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HomeMy WebLinkAboutHealth & Human Services 02-25-11 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD DATE AND TIME: February 25, 2011 at 8:30 LOCATION.• (Board Room, St Croix County DHHS Building, 1445 N. Fourth Street, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - DATE OF NEXT MEETING — 03/16/11 at 8:30 a.m. OLD AND NEW BUSINESS 1. Appoint member to review vouchers at next meeting 2. Follow up on Business Plan for St. Croix Health Center 3. Possible agenda items for next meeting NOTE: A quorum of the St. Croix County Board of Supervisors (County Board) may be present at this meeting. Therefore, this notice also serves as notice of a meeting of the County Board for the purpose of obtaining information relating to subjects listed above for use at future County Board meetings. 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. 2/17/2011 6:05 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 25, 2011 The St. Croix County Health and Human Services Board met on February 25, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Leon Berenschot Roger Larson Richard Marzolf Alfred Schrank Daryl Standafer (for quorum) MEMBERS ABSENT: Deb Rasmussen, excused Frederick Horne, excused Esther Wentz, excused Linda Luckey, excused Dr. Lisa Ramsay, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Frank Robinson, Nursing Home Administrator Tammy Funk, Human Resource Administrator Kathy Leisch, Secretary OTHERS PRESENT: Kim Dupre, Information Systems Analyst Sharon Norton - Bauman, County Board Member William Bauman Art Tobin, Building Services Director Jeff Holmquist, New Richmond News Shaela Leibfried, President, Nursing Home Local Union Norm Matzek Vice Chair Larson called the meeting to order at 8:35 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, March 16, 2011 at 8:30 AM. Larson will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Schrank, and unanimously adopted: That the agenda be approved as distributed. FOLLOW UP ON BUSINESS PLAN FOR ST. CROIX HEALTH CENTER Larson stated the purpose of this meeting was to come up with a business plan for the Nursing Home. He started with asking each member's opinion and how they would like to support the Nursing Home and any ideas they may have. St. Croix County Health and Human Services Board Page 2 February 25, 2011 Berenschot stated he personally will support the Nursing Home and we need to make sure the media gets enough information to know that St. Croix County will continue with the Nursing Home services. Berenschot stated that one of the things that has bothered him is with people in the community not knowing whether the Nursing Home will be in business. Berenschot stated we do have a 5 star rating and we want to continue with that rating. Berenschot stated that the citizens voted to continue with the Nursing Home and we certainly have to look at a long -term plan to support the Nursing Home and the citizens. Marzolf stated that he unequivocally supports the continuation of the endeavor here to provide for the needs of those who are unable to help themselves. Marzolf stated he had notes in front of him of the top priorities that were summarized July of 2009. Marzolf stated that among the top priorities that were summarized in July of 2009 were some things that would help bring revenue to our operation here. He stated that perhaps we work in partnership with other facilities where we might share the cost of some major pieces of equipment that we could all benefit from. Additional areas are short-term rehab, senior housing, assisted living, sub -acute rehab unit, detox facility and wound treatment facility. Marzolf stated that any one of these would require a minimal capital investment to get up and running. He also stated that at this time all the press has been negative. He stated if he was looking for a place for a loved one, he would think twice about sending them to our facility in spite of its 5 star rating if the press out there is making this a questionable operation. Marzolf indicated that we need to get as much positive information out to the public as we can and to include in that some of the priorities that he has shared with everybody at this table. Marzolf stated that there is something very wrong with our mentality and our value system if we are unable to embrace the needs of those less fortunate than we are by reaching out and somehow providing assistance to them. Marzolf said we must examine our value system and look at what we are committed to and what the citizens through their non - binding referendum vote did in fact mandate us to do. Schrank spoke in support of Nursing Home and the excellent care that people receive when they are in our facility. He supported what the other members have stated. Schrank stated he didn't know how much we can do with the economic times as they are. Larson stated he supports the Nursing Home and that he has been listening to what the constituents in his area are saying and the feedback that he has been getting. Larson stated that he has looked at the levy figures we have had since 2001 and this year has been the least that it has been. Larson stated he thinks we have been going in the right direction as far as making repairs and updating on a slow basis. Larson is not certain at this point that we would be able to get off the levy completely and run the Nursing Home without concessions. Larson stated we have looked at the $30.00 per day patient day care higher cost in the facility and it is important to look at that closely to get that number lowered and that could help to make the Nursing Home budget. Larson stated he concurred with what the other members have said. He also supported using levy dollars to keep the Nursing Home open because it is an important facility for us to keep open. Standafer stated he has listened to the comments from the Board members and has expected those comments from all of the members. He stated he is not speaking from a standpoint of support or non - support. He does not think that is the issue. He asked that the Board consider where we go in St. Croix County Health and Human Services Board Page 3 February 25, 2011 the future. He asked, "Where do we as a board or committee of St. Croix County go in the future ?" He stated we can't talk about the Nursing Home in isolation. It has to be part of a bigger picture. He stated that it is becoming abundantly clear that there will be significantly fewer dollars available for us in all categories. He stated that the budget released next Tuesday is going to have major contractions in it because there isn't any money and that the State of Wisconsin is broke. Counties will have significant contractions across the board. That will be particularly heartfelt in the general Health & Human Services area only because this is the largest budget. Standafer stated that this committee, the County Board and the public will have to consider what it is that we can do and what it is that we can not do with the dollars that we will have. Standafer stated that Johnson and Robinson will have major decisions to make in balancing what it is that we can do with those dollars. Larson stated this is a difficult time to make a plan and it may not come out of this meeting today. Larson said this is why he wanted everyone to speak today. This will take time and will get tougher as time goes on. Johnson stated he put together some data to take a look at, some of which has been previously provided. Johnson stated that ultimately making a statement of the direction this committee thinks we should go with the future operation of the Health Center is the purpose of this meeting. It would then appear necessary to have some specific dialogue at the County Board level to what people will support. Johnson stated he does not know the answer given the motion at the budget meeting where there was a 9 - 9 vote to remove all levy from the current budget for the Nursing Home. Robinson stated the County can be proud of the Nursing Home that we do have. Robinson stated he has appreciated the support from this Committee and the County Board. He said that anything he has asked for in the two years he has been here the Board has given him, whether it is dollars for a bus, computers or things he needs to just do the job. He would like to see the spirit of cooperation continue. Robinson stated we have made a lot of progress in reducing the amount of levy dollars being spent. Robinson said that he believes we can continue to work in the spirit of cooperation and to work with the employees to reduce costs. Robinson said that obviously his goal was to get off the levy and that we should work together to get off the levy or to reduce the levy and he thinks that we can do it. Larson asked for discussion on short term goals and what it is going to take to achieve those short term goals. He stated that these are difficult times to make decisions on what to do without knowing what is going to happen with the State budget. He asked Tobin to give an update on what the cost has been to renovate some of the rooms. Tobin stated they have looked at some of the costs that have been expended over the last couple years on room renovations. This has consisted of changing out and replacing broken wall sections, bathroom remodels, ceiling tile, electrical, sandblasting covers which were life safety issues, etc. Tobin stated they have worked approximately 8 — 10 of those rooms that were both private and double occupancy rooms and those costs were roughly $4,500.00 to $5,000.00. Tobin stated they try to do as much as they can in -house with staff but there are things that staff are unable to do. Tobin stated he is proud of the staff he has and the quality of work that they do but they are limited on the amount of staff that they have and so they have to contract out on some things. Tobin stated they are mapping out what needs to be done and where we are possibly cite liable for safety violations. Tobin stated that two big important short-term issues facing us right now are the loading dock issue and the west elevation basement wall. Tobin stated St. Croix County Health and Human Services Board Page 4 February 25, 2011 there is $64,000 in the capital outlay projects for the Nursing Home facility. This includes wall work and bathroom and lighting facility upgrades. Johnson clarified that the $64,000 budgeted is bond proceeds and this is above and beyond the wall repairs, etc. Tobin stated these are all short-term repairs for 2011. Marzolf questioned if there be a priority on which items that he talked about both today and back in 2009. Robinson said that in terms of priority that outpatient rehab is something they are looking at right now and will continue to look at. Robinson said they are currently doing outpatient rehab on- site and are advertising and getting people from the community doing outpatient therapy. Robinson stated they do hospice care now and have always done that. There are two serenity rooms in the facility that are larger for family to visit when a loved one is at the end of life. Short-term rehab is also being done right now. Home Health has been ruled out because of licensing issues. Robinson stated that you have to be doing the business for a year before you get licensed along with incurring expenses and not getting reimbursed so this has been ruled out as a viable option for the County at this time. Wound treatment facilities require more equipment and would need physicians to oversee the program and that could be a very costly thing. Johnson stated that outpatient services were part of the business planning model with LarsonAllen. Johnson stated the assisted living business models may have a potential 20% — 25% profit margin and this would help offset some of the losses on the Nursing Home. Berenschot also asked how it would affect the Nursing Home if there was no Medicaid. There are currently 37 people getting Medicaid in the Nursing Home and how would they pay for their nursing home costs if Medicaid is cut? Johnson stated he has no indication that Medicaid for nursing home residents won't be a funding source even though we have all heard some of the same talk about Medicaid sources being reduced or cut. Robinson said that Medicaid is a stable payer source and the turn around in Wisconsin is less than 30 days. Matzek asked Johnson if he had a chance to look at cost we are incurring within the County for the Chapter 51, Chapter 55 residents. He questioned how long they are staying and what kind of care are they receiving. Johnson distributed a list of individuals protectively placed at skilled care. Johnson stated that individuals are protectively placed within their own home, in group homes and in community based residential facilities as well, but this list is for skilled care. Johnson stated there are currently 35 individuals who are in a variety of facilities and currently six of those individuals are at the Health Center. Johnson stated that the funding source for these individuals when they are protectively placed is not the Behavioral Health Unit. They could be billed to Medicaid, private pay or Medicare. Johnson stated that these bills are not coming back to St. Croix County Health and Human Services. When there is an individual that needs crisis intervention, hospitalization or long- term placement, our Behavioral Health Unit will step in and meet the mental health needs of these individuals. Matzek asked what the total money is going out in this area. Johnson stated he doesn't know the total amount paid on an annual basis for these 35 individuals. Robinson stated that with the six individuals that we have we do not have any bills coming back to St. Croix County for those services. Norton - Bauman asked how many empty beds there were in St. Croix County at this time. Johnson stated there were approximately 93. Norton- Bauman asked if this Board had considered downsizing this facility to one floor. Marzolf stated that one of the disadvantages of that is with the type of patients that are on each of the floors. Norton- Bauman stated that her concern is that even if we were to invest the millions of dollars here in the County to provide for the kind of care that Robinson and others see on the horizon, the fact is that we can't fund this St. Croix County Health and Human Services Board Page 5 February 25, 2011 with our current wage structure. She stated it is very clear in all the studies that she has read. Norton - Bauman said we are at the top of the Nursing Homes that LarsonAllen surveyed with our wage and benefit structure. Johnson stated he has looked back at previous studies and previous discussions regarding the Nursing Home. There were four basic components of recommendations back in 2002 that are applicable to us today. They are: 1) Consider cost and benefits of downsizing the nursing home. At that time we were a120 -bed facility and now we are a 72 -bed facility. 2) Implement staffing levels relevant to census. Robinson manages that on a daily basis. 3) Implement available new technologies for both financial and non - financial reporting systems. The Board has been very generous in supporting kiosk and technology for better charting which enables us to get a better Medicare daily reimbursement rate. 4) Looking at wages. The Board recessed from 9:50 — 10:05 AM. Larson reconvened the meeting. He stated again that the Board would need to determine what direction they would like to go and to put together a short-term business plan along with a long -term goal to go along with that business plan. He said we need to think what we need to do to sustain the Nursing Home business. Johnson distributed information on business planning scenarios along with fiscal components that had previously been talked about. Standafer stated he would like to make one more observation as the Board moves towards making a business plan. Standafer stated that he thinks that much of the discussion of necessity will need to be somewhat open ended and somewhat philosophical because there are still some factual and financial pieces that we don't know yet. Even though some of those details will be more apparent next Tuesday, it will still not give us all the data that we need. Discussion should include a "what if' analysis. Standafer said that if St. Croix County continues to operate the Nursing Home, it is probably going to take some levy support. He said he is not saying if that is good or bad but he is just trying to be factual. He stated if the operation of the Nursing Home is always going to require some levy support, that there is the likely reality that we are going to be looking at constriction of funds across the board and in a lot of other services. He reminded the members that this committee is not the Nursing Home committee, it is the Health & Human Services committee. If we decide to continue to support the Nursing Home and if we believe that to do that it will take levy support, then to reach that objective as a committee we may need to eliminate things in other areas. We can look at it impacting 62 people in the Nursing Home, but how many are impacted by the whole Health & Human Services Department. Norton - Bauman stated that the Administrative Committee is asking all of the committees for a list of priorities from each department you are involved with. The County Board can come up with final decisions but each department should take the time and have a discussion to come up with a list of priorities in the order in which they should be funded. Larson said that even with all that has been said we are still sitting here and we need to formulate a plan going forward on which direction we need to go. Marzolf stated the community support for what this Nursing Home has to offer is in large part dependent on three factors. The first is personal St. Croix County Health and Human Services Board Page 6 February 25, 2011 experience from either having been a resident here or having a family member as a resident. The second factor is word of mouth and the third is what is reported in the media about what is going on here. Marzolf stated that we try to promulgate some positive image about what this facility has to offer. In 2008 when the referendum was on the ballot we had just concluded our second consecutive citation free accreditation visit. To date we started out the budget year in October with a $660,000 draw on the levy which is now down to around a $330,000 draw but in addition to that we still have the quality of care. Marzolf stated he feels it would be very helpful to have healing touch services here. He has heard a lot of positive feedback on the healing touch program and on the hospice program that is already present and would recommend enhancing these programs. He stated that word of mouth is positive and if the word gets out that we are providing these programs, we could realistically expect a corresponding increase in census. Larson stated we may need to look at a more positive way to manage our business here in long -term and this will take getting down to some hard facts of dollars and cents. Larson stated that Robinson is doing a great job right now but it comes down to dollars and cents to make the budget balance out. Larson stated he does not see where the Nursing Home will be off levy dollars totally. He stated he doesn't know if we can make it run any better than it is right now because he thinks we have done everything we can to make it run as efficiently as possible. We will need to look elsewhere to see what we can do to bring this whole thing together. Norton - Bauman asked if this Board has ever thought of going to the County Board with a request for a "binding referendum" forward to the taxpayers to see if they are willing to spend "X" amount of dollars for "X" number of years for the Nursing Home allocation and have that added to your tax bill over and above the tax levy. The previous referendum was advisory and not binding. Norton - Bauman asked if the taxpayers of this County feel strongly enough that they would vote to have an additional tax added to support the Nursing Home. Dupre asked if we would need to confer with Corp Counsel because she was under the impression that the County is not currently taxing the maximum of what we are allowed to, so it is her understanding that you can not have a binding referendum unless you had already maxed out what you could tax. Standafer stated this is correct but you can always have a binding referendum depending on the question you are asking and you could have a binding referendum asking to have a segregated amount specifically used for a purpose out of your ordinary levy even though you are not taxing to the amount you are limited. Matzek stated he has talked to a lot of different people in the community and they make the comment that the people have spoken regarding the Nursing Home and we play word games now in respect to a binding or non - binding referendum. He said that those were the people's voices and they were counted and they said they wanted to support the Nursing Home and at that point it is the County Board's task to continue the wishes of the people. Norton- Bauman stated the County Board has to be responsible with the tax dollars that we collect and that the decisions come down to what we would quit doing in continuing to support all other aspects of the County government including the Nursing Home. Larson stated we are not coming out of this meeting with the plan that he had expected today but there has been a lot of discussion. Johnson stated he is concerned that without something coming forth at some point, it will get back on the County Board floor in some shape or form. A potential next step may be to come together as a Committee of the Whole and discuss options around what board members will support given the planning that has already been completed. St. Croix County Health and Human Services Board Page 7 February 25, 2011 Standafer stated that the danger in not making a decision is that someone may make one for you and one may be forced upon us. Standafer stated he has no intention of placing on the County Board agenda a non - actionable item. He stated we are not going to have this kind of conversation in that forum. At some point there needs to be an actionable item at the County Board level and until this committee is ready to do that, it is not going to be there. Standafer stated he is perfectly willing to have an in -depth work session at another meeting of the Committee of the Whole to recommend an actionable item and that would be the appropriate forum. If this committee is ready to take the lead in that conversation and then sit down with all our colleagues in that forum, he will absolutely do that. Larson stated at this time there is nothing positive to go forward with as a business plan. Larson stated it would need to be put on the next agenda for this committee to hopefully come out with something for the Committee of the Whole with how we want to move forward. Standafer stated it would be wise for this HHS committee to have a pretty clear idea of what you want to recommend prior to getting to the April Strategic Planning and Prioritization Session. If there is a clear direction here, he thinks that will go a long ways toward them having a productive pre- budget process prioritization discussion. Robinson recommended that based on this timeframe that this committee may say right now we are not ready to make a recommendation of the entire HHS budget but between now and the April prioritization meeting, we will come up with prioritizing our budget based on the dollars that will come out of the Governor's budget. Johnson stated we will begin some discussion about priorities for the March HHS meeting. Johnson stated he has heard this committee state their interest in staying in this business. Larson stated he will close the meeting and we will have to come up with some positive direction for the April budget meeting. Larson asked if there were any other issues to bring before the Board. Larson adjourned the meeting. Time: 11:35 AM Chair: Attest: (Secretary)