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HomeMy WebLinkAboutHealth & Human Services 12-17-08 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD December 17, 2008 The St. Croix County Health and Human Services Board met on December 17, 2008 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Richard Marzolf Gerald Peterson MEMBERS ABSENT: Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Financial Manager Ron Kiesler, Behavioral Health Coordinator Wendy Kramer, Public Health Officer /Public Health Coordinator Mary Squyer, Economic Support Supervisor Steve Kirt, Behavioral Health Clinical Services Supervisor Dennis Reiman, Contracted Nursing Home Administrator Clark Schroeder, St. Croix Industries Director Geralyn Karl, Health Educator Malva Sirek, Secretary OTHERS PRESENT: Tammy Funk, Human Resource Administrator Chuck Whiting, Administrative Coordinator Art Tobin, Building Services Director Kim Dupre, Information Systems Analyst Norm Matzek Dave Ostness Dana Krahenbuhl, Hudson High School AODA Coordinator Samantha Otten, Hudson High School Taylor Nelson, Hudson High School Stephen Dahle, Hudson High School 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, January 21, 2009 at 8:30 AM. Larson will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Peterson, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Luckey, seconded by Larson, and unanimously adopted: That the minutes of the 11/19/08 Health and Human Services Board meeting be approved with the following addition on page 9 under the motion under personnel issues: "Luckey made a motion to amend the main motion as follows: That every five Richard Marzolf will review vouchers. Revised 12/08/08 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD December 17, 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 - 11/19/08 DATE OF NEXT MEETING — 01/21/09 OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. Health and Human Services aged receivable report 3. Behavioral Health certification 4. Mental Health Parity ** 5. Economic Support Management Review 6. Food Share Employment and Training Program ** 7. Long Term Care Reform Transition 8. Agency rate setting 9. Personnel Issues a. New employees /vacancies b. Recruitment for Nursing Home Administrator 10. Health and Human Services facility planning (10:30 AM) 11. Nursing Home Report 12. Long range planning for the future operations of the Nursing Home 13. Tobacco Free Grounds Resolution and presentation from local youth who are in support of a tobacco free resolution (10:00 AM) ** 14. City Watch notification software ** 15. Public Health communicable disease report* 16. County Board Strategic Initiatives 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. 12/8/2008 8:24 AM St. Croix County Health and Human Services Board Page 2 December 17, 2008 years, an outside firm specializing in nursing home operation audits be retained to do an operational assessment of the nursing home. With no second forthcoming, the motion was withdrawn." FINANCIAL REPORT The following financial report for Health and Human Services through October, 2008 was distributed. To be on budget, the percent should be 83.3% Pempek reported WIMCR dollars will be reflected in the November report. Prior year carryover funds will not be applied until year end, which, at this time, will result in a positive amount. Transition of Long Term Care Reform cases started in September. This results in a reduction in expenses in Long Term Support. At year end a payment of approximately $350,000 will be made to the State for the transition of Long Term Support. Berenschot questioned the utilization of $4,700 for General Relief in 2008 as the program was eliminated for 2009. Johnson explained most costs involve burials and some other medical needs are being met by the free clinic. HEALTH AND HUMAN SERVICES - 2008 SUMMARY Total OF REVENUES Budget October 31, 2008 Balance % Administration 1,117,400.00 (18,404.16) 1,135,804.16 -1.6% AODA Services 772,986.95 622,320.93 150,666.02 80.5% Long Term Support 17,681,645.51 14,712,827.58 2,968,817.93 83.2% Mental Health 3,303,479.98 2,422,335.28 881,144.70 73.3% Family & Children's 3,037,821.28 2,590,659.87 447,161.41 85.3% Public Health 1,678,621.37 1,408,242.09 270,379.28 83.9% Economic Support 1,227,133.10 882,467.53 344,665.57 71.9% General Relief 15,000.00 12,500.00 2,500.00 83.3% Coordinated Services /SED 2,500,931.96 1,528,779.10 972,152.86 61.1% REVENUES HUMAN SERVICES PROGRAMS 31,335,020.15 24,161,728.22 7,173,291.93 77.1% SUMMARY Total OF EXPENDITURES Budget October 31, 2008 Balance % Administration 1,117,400.00 923,563.80 193,836.20 82.7% Alcohol -Drug Abuse 772,986.95 665,382.33 107,604.62 86.1% Long Term Support 17,681,645.51 14,512,234.69 3,169,410.82 82.1% Mental Health 3,303,479.98 2,534,478.34 769,001.64 76.7% Family & Children's 3,037,821.28 2,373,899.84 663,921.44 78.1% Public Health 1,678,621.37 1,399,586.59 279,034.78 83.4% Economic Support 1,227,133.10 969,140.79 257,992.31 79.0% General Relief 15,000.00 4,701.21 10,298.79 31.3% Coordinated Service /SED 2,500,931.96 1,305,569.76 1,195,362.20 52.2% EXPENDITURES HUMAN SERVICES PROGRAMS 31,335,020.15 24,688,557.35 6,646,462.80 78.8% Excess Rev over Expenses S (526.829.13) The following financial report for Nursing Home through October, 2008 was distributed. To be on budget, the percent should be 83.3%. Pempek reported IGT funds of $428,000 were received for 2008, which is more than the budgeted amount. St. Croix County Health and Human Services Board Page 3 December 17, 2008 St. Croix Health Center Octobei 2008 Budget Actual Difference peicentaq Census 0 Operating Revenue: Medicare $842,975.00 $766,183.71 $76,791.29 90.89% Medicaid $2,431,627.00 $2,132,178.52 $299,448.48 87.69% Private Pay $760,413.00 $604,427.25 $155,985.75 79.49% All Other Sources $217,774.00 $191,482.70 $26,291.30 87.93% Total (►peiating Revenge $4.252,789.00 $3.894.272.18 $558.5'Iti.82 86.87 1 0 Opeiatiny Expenses Daily Patient Services $3,081,764.76 $2,813,769.24 $267,995.52 91.30% Special Services $284,516.00 $217,608.84 $66,907.16 76.48% General Services $1,167,643.63 $899,996.02 $267,647.61 77.08% Administrative Services $547,561.00 $594,247.04 - $46,686.04 108.53% Unassigned: Depreciation (% Based) $0.00 Others: $294,394.00 $209,349.15 $86,044.85 71.11% Utilities $114,523.25 Workers Comp, Computer Tech $24,419.90 Insurance $70,406.00 Total Opeiating Expenses $5.375.879.39 $4.7341970.29 $640.909.10 88.08 Net From Operations 1$1.040.668.111 (Cost of doing business prior to applying levy & outstanding rev) 011tstan +ling Revenges Outstanding Rate Appeal rev $12,000.00 $445.00 $11,555.00 3.71% Revenue - IGT Funds $318,000.00 $428,153.00 % of Outstanding IGT Rev $0.00 $0.00 ' #DIVroI Co Allocations (% Based) $259,859.39 $216,550.00 $43,309.39 83.33% Nursing Home Carry Over $533,231.00 $0.00 Total Outstanding $1.123.090.341 $645.148.00 $54.864.39 Net from all Sources 4395.550.11 AGED RECEIVABLE REPORT: The aging Accounts Receivable report through October was reviewed. Staff are continuing to work on receivables from 2006 -2007. 2006 Medicare and Medicaid accounts are ineligible to collect and some accounts may need to be written off. This information will be brought to the Board for consideration. Clients fill out financial information before an appointment is made. Court ordered services are paid for before appointments are made. Pempek reported Medicare and Medicaid billing has been submitted on a timely basis. St. Croix County Health and Human Services Board Page 4 December 17, 2008 ECONOMIC SUPPORT MANAGEMENT REVIEW Squyer reported a management review is done every three years. The team pulled 22 cases. Of these 22 cases, eight cases were correct, six were correct benefits but all information was not scanned into the electronic case file and eight were errors with one being a benefit error. The goal is to go paperless; however, there have been issues with the scanning equipment where all pages do not get scanned when doing multiple page scanning. Squyer reported the unit is not processing cases timely within the 10/30 day process time; however, with one new worker, the unit should be able to catch up a little but if caseloads rise, this may be impossible. St. Croix County is to do targeted case reviews on 33 cases a month. Squyer reported this takes a minimum of 15 hours a month. The unit is given a waiver from the Feds if the targeted case reviews are completed; however, due to high caseloads and lack of staff for the last year, the reviews have not been done. Currently, the lead worker is scheduled to do case reviews every Friday to meet the required number of cases to be reviewed. The civil rights people were not pleased with the building as the bathrooms are not handicap accessible due to not being able to turn a wheelchair around in the bathrooms, there is nothing in the building for blind people, signage is not good, large enough, or appropriately placed in the building. The hallways are wide enough; however, going up the ramp with a wheelchair is difficult. Information from the Office of Affirmative Action and Civil Rights Compliance is expected to be received in January of 2009. Squyer reported the case count 01/01/2008 was 3,202; as of 12/01/08, the case count was 3,790. Squyer said changes are being implemented now; however, if the caseload increases there may be a need to request additional staff for Economic Support to meet client needs and timelines. Squyer reported on the conversion to the Forward Health System, which resulted in errors in Social Security and Medicaid benefit information clients received. She said it can be very confusing when calls are placed to Social Security Administration. When questions cannot be answered by Social Security in Madison or calls are not answered, clients call Economic Support. Checks issued for clients no longer identify the client name on the check. For representative payees this can be very confusing as checks are received for multiple clients and client names are not identified and check amounts change. Information for SSI for 4000 individuals was incorrectly entered and notices went out stating SSI was ending checks to these clients. Also, BadgerCare Plus and MAPP premiums that were paid on time by the clients were not recorded at the State level and the cases closed 11/30/08. Approximately 3,300 notices, which are generated by a computer, not a real person, were sent out to individuals. The state informed Economic Support that if a client contacts us and tells us the check number used for paying the premium, a manual update can be made for the client. There are work - arounds for the problems, but they are time consuming and confusing to the clients. Members questioned what they can do to make the system work and what is being done in Madison to rectify the issues. Squyer said the system was implemented before it was ready and issues will be dealt with as they arise. Johnson highlighted that the issues identified in the management review to a large extent are volume related and this is something that we will need to track more closely in 2009. Should the caseload continue to grow, we will need to be more proactive regarding staff needs and this will be added as an agenda St. Croix County Health and Human Services Board Page 5 December 17, 2008 item at future meetings. FOOD SHARE EMPLOYMENT AND TRAINING PROGRAM This program will be referred to the W -2 agency due to being a huge undertaking for the amount of money we would receive. This also means $20,000 budgeted revenue for 2009 will go away but staff feel that amount should be able to be made up from third party liability, MA transportation, claims, etc. St. Croix County will receive 15% of recovery for MA /Food Share overpayments. Squyer said staff are doing an excellent job with the transition to the four - ten hour days and volume has increased. AGENCY RATE SETTING Suggested fee schedules for ADRC and Aging plus rates for St. Croix Industries (SCI) were distributed. The majority of the meal costs were based on donations, now there is the ability to recoup funding for these services as Community Health Partners (CHP) will buy meals from the Aging Office. These fees include everything from prep to delivery of meals and Beckman is looking at creating some efficiency in this area. The CHP clients will not have to pay for meals if this is part of their approved plan; the meals would then be paid for by CHP. SCI is providing services for CHP clients. The balance of the transitioning of clients to CHP will be completed by February. Schroeder indicated Day Services, community placement, and job coaching rates increased due to no county money being in the program. A contract has been entered with CHP for the suggested rates. Schroeder reported Channel 15 will be interviewing SCI clients and Schroeder today and report on community placements. Schroeder will investigate the ability to view the interview at a future Board meeting. Schroeder reported the City of New Richmond Chamber of Commerce membership has been completed. Schroeder is investigating the possibility of a satellite day program in the River Falls area. The program would be self- funded, clients would be enrolled in CHP and the program would offer life skills training, exercise, etc. to clients. Schroeder invited Board members to attend the SCI client Christmas party to be held at Ready Randy's on December 19 from 1:00 to 3:00. Schroeder expressed gratitude for help received from the Sheriff's Department with the vans this past week. He said new vans are scheduled to be built in mid - January. The Board recessed from 9:53 to 10:00 AM. PUBLIC HEALTH COMMUNICABLE DISEASE REPORT Kramer reported there was one identified case of Pertussis before Thanksgiving. Pertussis is preventable by vaccine and is a reportable disease. After disease investigation, five more cases were identified, plus two more cases were identified last week. Investigation and education are done to help prevent spread of the disease to others. Kramer reported this is an ongoing investigation with over 75 hours of staff time spent on the investigation to date. The Health and Human Services Board also acts as the Board of Health. Public Health will update the Board on • St. Croix County Health and Human Services Board Page 6 December 17, 2008 Public Health issues on a quarterly basis at a minimum. The County Board confirmed appointment of Kramer as the County Health Officer at the December 16, 2008 meeting. Johnson reported St. Croix County has been ranked the seventh healthiest county in the State due to staff working hard to keep the health ranking high. TOBACCO FREE GROUNDS RESOLUTION AND PRESENTATION FROM LOCAL YOUTH WHO ARE IN SUPPORT OF A TOBACCO FREE RESOLUTION Karl reported tobacco -free grounds has been discussed for quite some time. A resolution was passed in the early 1990's regarding smoke -free county government buildings and passenger vehicles. Discussion has been held regarding the inclusion of parks and the fair grounds in a tobacco -free grounds resolution. In August, 2008, the fair board indefinitely tabled a resolution regarding tobacco -free grounds and accepted the offer from the health department to work with building signage and receptacles for cigarette disposal. Karl reported the Parks Board unanimously supports 100% tobacco -free parks. Three students and an advisor from Hudson High School gave testimony supporting tobacco -free parks and fair grounds. It was stated by the students that no smoking in the parking lot or outside the Government Center building would give a better /positive image of the County. Marzolf commented it is encouraging to see students involved in issues. Johnson suggested a finalized version of the tobacco -free resolution be brought back to the Board in January. Education would be the primary focus to implement the resolution. The County recently began offering a wellness plan to employees. Karl said the point of the policy is not to be punitive but to set an example in hopes that the policy would be self- monitoring. Karl said the resolution has the support of the Tobacco -free Coalition. It was the consensus of the Board the resolution should include parks and the fairgrounds also. The Nursing Home is already considered a tobacco -free facility. HEALTH AND HUMAN SERVICES FACILITY PLANNING Johnson would like to discuss and explore options for long range facility planning for Health and Human Services and suggested that a long range planning committee could be one possible way to begin addressing concerns regarding HHS facility needs. At this point, concerns have been identified regarding the current HHS structure, but limited money has been allocated to address the multiple issues identified by building services. Johnson requested that a recommendation come from the HHS committee to the Finance Committee to begin to address the long range facility needs for HHS, which may be part of a larger plan regarding building countywide. Whiting indicated the Finance Committee is the building and grounds committee for the County. Discussion occurred regarding facilities needs are county issues and will need to involve county employees. The question was raised as to where to start with this process, Finance Committee, County Board or Health and Human Services Board. Tobin echoed support for building needs to be brought to Finance and also indicated that as part of planning, budgeted upkeep and maintenance of facilities needs to be addressed. Johnson reviewed Ayres and Associates previously submitted plans for building options in 2007 and could be used as part of the planning process. Johnson said there may be some ADA concerns regarding access to the Health and Human Services building for people with disabilities as noted from an earlier report from Economic Support, but the final report from that management review has not been received at this St. Croix County Health and Human Services Board Page 7 December 17, 2008 point. Discussion included the possibility of building a new nursing home. Whiting indicated that we are going to have a Nursing Home. Discussion also included the possibility of renting space. Tobin does not recommend renting out space as he believes it is not to be a cost effective option. The next Finance Committee meeting is scheduled for January 8, 2009. Motion A motion was introduced by Luckey, seconded by Berenschot, and unanimously adopted: That the Board requests as a Finance Committee agenda item discussion of creation of a long term facility planning committee to look at buildings and grounds countywide. Space needs should be researched countywide in New Richmond, Baldwin, and Hudson. Marzolf questioned why building a new nursing home was not acted on by Finance in the past. Marzolf would like employees to have ownership in decisions being made regarding the Nursing Home. The County has spoken out in support of the Nursing Home with the referendum outcome. In Behavioral Health strategic planning meetings, access to services and transportation were issues that emerged. Kiesler distributed a graph depicting client residence location within the county. The majority (53.30) of the clients are located within a ten -mile radius of New Richmond, with Hudson following with 25.6% and Baldwin with 21.0 %. Staff are investigating the possibility of creating satellite offices in locations other than New Richmond. Johnson indicated information gained from this workgroup could be provided to a facility planning committee for consideration. BEHAVIORAL HEALTH CERTIFICATION Kiesler reported Polly Wong from the Division of Quality Assurance completed a review of Behavioral Health Services on November 24 and 25. All services were recertified with no citations, so St. Croix County was awarded a two -year extension on licenses. MENTAL HEALTH PARITY Kiesler reported change in the law would affect Medicaid managed plans, group health plans, and State managed plans. The change is mandated to go into effect 01/01/2010. The plan requires insurance companies to treat mental health on an equal basis with physical illnesses when policies cover both. The plan should result in additional revenues for Behavioral Health individuals so they would not cap -out on their insurance and go to sliding fee scales for payment. LONG TERM CARE REFORM TRANSITION Johnson reviewed the County's cost and payment planning for the transition to Long Term Care Reform. He said payment should start to the State of Wisconsin within the next two weeks and outlined the following approximate payments: 2008: $350,000 to the State 2009 $1.754 million 2010: $1.572 million 2011: $1.412 million 2012: $1.267 million 2013: $692,498 2014: $376,005 This payment schedule was negotiated with the State primarily to avoid an increase in calendar year 2010. The initial payment in 2010 was slated to be approximately $2.1 million. The above noted payment schedule allows costs to • St. Croix County Health and Human Services Board Page 8 December 17, 2008 be shifted in the county budgeting process, rather than the initial State plan that crossed calendar years and was associated with the implementation date of the transition to long term care reform. The same amount of money will be paid to the State as part of our buy in to long term care reform. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES There are no new employees or vacancies to report. RECRUITMENT OF NURSING HOME ADMINISTRATOR It was the consensus of the Board to move forward with recruitment to hire a Nursing Home Administrator as a permanent County employee. Advertisements will go out next week and applications will be accepted through January. The Finance Committee strongly recommended using an outside firm to recruit for this position. Johnson will work with Funk regarding candidate recruitment. Support will be obtained from Wipfli, Pathways and the State of Wisconsin for recruitment. NURSING HOME ADMINISTRATOR'S REPORT Dennis Reiman was introduced as interim Nursing Home Administrator and Reiman gave a brief review of his employment history. The Nursing Home newsletter was distributed to Board members. The current Nursing Home census is 64 with three residents in the hospital. Reiman said he is impressed with the staff and care given in the Nursing Home. Reiman said the building is well taken care of but it is not suited for the way industry is trending. He said the building is institutional and the trend is toward more homelike structures. Reiman was impressed with the support received from the community. At the last survey, the state surveyors commented on the condition and age of furniture in resident rooms. Reiman said the bedside tables and dressers are compromised and may be a possible hazard to residents and staff due to infection control issues, injury and appearance. He said it is not financially feasible to fix this furniture. The State will be looking for a good faith effort on the County's part to replace old, unsafe furniture. Johnson recommended buying some of the furniture this year and to have a plan in place to complete the replacements in a three to four year period. There may be a need to go to Finance to request monies from the contingency fund to do this. Reiman distributed furniture and cost information received from three different vendors. Reiman suggested buying fewer dressers than other furniture as many times residents bring their own personal dressers in with them. Reiman recommended the furniture from vendor Hill -Rom as the furniture is built so that any damaged panels can be replaced by new panels rather than replacing the entire furniture piece. Hill -Rom also offers free shipping. Tobin recommended purchasing a few additional panels /door fronts when the furniture is ordered. Reiman informed the Board that beds are another critical need for the Nursing Home. Currently, 50% of the beds are mechanical lift beds and many of the devices that lower /raise the beds are broken and the parts cannot be fixed and are not replaceable. This is a hazard for resident falls and injury and potential worker's compensation losses. He recommended replacing the beds with electric high /low beds. Johnson requested Reiman to prioritize the items needed in the facility. Tobin requested wheelchairs be purchased from a standardized vendor(s) so parts can be ordered for a standardized chair. St. Croix County Health and Human Services Board Page 9 December 17, 2008 Motion A motion was introduced by Peterson, seconded by Berenschot, and unanimously adopted: That the Board approves purchasing ten (10) dressers and bedside stands from Hill -Rom at an approximate cost of $4,613.00 CONSIDERATION OF CLAIMS Health and Human Services Board member Marzolf reviewed the vouchers. He questioned a voucher payment for a St. Croix County resident at the National Deaf Academy in Florida. Johnson said 400 of the cost is county cost with the balance being paid for with State and Federal dollars. This client will be transitioned to Long Term Care Reform and Community Health Partners by February, 2009. This placement is appropriate for the health and safety of the client. Motion A motion was introduced by Marzolf, seconded by Larson, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 138905 through 138911, dated November 20, in the amount of $34,907.62. Human Services vouchers 139775 through 139815, dated December 04, in the amount of $35,207.41. Human Services vouchers 140548 through 140553, dated December 10, in the amount of $46,770.60. Human Services, Nursing Home, and ADRC vouchers 138783 through 138904, dated November 20, 2008 in the amount of $232,767.71. Human Services, Nursing Home, and ADRC vouchers 138912 through 138936, dated November 20, 2008 in the amount of $10,277.43. Human Services and Nursing Home vouchers 139268 through 139351, dated November 25, 2008 in the amount of $275,921.96. Human Services, ADRC and Nursing Home vouchers 139355 through 139510, dated December 04, 2008 in the amount of $104,951.37. Human Services, ADRC, and Nursing Home vouchers 140360 through 140516, dated December 10, 2008 in the amount of $104,218.39. Human Services, ADRC, and Nursing Home vouchers 140554 through 140716, dated December 10, 2008 in the amount of $141,300.72. Nursing Home vouchers 140517 through 140547, dated December 10, 2008 in the amount of $20,504.78. Human Services, Workshop, Public Health, Social Services vouchers 704 through 731, dated October 30, 2008 in the amount of $381,888.93. Human Services, Workshop, Public Health, Social Services vouchers 732 through 762, dated November 13, 2008 in the amount of $389,799.01. Human Services and Nursing Home vouchers 693 through 720 dated October 30, 2008 in the amount of $154,046.19. St. Croix County Health and Human Services Board Page 10 December 17, 2008 Human Services and Nursing Home vouchers 721 through 749, dated November 13, 2008 in the amount of $168,631.59. Workshop vouchers 140 through 145, dated October 30, 2008 in the amount of $13,279.42. Workshop vouchers 146 through 151, dated November 13, 2008 in the amount of $14,603.30. LONG RANGE PLANNING FOR THE FUTURE OPERATIONS OF THE NURSING HOME Nursing Home private pay rates were discussed at the County Board meeting yesterday. Suggestion was made to modify private pay rates as currently costs are $58 more than the current rate. If the rates are increased for private pay, the Nursing Home census could be impacted. More detail regarding private pay rates and costs will be provided to Board members. A survey of private pay rates in the private sector has previously been provided. Medicaid and Medicare rates for the Nursing Home are also being subsidized by the County. No formal recommendation will be made today. CITY WATCH NOTIFICATION SOFTWARE This item will be delayed to the January meeting. COUNTY BOARD STRATEGIC INITIATIVES This item will be delayed to the January meeting. Wentz asked if there were any other issues to bring before the Board. Johnson and Funk will discuss the process of hiring an Administrator for the Nursing Home with Wipfli and Pathways staff regarding questions to ask, site reviews and surveys, etc. Wentz adjourned the meeting. Time: 12:30 PM Chair: Attest: (Secretary)