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HomeMy WebLinkAboutHealth & Human Services 03-12-08 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD March 12, 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 - 02/20/08 DATE OF NEXT MEETING — 03/19/08 at 8:30 a.m. OLD AND NEW BUSINESS 1. Review of financial forecasts for the Nursing Home, which includes construction estimates to refurbish and remodel the facility, along with consideration of specialized units for residents that are difficult to place. 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. 2/27/2008 9:35 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD March 12, 2008 The St. Croix County Health and Human Services Board met on March 12, 2008 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Leon Berenschot Lois Burri Tom Caflisch Dr. Glenn Hoberg Linda Luckey Ron Troyer MEMBERS ABSENT: Deb Rasmussen, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Harold Morris, Contracted Nursing Home Administrator Ron Kiesler, Behavioral Health Coordinator Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Tammy Funk, Human Resource Administrator Larry Lester, Wipfli (via telephone) Fred Horne Dave Osness Dean Winquist Loyla Waskul Eloris Rivard Thor Backus Norm Matzek Gail Winship, New Richmond News 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 19, 2008 at 8:30 AM. Berenschot will review vouchers. AGENDA Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the agenda be approved as circulated. REVIEW OF FINANCIAL FORECASTS FOR THE NURSING HOME, WHICH INCLUDES CONSTRUCTION ESTIMATES TO REFURBISH AND REMODEL THE FACILITY, ALONG WITH CONSIDERATION OF SPECIALIZED UNITS FOR RESIDENTS THAT ARE DIFFICULT TO PLACE Johnson distributed a report created by Lester showing fringe benefits as a percent to salaries for nine nursing homes in the County, including St. Croix Health Center. He said health insurance is the largest cost category for fringes. He said the report does not include paid time off. Lester also pointed out that pension adds to the percent and the County has no control over pension as the state requires the county to participate. St. Croix Health Center has the highest total of fringe benefits in the County. Johnson would like the Board to review the financials, discuss resident mix and planning alternatives and make a recommendation on the Nursing Home that would St. Croix County Health and Human Services Board Page 2 March 12, 2008 give staff a definitive direction. Johnson listed the possible options to remodel or build a new 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. Awsumb questioned the most viable business /economic model for the Nursing Home. Lester recommended a market study on the patient needs to determine if there is a population that fits the model for the Nursing Home and when to get into the business. Lester questioned if the County decides to be a county nursing home to care for the general population, why be in the business? Johnson spoke with Sinikka Santala from the state regarding the current nursing home license. It is not possible to admit emergency detention clients under a short term admission under the current nursing home license. Trempealeau can do these types of admissions given their status as an IMD (institution for mental disease). Johnson and Morris visited with Phil Borreson, Trempealeau County Health Care Administrator. Trempealeau County serves between 40 -50 counties in the State and has a waiting list for services. This program serves adult clients that have a serious, persistent mental illness and need a structured setting to receive treatment prior to reintegration back into the community. They also provide services to the developmentally disabled clients who need institutional care. This is a difficult population to serve that geriatric nursing homes generally will not take. Trempealeau develops their budget and then determines what to charge other counties for taking clients from counties other than Trempealeau. The facility is full and has a waiting list. LaCrosse County is operating a similar service under a nursing home license and also has a waiting list. At a recent meeting of county nursing home administrators Lester attended, approximately 87% of the administrators indicated support of the need for behavioral health services for client placement. He reported need for the service is not the issue, the issue is how to structure to make it work for the County and to meet the needs of St. Croix County residents. Staffing levels and equipment needed to serve this population would have to be determined. Training costs would be involved to provide this service in addition to a remodel of the facility to secure the building. This service may be supported by other nursing homes in the area due to caring for the hard -to -care for behavioral problem residents. Morris warned facilities caring for behavioral problem residents may suffer more citations during surveys. Morris also warned there may be higher workman compensation claims with a behavior unit. Morris indicated it may be possible to section off the floors, putting behavioral health clients on one floor and the nursing home Medicaid /Medicare residents on the other floor. The Board expressed concern with this scenario driving out the current residents. Lester suggested a next step may be to survey the other four counties in the consortium (Chippewa, Dunn, Pierce, Eau Claire) to see if they would support a behavior health unit in St. Croix County. Lester said if St. Croix County continues to provide the same care as other facilities, it will be hard to justify the higher wages /fringe benefits paid than if care is provided for the hard to care for resident. A meeting was held with Community Health Partners (CHP) to address potential needs for nursing home care in the consortium. Other special units discussed include a bariatric unit, transitional care unit, dementia unit, younger St. Croix County Health and Human Services Board Page 3 March 12, 2008 physical disabled group, developmental disabled respite, tracheotomy unit, along with a behavioral unit. These units would not be specific to St. Croix County residents only, but would provide regional coverage. There are no providers north of this region that provide specialized care and no care management organization north of St. Croix County, so there may be other counties interested in utilization of specialty care units if developed. CHP is willing to partner with the County to develop this resource and would be willing to discuss reimbursement rates that are higher than Medicaid currently pays. However, enrollees do have the choice to dis- enroll from the managed care organization and be eligible for card services, which would then decrease the reimbursement to the Medicaid reimbursement rate. Lester said the community based residential care facility (CBRF) needs increased 300% when LaCrosse and Portage counties implemented family care. CBRF services are funded under family care but are not covered under Medicaid, so clients would end up in a nursing home. CBRF placement is less costly than nursing home placement. CBRF placement needs are very similar to the placement needs as listed earlier. Kiesler reported there may be three to four St. Croix County residents in Trempealeau County Health Care Center at any given time. He said typically when clients are admitted to an IMD, they lose their Medical Assistance. He indicated there are less community resources in St. Croix County so there has been a trend towards more St. Croix County residents being admitted to Trempealeau. Kiesler also reported there is a state moratorium in Minnesota on new hospital beds; however, there has been a movement, especially on the part of Prairie St. John's, to increase the number of acute psychiatric hospitalization beds in the Twin Cities area. If this is successful, work will be done to also get the additional beds certified for Wisconsin Medical Assistance. Johnson outlined the paths followed for nursing home options in the last year. He said a RFP was issued to sell, lease or partner for the operation of the nursing home. That proposal fell through with Christian Community Homes. Presbyterian Homes is now out of the picture due to purchasing New Richmond Meadows; however, Health Dimensions is still willing to discuss options. Information was given to the County on cost estimates to build a new 50 and 72 bed nursing home, along with a new 20 be CBRF. At the January meeting, the County Board directed the Health and Human Services Board to bring back information regarding a remodeling project of the existing building to create a 50 -bed unit on first floor. Johnson said contractors and architects have walked through the building and felt the building was in good repair but may need some upgrades to meet codes. The estimated cost to remodel the nursing home is approximately $1 to $2 million. Johnson reported Ayres and Associates completed a space needs study in December of 2007. He said the Health and Human Services building is not being utilized for the intended purposes of the building and there are building security issues. The study reported estimated costs of $10 to $13 million to build a new building for Health and Human Services (HHS) and estimated costs of $7 to $10 million to build a new building for the nursing home dependent upon the size of 50 or 72 beds. Johnson said if you combine the needs of HHS and Nursing Home and if the County is going to remain in the nursing home business, consideration should be given to building a new nursing home and remodel the current nursing home to meet HHS needs. The cost of building a new HHS structure could then be eliminated and while we do not have estimates for this type of remodel, it could be assumed to be much less, similar to the nursing home remodeling estimates. If the nursing home is remodeled, it may only meet St. Croix County Health and Human Services Board Page 4 March 12, 2008 the County's needs for five to ten years. If a new nursing home is built, the costs are reimbursable through Medicaid reimbursement. Additionally, if the new nursing home is reduced to 50 beds, the facility would be eligible for enhanced reimbursements. The Board recessed from 9:30 to 9:40. Luckey questioned if the nursing home could be reduced to 50 beds in the current building with remodeling. it is possible to do this; however, the nursing home would not have the single rooms and it would not accomplish what needs to be done. Johnson outlined costs associated with building options. Awsumb said the tax levy for each option should be included as this will be a permanent tax subsidy also. Awsumb listed four points for consideration. 1. The County should not continue to operate the Nursing Home under the current business model which competes with the private sector for a market that the private sector serves efficiently. 2. The County should not build a new nursing home or assisted living facility which would be owned and operated by the County because: a) the County wage structure differential with private sector can only be supported by a tax levy subsidy, and b) the entire care model for the elderly is changing such that traditional nursing home demand may decrease substantially and, therefore, the long term capital investment is not warranted. 3. The County should not hire as an employee a nursing home manager or head nurse. The County should continue as long as it is operated as a nursing home facility to contract with outside managers in order to stay on top of industry changes and manage costs effectively. 4. The County should study the alternative possible models to renovate the nursing home for either a 44 to 50 unit facility or a special care facility to determine if they can be competitive, if the County employee union will make concessions to bring benefit levels for newly hired employees within the 27% benefit percentile average. Wentz said the County's mission is to care for the vulnerable, elderly and those that cannot care for themselves. Caflisch said the County cannot continue to pay the benefits to employees at the rate they are currently being paid and the County needs to do what is right for the residents, not the employees. Wentz argued that the focus cannot only be on nursing home employees but need to look at all employees in the County. Caflisch countered the nursing home is in competition with private industry nursing homes and the County should not subsidize the nursing home business. Awsumb clarified his recommendations do not affect the current employees, only the new hires, and would change going forward from here to help make the nursing home competitive for the long term. It was the consensus of the Board that the nursing home cannot keep going as it has been going. The nursing home industry is changing and it is not clear how managed care will affect the nursing home business. Awsumb said the nursing home can be renovated at less cost, which will serve the nursing home needs for the next three to five years. Awsumb is not in favor of building a new facility. Caflisch said the nursing home is losing money with no debt and will lose even more if a new building is built. Wentz said HHS would be able to utilize the nursing home building if a new nursing home is built. Awsumb said a new nursing home is not viable for the long term and asked for a commitment from the union to keep the nursing home competitive with private sector St. Croix County Health and Human Services Board Page 5 March 12, 2008 business. Awsumb said most state /federal agencies lease space as building is not always a viable option and this may be the way to meet HHS needs. It was reported property taxes increased 10% this year and there was approximately 30% decline in home values plus little growth and increased foreclosures. Funds will be reduced due to market decline and there will be no new revenue due to no new building. Whiting reported there may be a new health insurance structure available that would save the County up to 10 %. He also reported there is a state law on participating in the Wisconsin retirement plan that the County cannot opt out; however, the County is only required to contribute half of the required contributions but most counties in Wisconsin make the total contribution. Whiting said the union will probably ask for a guarantee that the County is not getting out of the nursing home business in exchange for any type of concession. Johnson reported the nursing home is financially more viable now as the operational assessment has been implemented. Outside management assisted in this implementing the operational assessment; however, the County levy has not been eliminated. He does not want to hire a permanent County employee until after a definitive course on the future operation of the nursing home is set. Awsumb said the nursing home needs to be competitive and feels that we are more on top of issues and industry changes with outside management. Johnson indicated outside consultants could be utilized to conduct on site reviews to assure that we are up to date with industry standards. Motion A motion was introduced by Caflisch, seconded by Awsumb, that the Health and Human Services Board approves forwarding the following four recommendations to the County Board for approval: 1. The County should not continue to operate the Nursing Home under the current business model which competes with the private sector for a market that the private sector serves efficiently. 2. The County should not build a new nursing home or assisted living facility which would be owned and operated by the County because: a) the County wage structure differential with private sector can only be supported by a tax levy subsidy, and b) the entire care model for the elderly is changing such that traditional nursing home demand may decrease substantially and, therefore, the long term capital investment is not warranted. 3. The County should not hire as an employee a nursing home manager or head nurse. The County should continue as long as it is operated as a nursing home facility to contract with outside managers in order to stay on top of industry changes and manage costs effectively. 4. The County should study the alternative possible models to renovate the nursing home for either a 44 to 50 unit facility or a special care facility, if the County employee union will make concessions to bring benefit levels for newly hired employees within the 27% benefit percentile average. Matzek commented the nursing home doesn't truly compete with the private sector nursing homes. He mentioned Eau Claire County is having trouble placing people in nursing homes. He said the private sector doesn't always want or will not care for residents. Caflisch said the St. Croix Health Center has the same mix of patients as other nursing homes. Awsumb said if the County operates the nursing home efficiently and competitively, it can stay in business and provide more services. St. Croix County Health and Human Services Board Page 6 March 12, 2008 Roll call vote: Esther Wentz - no Gordon Awsumb - yes Leon Berenschot - yes Lois Burri - no Tom Caflisch - yes Dr. Glenn Hoberg - yes Linda Luckey - yes Deb Rasmussen - absent Ronald Troyer - -yes Six yes, two no, one absent motion passed. Johnson said he is not certain the motion sets a definitive direction for the future operation of the nursing home, but appears to continue operation of the nursing home as status quo with some modifications. Whiting felt this is a natural progression to get options narrowed down to a workable number. He said the union contracts will go to the County Board on March 18, 2008. He said the nursing home union has not made any concessions. Burri left the meeting at 10:30 AM. Caflisch said there are separate needs for the Nursing Home and HHS and does not want to tie HHS with the Nursing Home program. Awsumb said if the facility is renovated it may meet the nursing home needs for five years and at that time the market may be different than it is now. Johnson will give the options to the County Board. Luckey requested that the facility names be on the fringe benefit report when it is given to the County Board. Also, the budget models will be given to the County Board as a handout. Wentz asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the meeting be adjourned. Time: 10:40 AM Chair: Attest: (Secretary)