Greater Borough public‑health staff weigh FY26 budget options: contract nursing, part‑time hire and software trade‑offs

Mikaela, the Greater Borough shared‑service coordinator, presented two FY26 budget options for the municipal public‑health collaboration covering Southborough, Northborough, Boylston and Westborough and answered detailed questions from the Board of Health on May 6.

The options: continue the current contract with Salmon (30 hours per week of nursing services) while adding data‑visualization software and absorbing a Salmon per‑diem increase to $75 per hour; or hire a direct‑hire 16‑hour/week nurse at $48 per hour while reducing contracted hours and using a lower‑cost nursing software. Mikaela said the Salmon contract currently provides 30 hours per week and a per‑diem rate that has been $45 per hour; the vendor’s proposed per‑diem for FY26 is $75 per hour. ClearPath, a separate contract for hoarding‑case technical support, was discussed as an optional $8,000 annual expense for the four towns.

Why it matters: the Greater Borough public‑health program supports nursing services, inspections and trainings across four municipalities. Board members weighed tradeoffs between nursing hours, software tools for data and nursing coordination, and the cost and allocation of a regional hoarding contract.

Mikaela summarized fiscal trends and spending in FY25: the program underspent some staffing and fringe lines because of hiring delays; training and health‑communications spending rose above original budgets (from an originally budgeted roughly $3,000 to about $14,000, she said) to support shared‑staff trainings and purchased supplies such as EpiPens. Mikaela said some funds were moved between lines to buy nursing supplies and training following delayed hires.

Under Option 1, the program would keep Salmon’s 30 hours/week contract and add higher‑level nursing coordination software; the budget assumed the Salmon per‑diem would increase to $75 per hour and noted ClearPath could be added as a separate $8,000 line if permissible under grant rules. Under Option 2, the program would hire a 16‑hour/week nurse at $48 per hour, reduce the Salmon contract and rely on lower‑cost software; that option would leave only a small contingency in the FY26 budget, Mikaela said.

Board members expressed concerns about specific elements. Chelsea said, “I think that's astronomical, and I don't know that I would vote for that,” referring to the Salmon per‑diem increase from $45 to $75. Chelsea also said she did not support eliminating or substantially reducing the planned full‑time nurse role and favored preserving nursing hours. Safdar Medina asked for data on past hoarding cases to understand the likely demand for a shared ClearPath contract; Mikaela said ClearPath began in April and so far has worked four cases across two towns and that the contract includes a referral model and subsidizes services for clients who cannot pay. Safdar asked, “The $75 an hour, is that because you're looking for more specialized staff like that difference in that per diem, like you mentioned, lactation or things like that. So where did that increase come from?” Mikaela replied it is Salmon’s new standard per‑diem rate for FY26.

Board members discussed recruitment and costs for a full‑time nurse. Mikaela said hiring challenges and benefit costs make a full‑time hire difficult in FY26 without cutting other program lines; she noted a state rollout of an inspection data solution (referred to as “Metrc” in the meeting) projected for FY27 could free up roughly $30,000 in future budgets to reallocate toward staffing.

No formal budget decisions were made at the meeting. Board members asked Mikaela and staff to take their feedback to the Greater Borough board and return with more detail on ClearPath demand and recruitment feasibility. Several members indicated they would prefer preserving as much nursing coverage as possible rather than reduce to a 16‑hour position.

Next steps: staff will confirm allowable uses of PHE grant funds (which partially fund the shared coordinator position), verify the ClearPath scope and cost allocation across towns, and bring a refined recommendation to the Greater Borough board for an FY26 staffing and contract decision.