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HomeMy WebLinkAboutHealth & Human Services 11-16-11 NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 16, 2011- 8:30 A.M. Board Room, St. Croix County DHHS Building 1445 N. 4ch Street, New Richmond Wisconsin L CALL TO ORDER II. ROLL CALL III. APPROVAL OF MINUTES OF PREVIOUS MEETING: 10/19/2011 IV. BUSINESS ITEMS 1. Financial Report for Nursing Home and Health and Human Services 2. Nursing Home Administrator's Report 3. Nursing Home Operational changes 4. 2011 Department Operational Goals-Public Health 5. Public Health Accreditation-role of the governing board V. ANNOUNCEMENTS & CORRESPONDENCE VI. ADJOURN DATE OF NEXT MEETING: 12/14/11 at 8:30 A.M. REVIEWED AND APPROVED BY: Committee Chair and County Administrator DATE APPROVED: 11/03/2011 A quorum of the St. Croix County Board of Supervisors (County Board) may he present at this meeting. Therefore, this notice also serves as notice of'a meeting of'the County Boardfor the purpose of'ohtaining information relaxing to subjects listed above for use at future County Board Meetings. 11/4/2011 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD November 16, 2011 The St. Croix County Health and Human Services Board met on November 16, 2011 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Frederick Horne Roger Larson Linda Luckey Richard Marzolf Dr. Lisa Ramsay Deb Rasmussen Alfred Schrank STAFF PRESENT: Fred Johnson, Health and Human Services Director Cindy Anderson, Nursing Home Administrator Wendy Kramer, Health Officer/Public Health Coordinator Lisa Leahy, Director of Social Services-Nursing Home Malva Sirek, Clerical Supervisor OTHERS PRESENT: Pat Thompson, County Administrator Art Tobin, Building Services Director Daryl Standafer, County Board Chair Kim Dupre, Information Systems Analyst Tim Markgraf, YCSS Lead Worker 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, December 14, 2011 at 8:30 AM. MINUTES: Motion: A motion was introduced by Schrank, seconded by Berenschot, and unanimously adopted: That the minutes of the 10/19/11 Health and Human Services Board meeting be approved as distributed. FINANCIAL REPORT FOR NURSING HOME AND HEALTH AND HUMAN SERVICES: Johnson indicated the claims and vouchers report has been available for Board members to review; however, he has received no request from Board members to see the reports. Consequently, he recommended the reports will not be printed unless a specific request to do so is received from Board members. St. Croix County Health and Human Services Board Page 2 November 16, 2011 The following financial report for Health and Human Services, Nursing Home, St. Croix Industries, Aging and ADRC through October, 2011 was distributed. Johnson said overall revenues are at 71.8%, which is up 6% from September. He also reported expenses are 74.5%, which is up 6.6% from September. Expected percent of budget is 83.3%. Johnson has reviewed the report with Pietrick and no concerns were found with the figures. Johnson reported Nursing Home revenue is up 6.5% from September and expenses are up 7.3% from September. There is still a projected deficit of approximately $200,000 for the Nursing Home at year end and much of the shortfall will depend on resident count and payer mix. Johnson also indicated the supplemental payment will be booked when it comes in and no Nursing Home carryover has been booked. Johnson said work is being done to address the potential deficit, which will be addressed in more detail later in the agenda. Marzolf questioned if efforts have been made to recruit a non-contracted administrator. Johnson indicated nothing has been done yet, but anticipates recruitment will occur soon. The contracted administrator cost through Pathways is approximately $14,000 per month. The question was asked what the cost per month would be to fill the administrator position with a permanent salaried employee. Johnson will obtain those figures when the Board recesses. Plans are moving forward to lower the Nursing Home bed count to 62; however, there are no plans currently to de-license any nursing home beds. Johnson reported the trend of vacant beds for skilled care continues. 02017 Annual October Aduals Budget % of Revenues Budget s TO Date Rmmm Budget Heakh 8 Human Services S 15,971,121 S 846,106 S 10,446,189 S 5,524,932 65.4% 5t Croix tdustries 418182 336,69B 091599 326,583 86.5% Aging 943,362 16,481 785,802 157,5W 83.3% ADRC Z274,599 107,858 307 899 (33,300) 101.5% Nursi Home 6,499,631 395,805 4 560 953 1938 678 70.2% Total Progarn Revenue S 28.10G AN S 1,702,948 $ 20,192,442 $ 7,914,453 711-6% Exmerims Heakh 8 Human 5erAoes S 15,975,121 S 1,053,317 S 11,195,089 S 4,780,032 70.1% 5t Croix tdushies 2418,182 183,519 1,871,028 547,154 77.4% Aging 943,362 76,756 748,531 194,831 79.3% ADRC 2,274,599 68,596 2,079,330 195,2f 91.4% NirsingHome 6,499,631 472,158 5,047,933 1,451,698 77.7% Total Mm9ram ExPerdohres : 28,110 5 S 1A54,346 $ 20,941,911 S 7,168,984 74.99E Rer~►xaes Or~r(Unnfa►j Fn~Iiaes S 151,398 $ 49,469 P---taef 83.3% NURSING HOME ADMINISTRATOR'S REPORT: The average monthly census for October was 60, with 3 Medicare, 38 Medicaid, and 19 private pay residents. Referrals, admissions and discharges have held the census count level. St. Croix County Health and Human Services Board Page 3 November 16, 2011 Anderson reported seven Chamber of Commerce Ambassador members took a tour of the Nursing Home on November 15. Cindy Prokash, Activity Therapy Director, gave the members a brief history lesson of St. Croix Health Center and the group also toured the therapy department. Anderson invited Board members to attend the upcoming Holiday Craft Bazaar held at the Nursing Home on November 18th and 19th. Funds from the bazaar benefit the Activity department to fund resident activities. NURSING HOME OPERATIONAL CHANGES: Staff is moving forward to close a wing on second floor in an effort to save money and match the bed count closer to what the actual census has been. It is estimated if the wing is closed and residents moved to existing rooms, the Nursing Home would realize approximately $140,000 savings in salary and fringe. There would be very minimal cost savings with heat and electricity if the wing is closed. A 30-day notice letter went out to families notifying families of the intent to move residents on this wing. Wentz expressed concern regarding going ahead with plans to close the wing without the approval of the Board. Johnson indicated the need to balance resident care needs with the Nursing Home finances was discussed at the October meeting. He offered the Board more time and to stop the operational change if the Board directed this as a policy decision. At the October meeting there was no Board direction to not support closing the wing on second floor. Johnson indicated this move is not a permanent move to move from 72 to 62 beds. The Nursing Home has not regularly used up to ten beds in 2011. The Nursing Home still has to pay bed tax on beds that are not occupied. If the Nursing Home is not occupied at 94%, the Nursing Home also loses bedhold revenue when residents are on leave of absence. The plan is to analyze the census and the payer mix over the next few months when the Nursing Home is at 62 beds versus 72 beds. Staff cannot predict the resident mix and when referrals will be received. Johnson indicated nothing being done is permanent and no steps have been taken to remove the beds or de-license the beds. A variety of positions in the Nursing Home were not filled so the impact on staff to close this wing is expected to be minimal. Closing this wing would impact nine residents. As of today, there are no resident rooms open on first floor and only two beds open on second floor. Lisa Leahy, Director of Social Services, has had contact with family members and could provide additional detail on responses she has received. Thompson said steps need to be taken to lessen fiscal impact and the facility cannot wait to implement the steps. This move would reduce the ability to take over 62 residents; it would not reduce the licenses in the Nursing Home. Johnson indicated there has been a county-wide trend for lower nursing home occupancy in all facilities. The St. Croix Health Center is staffed according to census. In September the year end deficit was projected at $212,000; now in October, the projected year-end deficit is estimated at $200,000. This move was presented as a response to the projected deficit The Board recessed from 9:15 - 9:24 AM. St. Croix County Health and Human Services Board Page 4 November 16, 2011 Lisa Leahy addressed some of the concerns expressed regarding closing a wing of the Nursing Home. If a resident that was previously in the wing that is closing was moved and someone else is moving into the closed wing, there may be hard feelings for moving and disrupting the original resident. Closing a wing would result in not being able to offer as many private rooms. As mentioned previously, currently first floor is full and there are only two open beds on second floor, which limits the number of referrals the Nursing Home can take. A family council meeting is scheduled for November 28th at 6:00 PM. Johnson indicated if the Board made a policy decision to close a wing, there would be less flexibility than if it is left to staff to make operational changes. He recommends an evaluation of the census and bed availability over the next few months. There would be no plans to reopen the wing unless there is evidence that more nursing home beds are needed. By history, there are lower nursing home admissions in November and December. It was the consensus of the Board to revisit the issue in February or March; however the Board wants to be updated on the referrals made every month. If admissions are turned away due to lack of beds, the facility may lose the relationship developed with referring agencies. St. Croix Health Center takes admissions seven days a week plus therapies are offered seven days a week. Dr. Ramsay suggested the wing being discussed be treated as a swingbed unit. Tobin indicated it is possible to mobilize the beds in swingbed if needed for admissions. Staffing this area would have to be examined if admissions are placed there. Anderson reported of the nine residents that would be impacted by closing the wing, eight are Medicaid and one is private pay. It was the consensus of the Board to move towards 62 beds temporarily with the Board updated at each meeting for a three to six month period. The staff are striving for no deficit at year end and to maintain resident care. Wentz expressed appreciation to staff for the work that has been put into this effort; however, we need to be concerned with the bottom line. Johnson reported the cost for the contracted Administrator through Pathways is approximately $14,500/month. If an Administrator is hired as a County employee, the cost would be approximately $10,000/month. The Administrator position is not advertised at this point. Johnson recommended looking at operational changes discussed previously first and then move forward with filling the Administrator position with a permanent staff versus a contracted staff. Thompson recommended bringing the issue of filling the Administrator position to the Board next month. Tammy Funk, Human Resources, will be invited to next month's meeting. The additional expense of continuing with a contracted Administrator would cut into cost savings. 2011 DEPARTMENTAL OPERATIONAL GOALS-PUBLIC HEALTH: Johnson reminded Board members that a different Department will be highlighted each month to help guide the Board with policy decisions. Kramer reported Public Health has been working on strategic planning for the past three years. She recognized the efforts Johnson has made to recognize the importance of strategic planning for Public Health and implementing the plan. Public Health began Healthier Together implementation in May of 2011. There is currently a workgroup formed that is working on development of a website to be functional by the first St. Croix County Health and Human Services Board Page 5 November 16, 2011 quarter of 2012. Public Health staff are working on five identified health priorities from participation in Healthier Together. The state is moving toward a focus of population health versus individual health. Another portion of strategic planning is evaluating the program model for Birth to 3 to meet changing needs. The family service plan indicators for Birth to 3 are on target. Evaluation was done regarding the Birth to 3 Program after Norma Vrieze retired. Birth to 3 now has a speech therapist on staff. An evaluation of the Maternal Child Health program has been done; however, the data is still being compiled and a report should be ready by December. Public Health staff, as a group, decided to adopt a family and to have a paper goods, household and personal care items drive in the month of December, which was one area that was identified as an activity that will improve staff stability and motivation within the department. PUBLIC HEALTH ACCREDITATION - ROLE OF THE GOVERNING BOARD: Last month the Board approved applying for a grant to help with accreditation. Accreditation assures health departments meet a set of standards and measures to continuously improve their performance. Three major components to show quality and accountability for accreditation are already completed with the Community Needs Assessment, Community Implementation Plan, and Strategic Plan. Other components of accreditation include high performance and quality improvement. Accreditation would also offer increased potential to access financial resources through grant funding. The Board ensures that policies and procedures are in place to support an effective agency, provides financial management and follows state statute. Marzolf, Rasmussen, and Dr. Ramsay have been advocates for Public Health through the Community Health Improvement Planning; also Wentz and Rasmussen participated in the 140 review. The Board's role also includes being knowledgeable of public health services that are legally required and the department's responsibilities. Kramer will continue to share information regarding Public Health with the Board. Kramer requested a letter of support regarding the grant application. Wentz asked if there were any other issues to bring before the Board. Johnson indicated he would work with the IT department or the ADRC to see if information regarding homeless shelters can be added to the County website. Wentz adjourned the meeting. Time: 10:23 AM Chair: Attest: (Secretary)