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HomeMy WebLinkAbout02-15-2012 Health & Human ServicesNOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 15, 2012 — 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: 01/18/2012 IV. BUSINESS ITEMS 1. Financial Report for Nursing Home and Health and Human Services 2. 2011 Departmental Operational Goals— Family and Children's 3. Children's Waiver State Program Site Visit Report 4. Nursing Home Administrator's Report 5. Nursing Home Operational Changes V. ANNOUNCEMENTS & CORRESPONDENCE VI. ADJOURN DATE OF NEXT MEETING: 03/21/12 at 8:30 A.M. REVIEWED AND APPROVED BY: Committee Chair and County Administrator DATE APPROVED: 02/01/2012 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. 21212012 ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD February 15, 2012 The St. Croix County Health and Human Services Board met on February 15, 2012 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 Alfred Schrank MEMBERS ABSENT: Deb Rasmussen STAFF PRESENT: Fred Johnson, Health and Human Services Director Cindy Anderson, Nursing Home Administrator Kathy Dunlap, Family and Children's Administrator Malva Sirek, Administrative Support Supervisor OTHERS PRESENT: Pat Thompson, County Administrator Kim Dupre, Information Systems Analyst Pam Benson Dave Ostness Norm Matzek Jeff Holmquist, New Richmond News 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, March 21, 2012 at 8:30 AM. MINUTES Motion A motion was introduced by Schrank, seconded by Berenschot, and unanimously adopted: That the minutes of the 01/18/12 Health and Human Services Board meeting be approved as distributed. FINANCIAL REPORT FOR NURSING HOME AND HEALTH AND HUMAN SERVICES The following financial report for Health and Human Services, Nursing Home, St. Croix Industries, Aging and ADRC through December, 2011 was distributed. St. Croix County Health and Human Services Board Page 2 February 15, 2012 on IMMEN on ■ 1 ■ 1 ::.1.,. ■m on ■ ■ ■ ■� ■■ I I'IK 'K IK I '�'' ■■ I MINE ■■ MEREEM r ■■ IME MINE ■■ 1 I F1 0. ■ ■ ■ ■- ■■ IN MINE ■� ■ ■ �■ ,1 ■ ii � r ri � Iii � 1 1•., ■■ ■ ' til, �■ ■ MINE � m ■ �� ■■ ■ IN MINE on ■ 0 ■ ■MMEN ■■ -_ ME . �■ ■ ■■ 1 1 ■ 1 1 ■ i ■ 1 i 1 ■ 1 j I '', ■ ■ Kr ■ LIMV ■ St. Croix County Health and Human Services Board Page 3 February 15, 2012 Johnson indicated the report has a new format and reviewed the accounts for each department. He reported ADRC prepaid a Long Term Care bill as there were funds available to do so, thus the reason for ADRC expenditures being over budget. Johnson reported the Nursing Home expenditures reflect an extra payroll at the end of 2011. This additional payroll, along with decreased census in the Nursing Home put the estimated loss for the Nursing Home for 2011 close to $400,000. Johnson reported Nursing Home revenue reflects an approximate $219,000 IGT fund payment received for the second half of the year. Johnson indicated claims to the State for Health and Human Services (HHS) will be processed and finance recently processed a claim for approximately $1,500,000. The books for the State and the County will close March 31, 2012 and final year end close to claim available funding will be a priority for finance. Berenschot expressed concern regarding the books not being closed sooner than 90 days past year end. Johnson indicated this is the process and timeline that has been followed in the past. 2011 DEPARTMENTAL OPERATIONAL GOALS - FAMILY AND CHILDREN'S Johnson reminded Board members that a different Department will be highlighted each month to help guide the Board with policy decisions. Dunlap reviewed the Family and Children's Operational Performance Targets. Dunlap reported that a case management tool was developed and is being utilized by staff. There are many fields to complete in ESACWIS and the case management tool developed identifies and tracks the key concepts, criteria and requirements for each of the Family and Children's categories. Dunlap next reported on implementation of evidence based practice for juvenile justice staff. An initial intake screening tool and ongoing assessment tool are used by staff to determine risk level for the child and family. The risk level determines the evidence -based plan that is implemented. Dunlap also reported a new process has been developed to scan files so all required information is contained in the state system. A new copier, which also has scanning abilities, will be installed tomorrow so implementation of the scanning process will be much more efficient. Finally, Child Protective Services (CPS) staff attended a week -long training in April for advanced cognitive graphic interviewing. The State provided this training for free and several law enforcement agencies attended. This training supports staff and law enforcement in gathering appropriate information necessary to address service needs for families. Staff will be ready to provide feedback to the state on ongoing standards. This objective will be postponed until the state sets up the committee to develop ongoing standards and internal case management tool. The work that the staff has done to develop a case management tool is hoped to be a resource for the state committee when this process is started. Dunlap noted she is compiling figures for the 2011 annual report. There were 18,194 days of kids in out -of -home placement, which includes 12,576 days for kids in placement with relatives. This leaves a lower number of days of purchased alternate care services for a county our size. She noted it can be very difficult at times to find relatives for some placements, but the staff work hard to find these alternatives for children that cannot remain with their parents. St. Croix County Health and Human Services Board Page 4 February 15, 2012 CHILDREN'S WAIVER STATE PROGRAM SITE VISIT REPORT: The State performed an annual review of the records in Youth Community Support Services (YCSS) and the survey went very well. There are approximately 150 kids receiving services under YCSS. The State was impressed that as a county, we focus services on health and safety. They very much liked the assessment tool developed by St. Croix County. They noted that the assessment, the individual service plan developed for the youth and the ongoing case management provided by workers all tie back to health and safety. The state does not provide a written report of their findings, only a verbal exit interview. NURSING HOME ADMINISTRATOR'S REPORT The average monthly census for January was 60, with 9 Medicare, 35 Medicaid, and 16 private pay residents. There were seven admissions and seven discharges during the month. Census today is 59. Two potential admissions were declined due to census being at capacity on second floor. So far in February, there have been two admissions and three discharges. Anderson reported Cindy Prokash, Nursing Home Activity Director, was named volunteer of the year by the New Richmond Chamber of Commerce. Anderson reported a $600 donation was received for plants and fish for the Nursing Home. Anderson reported an extension was requested for the plan of corrections for the Nursing Home due to the considerable amount of time needed to get some of the items in place. Anderson reported the Nursing Home State survey window starts March 6 th NURSING HOME OPERATIONAL CHANGES REPORT Johnson noted several studies have been completed regarding the Nursing Home over time and two areas that have been focused on include operational reviews and options regarding the size of the facility. Most recently, the HHS Board passed a resolution to build a 50 -bed Nursing Home and 48 -bed assisted living building, which was tabled at County Board for a year. Pathway also recently did a review and recommended considering a 50 -bed or 57 -bed facility as this would provide private rooms for all residents. Discussions have been held at the Board meetings regarding trends in Nursing Home census, vacancy report and monitoring referrals. During all of 2011, the Nursing Home average vacancy was approximately 12 beds of the 72 licensed beds on a monthly basis. St. Croix Health Center occupancy rate for 2010 were 89% and in 2011 the occupancy rate was 82 %. As operational changes have been made to reduce expenses, few admissions have been declined due to the nursing home being at capacity, which was discussed earlier in the meeting. Johnson distributed a revenue /expense analysis that had the following categories: 2012 budget, current budget with operational adjustments, 57 -bed facility and 50 -bed facility. Johnson reviewed all of the scenario and the expected impact on revenues and expenses. Adjustments on expenses were based upon expected staffing levels and revenues were adjusted based upon an average percentage of the current payer mix between Medicare, Medicaid and private pay. Berenschot indicated St. Croix Health Center may have less exposure regarding liability insurance so that would probably be less and worker's compensation may also be less and that is not reflected in the analysis. This analysis completed by county staff was reviewed with the Nursing Home auditor, Trent Fast. He indicated that he thought that the analysis was appropriately completed. Johnson reviewed the 50 -bed planning dashboard analysis St. Croix County Health and Human Services Board Page 5 February 15, 2012 that was previously completed by Fast and highlighted that there were some differences when compared to the current analysis. There were different assumptions that were used between the two documents and as an additional review Johnson recommended that the 2011 trial balance be sent to LarsonAllen to update the 50 -bed planning dashboard. The planning dashboard was created using the 2011 budget, which was projected and is different from where we are now expected to end the year. An updated analysis can base projections for a 50 -bed facility off actual reported expenses and revenues from the trial balance as an additional verification of the proj ections. With the 50 -bed scenario, there would be a Medicaid enhanced rate for Medicaid reimbursement. Johnson indicated that he did not believe a new facility was a requirement to receive the enhanced rate. The enhanced rate would be an additional $17 /day on top of the Medicaid rate. However, the enhanced rate would still fall short of the actual cost for cost of care. IGT funds are projected as consistent for at least the first year as the IGT funds are based on prior year expenses. Following years IGT funds may be closer to $371,000 as funds are dependent on Medicaid census and this would also be reviewed by Fast. Thompson asked what Johnson would recommend and he indicated operating the Nursing Home as a 62 -bed facility and not maintain the 72 -bed licenses that are currently in place. St. Croix Health Center is currently losing bedhold when residents are on leave from the facility to the hospital, etc. plus the facility is paying $170 /month on bed tax for these ten beds the facility has not used for approximately the past 14 months. The Board questioned how many admissions have been turned away. The facility has not taken residents on three occasions over the past several months due to being at capacity, which was adjusted to 62 to minimize staffing expense. It was questioned how many admissions have not been accepted. Anderson indicated that each applicant is assessed on a case -by -case basis to determine if the facility can provide the care needed. If the facility cannot provide the care needed, the admission is declined. Matzek questioned if the facility is limiting itself by turning away Medicare patients. Anderson indicated just because an applicant has Medicare coverage does not mean the facility is able to meet the individual's medical needs. All applicants are evaluated on a case -by -case basis. Matzek would like to see verification of the cases that have been turned away. Johnson supports and trusts Connie Sarauer's, Director of Nursing, and Anderson's judgments regarding admissions. They are competent professionals and the facility is a five -star facility, due in part to good judgment around admission decisions. Johnson stands behind the decisions being made regarding admissions and said a policy board should not be involved in reviewing this level of detail regarding operational decisions we as staff are charged with doing. Dr. Ramsey supported Johnson's statements. She indicated a generic or larger level review might be appropriate, which Johnson said he would have staff compile for the next meeting. Johnson indicated CMS recently reconfirmed the St. Croix Health Center's five -star status. St. Croix County Health and Human Services Board Page 6 February 15, 2012 Horne left the meeting at 9:55 AM. Thompson expressed if the numbers for a 50 -bed facility are validated by the auditor, a move should be made to a 50 -bed facility. Dupre indicated other facilities in the county are experiencing reduced census and questioned if other nursing homes are downsizing with the decreased census. She questioned if there are enough beds out there available to Medicaid residents. Larson expressed concerned regarding continuing to reduce the number of beds in St. Croix Health Center. He indicated downsizing does not make sense. If the number of beds keep dropping, it makes it look like the St. Croix Health Center is going out of business and that is not what we are here for. If $400,000 is needed for the Nursing Home for 2011, a 50 -bed facility would get to a lower tax levy need. The question is what will the County Board support? The County Board sets the budget for 2012 and it is Thompson's and Johnson's job to stay within that budget. Benson indicated that the census was taken in 2010 and questioned the number of county residents over age 80 or age 85 that may need nursing home services. She questioned if that projection is being considered for future nursing home needs? Matzek questioned the accuracy of the numbers on the analysis sheet and using those numbers to make irreversible economic decisions regarding the Nursing Home. It was the consensus of the Board to wait until after the referendum question is asked before any decisions or changes are made regarding the Nursing Home. Board members requested the referendum question be included in the Board packet for the next meeting. Thompson will get census data for the next meeting. Berenschot recommended a letter go out to all 60, 70 and 80 year old people in county advertising that St. Croix Health Center is 5 -Star facility and point out the difference in services when it comes to a 5 -Star facility. Marzolf and Berenschot offered to help with this campaign. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 10:28 AM Chair: Attest: (Secretary)