Loading...
HomeMy WebLinkAboutNursing Home Steering Committee 04-20-01I ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Thomas Dorsey, Chairman St. Croix County Board FROM: John Borup, 246 -8223 COMMITTEE TITLE: St. Croix County Nursing Home Steering Committee DATE: 04/20/01 TIME: 1:00 P.M. LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: ACTION ON PREVIOUS MINUTES: 03/16/01 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. New Developments 2. Keefe & Associates Presentation: Demographic Trend Assessment 3. Keefe & Associates Presentation: Privatization Assessment 4. Review Draft of County Board Survey 5. Discuss Common Ground Elements ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup and Chuck Whiting DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA /NOTICE -1( n NURSING HOME STEERING COMMITTEE April 20, 2001 The Nursing Home Steering Committee met on April 20, 2001 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Robert Stephens, Chair Richard King Stan Krueger Ralph Swenson Esther Wentz MEMBERS ABSENT: None STAFF PRESENT: John Borup, Health and Human Services Director Carolyn Krieger, Nursing Home Administrator Malva Berg, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator John Keefe, Keefe and Associates Mike Edwin, Keefe and Associates Chair Stephens called the meeting to order at 1:00 PM noting the meeting was properly and legally publicized. AGENDA Motion A motion was introduced by Wentz, seconded by King, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Krueger, seconded by Swenson, and unanimously adopted: That the minutes of the 03/16/01 Nursing Home Steering Committee be approved as circulated. Keefe said we are in the planning process and wanted to touch base with the Committee to make sure there have been no new developments that would change the process. Stephens said Health and Human Services and the Nursing Home presented the annual report to the County Board in April. They also presented the preliminary exit audit for 2000 for the Nursing Home to the County Board. The preliminary audit showed a loss for the Nursing home of approximately $626,000 in 2000. If the County levy for fringes is added to this loss, the Nursing Home lost over one million dollars in 2000. Stephens said when the final audit is available in May or June, then the auditor and maybe Keefe would be asked to appear before the County Board. Swenson said not only is there a loss in the Nursing Home, but the fund balance is also shrinking. Krieger said we are anticipating receipt of $315,000 in IGT dollars in June as the final payment for the 2000 -2001 year. Stephens said the Nursing Home loses $22 /day /resident on Medicaid, but if the Nursing Home is full, it would breakeven. Krieger said this is because IGT funds differ according to census. Krieger said the Nursing Home books close in December but the State runs from July to June with the Nursing Home receiving new rates in July for Medicaid Keefe said he would work with the financial department to help make sure financial reports are consistent and understandable. Keefe said the cost report data is the best report as far as information and standard information but this is an annualized report, not monthly report. Stephens asked that Loney, Ziegler, Borup, Krieger and he meet to get a standard format report so the committee understands where the Nursing Home is at financially. Keefe suggested more detailed information go to the Committee and a summary go to the ful-, County Board. Keefe distributed a tentative schedule of meetings and topics of discussion for each meeting. He anticipates the study will be completed in September. At the next meeting the Committee will discuss facility issues such as bed banking, bed need, downsizing, etc. He said he has included common ground elements as a part of each agenda as there are basic assumptions for basis for moving in certain directions and for building strategic options. Keefe reviewed information sent to the Committee members regarding demographic trends in St. Croix County. Keefe said the information comes from a national demographics firm and is based on 2000 census and gives us some sense of general trends in population. He said information on the charts is projected from 1990 data and trended forward as the 2000 data is not finalized. Keefe said ages 65 -74 is not the target population for nursing home placement. He said the 75+ population is the core population for nursing home placement. He said 6% of the total population in St. Croix County 75rt- is the core population for nursing home placement. He said St. Croix County is two to four times higher in elderly population than the state as a whole. It is anticipated there will be a large increase in the 75+ population in the next five to ten years, but very little increase is anticipated in the 85+ population. He said most elderly population have no limits or.chronic limitations; most in need of nursing home care have chronic limitations where they need help with self cares and have limited mobility. According to 2000 census, St. Croix County is cne of the fastest growing counties in the State. Keefe said nursing home use continues to decline as new options become available to seniors such as assisted living, etc. He said in the future there will be a distinct need to take care of people with behavioral issues such as Alzheimer's /dementia as it is becoming increasingly difficult to support this care in the home. Under Community Options Program (COP) if the cost to maintain a person in their home exceeded the cost of nursing home placement, that person had to be placed in a nursing home. However, the State may average the cost of ten persons on the COP program to obtain an average cost and thus people with higher cost of care may remain in their own home. It is anticipated that the State may end this cost averaging in the future. Borup said the counties participating in the redesign are finding that it is costing the county a lot of money. Keefe said providing services on one campus is the most efficient way to serve the population. R Ibi 2 r Keefe said he understands that privatization is not an option that is being strongly pushed by the County Board at this time. Stephens said the County Board is viewing what the Nursing Home Steering Committee is finding. Keefe reviewed other county homes that have been sold in the last 20 years. He said there have been nine county homes sold since 1986 and reviewed the price paid for the various homes. He said the bed licenses were sold with each home but in only four out of nine, the land and building were actually sold. He said each home had -lifferent philosophies and varying levels of care. He said there were varying .impacts on the level of care and labor in each home. Keefe said there are various methods to determine the worth of a facility, such as cost of replacement, sales comparisons, and income generation potential. He said in the appraisal process there would be a physical plant assessment, management assessment and evaluation of market potential and competition. Other factors impact the value of the home also such as the facility's reputation, facility's location, current, recent and projected census, types of residents served, the condition of the facility, wage/ benefit structure and levels, labor pool availability, projected payer mix, and the potential for reimbursement and profit. He said a sales comparison would be difficult as no homes have been sold since 1998. Keefe said the counties have not received a fair value for the facilities sold. It is currently a buyer's market for nursing home beds, with bed value at approximately one -third to one -half of the value they were in the 1990 He said there are more empty beds, more competition and less reimbursement now. Keefe said the State has had a 19 -year moratorium on licensed nursing home beds and anticipates this will continue. He said the State controls the Medicaid liability. Keefe said the State's database does not provide sufficient information whether it is cheaper to stay in the person's home versus stay in a nursing home. The Committee recessed from 2:35 to 2:40 PM. Borup said he is concerned about the labor /management trust issue. Keefe said the cost of selling the home also includes employee costs both before and after closing, such as incentive pay to retain employees and unemployment, accumulated sick leave, vacation and retirement. After closing the county also has the cost to Health and Human Services for court - protected residents. Keefe said the population of seniors with increased needs will increase and it is anticipated in 2018 there will be a population boom of 75+ population. Keefe said the needs of this population will have to be met but the county has to decide what to do in the interim. Krueger asked for a projection of the population for an additional 15 years. Borup asked Keefe to determine the value of St. Croix Health Center before the end of the study. Keefe said it would be an uphill struggle to sell the home as the market is limited for buyers but the committee will be able to determine if the value will be in the high, medium or low range. Borup said if the home is sold, the county subsidy is eliminated, but it doesn't go away, the costs are just shifted to Health and Human Services and the courts. At this time, we are unable to determine exactly what those costs would be. Also, it may be difficult if not impossible to find 3 � alternate placements for court - protected residents. Keefe said another factor in this would be the impact on staffing needs in Health and Human Services. The State requires we develop a relocation plan for each court - protected resident, which takes approximately 120 days. Wentz asked where people would go if there are no facilities to take the 28 protectively placed residents. Keefe said this is a major issue. MISSION STATEMENT Keefe suggested changing the mission statement of St. Croix Health center. He said the philosophy statement he received was: 'The philosophy and major goal of the St. Croix Health Center is to provide the best possible care, treatment and rehabilitation, and return to the community of those who are entrusted to our care." He said the philosophy provides an inconsistent and confusing image. He suggested that a revised mission statement be developed as part of the study of the Nursing Home. Keefe said privatization is a crossroads type of issue. It was the consensus of the committee that this issue is still on the table and that we should continue operations and how to do so and minimize economic issues and serve the people who need to be served. Stephens said the nursing home costs continue to increase and we cannot take a dual track. Wentz said the committee needs to know the costs to place the protectively placed residents, unemployment costs and costs for staff vacation, sick time, etc. Stephens said we need to consider the human part of Human Services. Keefe said the county may need to consider developing services that may be in competition with the private sector and make the mission statement broader to take care of people in a larger capacity and expand the scope of the committee. A plan may need to be developed to look at assisted living or elderly housing and this may compete with the private sector. Wentz asked why the county would not pursue anything that would bring in money to the county. Stephens said the County is to provide services that the private sector cannot or will not provide. Whiting said we need to assess why the committee is here doing what it is doing. The committee was charged to provide and study options for the nursing home, not choose options and all the options need to be looked at. Stephens said bed banking will be discussed at the next Health and Human Services meeting. Keefe distributed a draft of a survey that he is proposing sending to County Board members. He said a survey is an efficient way to get responses in a confidential manner. He said he tried to form open -ended questions and tried not to lead for responses. Wentz said most County Board members are not sure what is going on with the nursing home except that it is losing money. Keefe suggested the survey be distributed in May so it will be back by June. Swenson felt the survey would be an educational opportunity to find out what the County Board wants to know and what people don't know and what kind of training may need to be done. The Committee suggested some possible changes in the question format. Keefe said the survey is offered as an alternative. Stephens asked Keefe to make suggested changes to the survey and bring back to the Committee who will decide at that time whether or not to send the survey out. 4 J Motion A motion was introduced by Wentz, seconded by Krueger, and defeated with all negative votes: That the survey be sent in the present format to the Health and Human Services Board and Nursing Home Steering Committee. Whiting said he is concerned that some County Board members will be surveyed and others not. Stephens said we are at this meeting to discuss the Nursing Home, not to do anything in secret. Motion A motion was introduced by Swenson, seconded by Wentz, and adopted with Stephens voting no: That the Committee will not send the survey to she full County Board. It was suggested the next meeting of the Nursing Home Steering Committee be held on May 23 at 12:00 noon. Krieger said there are currently 26 residents protectively placed that would be difficult if not impossible to place in other homes. She has one -year old cost estimates for their care and Keefe will work with her to update these to current costs. Keefe said he appreciates feedback from the committee as to where there is consensus in the group and where there is not consensus. Swenson said we are gathering facts but not forming opinions or allowing feelings to enter into the study. The Committee will remain open to all options that may result because of the study. Whiting asked about the status of the architect. Keefe said he is working with a firm out of Milwaukee. He said he is prepared to go ahead with the study. Swenson asked that Committee members receive information for the meeting in advance of the next meeting. Motion A motion was introduced by Wentz, seconded by King, and unanimously adopted: That the meeting be adjourned. Time: 4:10 PM Chair: Attest: (secretary) 5