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HomeMy WebLinkAboutHealth & Human Services 11-18-05 ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (Fred Johnson, 246 -8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 11/18/05 TIME: 8:30 a.m. LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 12/09/05 ACTION ON PREVIOUS MINUTES: 10/21/05 ANNOUNCEMENTS: APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Nursing Home Operational Assessment 4. Program reports a. Nursing Home Report b. Long Term Support Report c. Mental Health Report 5. Personnel Issues 6. Donation Accounts -DHHS and Nursing Home ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: Fred Johnson DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA /NOTICE * *ADDITIONS /CHANGES /CORRECTIONS it j ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 18, 2005 The St. Croix County Health and Human Services Board met on November 18, 2005 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Lois Burri Tom Caflisch Tom Dowd Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Dr. Michael Kretz, excused Linda Luckey, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Carolyn Krieger, Nursing Home Administrator Lisa'Leahy, Director of Social Services -NH Kristie Tellijohn, Director of Nursing -NH Malva Berg, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Mary Jo Graham, Wipfli Barbara Gunderson, Wipfli Dan Goodier, Christian Community Homes and Services Chair Dorsey 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 Friday, December 09, 2005 at 8:30 AM. Burri will review vouchers at 8:00 AM. AGENDA Motion A motion was introduced by Caflisch, seconded by Burri, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Wentz, seconded by Rasmussen, and unanimously adopted: That the minutes of the 10/21/05 Health and Human Services Board meeting be approved as circulated. ANNOUNCEMENTS The farm land rent contract is up for renewal at the end of 2006. Whiting is requesting a market analysis or RFP for all county land before the contract is renewed. CONSIDERATION OF CLAIMS Health and Human Services Board member Wentz reviewed the vouchers. Motion A motion was introduced by Wentz, seconded by Caflisch, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 60102 through 60130, dated October 17, 2005 in the amount of $38,380.55. J St. Croix County Health and Human Services Board Page 2 November 18, 2005 Human Services vouchers 60131 through 60132, dated October 17, 2005 in the amount of $244.59. Human Services voucher 60242, dated October 20, 2005 in the amount of $962.09. Human Services vouchers 60529 through 60535, dated October 27, 2005 in the amount of $63,096.70. Human Services vouchers 60236 through 60537, dated October 27, 2005 in the amount of $38.00. Human Services vouchers 61556 through 61728, dated November 11, 2005 in the amount of $121,258.51. Human Services vouchers 61782 through 61810, dated November 11, 2005 in the amount of $41,928.27. Human Services vouchers 61811 through 61966, dated November 11, 2005 in the amount of $146,459.24. Human Services and Nursing Home vouchers 60136 through 60241, dated October 20, 2005 in the amount of $202,123.25. Human Services and Nursing Home vouchers 60201 through 60241, dated October 20, 2005 in the amount of $962.09. Human Services and Nursing Home vouchers 60399 through 60528, dated October 27, 2005 in the amount of $356,618.73. Human Services and Nursing Home vouchers 60859 through 60927, dated November 03, 2005 in the amount of $145,599.74. Nursing Home vouchers 61729 through 61781, dated November 11, 2005 in the amount of $57,769.96. Human Services, Workshop, Public Health, Social Services vouchers 602 through 631, dated October 18, 2005 in the amount of $343,728.61. Human Services, Workshop, Public Health, Social Services vouchers 632 through 663, dated November 01, 2005 in the amount of $344,649.99. Human Services and Nursing Home vouchers 695 through 727, dated November 03, 2005 in the amount of $173,234.91. Human Services and Nursing Home vouchers 630 through 662, dated October 06, 2005 in the amount of $174,957.12. Workshop vouchers 55 through 60, dated October 18, 2005 in the amount of $13,761.59. Workshop vouchers 61 through 66, dated November 01, 2005 in the amount of $13,382.81. NURSING HOME OPERATIONAL ASSESSMENT Mary Jo Graham, RN, MSN, MS -HSRP, and Barbara Gunderson, RN, BA, NHA, both associates of Wipfli, visited the Nursing Home on November 2nd and 3 rd to complete an on -site assessment. They met with all Nursing Home Department Heads, viewed the Nursing Home facility and residents. Graham and Gunderson are familiar with county homes in St. Croix County Health and Human Services Board Page 3 November 18, 2005 Wisconsin and the problems homes are facing with decreasing nursing home payments by government. The goal of government is to keep people in the community, which is reflected in the current nursing home relocation initiative. Also, with advancements in meds and clinical intervention, people are staying in the community longer than ever. Traditionally, states had reimbursement rates which were based on the average cost to provide resident care. However, as the healthier residents are cared for in different settings, only the sicker residents remain in long term care settings. States have not increased their rate structures and will not increase under current budgetary constraints to account for the additional cost per day to care for these sicker residents. It was stressed that there is an enhanced reimbursement for facilities with 50 beds or less; however, operation costs will continue to exceed reimbursement. The current payer mix for St. Croix County is 72% Medical Assistance (reimbursement of $109 per resident per day in the state of Wisconsin), 60 Medicare (reimbursement range of $200 -$395 per resident per day), and 220 private pay (reimbursement of $165 per resident per day). The average cost of providing care per resident is greater than $200 per day. Decreased reimbursement and increased operating expenses leads to huge financial deficits. Also, the benefit structure for county employees exceeds that of other non - county homes. The County has traditionally taken care of residents that are difficult to care for along with those with limited financial resources (MA recipients). While approximately half of the nursing home residents have a diagnosis of dementia, the residents the facility cares for are not significantly different than those that are in private facilities. There are currently 30 to 35 empty beds (a statistic that is kept on a monthly basis) in St. Croix County community at the time of the study. These facilities care for MA recipients, along with a similar type of resident, so it could be concluded that the Health Center is actually competing with the private provider. The Nursing Home has no defined behavioral program even though there are a few behavioral residents in the facility and this is an option for development. Social services and therapeutic recreation directors could be leaders in developing an official inpatient behavioral program for the county. Manual data collection and sorting of information could be done by the automated clinical information system. The RHIT in medical records can help nursing develop summary reports to reduce manual data collection. There is no weekend or evening housekeeping on duty. If cleaning is needed during this time, it is done by nursing assistants who are not trained to do this. Cleaning surfaces is critical as flu season approaches. Housekeeping and laundry should be supervised by the director of environmental services and housekeeping extended to cover weekends. Recommendation was also made that the Health Center's staffing needs to fluctuate according to census and documentation needs to be part of nursing care. Staffing can be based on 905 of the average daily census and staff up as needed rather than having staff leave. The census in the nursing home today is 67. Additional it was determined that the nursing home has excessive administrative nursing personnel. It was determined there is excellent department leadership in therapeutic recreation, social services and medical records. Gunderson and Graham also felt that the quality of care in the facility was excellent. It is essential that a timely decision be made as a result of this summary. Options include downsizing the current operation, privatizing, outsourcing operation and /or management, selling the operation or closing the operation. St. Croix County Health and Human Services Board , Page 4 November 18, 2005 The state of Wisconsin has increased per resident reimbursement for facilities with 50 or less beds and there is community capacity for more traditional long term care residents. This incentive is only available in Wisconsin. IGT monies available continues to decline. However, the operation costs will continue to exceed reimbursement, which will have an impact on the county levy. Dowd joined the meeting at 9:50. The status of nursing homes statewide and nationally is similar and St. Croix County is not unique in this matter. At the time of the visit, 28 of the 68 residents are protectively placed by the county. By law, the County is legally mandated to take care of these residents; however, private facilities do provide nursing home services to protectively placed residents. It was requested that an analysis of cost be done on what the county's protective liability would be for current residents. Johnson will follow up with Wipfli on this issue and report back. Dan Goodier from Hudson Christian Community Homes and Services sent a letter to County Board Chair Malick expressing interest in acquisition of St. Croix Health Center. Goodier outlined services provided by Christian Community Homes and invited Board members to tour the home. A copy of Goodier's letter was distributed to Board members and Chair Malick said he would forward a copy to all County Board Supervisors. The Board recessed from 10:05 to 10:20 AM. Recommendations of the study will be reviewed with staff to implement changes at 72 beds and possibly look at reducing to 50 beds. Costs to implement the changes will be discussed. Timing is essential to implement changes so recommendations may be presented to the Health and Human Services Board on 12/09 and to the full County Board on 12/13. Malick said at this time the county has nothing to sell. Last time the issue of selling the Nursing Home came before the full County Board the Board voted in the affirmative to stay in the Nursing Home business. The letter from Christian Community Homes and Services is premature at this time. Dorsey indicated the Nursing Home would proceed with the 72 bed facility with recommendations made implemented. The presentation to the County Board on 12/13 will be informational only, not an action item. Swenson questioned what we could have in place by April 1, 2006. Phase one will be a meeting with staff to determine what can be done at this time and what is best for the facility. Phase two will be preparing a cost analysis. Phase three will be to inform the County Board what is being done and what we are going to do. FINANCIAL REPORTS The following financial reports for September were distributed to Board members. Financial reports for both Nursing Home and Human Services were also distributed projecting year end figures. It was emphasized that Human Services expenses fluctuate due to placement costs. Services were billed through June on the September report for Mental Health Outpatient Services. The Board was reminded that WIMCR monies were moved to Human Services Administration. A financial policy regarding expenses/ revenues and consistency of cut offs is being developed by Pempek and Pietrick and will be brought to the Board. a St. Croix County Health and Human Services Board Page 5 November 18, 2005 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH SEPTEMBER- JAN - SEPT 2005 BUDGET ACTUAL DIFFERENCE % CENSUS 70 71 1 1.0142657 OPERATING REVENUE: MEDICARE $ 743,498.00 $ 583,868.81 $ 159,629.19 0.7852998 MEDICAID $ $ 1,974,739.41 $ 667,657.59 0.7473288 PRIVATE PAY' $ 817,926.00 $ 511,978.68 $ 305,947.32 0.6259474 RATE APPEALS ACTUAL $ 17 ,652.00 $ 14 ,826.00 $ 2.826.00 0.6399048 I GT FUN DS - ACTUAL $ 450 ,000.00 $ 4A $ (26 ,007.00) 1.0577933 ALL OTHER SOURCES $ 9,484.00 $ 25,144.43 $ (15,660.43) 2.6512474 ;TRANSFER FROM CONTINGENCY $ - $ 8,600.00 $ (B,600.00) ,TOTAL OPERATING REVENUE $ 4,680,957.00 $ 3.595,164.33 $ 1,085,792.67 0.7680405 OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,411,4B7.50 $ 2,522,623.98 $ 888,663.52 0.7394499 ;SPECIAL SERVICES $ 266,510.42 $ 186,570.02 $ . 79,940.40 0.7000476 GENERAL SERVICES $ 1,111,184.21 $ 704,697.20 $ 406,487.01 0.6341858 ADMINISTRATIVE SERVICES $ 539,734.15 $ 464,310.62 $ 75,423.53 0.86025B UNASSIGNED: DEPRECIATION( %BASED) $ - $ - $ - 0THERS: (INS -WC- CAPITAL -UTIL) $ 255,835.00 $ 238,843.15 $ 16,991.65 0.9335828 TOTAL OPERATING EXPENSES $ 5,584,751.28 $ 4,117,044.97 $ 1,467,706.31 0.737194 NET FROM OPERATIONS $ $ (521,880.64) (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) OUTSTANDING REVENUES OUTSTANDING RATE APPEAL REV $ 2,828.00 $ - $ 2,628.00 0 % OF OUTSTANDING IGT REV $ _ .$_ ... $ ._ - 0 CO ALLOCATIONS( %BASED) $ 1,017,504.00 $ 763,128.00 $ 254,376.00 0.75 TOTAL OUTSTANDING $ 1,020,332.00 $ 763,128.00 $ 257,204.00 NET FROM ALL SOURCES $ 211,247.36 PERCENTAGE SHOULD BE 74.97% NHSEPTFINANCIAL Depreciation Expense Removed �- * Prior years dividend payment of $12,165.61 rec'd 4105 } 1 J :. St. Croix County Health and Human Services Board Page 6 November 18, 2005 HEALTH AND HUMAN SERVICES - 2005 SUMMARY Total OF REVENUES Budget Jan - September Balance % Administration 1,020,399.92 1,006,421.15 13,978.77 90.6% AODA Services 473,948.78 342,268.64 131,680.14 72.2% Long Term Support 17,299,811.93 12,514.715.79 4,765,096.14 72.3% Mental Health 3,006,239.35 1,636,805.82 1,369,433.53 54.4% Family & Children's 3,059,580.00 2,215,330.33 844,241.67 72.4% Public Health 1,471,999.17 1,148,372.21 323,626.96 78.0% Economic Support 927,622.06 716,975.31 210,646.75 77.3% General Relief 14,832.45 13,518.00 1,314.45 91.1% Coordinated Services /ED 360,509.80 380,509.80 0.00 100.0% REVENUES HUMAN SERVICES PROGRAMS 27,654,943.46 19.974,925.05 7.600.018.41 72.2% SUMMARY Total OF EXPENDITURES Budget Jan.- September Balance % Administration 1,020,399.92 669,488.15 330,911.77 67.6% Alcohol -Drug Abuse 473,948.78 388,748.41 65,200.37 B2.0% Long Term Support 17,299,811.93 12,326,934.03 4,972,877.90 71.3% Mental Health 3,006,239.35 1,911.360.43 1,094,858.92 63.6% Family& Children's 3,059,580.00 2,309,622.35 749,757.65 75.5% Public Health 1,471,999.17 1,087,947.83 384,051.34 73.9% Economic Support 927,622.06 741,652.74 1 B5,969.32 BO.D% General Relief 14,032.45 570.08 14,262.37 3.8% Coordinated Service /SED 380,509.80 32.763.42 347,746.30 8.6% EXPENDITURES HUMAN SERVICES PROGRAMS 27,654,943.46 19,409,307.44 8,165,636.02 7 0. 5 % Excess Rev over Expenses $ 485.617.61 Percentage of Budget: 74.97 August Human Services Total $ 485,617.61 Amount above includes County Appropriations of $4,830,669.00 $ (4,030,669.00) Amount prior to Co. App: $ (4,345,051.39) RESOLUTION ON COST OF MENTAL HEALTH PLACEMENTS This resolution calls for legislation which removes the cost from property tax for mental health placements. Motion A motion was introduced by Caflisch, seconded by Swenson and unanimously adopted: That the Board approves the following resolution: St. Croix County Health and Human Services Board Page 7 November 18, 2005 RESOLUTION REQUESTING THE STATE TO PAY THE COSTS OF PLACEMENTS Resolution No. St. Croix County, Wisconsin WHEREAS, Wisconsin counties are mandated by the state to pay the placement costs of individuals placed in one of the two state mental health institutions - Winnebago Mental Health Institute located in Winnebago, and Mendota Mental Health Institute located in Madison; and WHEREAS, while the costs of these placements does not fluctuate drastically from one year to the next on a statewide basis, the costs change dramatically from county to county each year depending on one or two cases; and WHEREAS, no county can accurately budget for the costs of these placements because they are entirely unpredictable from year to year; and WHEREAS, there is no good public policy reason why the property taxpayers of St. Croix County should bear this limitless risk every year; and WHEREAS, the daily cost of a placement for an adult at Mendota Mental Health Institute is $670 per day and at Winnebago Mental Health Institute is $645 per day; and WHEREAS, an adult placed in one of these institutions costs one quarter of a million dollars a year; and WHEREAS, St. Croix County has had 20 clients placed at Winnebago and Mendota at various times from January 1, 2005 through August 31, 2005 at a cost of $98,435; and WHEREAS, human services departments across the state have a primary role in providing community services to a large number of residents in need and the immense and variable costs of placements severely reduces a county's financial ability to provide those services; and WHEREAS, in the April 2005 election, 85% of those voting in Wisconsin agreed that these human services costs should be paid for with state tax dollars and not property tax dollars; and WHEREAS, additionally, the state approves the rate increases at these two state institutions; the state would have much more incentive to examine the necessity of rate increases if it was responsible for paying the costs of the replacements. NOW, THEREFORE, BE IT RESOLVED by the St. Croix County Board of Supervisors that it calls upon Governor Doyle and the Legislature to create law which removes the costs of placements at Winnebago and Mendota from the property tax. Offered by the St. Croix County Health and Human Services Board. DISPOSAL /SALE OF OLD GENERATOR AND OLD HANDRAILS Maintenance will keep the handrails and utilize throughout the building. If there are any left after a year, the remaining pieces will be sold on the county auction. The generator was sold through a broker. Timmerman determined the requirements to advertise were sufficient. The unit was sold `as is'. Johnson will meet with Pietrick regarding where the funds from the sale will go. St. Croix County Health and Human Services Board Page 8 November 18, 2005 BANKRUPTCY FILINGS The filing deadline under the old bankruptcy laws closed the end of October. The Department has received almost $80,000 in filing of new claims since the changes in the law were announced. The last notices received were dated October 25, 2005 so it is anticipated more filings will be arriving. PERSONNEL ISSUES There has been limited response for the vacant AODA position. Administration will work with Personnel for continued recruiting. Wentz will also bring the issue up at the next Personnel Committee meeting. Program reports for Long Term Support and Mental Health will be delayed until the December meeting. Dorsey asked if there were any other issues to bring before the Board. Motion A motion was introduced by Wentz, seconded by Caflisch, and unanimously adopted: That the meeting be adjourned. Time: 11:20 PM Chair: Attest: (Secretary)