On Dec. 6, Ellsworth Area Ambulance Service Director Jessi Willenbring was working a 24-hour shift. Working extra or long hours have become frequent for Willenbring as the eight-municipality ambulance service has seen dwindling volunteers over the last three years.
"I do this job and I do a lot of time outside my salary time sort of volunteering my time here," Willenbring said. "I want to be able to volunteer at my church, I want to sell popcorn for my boy's boy scouts ... but you just run out of hours in your day."
While the ambulance service has hired three more full-time employees in that time to help make up for the lack of volunteer time, and reduce strain on its director, Willenbring estimated they are still short about 300 hours that the service needs volunteers to fill.
Those new full-time employees help but come at a cost too. The ambulance service's approved 2019 budget has a roughly $3,200 shortfall - the first time the service has had a shortfall. The tight budget has resulted in the organization pushing back plans to buy a new ambulance and casts worries for future years' budgets.
"It isn't as bad as it looks, maybe, but looking down the road two years from now, we're going to be in trouble," said Dan Fischer, chair of the ambulance service's operating committee. "We're not on a sustainable budget."
Frozen or slowly rising tax levies, dwindling volunteers and increased costs for more paid, full-time staff hired have all strained the service's budget.
The service currently has three ambulances, one new, one in need of replacement and a third acts a backup. A new ambulance can cost over $200,000, while a cheaper option of just putting in a new chassis costs about $130,000, Fischer said.
The service also raised its per capita cost - an annual fee for village residents through their local municipality levy - to $25 to help pay for a paramedic wage increase earlier this year. Fischer said the per capita cost is already higher than most other places in the area, save for some affluent suburbs near the Twin Cities, which makes it difficult to justify to municipalities another hike.
The service originally planned to invest in a new ambulance, or chassis, in 2019, but the increased personnel costs pushed it back to future years, he said.
Over half of the services calls come from Medicaid or Medicare recipients and only bring in about a third of what a typical call does, said Rick Sweig, co-chair of the operating committee.
Combined with a low rising tax levy for municipalities and with Ellsworth's numerous senior-care centers, it puts the service in a difficult financial situation.
"That really is a shortfall for our budget," Sweig said. "We got to look at all the things possible to raise the capital."
Tax levies have failed to keep up with inflation since 2011 when Gov. Scott Walker tied levy raises to solely new construction, said Jerry Deschane, the executive director of the League of Wisconsin Municipalities.
"Local governments have for 10 years made due," Deschane said. "[Now] they've cut all the fat off the bone."
He said about 1 in 10 villages' levies have kept up with inflation rates, leading to struggles across the board. It's causing municipalities in the state to make tough decisions surrounding ambulances and other critical services, he said.
Recently he's noticed more referendums to raise the levies above the state limit, and most have passed. It's somewhat of a shift among conventional political wisdom - keeping taxes low is always politically popular, Deschane said.
"Keeping taxes low is a very popular slogan ... but so is keeping ambulances going," he said.
In order to piece together funding back into the group's ambulance fund and its general budget, Fischer said they plan to host a "barnstorming" session where they'll brainstorm ideas to increase income. Other methods have come through donations from local businesses, a hog roast and other measures, he said.
Few volunteers, few hands and long hours
In 2015, the service peaked at about 40 volunteers who get paid $1.50 for on-call hours, and today the volunteer count is at roughly 25. It results in overtime for the full-time staff or Willenbring "volunteers" extra hours to fill shifts.
It also means the service is often responding with the legal minimum of two people, instead of the preferred three, Willenbring said.
"We struggle to recruit and maintain a volunteer base," she said. "The volunteer spirit is different now ... most people just spend their time trying to get by."
To help ease the workload, Fischer said the service had to raise the pay for its paramedics so it could attract more. At the start of 2018, they paid paramedics about $13 per hour, that raised to $16 in the middle of the year and they raised it again for a $19 per hour wage starting in January 2019.
In order to incentivize volunteers the service has long offered a $1,000 reimbursement on EMT training classes and recently started offering $1,000 in class funding before they take the classes, Fischer said.
Since offering that they've had several people sign up, but haven't yet been able to get a training class nearby for the interested people.
"Along with fewer volunteers and more staff to pay for, all of a sudden it is kind of hard on the budget," he said.
The service made about $25,000 in 2018; however, most of that comes from Willenbring volunteering to cover up for hours that would typically be paid hours.
That same year, the ambulance services' last director stepped down due to similar straining hours. Fischer worries when Willenbring, who also volunteers at the Ellsworth Fire Department, might decide the hours are too much.
"It bothers the hell out of me," he said. "I'd hate to lose another director."
But for now, Willenbring said she doesn't find the hours too taxing. She says she loves the job and understands its significance.
"I would not put in the amount of work necessary if it was just a job," Willenbring said.