Board, emphasized that this would not be an immediate exit, rather a “planned” and “stepwise transition,” he said.
Municipalities in the Nashoba Associated Boards of Health include Ashburnham, Ashby, Ayer, Berlin, Bolton, Boxboro, Dunstable, Groton, Harvard, Lancaster, Littleton, Lunenburg, Shirley and Townsend.
Zeldin cited several reasons for the proposed change. First, he said Littleton has “outgrown, and will continue to outgrow” this shared, part-time arrangement. He added that although the board is currently able to fulfill its duties, it is at its personnel limit to provide Littleton with the timely assistance the town needs.
Second, he said the operations of the NABH are opaque to Littleton town officials.
“We don’t know what’s going on on a routine basis, except by verbal reporting and occasional written reports as requested,” he said, adding that the record-keeping at the NABH is poor.
Finally, he said the emergency alert system in Nashoba is “inadequate,” he said, especially during a pandemic situation, though he added that this is not the fault of the Nashoba group because its alert systems are not very active in any of the towns. He said he worries about the spread of misinformation with a slower system in place.
Jim Gareffi, of NABH, in response to Zeldin’s comments said in an email that, “The Nashoba Associated Board of Health serves as the Health Agents for 16 communities. … All of the communities have experienced growth over the past decade and some more than others. Our office works hard to provide the necessary services to our communities and meet our Boards’ expectation but given increased workloads (even before the pandemic) and same staffing levels I can image there are times we don’t.” He said that NABH does provide copies of necessary documents, but differing systems among towns can cause delays. He said there is also an after-hours hotline available for all communities.
“I can appreciate the Board of Health’s desire to provide more public health services for their residents and the District will support and assist the Board of Health with their decisions,” he said.
Zeldin broke down Littleton’s assessment fee to the NABH, which is about $39,000: $26,573 was allotted for “environmental” costs, and $12,126 was allotted for nursing costs. These environmental costs largely consist of for-fee services such as application and plan review, soil testing and sewage disposal construction work permits. The demand for these services is driven largely by home construction and renovation and septic system replacements.
Zeldin also differentiated the work a Board of Health does from what a doctor does. In Littleton’s case, the NABH performs functions such as vaccination programs, at-home critical monitoring, infectious disease spread, behavioral health and anything that prevents “further exacerbation of any disease in the community,” he said.
He laid out a few options for the Select Board to discuss, including continuing in the board as-is; continuing but hiring Littleton its own sanitarian and renegotiating NABH fees; and leaving and hiring more than one staff member of the town’s own.
Zeldin recommended that the town begin by hiring a sanitarian, who would work closely with the elected Littleton Board of Health.
Select Board member Paul Glavey reminded the group that many of the NABH leaders were Littleton residents at one time, meaning the Select Board was much better informed of the inner workings of NABH than it is now. Given the growing population of Littleton, he said, it would make sense to have health professionals working just for Littleton in Town Hall.
Select Board member Chuck DeCoste, who’s up for re-election on May 8, suggested partnering with a neighboring town to share resources, as Littleton and Boxboro already do with animal control. Zeldin said he looked at several nearby towns that are currently in the NABH as potential partners, but wasn’t convinced of their public health rigor as compared with Littleton.
“I have to say that in a lot of cases, for example, you wouldn’t even know that COVID was going on,” he said. “We’re a different town, I just can’t — I’m not — This is nothing against Groton or Harvard or any of these places, it’s just the approach is different.”
Zeldin suggested first focusing on hiring and on-boarding a sanitarian to keep pace with new residential and restaurant construction in town, then focus on hiring public health nurses. Once those people are in place, Zeldin suggested looking for cost-sharing arrangements with other towns. In the meeting packet, he suggested the department hiring be completed by February to complete the transition out of the NABH.
Select Board member Matthew Nordhaus asked Zeldin about the difference between the role of a sanitarian and a director. Zeldin said a director is in charge of programs with broader reach than the Department of Health. He gave the example of addressing issues related to Littleton’s large senior population in conjunction with the Council on Aging and any other relevant organization that deals with senior issues.
“A striking example, an extreme one, is what, what happened at one of the nursing homes here in Littleton, which was an avoidable situation, let’s put it that way,” Zeldin said, referring to the Life Care Center of Nashoba Valley, where more than 20 residents and at least one nurse died of COVID-19, and dozens more were infected by the virus.
Select Board Chair Cindy Napoli then questioned the administrative burden this approach may have on the town’s permitting department, which could require hiring an administrative assistant as well, which Zeldin agreed with. Napoli then reminded him this was the first time the board was given the opportunity to discuss the move, so she wanted more time to think about the implications of parting with NABH.
Because Zeldin had presented a phased approach to the Select Board, Glavey suggested “(getting) the ball rolling” at the town meeting ahead of the new fiscal year July 1 and making adjustments to the plan in the fall.
The Select Board then changed topics without making a final decision on whether to include the article in town meeting this spring. The board has until May 18 to post the town meeting warrants ahead of the June 12 meeting.