Loading...
HomeMy WebLinkAboutHealth & Human Services 04-16-08 u Leon Berenschot will review vouchers. NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 16, 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 - 03/19/08 DATE OF NEXT MEETING — 05/21/08 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 receivable report 3. Update on Children's wait list 4. Nursing Home Report a. Nursing Home Administrator Report b. Review of planning alternatives for Nursing Home/HHS Board motion on 03/12/08 ** c. Advisory referendum 5. Personnel Issues a. New employees /vacancies b. Filling Public Health Nurse Practitioner position ** 6. ADRC Transition Planning 7. Building Security/Health and Human Services Facility Planning 8. Strategic Planning -HHS 9. Review of Foster Care non - smoking policy 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. 4/11/2008 11:06 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 16, 2008 The St. Croix County Health and Human Services Board met on April 16, 2008 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Vice Chair Leon Berenschot Lois Burri Dr. Glenn Hoberg Linda Luckey Deb Rasmussen MEMBERS ABSENT: Gordon Awsumb Tom Caflisch Ron Troyer, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Kathy Dunlap, Family and Children's Coordinator Ron Kiesler, Behavioral Health Coordinator Steve Kirt, Behavioral Health Clinical Services Supervisor Harold Morris, Contracted Nursing Home Administrator Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Tammy Funk, Human Resource Administrator Art Tobin, Facilities Manager Roger Rebholz, County Board Chair Kim Dupre, Information Systems Analyst Kristen Severson, Social Work Intern Beth Anez, Contracted Social Worker 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, May 21, 2008 at 8:30 AM. Wentz will review vouchers. Wentz introduced Roger Rebholz, who is the new County Board Chair. The next County Board meeting is scheduled for May 20 at which time new members will be appointed to the Health and Human Services Board. Johnson asked that possible candidates for the Health and Human Services Board appointments be made aware of the meeting on May 21s as there is limited time for notice. AGENDA Motion A motion was introduced by Berenschot, seconded by Dr. Hoberg, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Luckey, seconded by Burri, and unanimously adopted: That the minutes of the 03/19/08 Health and Human Services Board meeting be approved with the following changes requested by Luckey: Page 4, paragraph 3, third sentence should remove the word the and read as follows: He said he has contacted the Sheriff who informed him that -tire he will continue to allow this practice to keep going until a new non - smoking policy is released. St. Croix County Health and Human Services Board Page 2 April 16, 2008 Page 6, last paragraph, 16 sentence should read as follows: CHP employs nurses and a nurse practitioner as part of the team plus has a Medical Director to meet client needs. Page 7, paragraph 4, 9 th sentence should read as follows: The Behavioral Health clinic appointments and groups are scheduled after this time and the Nursing Home has the only restrooms available to clients after 5:00 PM. Since the Nursing Home is not secured, clients go unattended into the Nursing Home after hours to use the restrooms. CONSIDERATION OF CLAIMS Health and Human Services Board member Berenschot reviewed the vouchers. Motion A motion was introduced by Berenschot, seconded by Dr. Hoberg, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 122420 through 122421, dated March 20, 2008, in the amount of $25,657.00. Human Services vouchers 122907 through 122949, dated March 20, 2008, in the amount of $52,909.03. Human Services voucher 122642, dated March 27, 2008, in the amount of $430.00. Human Services and Nursing Home vouchers 122228 through 122366, dated March 20, 2008 in the amount of $173,716.11. Human Services, Nursing Home, and Farm vouchers 122420 through 122421, dated March 20, 2008 in the amount of $32,213.46. Human Services and Nursing Home vouchers 122547 through 122639, dated March 27, 2008 in the amount of $340,844.40. Human Services and Nursing Home voucher 122640, dated March 27, 2008 in the amount of $667.20. Human Services and Nursing Home vouchers 122653 through 122764, dated April 03, 2008 in the amount of $195,204.14. Human Services and Nursing Home vouchers 123504 through 123656, dated April 10, 2008 in the amount of $68,955.02. Human Services and Nursing Home vouchers 123657 through 123702, dated April 10, 2008 in the amount of $35,897.61. Human Services and Nursing Home vouchers 123357 through 123503, dated April 10, 2008 in the amount of $317,739.54. Human Services, Workshop, Public Health, Social Services vouchers 173 through 202, dated March 20, 2008 in the amount of $390,326.67. Human Services, Workshop, Public Health, Social Services vouchers 203 through 234, dated April 03, 2008 in the amount of $393,046.45. Human Services and Nursing Home vouchers 159 through 187, dated March 20, 2007 in the amount of $152,055.45. St. Croix County Health and Human Services Board 'Page 3 April 16, 2008 Human Services and Nursing Home vouchers 188 through 218, dated April 03, 2008 in the amount of $154,205.62. Workshop vouchers 31 through 36, dated March 20, 2008 in the amount of $13,099.45. Workshop vouchers 37 through 43, dated April 03, 2008 in the amount of $14,118.12. FINANCIAL REPORT The following financial report for Nursing Home through February, 2008 was distributed. Also distributed was the December, 2007 report for the Nursing Home. After the $1,268,000 County levy was applied, there was a $79,496 surplus for 2007. Last year (2006) there was a $453,000 carryover applied to the 2008 budget. With the significant drop in carryover, there will be a large increase on the 2009 County levy request for the Nursing Home. Notice was received of a possible increase of 100 -135 new additional billing types coming for Nursing Home categories, which will result in a need to upgrade the ECS system in the Nursing Home. This system upgrade is needed to process the cost report also. It is estimated the upgrade will take approximately 16 hours at $100 /hour. St. Croix County Health and Human Services Board Page 4 April 16, 2008 St. Croix Health Center February 2008 Bud(iet Actual Difference Percentag Census 0 Dperating Revenue: Medicare ' $642,975.00 $135,401.10 $707,573.90 16.06% Medicaid $2,431,627.00 $405,242.52 $2,026,384.48 16.67% Private Pay $760,413.00 $130,378.50 $630,034.50 17.15% All Other Sources $217,774.00 $43,101.65 $17 19.79'% Total [Operating Revenue $=1,252,789.00 $ 714,123.77 $3,53,665.23 16.74° Operating Expenses Daily Patient Services $3,081,764.76 $631,128.63 $2,550,636.13 17.23% Special Services $284,516.00 $42,137.34 $242,378.66 14'.8 General Services $1,167,643.63 $172,723.38 $994,920.25 14.79% Administrative Services $547,561.00 $105,818.80 $441,742.20 19.33% Unassigned: _. Depreciation (% Based) $0.00' Others: $294,394.00 Utilities $48,700.85 $245,693.15 16.54 ° / °' $22,542.21 Workers Comp, Computer Tech $3,227.64 Insurance $22,931.00 Total Operating Expenses $5,375,874.34 _ $900,504.00 $4,475,370.39 16.75% Net From Operations {$186,385.23} (Cost of doing business prior to applying levy & outstanding rev) Outstanding Revenues Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00°!° Revenue - IGT Funds $318,000.00 $192,000.00 % of Outstanding IGT Rev _._ $0.00 $0.00 0.00 °I° Co Allocations (% Based) $259,859.39 $43,310 00 $216,549.39 16.67% Nursing Home Carry Over $533,231.00' $0.00' Total Outstanding $1,123,090.39 $235510.00 $228,549.34 Net from all Sources $48,424.77 The following financial report for Health and Human Services through February, 2008 was distributed. Pempek pointed out that revenues are above expenses but it is still early in the year. St. Croix County Health and Human Services Board 'Page 5 April 16, 2008 HEALTH AND HUMAN SERVICES - 2008 SUMMARY Total OF REVENUES Budget February 29, 2008 Balance % Administration 1,117,400.00 (10,693.48) 1,128,093.48 -1.0% AODA Services 772,986.95 111,822.71 661,164.24 14.51 Long Term Support 17,681,645.51 2,343,230.74 15,338,414.77 13.3% Mental Health 3,303,479.98 "Family 505,23863 2,798,241.35 15.3% & Children's - - 3,037,821.28 ; 488 008.74 2,549,812.54 16.1% Public Health 1,678,621.37 279,387.60 1,399,233.77 16.6 %' Economic Support pp 1,,227,133.10: 132 350.64 1,094,782.46 10.81 General Relief 15,000.00 21500.00 12,500.00 16.7 %' Coordinated Services/SED 2,500,931.96 306,724.91 2,194,207.05 12.3% REVENUES HUMAN SERVICES PROGRAMS 31,335,020.15 4,158,570.49 27,176,449.66 13.3 SUMMARY Total OF EXPENDITURES Budget February 29, 2008 Balance Administration 1,117,400.00 161,702.35 955,697.65 14.5% g 772,986.95 " 118,457.47 654,529.48 15.3 %' . Alcohol -Dru Abuse Long Term Support 17,681,645.51 2,257,303.15 15,424,342.36 12.8% Mental Health 3,303,479.98 414,473.49 2,889,006.49 12.5 Family & Children's 3,037,821.28 453,281.20 2,584,540.08 14.9 Public Health 1,678,621.37 267,245.04 1,411,376.33 15.9% Economic Support 1,227,133.10 159,284.88 1,067,848.22 13.0% General Relief 15,000.00 " 497.87 14,502.13 3.3 %' Coordinated Service /SED 2,500,931.96 184,694.47 2,316,237.49 7.4 EXPENDITURES HUMAN SERVICES PROGRAMS 31,335,020.15 =.. 4,016,939.92 27,318,080.23 12.8% Excess Rev over Expenses ; 141.630.57 AGED RECEIVABLES REPORT Pempek said the numbers for 2005 -2006 are going down slowly as accounts are getting cleaned up. She said current bills are processed in a timely manner and staff are taking care of past due accounts. She reminded the Board it will take time to get through 2005 and 2006 for write offs as each account needs to be processed individually. She said the inpatient hospitalizations are out of the County's control and not necessarily reflected on the 30 -60 -90 aging report due to the process of hospitals billing insurance, client, etc. before billing the county as the payer of last resort. Echo was recently updated to provide improved reports but there are still some work - arounds needed. Echo does not interface with Medicaid so double entry is required to process billings. It is hoped that more training will be available by the end of this month. The Board thanked Kim Dupre for all of her hard work on Echo and Accounts Receivable. UPDATE ON CHILDREN'S WAIT LIST: Kathy Dunlap, Family and Children's Coordinator and Ron Kiesler, Behavioral Health Coordinator presented a requested update on the Children's Long Term Support (CLTS) waiver. The CLTS waiver was absorbed into the Coordinated Family Services (CFS) unit in July, 2007, which has now been changed to Youth Community Support Services (YCSS) unit. At that time there were 117 clients on the wait list. Efforts were made to review all clients on that list and report results back to the Board. The question was raised on how to not let the wait list become stale again. The St. Croix County Health and Human Services Board Page 6 April 16, 2008 YCSS unit has been reorganized and a centralized intake position was created out of an existing YCSS Social Worker position. It was reported the unit has been busy with 11 new cases in March and 12 new families currently being assessed. Before the merger of the units, 19 families were served using county - match dollars. It was reported 50 calls were received in March requesting information about possible services. The numbers on the wait list have been reduced as a result of the assessments completed at the end of 2007 on all wait list clients. Those clients with health and safety issues received services to address the health and safety issues immediately; however, this does not mean those clients received funding to meet all identified needs. Hence, clients may be put on the wait list for non - health and safety needs. An intake policy and procedure has been developed which, in coordination with the family, determines what community and /or county services will be offered to the family in the most cost effective manner to meet their needs. The rules are continually changing within the CLTS waivers. It was reported that transition dollars are available for 17 year olds to transition into adult services prior to reform. Contacts are being made with families regarding the transition to Long Term Care Reform. The new cut -off age for Long Term Care Reform services is 18, instead of 21, except for Severely Emotionally Disturbed Waiver clients where the cut -off age remains at 21. The ADRC will coordinate work with youth in transition to adult services. Johnson highlighted information distributed regarding St. Croix County's growth in population from 2000 -2007. St. Croix County ranks third in number increase and first in percentage increase in the state. He said there are more consumers to serve. The Board questioned the average age of people moving into the County as this will have an impact on services. Johnson will investigate further and add this information to the next Board packet. NURSING HOME ADMINISTRATOR REPORT Morris reported the census today is 65 with two pending admissions. He said the average census for the last month has ranged between 64 -65. He announced the nursing home in Osceola is closing, which may have an impact on our census. He estimated that facility has approximately 40 residents. Morris reminded the Board surveyors were in the building a few months ago as a result a complaint received. He reported the annual survey team arrived last Monday. The annual survey is usually three days long; however, the team arrived on Monday and exited on Tuesday. He reported this is the second year that no health care citations were received. However, two minor engineering cites were given. One cite concerned timing of fire drills and the other was regarding a door that was held open in the therapy department. Morris said staff did an outstanding job during the survey and it was due to the team in the Nursing Home that excellent survey results were obtained. Morris said the Health and Human Services complex has one address but is actually two buildings. Steps are being taken by Tobin to separate the buildings for required inspections. Morris is reviewing provider contracts for nursing home services. He said the oxygen supplier will change in the next three months at a lesser cost. X ray services are being investigated along with use of a new digital x ray with digital picture. Some elevator repair has happened in the Nursing Home with additional repair by Shindler expected this week. St. Croix County Health and Human Services Board Page 7 April 16, 2008 Morris announced the week of May 14 -17 is Nursing Home week. Special entertainment and activities are planned throughout the week and invited Board members to attend. Morris reviewed several capital needs and their costs for the Nursing Home. These items are not in the 2008 budget. He said the surveyors had a problem with the furniture in the Nursing Home but did not issue a cite. He said the furniture cannot be refinished due to the poor quality of the furniture; however, this does pose an infection control issue. Morris quoted some prices obtained for replacement furniture. Wentz questioned if the request was channeled through Dana Baker. Wentz requested prices be obtained from other vendors for the furniture. He said a replacement schedule will need to be implemented soon. The Nursing Home does not have an option to not address the issue. He said if the Nursing Home is cited, there will be a crunch to replace furniture immediately whereas the Nursing Home will have more time to replace if there is a plan in place to replace furniture before a cite is received. Morris also reported on the following critical equipment for the Nursing Home. The ice machine in the Nursing Home quit working. The machine is 12 -14 years old and is used on a daily basis. He also reported the garbage disposal is not working. The housing of the disposal is gone. This also is used on a daily basis and needs to be replaced. Morris also reported the shelving in the linen rooms needs to be replaced due to an infection control issue. Wentz requested Morris to review these items with Dana Baker. Motion A motion was introduced by Rasmussen, seconded by Berenschot, and unanimously adopted: That the Board approves Morris working with Dana Baker to purchase an ice machine, garbage disposal, and shelving for the linen rooms in the Nursing Home at the lowest best price for quality items. REVIEW OF PLANNING ALTERNATIVES FOR NURSING HOME /HHS BOARD MOTION ON 03/12/08 ADVISORY REFERENDUM Johnson read the following motion from the 03/12/08 meeting: 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 27o benefit percentile average. St. Croix County Health and Human Services Board 'Page 8 April 16, 2008 Johnson also read the following motion from the March 18, 2007 County Board meeting: Motion by Supr. Mehls, 2nd by Supr. King to keep the Nursing Home operating as a county entity and put this on an advisory referendum for November 4, 2008, and in the meantime, get more information regarding construction and remodeling and appoint a 5- person ad hoc committee to draft exact words of the referendum. The Administration Committee will soon report back to the County Board recommendations for appointing the five - person Ad Hoc Committee to draft wording for the referendum. Johnson said in order to get more detailed construction and remodeling costs, the county may have to spend some money and questioned who would pay these costs. Dr. Hoberg said more direction is needed from the County Board on what is expected. Estimated project costs have been obtained from several vendors and these figures have been provided to the Health and Human Services Board and the County Board. Johnson will work with Tobin on this request and discuss construction management fees and other cost associated with building/ remodeling that may need to be included in the final cost estimate. Johnson has contacted WCA to find out what other counties have done regarding referendum questions and received a few responses. He will contact Cindy Campbell regarding a deadline to get the referendum question in for November. The question development is on hold until the Ad Hoc Committee is appointed. The Board recessed from 9:53 to 10:00. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson announced Christie Hill was hired as a new Ongoing Family and Children's Social Worker on 04/07/08. Cheryl Brickner will start 04/21/08 as the new Lead Worker in Economic Support. Ron Eichstaedt will retire from his position as Director of St. Croix Industries effective 04/25/08 and Clark Schroeder has been hired as the new Director of St. Croix Industries. FILLING PUBLIC HEALTH NURSE PRACTITIONER POSITION Funk reported advertising for this position resulted in one applicant; however, the applicant turned the position down due to the wage. Two Nurse Practitioners have indicated willingness to contract at $42 /hour on a temporary basis for this position. Currently the high end of the wage scale for RNs is $28.52 /hour. A new job description will need to be developed for this position, which will need to be approved by the Health and Human Services Board, Finance Committee and then the County Board. The position would then be able to be evaluated in the Springsted Study. It is hoped that this evaluation can be done on a priority basis. Behavioral Health also is pursuing an APNP who has prescriptive authority. Funk will perform a data analysis and give a recommendation on wage scale for the positions. A temporary solution may be to pursue a contract at $42 /hour for Nurse Practitioner services. ADRC TRANSITION PLANNING Johnson said Wentz, Funk and he reviewed applications for ADRC section manager position and interviews will begin next week. An interview on the ADRC application is scheduled for May 5 and will include Sue Nelson, Liza Gibson, Mary Squyer, Ron Lockwood, Norma Vrieze, Jennifer Pempek, Tammy Funk, Fred Johnson and possibly a representative from Age Advantage. Johnson reported Community Health Partners (CHP) will meet with Long Term Support and Department on Aging staff on 04/17/08 regarding new positions St. Croix County Health and Human Services Board 'Page 9 April 16, 2008 in their company. Johnson and Funk will participate in these meetings. The meetings are geared more towards staff and there is no need for Board members to attend. Johnson said memorandum of understanding (MOU) and policy and procedures will be developed after a manager is hired for the ADRC. Transition of staff will likely begin in July or August prior to the consumers transitioning in September. A two -part orientation for ADRC Council members is tentatively set for June, but this will be discussed with the new Council when appointments are completed. BUILDING SECURITY /HEALTH AND HUMAN SERVICES FACILITY PLANNING: Tobin drew a map that outlined building changes being proposed to increase building security. Clients will be allowed to enter the building via the main entrance only; all other entrances to the building will be locked at all times. The front parking lot will be for clients /visitors only and staff will utilize side and rear parking lots. The change in the parking lots will happen with change in signage. The double doors currently in the lobby will be locked during the day with the receptionist granting passage through the doors via a buzzer system. Staff will have to use ID /scan badges to pass through the doors. There may be an issue with tailgaters with this proposal. After hours, the double doors in the lobby will be opened and two double doors, proposed to be located past the restrooms and in the hallway by CSP reception, will be locked. This will allow any appointments or groups held after hours to have access to the restrooms. Also being proposed is installing a glassed partition with a sliding door to divide the front lobby and separate the Nursing Home. The double fire doors at the top of the ramp to the Nursing Home would be closed at all times. Cameras are being proposed to follow visitors down to the ramp to the Nursing Home. Cameras would be for visual purposes only with no recording ability, but this can be upgraded in the future. The nursing station would have a buzzer application for the front entrance to allow access to the Nursing Home. A card swipe was approved by Finance for the Nursing Home and will be installed for outside doors of the Nursing Home along with changing cores in the Nursing Home locks. STRATEGIC PLANNING -HHS Kirt announced an all staff meeting regarding strategic planning progress is scheduled for April 30. He shared survey findings from the state giving the agency high rankings in services provided. The survey indicated the managers of St. Croix County have a good idea of what is going on in the state. The survey findings also indicated that partners see us as doing a good to excellent job. Concerns raised in the survey were waiting lists in mental health and AODA services. Also indicated as a concern was a need for more services for children and adolescents. Out of the strategic planning process, an oversight committee was established and work groups have been formed covering Accounts Receivable, increase volunteers, employee evaluations and training matrix, conflict resolution, increased communication between staff to staff and staff to managers, and an events committee. The oversight committee is scheduled to meet again on Friday, 04/18/08 and the volunteer group is scheduled to report to the committee and present concepts. Marilyn Pash will be working with Pete Kling to refine what is being done with strategic planning in the agency and to tie into the county supervisor planning to ensure consistency. Kirt indicated several units have embarked on their own individual unit strategic plan process also. Kirt extended an invitation to Board members to attend the all staff meeting on April 30, 2008. ' St. Croix County Health and Human Services Board 'Page 10 April 16, 2008 REVIEW OF FOSTER CARE NON - SMOKING POLICY: Johnson said the policy is scheduled to be implemented May 1, 2008. He said current foster parents are in agreement with the policy. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:55 AM Chair: Attest: (Secretary)