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St. Croix County * Wisconsin
AGENDA - NURSING HOME PROPOSAL REVIEW COMMITTEE
ST CROIX COUNTY
NOTICE OF COMMITTEE MEETING
ST. CROIX COUNTY NURSING HOME
County Map PROPOSAL REVIEW COMMITTEE
October 24, 2007 at 9:oo A.M.
(Board Room, St. Croix County DHHS Building, New Richmond, WI)
CALL TO ORDER
REVIEW OF AGENDA
CONSENT AGENDA
DATE OF NEXT MEETING -
OLD AND NEW BUSINESS
1. Review of other proposals /alternatives for future operation of the Nursing Home
2. Follow up with City of New Richmond correspondence regarding the future operation of the Nursing Home.
3. Committee's definition of serving Medicaid including level of acuity
4. Recommendation to County Board on closed session
ADJOURN
(Items may be taken in different order)
**Additions /Changes /Corrections
MINUTES
NURSING HOME PROPOSAL REVIEW COMMITTEE
OCTOBER 24, 2007
The St. Croix County Nursing Home Review Committee met on October 24, 2007 at the St. Croix County Government
Center.
MEMBERS PRESENT: Esther Wentz, Chair
Gordon Awsumb
John Borup
Tom Callisch
Dr. Glenn Hoberg
Stan Krueger
MEMBERS ABSENT: Don Jordan, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Connie Sarauer, Director of Nursing- Nursing Home
William Van Offeren, Nursing Home Administrator
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Nursing Home Proposal Review Committee - October 24, 2007 Page 2 of 3
Malva Sirek, Secretary
OTHERS PRESENT: Brian Purtell, DeWitt, Ross and Stevens Law Firm (via phone)
Bradley Raaths, DeWitt, Ross and Stevens Law Firm (via phone)
Chuck Whiting, Administrative Coordinator
Buck Malick, County Board Chair
Dave Schnitzler, City of New Richmond
Dennis Horner, City of New Richmond
Kim Dupre
Loyla Waskul
Norm Matzek
Julie Speer
Lois Satterlund
Florine Rondeau
Gail Winship
Wentz called the meeting to order at 9:oo AM noting the meeting was properly and legally publicized.
Consent Agenda: Motion by Borup, seconded by Krueger to adopt the agenda. Carried unanimously.
Motion by Krueger, seconded by Borup to approve the minutes of 10 /10 /07. Carried unanimously.
REVIEW OF OTHER PROPOSALS /ALTERNATIVES FOR FUTURE OPERATION OF THE NURSING HOME
Purtell said since the last meeting Ecumen has expressed interest in the nursing home. They have a variety of
services available. Purtell forwarded packets describing services offered and what the company has done. Johnson
will make copies and forward to committee members.
Purtell recommended meeting with each of the vendors in about three weeks. The vendors Purtell would be
scheduling with at this time would be Health Dimensions, Presbyterian Homes, and Ecumen. The consensus of the
committee was to meet on Friday, November 16, 2007, with a time to be determined by Purtell. The committee will
meet with each vendor separately. It was recommended the committee conduct part of the meeting in closed session
when negotiating with each vendor.
FOLLOW UP WITH CITY OF NEW RICHMOND CORRESPONDENCE REGARDING THE FUTURE OPERATION
OF THE NURSING HOME A letter from the committee chair was sent to the City of New Richmond requesting
clarification of what the City of New Richmond would be able to propose for the future operation of the Nursing
Home. A response was received from David Schnitzler, Mayor of the City of New Richmond. The City has gone on
record opposing the sale of the nursing home but keeping it as a County-run facility. That is still their position but if
that is not economically viable, the City would support a County partnership with another entity as long as the County
Health and Human Services and the Nursing Home remain in New Richmond. However, because of budget
constraints and many ongoing projects, the City of New Richmond is not prepared to make a proposal to the County
regarding the Nursing Home.
Purtell was questioned as to the information received from Health Dimensions (HD) regarding the location they are
proposing for a new building for the Nursing Home. Purtell said this will need to be discussed later.
Schnitzler and Horner expressed appreciation for being invited to this meeting and being kept informed.
COMMITTEE'S DEFINITION OF SERVING MEDICAID INCLUDING LEVEL OF ACUITY Definitions of Intensive
Skilled Nursing Services (ISN), Skilled Nursing or Rehabilitation Services (SNF), and Intermediate Nursing Care
(ICF) care levels were distributed to committee members along with a report on payor sources for residents. The level
of care of residents and payor source fluctuates in the facility. Currently the census is 67 with 62 at SNF level, four at
ISN and one at Intermediate Nursing Care (ICF -t). For payor source the averages for the past eight months are 68%
are Medicaid, 24% are private pay, and 8% are Medicare.
Awsumb indicated vendors have been made aware of the County's desire to provide care on a first come, first serve
basis. This is not an issue in Minnesota due to rate equalization (private pay and Medicaid rates are the same).
Wisconsin does not have this policy in place. Awsumb indicated the facility does not follow the first come, first service
policy for admissions to the Nursing Home currently. Residents are evaluated to determine if the facility is able to
meet the medical and behavior needs and that behaviors of referrals will not put current residents at risk before they
are accepted for admission. Purtell indicated adding conditions to vendors, such as first come, first serve, will come
with a price. If conditions are placed on vendors for level of Medicaid and level of acuity, staff voiced concerns
regarding monitoring that the conditions are met. Sarauer indicated a full time person would have to be employed to
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Nursing Home Proposal Review Committee - December 12, 2007 Page 3 of 3
Seven yes, motion passed.
The committee entered closed session at 1:40 PM.
Motion A motion was introduced by Borup, seconded by Krueger, and unanimously adopted: That the Committee
reconvene in open session.
The Committee reconvened in open session at 2:45 PM.
Chair Wentz announced a brief recess. The committee recessed from 2:45 PM to 2:57 PM.
REVIEW NEGOTIATED PROPOSALS As proposals would impact employees, Awsumb raised a question again about
how many employees would be affected by decisions made regarding future operations. Johnson indicated that he
will coordinate with Human Resources to get information. Options around early retirement would need to include
Human Resources as well.
Wentz indicated the committee must decide what information, if any, will be released. It was suggested that the two
options be released with some modifications in the cover letter from Purtell. Release of the information now was
discussed as a preferred method and then further exploration of alternatives could be pursued dependent on County
Board actions.
Motion A motion was introduced by Borup, seconded by Caflisch, and unanimously adopted: That the Committee
release the two preliminary proposals today.
Krueger and Jordan left the meeting at To8 PM.
The market study and previous powerpoint that was presented to the County Board will be provided to the
supervisors at the December 18th meeting.
Malick asked for feedback from the supervisors on how to handle public input on December 18 Malick referenced
the bylaws require that a person must be recognized by their supervisor to address the County Board. Discussion
occurred on time per person, limitations on repeat comments, alternating those that are for or against various
options. Wentz commented that it will be important to let people speak. Awsumb commented that this has already
been done at previous meetings.
Borup questioned if it is the County Board Chair's hope that enough information is available on the 18 to move
forward with a decision on direction, either one proposal or another. Discussion occurred on authority of a committee
to pursue planning —if not this body, then who?
Marzolf questioned if a representative from Larson /Allen should be present to review the market study. Wentz did
not know if that was possible.
Johnson commented that this discussion on the future of the Nursing Home has been in process since approximately
September of 2oo6, when the Health and Human Services Board did not approve the Nursing Home budget. Several
options have been reviewed and it is hoped that the County Board sets some course of action soon so residents,
families, and staff are not left continuing to wonder about the future of the Health Care Center. This does not mean a
decision must be made on the 18 of December, but this should be addressed soon.
Dr. Hoberg questioned that he thought this Committee was to accumulate facts and make a recommendation to the
County Board to set direction. Malick commented that nothing would preclude the Committee from doing just that.
Wentz commented that the Committee should present proposals.
Wentz adjourned the meeting.
Time: 3:20 PM
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Nursing Home Proposal Review Committee - October 24, 2007 Page 3 of 3
monitor that conditions are being met if it is even possible to monitor. It would be possible to monitor cost reports
but this would occur after the fact and would not cover all areas. Resident level of care changes would make it difficult
to monitor also.
Purtell indicated Presbyterian Homes (PH) has indicated an interest in purchasing the beds as part of their master
plan for a campus and only want 5o beds. They are not interested in taking over the facility or taking St. Croix Health
Center residents.
Benchmarks are set and requirements need to be met to receive enhanced capital reimbursement rates, which include
serving a certain percentage of Medicaid and Medicare residents. Purtell indicated it may be possible to get credit for
giving up beds previously but there will have to be discussion with DHFS, Dave Lund for clarification if the significant
reduction in beds has already been met. However, there are other conditions that need to be met to receive enhanced
capital reimbursement rates.
Purtell indicated negotiations will need to include some qualifying language for the future of the nursing home and
continued services to the financially indigent population. He indicated a lot could change in the future with factors
such as Family Care implementation, etc.
RECOMMENDATION TO COUNTY BOARD ON CLOSED SESSION Johnson brought forward a resolution from the
committee to the County Board to enter closed session.
Motion A motion was introduced by Krueger, seconded by Borup, and unanimously adopted: That the committee
approves to change the wording in the resolution from two entities to any entities.
Motion A motion was introduced by Caflisch, seconded by Krueger, and unanimously adopted: That the committee
approves the following resolution:
RESOLUTION AUTHORIZING NURSING HOME PROPOSAL
REVIEW COMMITTEE TO MEET IN CLOSED SESSION
Resolution No.
St. Croix County, Wisconsin
WHEREAS, on September 18 th , 2007, the St. Croix County Board of Supervisors appointed a new Nursing
Home Proposal Review Committee to consider new options for the possible future disposition of the County Nursing
Home; and
WHEREAS, the St. Croix County Board of Supervisors passed a motion requiring meetings of the Nursing
Home Proposal Review Committee to be held in open session unless the Health and Human Services Board or the
County Board authorized meetings to be held in closed session; and
WHEREAS, legal counsel representing the County in discussions with entities interested in the future
operation of the County Nursing Home recommends that the Nursing Home Proposal Review Committee meet in
closed session with any entities to negotiate final terms of proposals.
THEREFORE, BE IT RESOLVED by the St. Croix County Board of Supervisors that the Nursing Home
Proposal Review Committee is authorized to conduct meetings in closed session pursuant to Wisconsin Statute§ 19.85
0) (e) to negotiate with any entities the final terms of proposals for the future operation of the Nursing Home.
It was requested that vendors come forward with their best offer for the meeting on November 16. It is anticipated
Purtell and Raaths will be here in person for the meeting on November 16 Purtell and Raaths will structure the
meeting discussions and set up the meeting format. Committee members are encouraged to ask questions. The
meeting will be an open meeting with a probable closed session with each vendor to negotiate with each vendor
separately.
Motion A motion was introduced by Caflisch, seconded by Borup, and unanimously adopted: That the meeting be
adjourned.
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