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HomeMy WebLinkAboutHealth & Human Services 02-20-08 Esther Wentz will review vouchers. Revised 02/13/08 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 20, 2008 at 8:30 (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 01/30/08 DATE OF NEXT MEETING – 03/19/08 at 8:30 a.m. OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. Aged receivables report c. Update 2007 year -end projection 3. Planning for 2007 audit report 4. Juvenile Corrections Utilization Report 5. Economic Support Badgercare Plus— including staffing needs. ** 6. Psychiatry coverage and consideration of recruitment for Advanced Practice Nurse Practitioner position 7. Consideration of resolution in support of Assembly Bill 509— Reducing reimbursement by county departments of community programs for inpatient facility care and services for mentally ill county residents sease Update on Wisconsin Disease Surveillance System 8. Public Health Communicable Di (WEDSS): Kim Gearin Epidemiologist 9. Public Health Report on WIC: Ruth Lehmann, Teresa Kvam 10. Public Health community needs assessment planning 11. Update on new phone system 12. Personnel Issues a. Employee recognition/appreciation b. New employees /resignations C. Altered schedule – 4 x 10 or less than 5 work days pilot in outpatient clinic 13. Nursing Home Report a. Nursing Home Administrator Report b. Hospice C. Review financial forecasts for the Nursing Home, which includes construction estimates to refurbish and remodel current facility 14. Update rules and Bylaws of the St. Croix County HHS Board 15. Re- consideration of resolution in support of statewide clean indoor air 16. Resolution for Tobacco -free Government Grounds and Vehicles Effective 01/01/09 ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 2/13/2008 11:18 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 20, 2008 The St. Croix County Health and Human Services Board met on February 20, 2008 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Lois Burri Tom Caflisch (arrived at 10:10) Linda Luckey Deb Rasmussen Ron Troyer MEMBERS ABSENT: Gordon Awsumb (via phone conference, 11:25)" Dr. Glenn Hoberg STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Harold Morris, Contracted Nursing Home Administrator Kathy Dunlap, Family and Children's Coordinator Pat Haeny, Family and Children's Supervisor Ron Kiesler, Behavioral "Health Coordinator Kathy Huston, Adult Community support Services Coordinator Mary Squyer, Economic Support Supervisor Art Tobin, Facilities Manager Charlotte Soredahl, Public Health' Coordinator Health Officer Ruth Lehmann., Public Health Nutritionist Teresa Kvam, Public Health Nutritionist Malva 'S "irek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Tammy Funk", Human Resource Administrator -Tom Boron, Director of Information Technology Larry Lester, Wi�pfli Kim Gearin, Epidemiologist -Kim Dupre Loyla Waskul Dean Winquist Jennifer Kirchner, Social Work Intern Jennifer Wilson, Social Work Intern Kristen Severson, Social Work Intern Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, March 12, 2008 at 8:30 AM; the following meeting will be Wednesday, March 19, 2008 at 8:30 AM. Berenschot will review vouchers. AGENDA Motion A motion was introduced by Berenschot, s by Troyer, and unanimously adopted: That the agenda be app requested to delay discussion on Nursing Home hospice to the next meeting. MINUTES Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the minutes of the 01/30/08 Health and Human Services Board meeting be approved as distributed. St. Croix County Health and Human Services Board Page 2 February 20, 2008 CONSIDERATION OF CLAIMS Health and Human Services Board member Wentz reviewed the vouchers. Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 117312 through 117314, dated January 17, 2008, in the amount of $29,479.00. Human Services voucher 117577, dated January 24, 2008, in the amount of $215.00. Human Services vouchers 117578 through 117579, dated January 24, 2008, in the amount of $2,553.54. Human Services vouchers 118373 through 118411, dated February 07, 2008, in the amount of $56,095.09. Human Services and Nursing Home vouchers 117117 through 117311, dated January 17, 2008 in the amount of $381,446.45. Human Services and Nursing Home vouchers '117315 through 1.17344, dated January 17, 2008 in the amount of $14,408.99,. Human Services and Nursing Home vouchers 117604 through 117641, dated January 24, 2008 in the amount of $44,606.55. Human Services, Nursing Home, and Farm vouchers 117580 through 117603, dated January 24, 2008 in the amount of $272,260.81. Human Services and Nursing Home vouchers 117809 through 117843, dated January 31, 2008 in the amount of Human Services and Nursing Home vouchers 117844 through 117875, dated January 31, 2008 in the amount ofv$55,315.24. Human Services and Nursing Home vouchers 118238 through 118267, dated February 07, 2008 in the amount of $79,245.74. Human Services and Nursing Home vouchers 118268 through 118372, dated February 07, 2008 in the amount of $149,584.56. Human services and Nursing Home vouchers 119645 through 119785, dated February 14, 2008 in the amount of $62,475.57. Human Services and Nursing Home vouchers 119836 through 119899, dated February 14, 2008 in the amount of $16,987.17. Human Services and Nursing Home vouchers 119481 through 119644, dated February 14, 2008 in the amount of $293,477.44. Nursing Home vouchers 118786 through 119835, dated February 14, 2008 in the amount of $46,661.97. Human Services, Workshop, Public Health, Social Services vouchers 41 through 70, dated January 24, 2008 in the amount of $383,632.56. St. Croix County Health and Human Services Board Page 3 February 20, 2008 Human Services, Workshop, Public Health, Social Services vouchers 71 through 102, dated February 07, 2008 in the amount of $391,596.35. Human Services and Nursing Home vouchers 41 through 69, dated January 24, 2007 in the amount of $157,396.85. Human Services and Nursing Home vouchers 70 through 99, dated February 07, 2008 in the amount of $159,133.62. Workshop vouchers 7 through 12, dated January 24, 2008 in the amount of $12,819.40. Workshop vouchers 13 through 18, dated February 07, 2008 in'the amount of $14,166.69. FINANCIAL REPORT AGED RECEIVABLES REPORT Pempek reported staff continue to work on cleaning up old reports and working on accounts receivable balances. Berenschot questioned other counties' experience .with accounts receivable and their data on their aging reports. We have not reviewed what other counties' experiences are, but an important factor is that we are billing for services and collecting for some but not all services. Follow up with other counties will be completed. Pempek indicated the over 90 day numbers are higher due t hospitalizations and delays in receiving bills. The County is the payer of last resort and hospitals are required to bill insurance and the client before billing the County. The following financial report for Health and Human Services through December, 2007 was distributed. Pempek indicated the following are preliminary numbers as the state is in the process of take - backs "`for revenues. It is anticipated there will be large take backs due to WIMCR. Adjustments will be made during this process. Also, Pempek indicated capital expenses are not reflected in the report at this point. St. Croix County Health and Human Services Board Page 4 February 20, 2008 HEALTH AND HUMAN SERVICES - 2001 SUMMARY Total OF REVENUES Budget December 31, 2007 Balance Administration 1,080,749.83 2,211,480.,03 (1,130,730.20) 204.6 %' AIODAServices 765,599.92 729,325.50 36,274.42 95.3% Long Term Support 18,196,351.85 18 752,043.19 (555,691.34) 103.1% Mental Health 2,879,503.70 2,674,334.71 205,168.99 92.9% Family & Children's 3,132,978.40 2,977,034.85 155,943.55 95.0% Public Health 1,617,175.53 1,711,474.02 (94,298.49) 105.8% Economic Support 1,112,508.60 1,082,064.26 30,444.34 97.3% General Relief 15,000.00 15,000.00 0,00 100.0% Coordinated Services /SED 900,066.00 711,382.10 188,683.90 79.0 %' REVENUES HUMAN SERVICES PROGRAMS 29,699,933.83 30,864,138.66 (1,164,204.83) 103.9% SUMMARY Total OF EXPENDITURES Budget December 31, 2007: Balance Administration 1,080,095.83 1,039,305.47 40,790.36 96.2 0 /. ' Alcohol -Drug Abuse 765,599.92 724,387.29 41,212.63 94.6% Long Term Support 18,196,351.85 18,053,886.66 142,465.19 99.2% Mental Health 2,883,224.57 3,095,524.82 (212,300.25) 107.4% Family & Children's 3,132,978.40 2,979,714.77 153,263.63 95.1% Public Health 1,617,837.53 1,608,702.56 9,134.97 99.4% Economic Support 1,112,508.60 996,268.45 116,240.15 89._6% General Relief 15,000.00 3,412.90 11,587.10 22.8% Coordinated Service /SED 900,066.44. 597,51 2.56 302,553.88 66.4% EXPENDITURES HUMAN SERVICES PROGRAMS 29,703,663.14 29,098,715.48 604,947.66 98.0 %' Excess Rev over Expenses 1,765,423.18 The following :financial report for Nursing Home through December, 2007 was distributed.'Pempek« indicated $398,000 in ITP funding is not reflected in the statement .plus deprecdation and capital items are not figured in. St. Croix County Health and Human Services Board Page 5 February 20, 2008 St. Croix Health Center December 2007 Budget Actual Difference percentagf Census 6$ _ 61 7 Operating Revenue: Medicare $840,960.00 $724,412.92 $116,547.08 86.14 %' Medicaid $2,466,310.60 $2,145,427.85 $320,882.75 86.99% Private Pay $699,887.50 $924,095.77 - $224,208.27 132.03% All Other Sources $217,171.45 $220,055.19 - $2,883.74 101.33% Total Operating Revenue $4,224,329.55 $4,013,991.73 $210,337.82 95.02 Operating Expenses Daily Patient Services $3,557,580.61 $3,150,062.90 $407,517.71 88.55% Special Services $274,024.76 $261,431.62 $12,593.14 1 95.40 %'. General Services $1,172,794.05 $1,066,367.90 $116,406.15 90.07% Administrative Services $593,527.93 $719,552.57 $126,024.64 121.23 ° / 0' Unassigned:_ Depreciation (% Based) Others: - m $286,002.20 $199,730.18 $86,272.02 69.84 Utilities $112,221.93 Workers Comp, Computer Tech $6,343.00 Insurance $81,165.25 Total Operating Expenses $5,883,929.55 $5,387,165.17 $496,764.38 91.56% Net From Operations ($1,373,173.44) - (Cost of doing business prior to applying levy & outstanding rev) Oritstaneling Revenues Outstanding Rate Appeal rev $14,000.00 $0.00 $14,000.00 % of Outstanding IGT Rev $377,000.00 $0.00 $377,000.00 0.00% Co Allocations ( %° Based) $1,268,600.00 $1,268,604.00 -$4.00 100.00% Total Outstanrling $1,659,600.00 $1,268,604.00 $390,996.00 Net from all Sources - $104.569.44 $196,000 Outstanding IGT Rev moved to 2006 via auditors PLANNING FOR 2007 AUDIT REPORT Pempek reported the Nursing Home audit by new auditors, who specialize in nursing homes and are from Larson Allen, is scheduled to begin March 17 She reminded the Board the auditors reported a finding last year and the finding, in part, was a communication issue, and a meeting was held to discuss improvements. The time frame for the audits is moving forward in the year. No information has been received as to when the Health and Human Services audit will begin. Reconciliation for Long Term Support is not done until May or June so those numbers will need to be predicted or left open if the audit is done in April or May. UPDATE ON NEW PHONE SYSTEM The new phone system was activated February 6, 2008. Overall, the transition has gone well. It was discovered that we are short several ports and no expansion plan is in place. It is possible to St, Croix County Health and Human Services Board Page 6 February 20, 2008 purchase some additional equipment that would be a temporary fix but would also allow more points of failure. The recommended answer to this problem is to purchase additional equipment for a cost of approximately $9,700. There may be some rebate money available to lower the $9,700 plus the old phone system will be offered for sale. Johnson said the cost on the total system is over approximately an additional $5,000. Sirek reported there have been problems with voicemail but Marco continues to work on the issue and the project will not be considered complete until the voicemail issue is resolved. Johnson thanked Sirek for all of her effort during the planning and implementation of the new system. PUBLIC HEALTH COMMUNICABLE DISEASE UPDATE ON WISCONSIN DISEASE SURVEILLANCE SYSTEM (WEDSS): KIM GEARIN EPIDEMIOLOGIST WEDSS is a secure, web -based system designed to facilitate reporting, investigation and surveillance of communicable disease in Wisconsin. Gearin reported WEDSS will be implemented in St. Croix County later this year. Reports regarding,•disease come to °health departments, who have to follow up. Providers have access,_to report which allows for less paperwork and quicker action. The - :program i's currently being piloted in Milwaukee, Burnett and Brown County. Major upgrades to the system are being planned for February 2008, which means it will be a better system when it is implemented in St. Croix County. An investment will be required to train staff but there will be a time savings on each - case. reporters are required to report; however, they are not rrequired to use WEDSS. Gearin indicated there may be more reporting,,,with,WEDSS as othe,r areas have seen up to a 50% increase after WEDSS was iMplement_ed. This, in turn, will affect Public Health time. Johnson said Public Health is a population -based service R�. and Public Health has had no staffing increase with -:the population growth experienced in St. Croix County. Even without the WEDSS system, reported cases, not including suspected cases, have increased over the past years. Wisconsin DHFS has reported the following number of reportable ( "official) cases of communicable disease in St Croix County: 2001 -124, 2002 -166, 2003- 192, and 2004 -229. Sortedahl` indicated each case requires significant staff time to follow up on the report and -more staff are needed to meet requirements. PERSONNEL ISSUES NEW EMPLOYEES /RESIGNATIONS Johnson reported Kris Ylikopsa, Public Health Nurse Practitioner, has s ubmitted her retirement to be effective 05/02/08; Ron Eichstaedt -- c-pr t. Croix Industries, has submitted his retirement to be effective 04/28/08 Human. Resources is working to recruit for both of these positions. He also reported Colleen Linder has been hired as a resource aid for Youth Community' Support - Services. Darlene Krenz accepted the Accounts Payable Supervisor position effective 02/29/08. Joan Chamberlain, former contracted employee, accepted -a full -time AODA Counselor position effective 01/01/08. Roberta Dale- Wozniak accepted an Economic Support Specialist position. Amy Marko, CSP S Worker, resigned effective 02/19/08. Holly Bjerke, Family and Children's Social Worker, has moved to a CSP Social Worker position, which leaves an opening in Family and Children's. Johnson reported there is one Accounts Receivable staff on leave and three Economic Support staff on leave. Interviews took place on 02/19/08 for an open Accounts Receivable position. EMPLOYEE RECOGNITION /APPRECIATION The County recognizes employees for years of services every five years, starting at year 15 with a banquet plus gifts for the employee. Also, every year, the County sponsors onsite picnics at each location. Suggestions have been submitted to also include the employee's supervisor in the years -of- service banquet for some direct recognition. Johnson said there is limited recognition opportunity department by department now and would like consideration given to department employee recognition and appreciation. Johnson will work with Tammy Funk for 2008 to tie St, Croix County Health and Human Services Board Page 7 February 20, 2008 recognition/ appreciation for employees and /or department with a specific function and /or activity. It was the consensus of the Board that the recognition dinners and picnics will continue, as well as employee recognition within the department. ALTERED SCHEDULE - 4 X 10 OR LESS THAN 5 WORK DAYS PILOT IN OUTPATIENT CLINIC Working four ten hour days was banned up in the mid- 1990's by personnel policy. There is one Behavioral Health staff that was grandfathered in and works four ten hour days. Behavioral Health clinic staff are required to work four hours per week after 5:00 PM. The Behavioral Health staff consist of union and non- union staff. AODA staff, who are union, conduct the MATRIX program three nights per week. There is a conflict between meeting the union contract and providing the MATRIX program. Funk suggested looking at a "six -month pilot to offer staff to work four ten hour days. Altering this schedule would allow more opportunities to consumers for appointments to address consumer - needs;, however, there is a question on the impact there may be on Accounts Receivable scheduling. Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the Board approve a ° six -month pilot of four ten hour days for both Mental Health and Alcohol /Other Drug Abuse outpatient clinic staff. PUBLIC HEALTH REPORT ON WIC: RUTH LEHMANY TERESA KVAM Lehmann and Kvam introduced themselves as Public Health Dietitians. Both employees divide their time between the WIC program: "and Public- Health.:. WIC is a Federal nutrition program. The WIC package will change -in "2009 to offer whole grain bread and vegetables, soy milk `however, the change will be cost neutral. There is a large issue on how to maintain the food package with the increased costs. Lehmann reported more people are coming"to WIC due to their limited incomes. Lehmann distribut "ed WIC ".data comparing 2001 to 2007 statistics. In 2001 there were 636 WIC> clients with 1.05 FTE Registered Dietitian (RD) time, in 2007 there were 1066 with .87 FTE RD time. This computes to a 168% increase in clients with an 18% decrease in RD time. Kvam also works with the schools for nutrition programs and is an educator in the prenatal care coordination °.HBadgerCare+ began February 1, 2008. Anyone on Badgercare+ program or on Medical Assistance is eligible for WIC. Badger Care+ will increase the number of clients eligible for WIC without additional state funding to serve those - clients. An additional RD position may be included - in the 2'b09budget, but administration will be looking to increase RD contract time in 2©08, which will likely put the Public Health contracts over budget. The Board recessed from 9:55 to 10:05. ECONOMIC SUPPORT BADGERCARE+ — INCLUDING STAFFING NEEDS Squyer distributed information regarding BadgerCare+ including enrollment and benefits. She explained no one gets BadgerCare+ without a child, but it does now include self - employed people. She further explained the money for BadgerCare+ is coming from the client (co -pay and deductible). All income in the household is included in the premium determination. She said the deductibles last six months and then start all over again. She said the conversion went through the middle of January; however, the information distributed at this meeting just became available this morning. Squyer said children coming out of foster care will qualify for BadgerCare +. BadgerCare+ is an income -based program, not expensed based program. Squyer reported her staff have been inundated with phone calls regarding BadgerCare+ because it is difficult to understand. She said all other counties are in the same position. She said all State trainers are done St. Croix County Health and Human Services Board Page 8 February 20, 2008 05/31/08 and then the state will contract with trainers; however, there are no trainers available in Wisconsin at this time. She said the training changes are happening due to BadgerCare+ implementation. She said it is difficult to fill positions as there is no training available. She said if the state demands 12 weeks of state training then the state must provide the training or rescind the demand. She said there are no appointments available in Economic Support until April and that is out of compliance. Johnson will call local legislators regarding this situation and encouraged Board members to do the same. An LTE has been brought into Economic Support and overtime may be available to staff to address the increased backlog of work. Public Health was awarded a grant of $22,340 to sign children up for BadgerCare+ and all these applications are processed through Economic Support. This issue will be included on the agenda for the April 7 th Legislative breakfast. Squyer plans to attend a gathering where legislators will be present at St. Pat's on Saturday. JUVENILE CORRECTIONS UTILIZATION REPORT Dunlap,eported juvenile - justice staff have worked hard to keep offenders out of juvenile correction institution placement. Dunlap said there is one juveni-e currently in corrections who has been identified as a serious juvenile offender, so thewcounty_'s not paying for this placement, which will go up to $268 /day July 1, 2008- Johnson reminded the Board there has been no increase in Youth Aids allocation for at least the last 20 years so the charges are passed on to the counties. There is a movement occurring to get 17 year olds out o€ adult court and back into the juvenile justice system. Family and Children's will have an. increased caseload if this happens. In 1995 a change was,- implemented to move ''17 year olds into the adult court system. Brain development study findings revealed that 17 year olds had more success if treated in - the juvenile justice system compared to the adult system. Dunlap reinforced that" certain offenses would still require automatic adult jurisdiction and , e that 'there,-would continue to be the ability to waive appropriate juveniles into adult court if the jurisdiction change occurs. PSYCHIATRY COVERAGE AND CONSIDERATION OF RECRUITMENT FOR ADVANCED PRACTICE NURSE PRACTITIONER (APNP) POSITION Kiesler related psychiatry costs have increased dramatically since ending the contract with Dr. Colon. He said the hours have been difficult to fill and the cost is much higher than it was previously.. Previously, the unit had 85 hours of psychiatry coverage from Dr. Colon per month and now there are only 24 hours covered with an additional 35 hours available through April only. Previous rates were $155 /hour and now rates range from $200 to $250Jhour. This will dramatically impact the 2008 budget. Kiesler has - 'a meeting scheduled for the end of February with a doctor from Allina that may be able to provide additional hours. Kiesler would like to investigate the possibility of recruiting an APNP with prescriptive authority to the clinic and may work with Public Health due to the recent announced retirement of their Nurse Practitioner. Johnson indicated that Public Health needs are certainly the priority in recruitment, but it is an opportunity to collaborate on hiring and would like to see this occur. He would like to pursue this as an alternative for psychiatry coverage and work with Human Resources to do this; however, it is also possible the concept may not work. Kiesler said an APNP would be involved in all aspects of client treatment. A contract with a psychiatrist would still be necessary, but is anticipated to be less time if an APNP could be hired. An APNP would be paid at a lower rate than a psychiatrist. Funk indicated there is market data available for scale for rates. Kiesler indicated the position is in the Hay grid as a grade 9. With the current limited pool of candidates, companies have hired and paid for training costs for these employees. A contract would be required to St: Croix County Health and Human Services Board Page 9 February 20, 2008 assure service from the staff after training, or a repayment of costs the county incurred would be necessary. Motion A motion was introduced by Berenschot, seconded by Troyer, and adopted with Caflisch voting no: That the Board approve Behavioral Health to work with Human Resources to investigate the possibility to hire an APNP position. CONSIDERATION OF RESOLUTION IN SUPPORT OF ASSEMBLY BILL 509 — REDUCING REIMBURSEMENT BY COUNTY DEPARTMENTS OF COMMUNITY PROGRAMS FOR INPATIENT FACILITY CARE AND SERVICES FOR MENTALLY ILL COUNTY RESIDENTS: A copy of Assembly Bill 509 was provided to the Board. Kiesler reported this bill is locked down in committee but would like to create a record that the county supports this Bill. He reported hospitalization costs have '.,doubled in the last four to five years and the county tax payers have a high burden to meet these rapidly rising costs. Johnson recommend support of the Board - ''of Assembly Bill 509 and to forward a resolution on to the County Board and then on to the State. Motion A motion was introduced by Caflisch, seconded by Burri, and unanimously adopted: That the Board supports the following resolution supporting Assembly Bill 509 and supports ,forwarding the .resolution to the County Board. RESOLUTION IN SUPPORT OF ASSEMBLY BILL 509— REDUCING REIMBURSEMENT BY COUNTY DEPARTMENTS OF COMMUNITY PROGRAMS.OF COSTS FOR INPATIENT FACILITY CARE AND SERVICES FOR MENTALLY ILL COUNTY RESIDENTS St: Croix County, Wisconsin WHEREAS, 2007 Assembly Ball `509 would reduce reimbursement paid by county departments.r ©f community programs of costs for inpatient care and services for mentally ill county residents; and WHEREAS, the Departmentof Healthy and Family Services would begin to pay 50 percent of. the,cost of inpatient care and county departments would reimburse for.the! -other 50 percent; and WHEREA§ the County's responsibility for the costs of care would reduce -the burden on the County tax levy to fund the cost of care of underinsured or noninsured residents. THEREFORE ZE IT_ RESOLVED that the St. Croix County Board of Supervisors supports 2007 Assembly Bill 509. The Board recessed from 11:15 to 11:23. REVIEW FINANCIAL FORECASTS FOR THE NURSING HOME, WHICH INCLUDES CONSTRUCTION ESTIMATES TO REFURBISH AND REMODEL CURRENT FACILITY: Awsumb joined the meeting via teleconference. Lester created a forecast for three separate scenarios for the Nursing Home. The first scenario is for a 50 -bed Nursing Home utilizing both floors of the Nursing Home. The second scenario is for a 50 -bed Nursing Home on first floor and 20 -bed CBRF (assisted living) on second floor. The third scenario is for a 44 -bed Nursing Home on first floor and 20 -bed CBRF on second floor. Lester explained the difference in licensing of a CBRF and a RCAC. A RCAC is not allowed to be in the same structure as a nursing home, thus the reason a CBRF is being considered. Of the architects /builders contacted, three responded and submitted building /remodeling estimates: Ayres, Derrick Construction and Kraus Anderson. Lester outlined the assumptions taken into account to create the financial forecast. He said there is currently not St.. Croix County Health and Human Services Board Page 10 February 20, 2008 a lot of funding for CBRF stays so the population would probably have to be private pay. However, that may change when Family Care is implemented, which is anticipated to happen in late 2008. However, the next step would be to determine if we are able to offer a competitive rate for a CBRF. Lester predicted that ITP may increase as more counties exit the nursing home business. Medicaid rates were projected using the 07/01/2007 Medicaid rate worksheet adjusted for the impact of 50 beds, conversion to 100% RUGS and additional depreciation and interest expense related to the nursing home. Many of the assumptions, such as wages, fringe benefits, nurse aide training revenue and OBRA screening revenue, etc. were based on the 2008 budget. Lester mentioned that new furniture was not included in any of the scenarios. Lester said there is no historical data available from the county to operate a CBRF so figures are based on predictions. Lester recommended the facility look to specialize to justify the county involvement in the nursing ,home business. He gave examples such as bariatric patients, behavior patients, _isolation patients. He rationalized by specializing the county-, be able to justify the higher wages and fringe benefits because staff are caring for more difficult patients. It would set the county apart, ,.from the rest of the nursing homes in the county if the county provided servi other facilities cannot /do not provide. Johnson indicated if we were able to serve behavioral health residents, along with the residents previously mentioned, .residents would probably come from more than just St. Croix - County'as there are four other counties in this region that are planned to be part of the Community Health Partnership service area. Other counties in this region may also be interested in contracting for services as well. Tobin indicated a full assessment of the buildings should be done. The architects /builders only gave an'estimate of project costs. He also indicated there is unused area in the bower level of. the nursing and discussed options for this area such as office area;, expanded therapy, etc. The area cannot be used for major resident space as it is below level. Also discussed were options for the social room in the Nursing Home such as offices, conference room, etc. Caflisch raised concern regarding the wages and large fringe benefit amounts paid to employees.. Awsumb again questioned Nursing Home staff willingness to make concessions in negot`iating� the labor contract and to come forward with their best cc tract- offer. -Whiting indicated it may be possible contracts may be ready to present at the March 18 County Board meeting. Johnson reque Board to narrow down the decisions so one option is followed in a definitive direction. Johnson questioned how much more analysis can be done and asked for a direction to stay as is, divest or invest in the Nursing-Home. Dupre questioned- what the County would do regarding the County's responsibility for Chapter 51'and Chapter 55 residents as there is a shortage of available beds in other counties. It was the consensus of the Board to hold an additional meeting on March 12, 2008 at 8:30 AM to discuss the Nursing Home. Only one item will be on the agenda to discuss the Nursing Home future. RE- CONSIDERATION OF RESOLUTION IN SUPPORT OF STATEWIDE CLEAN INDOOR AIR: Johnson reported legislators need to act on the Breathe Free Wisconsin Act in March or it will go to the next session. The Health and Human Services Board is already on record in support of Senate Bill 150 and recommends no further action at this time. St Croix County Health and Human Services Board Page 11 February 20, 2008 RESOLUTION FOR TOBACCO -FREE GOVERNMENT GROUNDS AND VEHICLES EFFECTIVE 01/01/09: Timmerman has reviewed the resolution and would like more clarification in the resolution in regards to government buildings. Johnson will revise the resolution and entitle it tobacco -free versus smoke -free and bring back to the Board at the next meeting. Caflisch gave a brief update on drug court. He attended a graduation of a client from drug court this morning. He said drug court is one of the best things the county has done. Wentz and Caflisch complimented Judge Vlack to stepping up and making drug court work. NURSING HOME ADMINISTRATOR REPORT Morris said the current census is 64 with one bedhold. He said the census was 69 but two residents were discharged home and there were two deaths. He said there are three residents with influenza and a proactive stance of asking the public not to visit the nursing home residents is being taken at this time. He reported a state surveyor was in last week and no cites were received. He mentioned the nursing home is,- in the annual survey window so we can expect a survey team to ''arrive at any time. He said it seems accidents /incidents are the top survey item this` ° year. Morris said every nightstand and dresser in the Nursing Home are in need of replacement. He said additional electric "beds for the facility would be helpful. Morris reported the new rate for the Nursing Home was received and it is $143.47. HOSPICE This item will be delayed until., the next meeting at the request of Awsumb. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting."" Time: 12:55 PM Chair: Attest: (Secretary)