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HomeMy WebLinkAbout09 09 2013 Health and Human Services Minutes MINUTES HEALTH & HUMAN SERVICES BOARD September 9, 2013 1:00 PM Board Room, Department of Health & Human Services 1445 N 4th Street, New Richmond, Wisconsin CALL TO ORDER Meeting called to order @ 1:00pm on Sept. 9, 2013. Chair Horne welcomed everyone. ROLL CALL Attendee Name Title Status Arrived Tim Hood Supervisor Present Fred Yoerg Supervisor Absent Chris Kilber Supervisor Present Tom Hawksford Supervisor Absent Roger Larson Vice Chair Present Fred Horne Chair Present Leon Berenschot Board Member Present Lisa Ramsay Board Member Late 1:30 PM Deb Rasmussen Board Member Absent Others in attendance: Health and Human Services Director Fred Johnson, Human Resources Director Tammy Funk, Social Services Director Lisa Leahy, Director of Nursing Sandy Hackenmueller, Nursing Home Administrator Jack Williams, County Administrator Pat Thompson, St. Croix Industries Administrator Clark Schroeder, Public Health Administrator Deb Lindemann, Finance Director Tabatha Hansen, Fiscal Manager Beata Haug, several other HHS staff, community members, and staff from NR News. APPROVAL OF MINUTES 1. August 5, 2013 8:30 AM Chair Horne asked if there were any corrections to the August 5, 2013 minutes. No corrections were stated. Chair Horne announced minutes are approved and stand as distributed. RESULT: ACCEPTED PUBLIC COMMENT* No Public Comment BUSINESS ITEMS 1. Financial Reports Tabatha Hansen, Finance Director introduced Beata Haug as the new Fiscal Manager. She comes to us from Dunn County after 2 years in a similar position there. The Board report shared is through July. The variance of HHS Revenues was addressed first. $200,000 of this is attributable to a CLTS administrative fee which was discussed the preceding month. Additional review of the revenue variance will continue. The expenses are up in HHS with the increase in out of home placements, however, expenses continue to be under budget overall for this fund. The ADRC shows a positive operating margin when carry over revenue is added. Nursing Home operating margins for July is a negative $152,000 but $87,000 is depreciation and $10, 000 is in architect fees so operating margin is closer to $60,000 over. 2. Nursing Home Report Jack Williams, Nursing Home Administrator, spoke stating that occupancy is strong at 96%; the average census is at 48 for 2013. A report they receive shows in comparison to Nursing Homes is Western WI. we show one of the strongest occupancy rates. Lisa Leahy, SW, shared that referrals are high but they have only been able to take a few as they have been at full occupancy. Referrals are coming from facilities all over, the strongest being Regions. Sandy Hackenmueller, Director of Nursing, touched on the recent Surveys preliminary results showing potentially 9 citations. There was issue with a few care plans, and a few other minor issues that will be easily corrected with systems changes. The Survey process has changed and has become very stringent, with many facilities reporting higher citation numbers. The Lead surveyor shared that some of this surveys findings were prior to Jack and Sandy coming on board. They will send final results soon, so Jack and Sandy will bring those back to the Board with a more in depth report. The question was asked if there were any facility related issues. Williams shared that there were some minor things noted on the life safety survey such as cracked door knob covers, which render them unable to be disinfected. Also, some caulk around a cord was missing. In touching on the Financials, Williams shared that 1 yr. ago this facility had 72 beds, now has 50 beds, yet gross revenues are only approximately 1% less than that same time period last year. Also, expenses are down 16 % for first 7 months in comparison to last year. This facility had a $ 667,000 net loss last year in first 7 months, and this is at $152,000 for the same time period this year. The net loss is at an improved rate of over a half million dollars. He attributes this to the high occupancy and quick response to filling beds. Also, cost control with Wage and Benefit compensation package adjustment, and reducing the FTE is making a significant difference. Another question was raised regarding cost per day, & operating cost so far in 2013. Williams will bring this information back next meeting. 3. Modernization Application Approval Williams shared that they have received a letter back from the State. In Oct. 2012 the County Board of Supervisors passed a resolution to proceed with plans, financials, & business modeling for building a new Nursing Home. We sent to the state for a property incentive application. The state has responded with a conditional type approval. The State did not accept the County's financial assumptions and presented two alternatives. The 1st alternative is to adjust our assumptions, and resubmit. The 2nd alternative is to go ahead and build using our assumptions, but if we don't meet these financial assumptions we would assume all financial risks. Alternative #2 is not an option, though we feel it was realistic, it is too high of a risk. Williams will be reviewing with Larry Lester from WIPFLI the adjustments regarding option # 1 to determine what the state would be comfortable in approving. The timeline on resubmitting is an unknown; hopefully a meeting can be scheduled with WIPFLI within the next 2-3 weeks. Williams will follow up with the Board at next months' meeting. A Board member shared his concerns regarding the Nursing Home still being underwater in 2013, the costs are still high and the business model isn't working. When will we have the vote towards building, which is what we told the people we would do? There was some discussion, but since there potentially won't be an answer back from the state before the end of the year regarding the property incentive, it seems we first need to approve a 2014 budget. This will get us into next year. We can then begin recommendations to the County Board whether or not to issue bonds for a new facility. 4. Community Health Improvement Collaboration Planning Fred Johnson, HHS Director, spoke in regards to follow up meetings that have been held with Pierce County, local hospitals and state staff. All involved favored continued collaborations, but should consider narrowing our focus on the number of goals and work to improve, where possible, outcomes that are measurable. Each of the entities involved wanted to bring information back to their governance boards for support. Public Health Coordinator, Deb Lindemann shared that by statute we have to do a Community Health assessment, it just makes sense for us all to work together. Motion made by Hood to support Community Health Improvement collaboration with Pierce County and the four hospitals in St. Croix County. Seconded by Berenschot. RESULT: APPROVED [UNANIMOUS] MOVER: Tim Hood, Supervisor SECONDER: Leon Berenschot, Board Member AYES: Tim Hood, Chris Kilber, Roger Larson, Fred Horne, Leon Berenschot, Lisa Ramsay ABSENT: Fred Yoerg, Tom Hawksford, Deb Rasmussen 5. Health and Human Services Facility Planning Report Last Friday the purchase of the County Market building was closed. The planning work since last meeting includes a survey for all HHS staff, review of FTE staffing levels and what type of office space needs will be needed. In this preliminary work, the staff assigned flexible work spaces have a 70% ROWE ratio built in as an initial estimate. As design work progresses, administration will work with Hoffman to review plans with all HHS departments as a final review. When we have determined a design and final plans, an RFP for the construction will be completed. Construction build out is anticipated to be complete in June or July of 2014, with relocation taking place soon after. 6. 2014 Budget Review A general overview of the County budgeting process was provided. Budgets include a 5% increase factor built in for Health Insurance, but this is not finalized. Wage adjustments related to pay for performance and any new position requests are not in this budget at this time. Equipment items under $5000 are in Dept. Budgets, but capital items that require depreciation are not. A five year capital improvement plan will be developed and departments have been asked to provide input. Operating expenses in the nursing home are up and the IGT revenues are down. This budget is based on a census number of 47, which is two higher than this year. The fact that the building is in need of attention did factor in on the operating expenses. Wages are up due to a need to increase Facilities staff time after seeing the findings of the inspection. Depreciation has been built in this year as requested by the Board. The proposed 2014 tax levy need is around $577,000. Concern was raised around this amount of loss, and the costs continuing to be above industry standards. Discussion followed regarding these questions. NH Administrator and Finance will try to get on WIPFLI's schedule to address the property incentive application and possibly report back to the Board in November. The Board received a high level summary of all Departments in HHS, ADRC, Aging, and SCI. In making the 2014 budget, discussion was had around collaborations and the LEAN events that could be had to help streamline and increase efficiencies. Also, discussion with each department was had to make consistent use of object codes, so you will see shifting of expenses from one line to another. Health insurance increases make up a big portion of the expense increase. Health Care reform is leading a change in health care eligibility so staff will have to be at 30 hours or more to participate in the health insurance plan at the county. Other increases in expenses are the ongoing maintenance of the Electronic Health Record, this was a must, but will hopefully lead to more efficiencies, integrity, and reduction in need for temp staff services. The increase in purchased services is primarily in 3 areas: increase need for foster care services in F&C Budget, in YCSS our local match requirement is up, and thirdly we have contracted services for our Energy Assistance program so ES staff has more time to focus on the Affordable Care act implementation. An added revenue source is anticipated with the Comprehensive Community Service (CCS) program which will account for 100% funding match for eligible clients. Department staffs have begun preliminary work to implement this program within a multi-county consortium approach. The intent with implementation is to begin with children that we currently serve so we can take advantage of funding and implement slowly to allow adequate time to evaluate service delivery expenditures, as well as effectiveness. SCI budget is a 3 month or one quarter budget for current cost of operations. The Facilities budget will include nine months of expenses to heat, cool, and maintain the building. The $180,000 in reserves could potentially cover the losses for the first quarter. ADRC budget shows a reduction in the Long Term Support payment from the Family Care buy in. Aging is showing an increase in food costs. 7. St. Croix Industries Transition Planning Since the August Board meeting a couple of things have taken place. A Parent & Stakeholders meeting was held with ContinuUs on August 21st. The RFP advisory meetings have been set for Sept.18th and 25th. Colleen Hammer, an employee from SCI, will be part of the RFP team as the additional staff person appointed by the County Administrator. Internally, discussion has addressed the use of the building, vehicles, and equipment to the new provider. The plan is that the county is not looking to make money on this transition. A meeting with SCI staff will be had today and individual meetings to follow regarding incentives and severance that may be available to them. Clark Schroeder, SCI Director, shared they are doing the best they can in dealing with the transition. We are trying to assist staff with interview and resume' skills as they begin looking for employment elsewhere. We are trying to stay focused on making the next provider successful. ANNOUNCEMENTS & CORRESPONDENCE NA ADJOURN Meeting adjourned @ 2:45 PM Respectfully Submitted: Colleen Linder DATE OF NEXT MEETING - OCTOBER 7, 2013