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HomeMy WebLinkAboutHealth & Human Services 01-09-04 w WILL REVIEW VOUCHERS AT 8:00 AM ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (John Borup, 246 -8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 01/09/04 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: 02/13/04 ( ?) ACTION ON PREVIOUS MINUTES: 12/12/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: 1. Nursing Home Admission /Discharge Policy 2. Fence for Health Center Community Garden NEW BUSINESS: 1. Consideration of Claims and Vouchers 2. Financial Report 3. Personnel Issues 4. Program Reports: a. Public Health b. Long Term Support C. Family & Children's d. Nursing Home 5. Action on Nursing Home bid specifications and bidding document plans ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA /NOTICE K I ' ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD January 09, 2004 The St. Croix County Health and Human Services Board met on January 09, 2004 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Chris Bethke Lois Burri Mary Louise Olson Ralph Swenson Esther Wentz MEMBERS ABSENT: Dr. Michael Kretz, excused Deb Rasmussen, excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Barbara Nelson, Public Health Supervisor - Health Officer Ron Lockwood, Long Term Support Fred Johnson, Family & Children's Supervisor Ed Thurman, Environmental Health Specialist John Bretl, Alternate Care /Kinship Coordinator Laurie Diaby - Gassama, Sanitarian Ralph Robole, Facilities Manager Kathy Leisch, Secretary OTHERS PRESENT: Mike Berg, Ayres & Associates 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, February 13 at 8:30 AM. Burri will review vouchers at 8:00 AM. AGENDA Motion A motion was introduced by Berenschot, seconded by Bethke, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: That the minutes of the 12/12/03 Health and Human Services Board meeting be approved. NURSING HOME ADMISSION /DISCHARGE POLICY Krieger reviewed the draft and final copy of the admissions /discharge policy as approved by Corp Counsel. Discussion followed on the hi- lighted changes. Krieger stated that most of the changes were minor and were correction of typos. Krieger stated that the major change was in the second paragraph, last sentence, stating in effect, that some of the things listed in the determination of an admission may not always include everything and this list is not exhaustive and gives some flexibility in determining whether an admission is appropriate for our facility or not. St. Croix County Health and Human Services Board Page 2 January 09, 2004 Motion A motion was introduced by Wentz, seconded by Berenschot and unanimously adopted: That the Board approves the policies as submitted by Krieger and approved by Corp Counsel. FENCE FOR HEALTH CENTER COMMUNITY GARDEN Berenschot stated he has been working to get donations to pay for the fence. He stated there are several possible sources for the monies. Berenschot asked for a cost of the materials and in -kind charges to give to the prospective businesses that may donate money for the fence. CONSIDERATION OF CLAIMS The following reports were distributed to the Board: December cash report and December fixed asset report. Ziegler stated the only fixed asset for December was monies for the Architectural Fees for the Nursing Home remodeling. There was no unemployment report for December. The December IGT monies of $235,148 was not received until January. Ziegler stated the General Relief program will be ending the year with a $- 6,283. Squyer had a client that had a large medical cost. The client is now on MA and Squyer is expecting a retroactive billing and is expected to collect $4,500 on those bills. Borup stated there will be a review this spring for the General Relief policy and draft that was enacted by the Board in 1995. Borup stated a deficit of $25,375.10 in the Nursing Home. Borup stated that $880,135 of the Economic Support revenue was a "take back" of $62,686 from the closeout of the W -2 program. Economic Support expenditures are a bit over but are slowing down. Economic Support is down two full positions as of August 2003. Economic Support is expecting Federal passthrough dollars from the State which covers 50% of deficit spending along with $36,000 in anticipated third party collections. Borup stated that with revenues this spring he is anticipating a small surplus in the Long Term Support Unit for 2003. These revenues are always late and slow down year -end "close out ". Borup stated we would work with the Courthouse and auditors to project State revenues. We realize these projections may change when the final State "close outs /reconciliations" are received in June. According to the auditor, this will result in audit adjustments that will not be considered "material" in nature. We hope to close the Department and Nursing Home books by late March, which would allow the Audit to be completed by late April. PERSONNEL ISSUES Bargaining agreements: tentative agreement reached with Human Services "non -pro" contract. Their leadership will recommend ratification vote prior to January 20 (County Board meeting date). Tentative agreement also reached and concluded negotiations with Nursing Home union. These proposals will go to union membership without endorsement prior to January 20 If approved, this agreement(s) will go to the County Board for vote on January 20 If not approved, this process will go to binding arbitration, with an estimated nine -month turnaround. The above agreements will result in the following wage increases: Effective January 1, 2003 3% St. Croix County Health and Human Services Board Page 3 January 09, 2004 Effective January 1, 2004 4% Effective July 1, 2004 .5% Effective January 1, 2005 3% The employee share of health insurance costs will go to 10 %. Health and Human Services Board member, Wentz, reviewed the following vouchers: HUMAN SERVICES: 12806 ": R & D Cleaning, $255.00, LTS client expense. Cost of five weeks of house cleaning services purchased for a client receiving services under the Brain Injury waiver. These costs are reimbursed under the waiver from the State Motion A motion was introduced by Wentz, seconded by Bethke, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services voucher 11544 through 11651, dated December 18, 2003 in the amount of $158,640.41. Human Services vouchers 11669 through 11697, dated December 23, 2003 in the amount of $242,314.77. Human Services voucher 11714 through 11765, dated December 31, 2003 in the amount of $419,249.91. Human Services vouchers 12496 through 12662, dated January 09, 2004 in the amount of $227,591.50. Human Services vouchers 12728 through 12820, dated January 09, 2004 in the amount of $83,695.46. Human Services vouchers 12881 through 12917, dated January 09, 2004 in the amount of $51,724.33. Human Services voucher 11766, dated December 31, 2003 in the amount of $746.84. Human Services vouchers 11767 through 11771, dated December 31, 2003 in the amount of $15,750.99. Nursing Home vouchers 11534 through 11543, dated December 18, 2003 in the amount of $6,663.12. Nursing Home vouchers 11662 through 11668, dated December 23, 2003 in the amount of $761.07. Nursing Home vouchers 11710 through 11713, dated December 31, 2003 in the amount of $626.47. Nursing Home vouchers 12663 through 12727, dated January 09, 2004 in the amount of $37,640.30. St. Croix County Health and Human Services Board Page 4 January 09, 2004 Human Services, Workshop, Public Health, Social Services vouchers 681 through 709, dated December 16, 2003 in the amount of $325,542.14. Human Services and Nursing Home vouchers 703 through 733, dated December 16, 2003 in the amount of $180,594.07. Human Services, Workshop, Public Health, Social Services vouchers 710 through 726, dated December 30, 2003 in the amount of $281,209.86. Human Services and Nursing Home vouchers 734 through 750, dated December 29, 2003 in the amount of $137,350.14. FINANCIAL REPORTS: The following financial reports through November were distributed to the Board. ST. CROIX COUNTY HUMAN SERVICES BOARD FINANCIAL SUMMARIES FOR THE PERIOD OF 01/01/03 THROUGH 11/03/03 NURSING HOME Noy 3n 2003 Cash Balance 11/30/03 $408,744.65 Add: Accounts Receivable 11/30/03 $296,149.32 Accounts Payable 11/30/03 ($266,169.41) Net Current Items 11/30/03 $438,724.56 2003 Revenue Recorded Through 11/30/03 $5,573,867.20 Includes Allocations of Anticipated Revenues 2003 Expenses Recorded through 11/30/03 $5,599,242.30 Includes Allocations of Expected Expenses Excess Revenues over Expenses ($25,375.10) St. Croix County Health and Human Services Board Page 5 January 09, 2004 ST CROIX HEALTH CENTER OPERATIONS REPORT JANUARY THROUGH OCTOBER JAN -OCT 2003 BUDGET ACTUAL DIFFERENCE % CENSUS 88 80.4 7.6 9136% OPERATING REVENUE: MEDICARE $ 1,254,708.00 $ 676,124.41 $ 579,583.59 53.81% MEDICAID $ 2,929,061.00 $ 2,757,576.94 $ 171,484.06 95.15% PRIVATE PAY $ 1,025,316.00 $ 740,885.74 $ 284,430.26 72.26% ALL OTHER SOURCES $ 1,117.00 $ 12,201.11 $ (11,084.11) 1092.31% TOTAL OPERATING REVENUE $ 5,210,202.00 $ 4,185,788.20 $ 1,024,413.80 80.34% OPERATING EXPENSES: DAILY PATIENT SERVICES $ 4,252,427.00 $ 3,357,478.74 $ 894,948.26 78.95% SPECIAL SERVICES $ 300,748.00 $ 256,439.96 $ 44,308.04 85.27% GENERAL SERVICES $ 1,279,983.00 $ 1,018,133.50 $ 261,849.50 79.54% ADMINISSTRATIVE SERVICES $ 507,779.00 $ 475,021.36 $ 32,757.62 93.65% UNASSIGNED: $ - DEPRECIATION( %BASED) $ - $ 170,664.00 $ (170,654.00) OTHERS $ 367,926.00 $ 321,514.72 $ 46,411.28 87.39% TOTAL OPERATING EXEPNSES $ 6,708,863.00 $ 5,599,242.30 $ 1,109,620.70 83.46% NET FROM OPERATIONS NON- OPERATING ITEMS: REVENUE FROM RATE APPEALS $ 14,808.00 $ 13,574.00 $ 1,234.00 91.67% ITG FUNDS ( %BASED) $ 798,386.00 $ 746,163.00 $ 52,223.00 93.46% CO ALLOCATION ( %BASED) $ 685,467.00 $ 628,342.00 $ 57,125.00 91.67% TOTAL NON - OPERATING ITEMS $ 1,498,661.00 $ 1,388,079.00 $ 110,582.00 92.62% MA BED REDUCTION EST FUNDS NET FROM ALL SOURCES $ - $ PERCENTAGE SHOULD BE .83 $ (25,37510) FUND BALANCE 01/01/03 AUDITED $ 1,684,566.10 PRIOR OPERATIONS $ (25,375.10) CASH REPLENISHMENT( %$250,000) $ 229.167.00 FUND BALANCE END OF PERIOD $ 1,688,358.00 St. Croix County Health and Human Services Board Page 6 January 09, 2004 HEALTH AND HUMAN SERVICES - 2003 SUMMARY Total OF REVENUES Jan. - November Budget Balance % Administration 753,998.50 763,412.00 9,413.50 98.8% AODA Services 439,614.94 440,846.00 1,231.06 99.7% Long Term Support 11,853,661.84 12,731,125.00 877,463.16 93.1: Mental Health 2,203,324.19 2,381,245.00 177,920.81 92.5% Family & Children's 2,307,956.08 2,648,969.00 341,012.92 87.1% Economic Support 880,135.71 1,025,999.00 145,863.29 85.8% General Relief 7,937.04 18,663.00 10,725.96 42.S% REVENUES HUMAN SERVICES PROGRAMS 18,446,628.30 20,010,259.00 1,563,630.70 92.2% Public Health 1 329 676 71 1.147.443_nn 17 766.29 98,71 TOTAL REVENUES HEALTH AND HUMAN SERVICES 19.776- 305 01 21.357.702.00 1 S8�99� SUMMARY Total OF EXPENDITURES Jan.- November Budget Balance % Administration 680,665.56 763,412.00 82,746.44 89.2'/. Alcohol -Drug Abuse 420,920.44 440,846.00 19,925.56 95.5% Long Term Support 12,677,130.97 12,731,125.00 53,994.03 99.6% Mental Health 2,421,358.42 2,381,245.00 (40,113.42) 101.7% Family & Children's 2,350,640.43 2,648,969.00 298,328.57 88.7% Economic Support 983,925.99 1,025,999.00 42,073.01 95.9% General Relief 12,142.60 18,663.00 6,520.40 65.1'/. Accrued Payroll 0.00 0.00 0.00 0.0% EXPENDITURES HUMAN SERVICES PROGRAMS 19,546,794.41 20,010,259.00 463,474.59 97.71 Public Health 1 716 62 3 63 1 147 443 nn 13n 819 17 9n 33i TOTAL EXPENDITURES HEALTH AND HUMAN SERVICES 2n 763.4ne_n4 71 397 707.0n 594 ?93 y6 97 2; *Salaries and fringes for all union staff are being paid at the 2002 rate until the contracts are settled. To be on budget, percentage should be 91.67. ACTION ON NURSING HOME BID SPECIFICATIONS AND BIDDING DOCUMENTS PLANS Berg stated they have completed the bidding and construction documents for the project. They also had a set of drawings and specification book that they put together that would be ready to go out to the contractors to receive bids and also for the approval of the Health and Human Services Board. Berg stated he brought extra copies of the drawings and spec book for board members to go over if need be. He stated that in general nothing had been changed from what the preliminary discussions were for the project. Berg stated that the St. Croix County Health and Human Services Board Page 7 January 09, 2004 mechanical and electrical have completed their work and there were some changes to electrical and mechanical needs which did bring the cost up somewhat. Wentz asked for a clarification of how much somewhat was. Berg stated the cost went up approximately $30,000 but the 10% contingency of $26,695 leaves $3,500. Robole noted there was also a $3,500 decreased adjustment because of a change in flooring from wood to vinyl and that should help reduce the cost. Robole noted the change is shown in the spec book. Berg stated there is a 10% contingency and a 20% difficulty factor built into these numbers. Berg stated they would not know actual costs until they receive the bids. Swenson questioned how we will pay the extra $30,000 if we receive those bids and how can we go forward with the specs if we don't have the money in the fund. Berg stated that the only other amount that is needed that is not included is the approval fee that needs to go the Department of Health and Human Services in the amount of $883.50, which would go directly to the State. Berg stated they would need a submittal for the approval from Health and Human Services. Berg said he would need to collect a signature and the fee and then the release for bids could go out next week. Borup asked Robole if any of this work could be done in- house. Robole stated some of the painting could be done in -house but it would be a limited amount. Swenson asked if there was anything significant, other than the electrical and flooring, that had been added or deleted from the original plan that was discussed. Berg stated there was not anything else that had been added or deleted. Berg stated this is a good time to be going out for bids because contractors don't have a lot of work lined up for later on yet. Swenson said he would be supportive of this going out for bids contingent on the notation in the minutes that nothing of substance other than flooring has been added or deleted to the concept that was first given to the committee and that Dorsey, Borup and Krieger sign on the blueprints. Motion A motion was introduced by Swenson, seconded by Wentz and unanimously adopted: That the Board approves to move forward to request bids contingent on statements that no significant changes other than flooring has been added or deleted to the concept as originally discussed with the Health and Human Services committee and that Chair Dorsey, Borup and Krieger sign on the blueprints. Berg stated that bids could be received on February 12th at 2:00 PM and be publicly read at that time and be brought forward to the next board meeting on February 13th. Berg stated the advertisements would be put out next week and the submittal would be made to Health and Human Services. Borup stated that February 13th would be tentatively set for the approval or rejection process. Dorsey asked what document was needed for them to sign. Krieger asked what liability there is for signing a document when they are not professionals. Swenson stated the intent was to sign the agreement stating this is what was wanted as far as the plan and layout but nothing as far as the quality of the construction or specs. Berg stated that the signing of the document was for internal use only. Berg stated the only document he needed signed was for the approval of the Health and Human Services. Borup signed the document for approval. Berg stated there was a $883.50 submittal fee that needed to be made out to the Department of Commerce. Berg will submit the request to Michelle Petrick on Monday. The Board recessed from 9:45 to 10:00 AM. LONG TERM SUPPORT Lockwood stated there is a new Medical Assistance Children's Waiver program. The State has negotiated with the Federal Government to serve 10 children with autism. The Medical Assistance program St. Croix County Health and Human Services Board Page 8 January 09, 2004 had been funding this through three provider agencies. It is now being converted from a State service plan where a person uses their Medical Assistance card to a home and community based waiver program. This is being administered through the County now. It will no longer be open -ended for as long as the provider thinks it is necessary. There will be a three -year limit and will be available for children to start the program between the ages of three and eight and the monies will flow through the County. The program is fully funded by the State and the Feds and there is no County contribution in this program for autistic children. This program is highly regimented and is a very specific program. With regard to the Children's Waiver for severely emotionally disturbed (SED), many of these children are being provided services through Family and Children's services or the Mental Health Unit and the Community Support program. We are already putting County money into services for these children so if we can get them on the waiver for severely emotionally disturbed then 60% of the cost will be paid by the federal government as opposed to the being paid for by the County. Lockwood stated these children do need to be determined disabled by the Social Security Administration and the case managers are working with Economic Support to get that facilitated. Johnson, from Family and Children's, stated that the benefits from a fiscal standpoint, for treatment foster care, could be reduced by 60% while they are in care. Johnson stated this is a significant saving. Lockwood stated only 240 children will be served across the State in the first year. Lockwood stated the central office staff in the State Department of Health and Family Services are saying that the amount of CIP2 /COP -W supplemental State funds available to reallocate from County to County during the CY 2003 reconciliation process will be much less than has been available in recent history. They are also forecasting another tight year in CY 2004. The LTS Unit has grown to depend on these supplemental allocations that have ranged from $85,000 to $270,000 over the past eight years. To accommodate the shortfall in estimated State match money in the coming year it is necessary to freeze new admissions to CIP2 /COP -W for the first several months of CY 2004. PUBLIC HEALTH Laurie Diaby - Gassama, Registered Sanitarian, Agent Program, was asked to discuss Public Health's role at concerts and temporary campgrounds. She was asked to speak about special campground licenses specifically licensed and issued at Somerset's music festivals in the summer. She stated there are two types of campground licenses. One is a regular license, which is an annual license issued to a permanent campground. The other is a special event campground license, which allows the event coordinator to have a higher capacity at the campground than a regular campground license. The special event campground license is only good for seven days and is intended for a special event. There are not as many requirements for the special event campground license as there is a regular campground license. The Public Protection Committee is concerned about emergency access at the special event campground for the Somerset music festival. Committee members feel that the campground is congested and it is hard to locate their persons in need of emergency services. The committee is looking for assistance as to what could possibly be done to improve that situation. Diaby - Gassama suggested it might be helpful to have site designations set up before the event to mark off the campground or to have a register of the people in the campground. Diaby - Gassama stated she could not enforce something that is not in the code. She feels that she has a good working relationship with the events coordinator and the events coordinator St. Croix County Health and Human Services Board Page 9 January 09, 2004 said he will be happy to work with Diaby - Gassama and is open to suggestions on how to improve the situation. Olson stated that there seems to be a problem with emergency vehicles able to get to people who are in need of help. Diaby - Gassama stated someone should see if they could locate any records available that show emergency response times. Those records would show how different those response times are than average and from that move forward with some ideas on how to improve the situation. Diaby - Gassama stated that the events coordinator asked her to let the Public Protection Committee know that he would be happy to meet and have the conversation with them. Swenson said he appreciated all the options she has looked at but he would not suggest any changes in any ordinances that can not be enforced. Olson said it is a positive step forward that there are serious attempts by the parties involved to improve the situation. Nelson stated that Thurman has provided the board with a handout on water stoves and their potential health issues. Nelson stated this was given to the Board as an awareness and not to make any decisions on at this time. Thurman stated these outdoor wood furnaces are located outside the house. These wood furnaces heat water and the water is pumped to the house as primary heat for the house. Thurman stated one of the problems is they are designed that when there is enough heat in the house it shuts the oxygen down in the fire and the fire sits and smolders and produces pollutants in the air that can be irritants to the neighbors. The second problem is the top of the chimney is only about eight feet high and all these irritants come right back to where they live. Thurman stated they have had problems with these wood furnaces. These are not regulated at all. DNR does not regulate them because they are not open burning. Borup stated that emergence of these units in urban settings is starting to occur and in some denser population areas it is a big concern. Borup stated these are safer than indoor units because when you have a wood fire indoors you run the risk of mechanical failure and creating a housefire. But the problem with these outdoor units is that they damper down and create a heavy smoke in the environment. Nelson stated we are starting to see more complaints coming to us about these units. Nelson stated there doesn't seem to be ordinances within towns or villages so therefore people come to us and want us to do something about the problem. Nelson stated that Thurman could do an assessment and give advisement to the homeowner in terms of what should be done in terms of improving the situation. Nelson stated as we get more complaints and issues coming up it may be something we have to make a decision as to whether we can do anything to control the problem. Dorsey said that before we get too involved we should find out how the stoves work and what they do because they do work. Nelson stated the intent is not to say the stove is not a useable viable unit. The issue is the potential human hazard that it is creating during the damper down state. Nelson said she wanted the Board to be aware of the issue and if it continues to grow and people continue to think the health department can fix it we may need to look at how we can deal with the issue. Right now we can give advisement but we don't have any power to say that they can't operate the stoves. Nelson stated in regards to communicable disease it has not peaked yet and several western regions have continued to increase. Influenza A is the only influenza that has been confirmed in Wisconsin. Nelson stated we have had concerns with vaccine this year. Vaccine became hard to find because more people became vaccinated this year. Nelson stated we have received additional ten doses but there is a waiting list in terms of vaccine. Nelson stated that because the season has not peaked it is still not too late to get a shot. Nelson stated that Whooping Cough Pertussis cases in Wisconsin has more than doubled. There have not been any cases in St. Croix County. Nelson said St. Croix County Health and Human Services Board Page 10 January 09, 2004 children not completing their vaccination series have contributed to the increase in Whooping Cough Pertussis. Nelson stated she was notified of one case of measles in the Milwaukee area. Nelson stated they completed an audit of sorts for the WIC program and the outcome was good. The evaluator commended the staff for their customer friendly services and for support of community nutrition services. Nelson stated the next Legislative Event would be held on Monday, January 19th. Borup stated that Laurie Moyer has decided to stay on maternity leave to be a mom and will not be returning so we will be recruiting a Public Health nutritionist. FAMILY AND CHILDREN'S Johnson stated that in July 2003 we terminated the contract with Children's Services Society (CSSW) which basically saved about $25,000 of County money for 2003. Johnson stated that CSSW certainly helped stabilize our numbers, eight foster homes, but we never reached a point where we felt that we had an abundance of homes or had to turn people away. Johnson stated we do get many more referrals or people interested in taking young children versus adolescents. Johnson stated it was probably time to terminate that contract but they clearly helped stabilize our program. Since we discontinued that program John Bretl has taken over the recruitment and licensing of homes. Bretl also did kinship licensing and certification, which has since been switched to one of the resource aides. This has alleviated some of Bretl's responsibilities to accommodate recruitment. Johnson stated they have looked at other sources to see how they handle recruitment. He said as we continue to grow as a County we currently have 23 homes available for placement of children for a County of 70,000 and that is not enough. Bretl currently has six homes that are in the licensing process with no specific organized recruitment campaign in place. Johnson stated he is not proposing a specific recruitment plan but thought we can look at developing a committee to come up with strategies or options to consider recruitment efforts to bolster our system. This group would meet once or twice to consider recruitment alternatives and report back to the Board. NURSING HOME Krieger stated the census has been on a roller coaster during the last two or three weeks. We assumed there would be a large waiting list and we found that over the months of limited admissions we in essence lost some of the clout in doing admissions. Recent deaths and referrals have caused census to drop. Staff is marketing to area discharge planners. Krieger stated the census is 69 today. Krieger said this has caused us to go forward with the Per Patient Day Staffing Concept. Krieger stated now that we are at the 72 mark and have the staffing pattern set so that we know how many hours that we need for the department it is time to look at this concept. The per patient day staffing concept has been used for years for staffing the necessary hours using a multiplier and the currently daily census. With fluctuating census numbers, staff may need to have more flexibility in staffing to remain within budget. Census drives revenues, so it is only logical that census should also drive staffing. Krieger showed two examples of staffing for housekeeping, laundry, and first floor day shift CNA's. Each department evaluates the number of hours needed to perform the work which becomes the number of hours needed when full census. A multiplier is use that determines the number of hours needed as census decreases. The multiplier is derived by dividing the number of hours by the census. This multiplier becomes the number of hours needed per resident regardless of the St. Croix County Health and Human Services Board Page 11 January 09, 2004 census. It assumes the same number of hours per resident, but reduces the work hours as the census drops. Borup stated this is the future of the facility and of us having a good handle on matching revenues with census. Swenson asked if they could get a tracking device for census to see what census is running for 2004. Krieger stated that they track census daily. Swenson asked Krieger if she knew what we were short in revenues in January because we were under the 70.5 census. Krieger said she would need to find the actual budgeted amount and see where we actually ended up and that would tell us if we were down in the Medicare revenue or the Medicaid revenue. That would tell us the source we were down and how much based on how much was budgeted. Swenson said he would like to have some means of maintaining an awareness of how we are doing. Borup stated that there might be some legal fees involved in accomplishing this task. Wentz asked Krieger if background checks were done by her or by personnel. Krieger stated that personnel does all employee background checks and Krieger does volunteer background checks. Wentz asked if we had been cited by the State because there had not been a timely manner of these backgrounds checks being done. Krieger said we did not get cited but they recommended that we have a better plan in place. Carol Lewis, benefits coordinator, now does this process. These records are all kept at the personnel office at the Government Center. Krieger stated that she had emailed Kathan several times and she has been assured that the new person would be doing that. Kathan said there is a checklist and a tickler file that would tell them when the four years is up and when they have to redo the check. Borup feels he has assurance that this is being done. Borup stated we would be getting into a costly unbudgeted excursion to get policies for all programs to Whiting. Borup said that Malva Berg is gone for this month and both Long Term Support and Economic Support are down one clerical position. Borup stated this would be an expensive ongoing project. Borup stated his preference is to bring Whiting and Board members up here and show them all the documents and take whatever time it takes to go through them. Borup stated that more important than the policy documents we have is that we comply with the statutes. Borup stated we will do what we have to but there will be a price attached to it because clerical will be spending time standing over a copy machine taking papers out of jackets and putting them back together. Borup stated this will be a costly venture and we really encourage the Board members that want to do this to think carefully about what it is that you want. Swenson asked Dorsey how he wants to proceed with John's annual performance evaluation. Borup stated it was scheduled for March, which is his anniversary date. Dorsey will talk to Whiting to get a copy of the old review for the February meeting and then request a closed session for the evaluation in March. Dorsey asked if there were any other issues to bring before the Board. Motion A motion was introduced by Wentz, seconded by Burri, and unanimously adopted: that the meeting be adjourned. Time: 12:10 PM Chair: St. Croix County Health and Human Services Board Page 12 January 09, 2004 Attest: (Secretary)