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HomeMy WebLinkAboutHealth & Human Services 08-22-02 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: 08/22/02 TIME: 6:00 PM (Please note time change) LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 09/12/02 (Please note date change) ACTION ON PREVIOUS MINUTES: 08/13/02 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Presentation and action on 2003 Budget for Health and Human Services Department and Nursing Home a. Deputy Director-status of position and possible action on position 2. Program Reports a. Nursing Home b. Public Health 3. Personnel Issues 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 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 22, 2002 The St. Croix County Health and Human Services Board met on August 22, 2002 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Chris Bethke Lois Burri Fern Johnson-Schmidt Mary Louise Olson Ralph Swenson Esther Wentz MEMBERS ABSENT: James Craig, excused STAFF PRESENT: John Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Ron Kiesler, Mental Health/AODA Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Ron Lockwood, Long Term Support Coordinator Fred Johnson, Family and Children's Supervisor Kathy Dunlap, Family and Children's Supervisor Mary Squyer, Economic Support/W-2 Supervisor Barbara Nelson, Public Health Supervisor-Health Officer Norma Vrieze, Early Intervention Supervisor Malva Berg, Secretary OTHERS PRESENT: Clarence Malick, County Board Chair Chair Dorsey called the meeting to order at 6:00 PM noting the meeting was properly and legally publicized. NEXT MEETING: The next Health and Human Services Board meeting is scheduled for Thursday, September 12, at 8:30 AM, Bethke 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 Olson, and unanimously adopted: That the minutes of the 08/13/02 Health and Human Services Board meeting be approved as circulated. PRESENTATION AND ACTION ON 2003 BUDGET FOR HEALTH AND HUMAN SERVICES DEPARTMENT AND NURSING HOME: Borup said the overall budget increased from $20,793,680 to $21,426,193 for a 3.04% increase. He said the County levy is increased from $4,166,839 to $4,625,972 for an increase of $459,133, which equals 11.02% increase. He said Finance recommended a 4% County levy increase limit. Borup said $575,000 in prior year carryover funds has been applied to attain the above numbers. He said he is satisfied with these numbers but next year the Department may be faced with a lower account balance with St. Croix County Health and Human Services Board Page 2 August 22, 2002 applying such a large carryover amount to the 2003 budget. Borup said the total Department budget increase of 3.39% and the County levy increase of 11.02% reflects the State's informal policy of transferring State/Federal mandated service costs to counties. The Department budget also includes a request to transfer $45,000 from the Farm account to cover fixed asset costs per the capital outlay plan to reduce the levy. Malick questioned why only $45,000 was requested from the farm account when there was more money in the account. Borup said he would like to see $15,000 to $20,000 remain in the farm account in case there are building repairs needed, etc. Olson said maybe it is time for the Board to look at services we provide that are not mandated. Borup said there are support services that are not mandated but if those support services were not in place, the Department would pay more for the mandated services in the future. He said there may be a short- term immediate savings by eliminating some support services but the long-term expenses would be higher. Olson said with the shift of the costs from the State/Federal to the counties that maybe the local counties have a better handle on local needs and are better able to serve the public than the State/Federal. Swenson said with the transfer of $45,000 from the Farm account, it doesn't reflect a true account of the cost of operations for Health and Human Services and he is uncomfortable with masking what it really costs to run Health and Human Services. Borup said the Deputy Director position was budgeted for six months in the 2002 budget but was not filled due to the State budget crunch. He said the position is in the 2003 budget for $83,433 with a net cost for the position including revenues at $58,433. He said this is a conservative estimate. Lockwood said an additional half-time driver position was approved to reduce the amount of time on the van for wheelchair bound clients. He said there has been an increased demand and also a shortage of direct service workers. He said there about 20 clients on the COP waiting list, which will stay the same as it would cost too much county money to reduce the size of the waiting list. He said there is about a three to four month wait for clients on this list. The State changed the policy to use brain injury waiver money that has not been used the last few years. The County is able to use the money to serve approximately two to three more other brain injury clients in the community with these monies. The supportive home care program was down to one person this year so in budget planning, this program was closed and folded into supportive living program. Swenson questioned the increase in the client services line item. Due to accounts being allocated to different departments from one year to the next, Lockwood and Ziegler will provide an explanation after the meeting. The reduction in Economic Support/W-2 is primarily due to the position reduction for 2003 and continued W-2 funds. Borup said 2003 may be the last St. Croix County Health and Human Services Board Page 3 August 22, 2002 good year of W-2 monies. Squyer said the unit received three main sources of monies; performance bonus dollars in the amount of $48,000, grant for childcare in the amount of $26,500, and $6,000 for food stamps. Family and Children's has experienced increase in out-of-home expenses for 2002 and increased the alternate care line item by $73,000 for 2003 based on past expenses. Johnson said alternate care costs may be short approximately $60,000 for 2002. He said he used a four-year average to provide a most probable figure for the 2003 budget for alternate care. He said the unit will not use the extra money unless it is needed. Olson questioned foster care recruitment and if this service is doing a better job than if a social worker was doing recruitment. Johnson said we have seen results. He said it is a success for foster homes care compared to what the County had before the contract. Their contract focuses on foster home recruitment, training and licensing. Olson questioned investigating the program to see if it is actually needed. If the County had to provide this service, time would be taken from other areas or another employee would have to be hired to provide the service and contracting for this service, thus contracting for this service is an easier and faster way to go. Johnson said Children's Service Society is required to supply a specific number of licenses and to re-license homes. Johnson said there is still not an adequate number of treatment homes licensed. Dunlap said with the beginning of the implementation of WISACWIS there is an enormous amount of additional work. Although Family and Children's is not requesting additional help at this time, the pilot counties for WISACWIS are requesting three to four new workers to implement the program. Board purchased services for Mental Health and AODA increased 5% at Aurora and 40% at United Hospital for the 2003 budget. Swenson would like a protocol developed for putting revenue, levy and expenditures in the same pot as it is hard for the Board members to track changes from year to year and why split the items out if the Board cannot take action on the line items. AODA has been self-sustaining due to IDP doing so well. The Environmental Health Specialist for Public Health was approved by the Personnel Committee to go from a 60% to 100% position. 52% of Public Health is county operations where as statewide counties fund public health at 65%. Nelson said we are on schedule for agent status. She said revenues have exceeded expenditures at this point and should be breakeven by year-end. Olson questioned various line items in the Public Health budget. Nelson said WIC has a caseload of 727. WIC is contracted at 97% caseload and for the last six months the caseload has been at 103% with no additional monies. WIC clients come from many referral sources. Nelson said it is mandated that staff that administer WIC attend WIC conference. RN staff time of 30 hours for jail services was built into the Public Health budget, but administration found out this afternoon that the jail may provide its own nurses. In the past the jail has requested 20 hours per week of RN time but in 2002 it was increased to 30 hours per week. The jail hasn't utilized the full amount of hours in the past. Nelson said this service is provided by a single person but there is a back up staff person. More discussion of this service will take place at a future meeting. St. Croix County Health and Human Services Board Page 4 August 22, 2002 The Board recessed from 7:35 to 7:45 PM. Motion: A motion was introduced by Wentz, seconded by Bethke, and adopted with Swenson opposing: That the Board approves leaving the $45,000 from the farm account in the budget. Wentz said the money in the farm account is county money no matter how it is used. Swenson said it doesn't give county colleagues equity with Human Services' ability to use the farm account for their budget. Borup said it is important that the issue of the Deputy Director position be settled. The position has been vacant for five and a half years but within that time the complexity of the programs and the demands on time continues from the State. Berenschot said he understands the budget is tight, but is uncomfortable that there is no one to back the Director up. Borup said work has been absorbed by a number of managers, but that wears thin in time. Swenson questioned if the position could be a lesser position and hire another manager. Borup stressed there continues to be more work and demands from the State and accountability with the Board. Motion: A motion was introduced by Berenschot, seconded by Burri, That the position of Deputy Director be filled. Roll call vote: Thomas Dorsey-no Leon Berenschot-yes Chris Bethke-no Lois Burri-yes James Craig-absent Fern Johnson-Schmidt-no Mary Louise Olson-no Ralph Swenson-no Esther Wentz-no Two yes, six no, one absent, motion failed. Motion: A motion was introduced by Swenson, seconded by Olson, and unanimously adopted: That the Board accept the $575,000 carryover funds to be included in the 2003 budget with the Deputy Director position adjusted out of the budget. Motion: A motion was introduced by Dorsey, seconded by Berenschot, and unanimously adopted: That the Board accepts a total County levy for the 2003 budget of $5,200,972 less $575,000 prior year carryover, less $58,433 for taking out deputy director position for a total of $4,567,539 county levy. NURSING HOME BUDGET: The position reductions and other cuts in the Nursing Home resulted in $584,059 reduction in the Nursing Home budget for 2003. September 30 is the deadline that has been set for the Wipfli report to be completed for the Nursing Home. Krieger said she based the 2003 budget on a census of 88 and went on the most probable as to what would happen with the State and Federal budgets as they are not finalized. Krieger said $100,000 for depreciation is included in the Nursing Home budget for roof repair, computer replacement, lift replacement. Board questioned whether this was a St. Croix County Health and Human Services Board Page 5 August 22, 2002 • duplicate expense as the roof repair is already in the capital outlay plan. The capital outlay plan was revised. Krieger said this is not a duplicate expense. Motion: A motion was introduced by Wentz, seconded by Swenson, and unanimously adopted. That the Board approves the following revised capital outlay plan for the Nursing Home for 2003: 52,000 Roof Repair 10,000 Maintenance truck 3,000 Water softener replacement 3,900 Computer replacement 2,600 Computer addition 3,500 Relamp light fixtures 10,000 Repair block foundation 3,000 Resident room furniture 500 Breakroom carpet replacement 2,000 Office furniture 7,000 Nursing station remodeling-1st and 2nd floor 2,500 Nursing Offices remodeling-i$t and 2nd floor 100,000 TOTAL The levy amount in the Nursing Home budget is $673,941. Swenson questioned if anything was factored in the budget for follow up for recommendations made in the Wipfli report. Malick questioned whether recommendations made by the Wipfli report would save enough money to pay for their implementation. Not all parts of the budget for the Nursing Home came through when printing out the report so Krieger was unable to give the Board bottom-line figures. Board members questioned whether computer software exists that would do the accounting the Nursing Home needs. Krieger said the 2003 budget maintains the 12.21 FTE position cuts that have been implemented over the last year. Krieger said the labor region change will amount to approximately $224,000 for the Nursing Home. She said the law has been changed but the application for the labor region hasn't been determined, but will go back to July 1, 2002. She said the Medicaid rate will not be set until approximately October but will be effective back to July 1, 2002. The Wipfli report is due to staff by September 30, 2002 with the staff to review by November 30. Motion: A motion was introduced by Dorsey, seconded by Swenson, and unanimously adopted: That the Board put $25,000 in the Nursing Home budget to implement recommendations of the management audit, which is not subject to this committee for any line item transfers for any other item and if not used the $25,000 will be transferred back to the general fund. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: That the Board approves the Nursing Home budget with a County Levy of $698,941. PERSONNEL ISSUES: Krieger said at a nurse's meeting this week, announcement was made regarding changes being planned as a result of the Wipfli report. She said the Director of Nursing has the option to reposition RN coverage. As a result of this meeting, two long-term RN employees walked out and a third resigned making allegations that administration was picking people for positions and then lying about it. Krieger said it has been a very trying week and this has caused a lot of disruption in the Nursing Home. She said St. Croix County Health and Human Services Board Page 6 August 22, 2002 • the nursing home staffing pattern is tight. She said Dawn Budrow has offered to come in and help work with staff with the position changes. She said these employees will be difficult to replace. Dorsey asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Swenson, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 9:30 PM Chair: Attest: (Secretary)