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HomeMy WebLinkAboutHealth & Human Services 04-15-09 S. Wentz will review vouchers. NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 15, 2009 at 8:30 (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 03/18/09 DATE OF NEXT MEETING — 05/20/09 OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting 2. Financial Report a. Monthly financial report for Nursing Home and Health and Human Services b. 2008 updated year end financials for Nursing Home and Human Services c. aged receivable report 3. Cost to County Human Services in the 2009 -2011 State Biennial budget 4. Nursing Home Report 5. Nursing Home Engineering Survey 6. Long range facility planning 7. Personnel Issues a. New employees /vacancies 8. Health and Human Services planning for office moves and costs 9. Centralized intake for Behavioral Health and Family & Children's 10. Public Health Preparedness annual report for 2008 11. Photovoice Exhibit in Public Health 12. June 15 preparedness functional exercise in Public Health 13. 2009 budget planning/timeline for DHHS and Nursing Home - Planning for June 17 open hearing 14. Safety and Security Assessment (John Shilts) ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 4/1/2009 7:58 AM ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD April 15, 2009 The St. Croix County Health and Human Services Board met on April 15, 2009 at the St. Croix County Health and Human Services /Health Center complex. MEMBERS PRESENT: Esther Wentz, Chair Leon Berenschot Charles Grant Roger Larson Linda Luckey Gerald Peterson Deb Rasmussen MEMBERS ABSENT: Richard Marzolf, excused STAFF PRESENT: Fred Johnson, Health and Human Services Director Ron Kiesler, Behavioral Health Coordinator Wendy Kramer, Public Health Officer /Public Health Coordinator Geralyn Karl, Health Educator Clark Schroeder, Director, St. Croix Industries Pat Haeny, Family and Children's Supervisor Fay Strenke, Accounts Receivable Supervisor Joyce Jurisch, Nursing Home RN Rich Monn, Lead Worker, Building Services Dennis Reiman, Contracted Nursing Home Administrator Malva Sirek, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Tammy Funk, Human Resources Administrator Dave Ostness, County Board member Doug Schact, Community Living Solutions Brian Zager, Community Living Solutions 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, May 20, 2009 at 8:30 AM. Marzolf will review vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the agenda be approved as distributed. MINUTES Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the minutes of the 03/18/09 Health and Human Services Board meeting be approved as distributed. CONSIDERATION OF CLAIMS Health and Human Services (HHS) Board member Wentz reviewed the vouchers. Motion A motion was introduced by Wentz, seconded by Berenschot, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: St. Croix County Health and Human Services Board Page 2 April 15, 2009 Human Services vouchers 147460 through 147464, dated March 19, 2009 in the amount of $27,343.27. Human Services vouchers 147671 through 147708, dated April 02, 2009 in the amount of $39,940.77. Human Services vouchers 147991 through 148028, dated April 09, 2009 in the amount of $57,736.34. Human Services and Nursing Home vouchers 147096 through 147172, dated March 19, 2009 in the amount of $136,735.65. Human Services and Nursing Home vouchers 147173 through 147223, dated March 19, 2009 in the amount of $33,304.06. Human Services, Department on Aging, ADRC, Government Center and Nursing Home vouchers 147465 through 147518, dated March 26, 2009 in the amount of $121,288.57. Human Services, Department on Aging, ADRC, Government Center and Nursing Home vouchers 148029 through 148144, dated April 09, 2009 in the amount of $69,176.47. Human Services, ADRC, Department on Aging and Nursing Home vouchers 148159 through 148291, dated April 09, 2009 in the amount of $58,964.64. Nursing Home voucher 147076, dated March 19, 2009 in the amount of $1,200.00. Nursing Home vouchers 147709 through 147758, dated April 02, 2009 in the amount of $25,888.91. Nursing Home vouchers 148145 through 148158, dated April 09, 2009 in the amount of $10,359.28. Human Services, Workshop, Public Health, Social Services vouchers 186 through 216, dated April 2, 2009 in the amount of $386,125.57. Human Services, Workshop, Public Health, Social Services vouchers 217 through 246, dated April 16, 2009 in the amount of $395,001.93. Human Services and Nursing Home vouchers 181 through 209 dated April 2, 2009 in the amount of $153,786.25. Human Services and Nursing Home vouchers 210 through 236, dated April 16, 2009 in the amount of $147,853.91. Workshop vouchers 37 through 42, dated April 2, 2009 in the amount of $13,138.90. Workshop vouchers 43 through 48, dated April 16, 2009 in the amount of $10,426.68. LONG RANGE FACILITY PLANNING Doug Schacht and Brian Zager from Community Living Solutions (CLS) gave a presentation regarding the Nursing Home. Their company focuses exclusively on senior living environments and sustainable business solution approaches. They reported the current nursing home building St. Croix County Health and Human Services Board Page 3 April 15, 2009 is nearing the end of its useful life. Some maintenance on the building has been delayed or deferred and the building offers operational inefficiencies for staff and residents. Other issues include the county subsidy is again rising; there is also the threat of increasing competition in the area in 2010 plus changing consumer demand. Consumers of the future will demand more private rooms, more private bathrooms, cable television and telephone service. The Family Care model offers an opportunity to add assisted living as this service will be part of the benefit package. The trend in Long Term Care is towards increased assisted living use. It is predicted there will be an increase in dementia - related behaviors in the future. It is also predicted staffing shortages will become more acute in the future. Government trends are constantly changing. Berenschot questioned the occupancy level of an assisted living facility versus nursing home. Typically, assisted living facilities are full within a few months; however, skilled nursing home facilities census for long term care beds is going down. Whiting indicated the current HHS building has limited time for expected use. He said the Nursing Home is the best building in the county as it is the only building without major issues. Peterson said the HHS committee is the oversight committee for the Nursing Home and has responsibility to move forward with construction of a nursing home and assisted living or forget it as the nursing home will die. Building an assisted living first would give the best return on investment and buy time for the Nursing Home to make decisions. An assisted living would act as a feeder to keep the Nursing Home full and improve the financial picture for the Nursing Home. A decision should be made to accomplish this in a manageable timeframe. Johnson briefly discussed the consortium model in LaCrosse County and possibly capturing niche markets, particularly with needs the new care management organization needs and would be willing to fund. Another consideration in the decision making process is a nursing home building would be reimbursable for capital expenditures; however, a building for Health and Human Services would not be reimbursable for capital expenditures. Johnson said if nothing is done, the county appropriations will continue to increase. Wentz felt this issue should be discussed when the new Nursing Home Administrator is on board. The issue will be discussed every month. Berenschot disagreed with waiting. Peterson recommended the Health and Human Services (HHS) Board go to the full County Board to recommend a feasibility study for assisted living care and engage consultants to work through it. Peterson would like a binding referendum to be offered to the county voters. Johnson will get cost estimates from CLS. The Board recessed from 9:45 to 9 :50 AM FINANCIAL REPORT The following financial report for Health and Human Services through February, 2009 was distributed. The State of Wisconsin has not adjusted the Long Term Support contract monies but will be taking back surplus monies when adjusted. The Health and Human Services books are not closed by the auditors yet. St. Croix County Health and Human Services Board Page 4 April 15, 2009 HEALTH AND HUMAN SERVICES - 2009 SUMMARY Total OF REVENUES Budget February 28, 2009 Balance % Administration 1,038,854.00 (131,859.12) 1,170,713.12 -12.7% AODA Services 760,671.16 115,596.92 645,074.24 15.2% Long Term Support 2,631,402.00 3,023,403.77 (392,001.77) 114.9% St. Croix Industries 2,482,747.71 347,093.52 2,135,654.19 14.0% Mental Health 3,448,843.99 594,186.36 2,854,657.63 17.2% Family & Children's 2,911,874.13 588,960.27 2,322,913.86 20.2% Public Health 1,976,209.95 342,353.08 1,633,856.87 17.3% Economic Support 1,152,939.29 134,684.16 1,018,255.13 11.7% General Relief 0.00 0.00 0.00 0.0% Coordinated Services /SED 2,836,586.35 390,023.61 2,446,562.74 13.7% ARDC 632,000.00 81,329.00 550,671.00 12.9% Department on Aging 846,623.00 50,538.05 796,084.95 6.0% REVENUES HUMAN SERVICES PROGRAMS 20,718,751.58 5,536,309.62 15,182,441.96 26.7% SUMMARY Total OF EXPENDITURES Budget February 28, 2009 Balance % Administration 1,038,854.00 176,945.39 861,908.61 17.0% Alcohol -Drug Abuse 760,671.16 112,291.16 648,380.00 14.8% Long Term Support 2,631,402.00 194,305.57 2,437,096.43 7.4% St. Croix Industries 2,482,747.71 445,238.56 2,037,509.15 17.9% Mental Health 3,448,843.99 583,077.01 2,865,766.98 16.9% Family& Children's 2,911,874.13 534,363.40 2,377,510.73 18.4% Public Health 1,976,209.95 337,584.72 1,638,625.23 17.1% Economic Support 1,152,939.29 210,128.55 942,810.74 18.2% General Relief 0.00 29.59 (29.59) 0.0% Coordinated Service /SED 2,836,586.35 310,568.93 2,526,017.42 10.9% ARDC 632,000.00 67,895.50 564,104.50 10.7% Department on Aging 846,623.00 95,548.77 751,074.23 11.3% EXPENDITURES HUMAN SERVICES PROGRAMS 20,718,751.58 3,067,977.15 17,650,774.43 14.8% Total 2.468.332.47 The following financial report for the Nursing Home through February, 2009 was distributed. There were a number of residents with higher acuity needs in the last month so staffing levels had to change to meet those needs. This affected the daily patient services line. The Nursing Home books are closed but the audit report has not been received. Larson /Allen will report to the Board in June or July. Larson /Allen staff have been very complimentary to HHS staff for their work and preparations made for the auditor visits. St. Croix County Health and Human Services Board Page 5 April 15, 2009 St. Croix Health Center Budget Actnial Diffeierrce percentagf Census 0 Opeiatinq Revenue: Medicare $903,252.00 $145,789.39 $757,462.61 16.14% Medicaid $2,481,432.00 $397,204.05 $2,084,227.95 16.01% Private Pay $760,413.00 $138,773.25 $621,639.75 18.25% All Other Sources $216,041.00 $95,539.99 $120,501.01 44.22% Total 01)eiatiny Revenue $4.36'1.138.00 $777,306.68 $3.583.83'1.32 '17.821. Orperating Expenses Daily Patient Services $3,407,942.00 $597,748.57 $2,810,193.43 17.54% Special Services $284,262.00 $48,261.52 $236,000.48 16.98% General Services $1,132,974.00 $171,541.29 $961,432.71 15.14% Administrative Services $630,702.00 $98,963.45 $531,738.55 15.69% Unassigned: Depreciation (% Based) $0.00 Others: $402,923.00 $34,984.88 $367,938.12 8.68% Utilities $202,080.00 $11,770.88 Workers Comp, Computer Tech $133,400.00 $0.00 Insurance $67,443.00 $23,214.00 Total Orpeiatinq Expenses $5.858.803.00 $95'1.499.71 $4.907.303.29 16.2.11c Net Fiom Opeiatioos 4174.193.031 (Cost of doing business prior to applying levy & outstanding rev) thastandiuq Revemres Outstanding Rate Appeal rev $12,000.00 $0.00 $12,000.00 0.00% Revenue - IGT Funds $350,000.00 $0.00 % of Outstanding IGT Rev $0.00 $0.00 0.00% Co Allocations (% Based) $944,665.00 $157,444.18 $767,220.82 16.67% Nursing Home Carry Over $191,000.00 $31,833.34 TotalOrutstanding $1.497.665.00 $189.277.52 $799.220.82 Net from all Sources $15.084.49 AGED RECEIVABLE REPORT: The aging Accounts Receivable report for Health and Human Services through February was reviewed. A report showing collection charges billed at full fee, sliding fee adjustments, insurance discounts, CSP discounts and write offs for January and February, 2009 was developed and shared with Board members. Strenke explained write offs and accounts that are moved to doubtful accounts. She said vendor expenses paid out for clients are in turn billed to the client. Currently, there are approximately 13,000 clients in ECHO. SAFETY AND SECURITY ASSESSMENT (JOHN SHILTS Haeny, Chair of the Safety and Security Committee, presented information on the Safety and Security Assessment St. Croix County Health and Human Services Board Page 6 April 15, 2009 conducted by John Shilts. The assessment was done in an attempt to make the work environment as secure and safe as possible. The facility has moved to single point of entry, added signage and reconfigured parking because of recommendations made. The Lynx system has been installed which added a `panic button' to every computer in the facility. If the button is activated, information is immediately transferred to emergency communications. However, there are no panic buttons in meeting rooms so remote wireless access to add this feature is being explored. Another item highlighted from the report is the lighting inside and outside of the building is an issue. It is recommended that additional security cameras be added throughout the building, the Nursing Home ambulance entrance, Nursing Home employee entrance and St. Croix Industries. Cameras could move if there is a building change. The fire alarm system is inadequate along with the public address system as it is difficult to hear in many areas of the building. The next steps in the recommendations for the assessment involve cost and may not go further due to the uncertainty of the future of the building. NURSING HOME ENGINEERING SURVEY Reiman reported there were three engineering cites given; however, no fines were attached to the cites. The plan of correction has been written and will be sent out by the end of the week. The gauges on the sprinklers need to be changed every five years. The sprinkler company will train staff and a form will be signed and dated when staff are trained. Rich Monn will make the needed changes. Smoke detectors in the clean linen room, which contains the auto - dialer, need to be moved as they were too close to the fresh air supply. A damper test log will be implemented. For generator tests, AMP rating needs to be 300 of the load capacity, which is identified on the name plate on the generator, and this is to be tested and recorded every fourth week and a generator log to show the three phases of amperage will be maintained. As an observation, the engineer indicated the fire drill log needs to have an additional column to indicate that dispatch was contacted for alarms to make sure the alarm went through to dispatch. Also, there are several empty rooms on second floor that were being used as storerooms. These rooms cannot be used as storerooms unless they have an auto -close door and a sign indicating storage on the doors to the rooms. The rooms have since been cleaned out. Also, there are not enough outlets in the rooms in the Nursing Home. Extension cords and adapters are not allowed nor are they acceptable. Building services staff is working to hard wire additional outlets. All of the above are corrected or scheduled to be done soon. Monn said overall it was a very good inspection. Nothing in the facility had been changed by Building Services since 1982; items listed above were just things that changed in the survey process as all observations had been acceptable in prior years. HEALTH AND HUMAN SERVICES PLANNING FOR OFFICE MOVES AND COSTS Kiesler said building services has renumbered offices so room numbers are more consistent throughout the building. Labeling appropriate room numbers on doors and getting consistent signage is estimated to cost approximately $3,750. To do the balance of the proposed changes of additional cabling, new breakroom, sink, countertop and miscellaneous plumbing plus miscellaneous materials, the cost estimate is approximately $1,850. Approximately 21 computer drops at a cost of $50 /drop will be needed. Headstart will take over the additional space vacated St. Croix County Health and Human Services Board Page 7 April 15, 2009 by Birth to Three, which will increase rent revenue from Headstart. It has also been proposed to the Sheriff that an office be prepared for deputies to have an office in New Richmond. This is not definite yet. Grant questioned if there would be a radio system in the deputy office. Kiesler said there will be approximately 35 individuals moving offices. The first phase of the move is anticipated to begin June 2nd Motion A motion was introduced by Berenschot, seconded by Larson, and unanimously adopted: That the Board approves mapping, move of offices and the costs to go along with the moves. The Highway Department made up new signage used in the exterior lots. COST TO COUNTY HUMAN SERVICES IN THE 2009 -2011 STATE BIENNIAL BUDGET Counties were requested to forward estimates and possible service impact to the Wisconsin Counties Association (WCA) for four major programmatic areas including Income Maintenance cuts, Youth Aids cuts, Mental Health charges, and Community Aids cuts for 2010 and 2011. Johnson reported Health and Human Services has been flat funded for years, and anticipated cuts in the proposed budget for 2009 -2011 will impact Health and Human Service. He reported 97 cases were added to Economic Support in March, which equals the number of cases added in January and February combined. Costs at State institutions have increased. The proposed budget will move the State portion of institutional costs to the county for youth and adults over 65. St. Croix County's resident population is also increasing so this adds to the burden of being flat funded for so many years. The impact of these cuts and cost shifting are significant to the county and estimated at approximately $600,000. Johnson reported the Nursing Home has already lost rate appeal monies for 2008. Bed tax increase will be diverted from Nursing Home to fund other Medical Assistance programs. Johnson plans to be in Madison on April 22 regarding Nursing Home revenue shifting and funding cuts. Whiting indicated there is no methodology regarding who should make program cuts. Johnson questioned how we can continue to receive these cuts and still provide the services we have in the past as the agency cannot absorb the cuts any longer. He said some grant monies may be available and staff are looking at alternatives. Johnson is meeting with the courts today regarding a joint grant application between Health and Human Services and the courts which is being spearheaded by Judge Vlack. Whiting said parent committees and departments will need to decide what to do with cuts in funds as we are not getting the revenue we used to get. Priorities will need to be set in the county regarding funding programs. Whiting emphasized this is a state -wide problem and does not affect only St. Croix County. Johnson reminded the Board that Long Term Care Reform and the care management organization transition reduced the County levy requirement over the next five years, but the bulk of those savings will not occur in the next county budget cycle. NURSING HOME ADMINISTRATOR'S REPORT Reiman reported the March census average was 67 and the census today is 66 with one resident in the hospital and one anticipated admission later today. Reiman reported there were ten Medicare St. Croix County Health and Human Services Board Page 8 April 15, 2009 residents in the last month and the Nursing Home also had nine Medicare B residents in therapy in the last month, so the Medicare payor mix has been very good over the last month. Reiman indicated he checked into the OSHA safety grant and found that it was a Minnesota program only and does not pertain to Wisconsin. Reiman indicated services from Omnicare Pharmacy have not been satisfactory and is looking into issuing RFPs through Dana Baker to local pharmacies for alternate pharmacy vendor possibilities. Reiman distributed a priority list of capital expenditure needs. Reiman said the braising pan will be removed from the list due to efforts put forward by Building Services employee Brian Cloutier to get the current braising pan repaired at a cost of approximately $700 versus replacing the braising pan at a cost $13,000. Reiman reported Cloutier, on mostly his own time, has saved the county over $25,000 in the last two months between repairing the braising pan and obtaining two tubs for the Nursing Home and recommended someway to recognize Cloutier's contribution and dedication. Reiman said dressers and bedside cabinets continue to be replaced as needed. He gave the following updated priority list for capital expenditures: 1. Standing frame - needed to better serve residents and possibly serve outside clients. The procedure now is labor intensive and is a worker comp hazard. The frame will pay for itself with use by therapists. 2. Furniture -to meet State compliance. 3. Electric beds - current beds are a worker comp issue. 4. New lifts - worker comp issue. 5. Ceiling fans with light kits. Johnson and Reiman will be reviewing the budget to devise a plan on how to proceed with the above listed needs. PERSONNEL ISSUES NEW EMPLOYEES /VACANCIES Johnson announced Tammy Wilson, RHIA, started in Medical Records on 04/13/09. Johnson is looking at consolidating management functions to possibly combine with the Nursing Home medical records needs. Johnson said Frank Robinson is scheduled to start as Nursing Home Administrator by the end of May. Johnson indicated Robinson has a significant amount of nursing home administration background. PUBLIC HEALTH PREPAREDNESS ANNUAL REPORT FOR 2008 There are 11 counties in the Western Region Partnership for Public Health Emergency Preparedness. Of those 11 counties, St. Croix County scored the highest in the region on a competency test for preparedness. Kramer encouraged that each of us have a preparedness plan for our own family. Kramer outlined several achievements for preparedness St. Croix County accomplished in the last year. A phone banking policy was developed in partnership with HHS and Emergency Communication staff to allow additional communication with the public during emergencies. Personal protective equipment such as respirators, gloves and hand -held radios were stockpiled. Staff participated in a successful functional exercise focusing on response to pandemic influenza. St. Croix County Health and Human Services Board Page 9 April 15, 2009 JUNE 15 PREPAREDNESS FUNCTIONAL EXERCISE IN PUBLIC HEALTH Kramer announced there will be a City Readiness Initiative exercise on June 15. This exercise will use the incident command system and will be an anthrax initiative. The exercise is not open to the general public; however, Board members were invited to attend. PHOTOVOICE EXHIBIT IN PUBLIC HEALTH Johnson encouraged Board members to tour the exhibit set up in Public Health after the meeting. This exhibit is part of the Community Needs Assessment. 2009 BUDGET PLANNING /TIMELINE FOR DHHS AND NURSING HOME- PLANNING FOR JUNE 17 OPEN HEARING The open hearing is planned for 6:00 PM on June 17 with a short HHS Board meeting to be held prior to the open hearing. CENTRALIZED INTAKE FOR BEHAVIORAL HEALTH AND FAMILY & CHILDREN'S This item will be delayed until next month. Wentz asked if there were any other issues to bring before the Board. Johnson read proclamations announcing this week is Public Health Week and next week is Economic Support week. Johnson distributed a petition in support of a statewide clean indoor air act. Wentz adjourned the meeting. Time: 11:20 AM Chair: Attest: (Secretary)