Julie Monoy, executive director of Tamworth Community Nurses Association (TCNA), told the Select Board that TCNA provides nursing services in Tamworth that are not reimbursed by typical healthcare payers and that town support remains essential to sustain those services.

"TCNA's role is still filling those gaps," Monoy said, describing three case examples in which staff provided home visits, facilitated virtual provider visits and helped a 93-year-old resident arrange end-of-life supports to allow that person to remain at home.

Monoy said TCNA's 2024 workload included about 2,037 home, office and phone visits and that the agency consistently serves roughly 350 Tamworth residents. She described TCNA's revenue mix as roughly one-third endowment interest, one-third grants and fundraising, and one-third town affiliation.

Several select board members pressed TCNA on the size and sustainability of its town request. Board member Leanne Prentice said past town actions had raised expectations about larger annual appropriations and asked how TCNA planned to reduce its dependence on the town. "What happens if we say no? What happens if we don't support them?" Prentice asked.

Board members and members of the public suggested options including charging fees on a sliding scale, charging modest fees for some services (flu shots, COVID tests, vaccine clinics), renting space to allied providers (midwives, podiatry, mental health clinicians) and expanding fundraising. A TCNA board member, Maureen Diamond, said the current request had been reduced as a share of TCNA's budget and characterized further reductions as needing a phased approach.

There was particular attention to history: several speakers recalled a prior increase in town support that rose to $80,000 at a town meeting after earlier votes at lower levels. Monoy and other TCNA board members said the organization is still recovering from building-related expenses and that operational costs are clearer now that the organization has a new building and has implemented an electronic records system.

Select board members recommended that TCNA pursue a clearer, multi-year plan with explicit steps to reduce operating reliance on the town and to consider bylaw changes if TCNA wished to adopt a fee-for-service model. Monoy said TCNA would continue fundraising and explore modest new revenue streams while prioritizing core nursing services.

No formal appropriation was made at the Jan. 2 meeting; the board and TCNA agreed to continue discussions during the budget process.