DATE: October 27, 2004
PRESENT: Arthur Carlson, Larry Volz, Linda Borleske, Tom Bychinski, Paul Endres, Al Dippel, Joan Wheeler, Joan Fordham, Lowell Haugen, John Earl, Judith Stoeckmann, Cindy Bodendein, Kerry Beghin, Jeanne Leeck, Lisa Buttonow, Bill Orth, Carol Jeffers, Sue Hebel, Trish Vandre, Diane Keylock, Kathy Schauf
Community Program numbers - Community Integration Programs (DD persons who are relocated from state centers or nursing homes) - 149 being served - 93 on waiting list. Brain Injury Waiver Program (Brain injury persons relocated from rehab centers or NH) - 6 being served - 3 on waiting list. Community Options Waiver Program and Community Integration Program (Frail elderly and persons with physical disabilities) - 230 being served - 83 elderly and 34 physical disabilities on waiting lists. Community Options Program (Elderly, physically disabled, developmentally disabled and persons with serious mental illness - pays for some services that MA waiver programs do not pay for - 101 being served 106 on waiting list.
Barriers to services include a lack of cost-effective living choices in Sauk County, low and unskilled labor force for in-home services and assisted living facilities, not enough specialized treatment services for challenging people (dementia, developmentally disabled and medically intense).
Trends seen are an increase in Assisted Living facilities and a decrease in nursing home and FDD use, "Campus" concept in new construction, aging population, many issues of choice, shrinking labor force and higher acuity.
Funding for Human Services Programs - For COP and Waiver funding 46% is federal; 37% is state and 16% local - projected for 2004 year end. Other programs funding 12% federal; 12% state and 76% local - projected for 2004 year end.
Commission on Aging - Mission is to "...assist the 60 years plus population by the provision of programs and services designed to maintain an optimum of independent living." Services are provided to people needing help to function independently to remain at home. People can access answers to their questions, find out about resources in the community, check benefit eligibility and enroll in programs that would assist or prolong their independence. Aging services are required to engage in advocacy and find services that fit people not fit people to services. Volunteer staff are widely used for transportation, meal delivery, nutrition site operation, special projects, newsletter and office projects. Efforts are made to develop awareness to the public about resources offered through the newsletter, our Web site, staff appearances on radio and in public appearances. There also is a toll free number for information and assistance. Statistics are a requirement of the grants received. Are able to track services by client and call requests by program.
Home Delivered Meals - Ave. 123 meals with majority being 85+ years old. Need additional funding for continuance of growing demand, expanded routed, and more volunteers. Trends are extension of routes into rural roads, younger seniors donate less for the meal than older seniors, children of seniors donate more for the service their parent receives, home delivered meals is growing much faster than congregate meals. Barriers are depending on volunteers, price of gasoline, county terrain, inclement weather, medical professionals not as educated about the program as needed. Funding is mainly from the federal government and donations with the county only funding $900.
Driver Escort Program - 39 drivers, 126,428 miles driven, 4,604 one way trips. Unduplicated people served is 435. Purpose of trips was medical, personal, and nutrition site transportation. See the need for dialysis routes and cancer routes scheduled for long term. See trends as increasing demand for MA clients of all ages. Requests have quadrupled this last year.
Aging Resource Center - Funding mostly from state money. Barriers seen are Human Services workers seem uninformed regarding transportation service limitations and MA procedure, grants require data on each rider, dispatch transportation takes more staff time, but is better and more efficient, depend on volunteers with 48 hour notice, and increased cost of fuel.
Staff Transportation - County Staff/Vehicles. 1198 one way trips with 18,943 miles driven for medical, personal shopping and Miles of Smiles trips. Need replacement vehicle holding more than 10 passengers. Trends seen are younger people taking the fun trips, need for senior grocery shopping day and expand the coverage to other areas of the county. This needs the support of grocery stores for funding. Barriers are limited funding. Most of the funding is from the state and Trust.
Chore Service - Provided by county staff, able to monitor client changes and report back. Cleaning offered every 2 weeks for 1 1/2 - 2 hours. Currently 42 clients served. Funding is mostly federal and county. Needs seen are service designed to stabilize persons at risk. Trends are demands centered in the Baraboo, Reedsburg, Sauk City and Spring Green area. Barriers are part-time workers time limits ability to accept more clients, federal funding not increasing to meet any growth needs.
Benefit Specialist - Information and counseling on benefit programs. 146 clients served with 2,150 client hours. Need staff to meet need of on-call questions and answers and more donations to support the programs. Trends seen are the elderly population is exposed to more program changes that they don't understand and programs are complicated. Barriers seen are the Elder Law Center supervises legal work, county supervises daily time. Awareness of the issues limited access by Aging Unit. Funding mainly from county funds.
Congregate meal sites. Seven lunch sites for nutrition and socialization. 17,615 noon meals served yearly with daily average of 71 meals. Need more transportation choices, more health education/screenings and more exercise activities. Trends seen are balanced noon meal is a prevention service, keeps person healthier while recovering from illness, more caregivers are using the service, younger seniors donate less than the older seniors. Barriers are volunteer supply, price of fuel and affordable site rental. Funding is mainly federal.
Information and Assistance - Local and 800# telephone help line with live phone staff plus walk in assistance. Served 1,704 clients with yearly calls being 13,973. Information provided by newsletter, Web site and tape. 3,600 Newsletters mailed and the Healthy Aging Fair attendance was 770 for 2003. Need more staff time for data entry, full time nurse to counsel clients, and build library of more information. Trends seen are value of correct information to assist residents to stay at home longer and function in the system, Social Workers use as resource for clients. Barriers are lack of Day/Respite Care, other long term care staff do not share information, shared central information data system, lack of information from other county departments regarding program status. Funding is mostly federal.
Family Caregiver Support - Reimbursements of respite caregiver expense. 12 approved in 2004 program. Need money for continuance of program and expansion. Trends seen are number of applications increasing each year. Caregivers need more help with home based nursing services, anxiety and guilt of caregiver, elders do not want outside interventions. Barriers are federal money does not keep up with growth and county lacks facilities that offer respite drop off or respite service. Funding is federal.
Public Health - Sauk County Home Care is state and federally certified and provides skilled nursing, home health aide services, and physical/occupational/speech therapy. There are 5 home care nurses and 4 home health aides. Therapy services are contracted through four different companies. Foot clinics are held in seven communities with an average of 130 people seen each month. Referrals come from hospitals, nursing homes, family, friend or self referral as well as through contracts with an infusion company and insurance companies. Medication management is contracted through the Magdalene Home.
Funding source is Medicare (68%), Medicaid (24%), Private insurance (3%), private pay (1%), Magdalene Home (3%), and contracts (1%) with Chartwell infusion company. Home care services are subcontracted by Sauk Counnty Home Care for the WEA contract that is managed by Chartwell. Sauk County is the preferred provider for home care for Blue Cross Blue Shield insurance. Home care has gone from cost based system under Medicare to a prospective payment system in 2000. Sixty day episodic payments are made and services provided to meet patient need and stay within the dollar amount allotted. Medicaid payment is based on set rate, which is less than the cost of service. No tax levy is used for home care.
Major admitting diagnosis are Cardiovascular (27%), Respiratory (18%), Arthritis (15%) and Diabetes (13%). A total of 152 patients were served in 2003 and 173 episodes (up to 60 day period)
Barriers to home care are cuts in reimbursement, availibility of therapy in Sauk County and referring hospitals and nursing homes are not gving patients a choice of home care agency.
Trends are decrease in home care agencies, difficulty providing therapy services, decreased payments, and increased requests for private pay services due to lack of health insurance.
Veteran's Service Office - The Veterans Service Office assists elderly and disabled veterans and their dependents in applying for and using Veterans benefits.
VA Non Service connected pension - Wartime veterans only. Benefit based on income, assets and disabilities. 141 veterans served. Turnaround on VA decision of claim is 6 months. Funding is federal. Barriers to service are individuals being over the income and asset limitations and not being notified when a veteran is admitted to a nursing home.
VA Widow/Widower Pension - Wartime veterans dependents only. Benefit based on income and assets. Approximately 20 widows/widowers served in Sauk County. Turnaround on VA decision is 6 months. Federal funding. Same limitations as above. Trends seen are more individuals not being eligible for benefits due to income and asset limitations. More individuals that are receiving benefits becoming eligible for medical reimbursements from the VA.
VA Hospital System - Veterans only. Approximately 1039 veterans served on an outpatient basis in 2003. Services included are regular hospital, nursing home and hospice care. Funding is federal. Barriers are availability of beds, only those that are 70% or more service connected are admitted. Trend seen is Viet Nam veterans' health is declining and they are becoming disabled at an accelerated rate.
Wisconsin Dept. of Veterans Affairs Homes - Available to veterans, spouses, widow/widowers of veterans and parents of veterans. Are assisted living buildings as well as skilled nursing homes available including Alzheimer's beds. There are currently no waiting lists at these homes. Sauk County has 12 residents at King and none at Union Grove. Federal, state and individual funding. Barriers of service include availability of beds and the family not wanting the individual to be so far away from them. Trends are more effort being made to try to keep more veterans at home rather than admitting them to nursing homes.
Transportation to VAMC appointments - Veterans only. Transportation is provided to veterans to VAMC's in Madison, Tomah and Milwaukee. Will have transported approximately 492 veterans to VA facilities in 2004. Use volunteer drivers and have access to the Disabled American Veterans handicapped van. Primarily Sauk County funding and a transportation grant from the Wisconsin Dept. of Veterans Affairs. 2004 budget for mileage and meals was $24,680. Grant from WDVA was $2,362. Veterans are charged CO-payments for round trip. Barriers to service are availability of volunteer drivers. Trend of more veterans using this service and we have fewer volunteer drivers.
Opinion and Recommendations - It is our opinion that there is a need for a facility for hard to place individuals such as locked units for residents with behavioral issues, Alzheimer's and dementia. Would like more interaction with the nursing homes in Sauk County. Currently have 11 residents at the SCHCC. In 2003 we had approximately 20 residents in other nursing homes in Sauk County. Feel there should be public hearings regarding the HCC.
Sauk County Health Care Center - Our mission is to provide Sauk County area citizens with high quality 24 hour individualized nursing, rehab and supportive care services to maximize personal independence. Our average resident is a Sauk County citizen over the age of 84 who has MA as a pay source. They have a skilled level of care with a primary diagnosis of dementia (38%), cardiac problems (37%) or congestive heart failure (25%). All residents need the assistance of one staff and 67% need assist of 2 persons to transfer or evacuate. 62% have behaviors which justify use of psychoactive drugs. 37% of admissions stay less than one year. Our primary referral source is the hospitals (94%) for short term rehab or hospice/terminal care. 15% of admissions are from home for the dementia unit. Our discharges are mostly to home with services in the home (51%) or pass away (34%). Of our rehab admissions 80% are discharged home with services or to a group /assisted living facility (15%) Also gave summary of our DD population. Those residents are mostly Sauk County residents between 20 and 64 with MA as a pay source. Most residents have stayed more than 4 years. As of 1/1/05 we will not be able to admit residents to this unit and will be working to discharge more residents to the community. These statistics are from the Annual Survey of Nursing Homes. We currently have a waiting list of 2 for the Nursing Home and a long list for the dementia units. Our funding sources are MA (79%), private pay (18%) and Medicare (8%).
Services Provided: Nursing - 24 hour assessment and monitoring including palliative/hospice care and pain management. Also do medication teaching, preparation for discharge, dietary, diagnosis teaching, OT in home community visit, resource for Home Health, support ant training for families, referrals, Psychiatric follow up, Psychological consultation, Pharmacist consult, appointment transportation. Also are services provided by Dietary such as meals, consultation, training/teaching for resident and families. Social Services deal with psycho-social adjustment. Can extend to referrals for legal services, Commission on Aging programs, financial and legal referrals, advance directives, plans of care. Work as a liaison between what is wanted and what is possible for resident. Laundry assures clean linen and personal clothing, marks clothing, have closet of extra clothing to give to needy residents and the community. Medical records provide information to other agencies, provide electronic transfer of information for billing and funding reo reimbursement, focus for HIPAA, privacy for resident records, historical data information. Environmental Services provide cleaning services for facility, coordinated repair and maintenance of living areas, odor control, pest control, loan closet for equipment for residents as well as the community, manages donated clothing for residents. Maintenance manages the ongoing challenges of operating an old facility, vehicle repair and maintain four rental units as well as pasture and crop land. Volunteer Coordinator does grant writing, helps out with planning for community contact, maintains a volunteer group. Therapies - contracted program for speech, physical and respiratory therapies. Starting an outpatient Physical and Speech Therapy area to begin another source of income. OT is in house and works to ensure home safety after discharge as well as wheel chair maintenance and other adaptive equipment needs. FDD Unit - 24 hour residential care that includes skilled nursing as well as behavior programming. Have also a sub-minimum wage program to provide job experiences for Clients.
Possible future services suggested are adult daycare, thrift store/resale shop, another dementia specific unit, transitional unit for DD clients moving to the community, elderly meal site, assisted living site, hospice rooms, respite rooms, outpatient OT/PT/ST, elderly health screening, transportation services, community education, out source home care services such as laundry/housekeeping/dietary, secure unit.
Barriers to these services are funding, renovating/building space for services, licensing/insurance, staffing, training, getting volunteers, increased need for sheriff/courts/Human Services/emergency transportation.
Trends seen are increased need for short term rehab beds and dementia care; increase in referrals of younger people with no pay source, AODA people, aggressive violent behaviors; and more budget restraints in all areas. We also see increased need but fewer workers available. See increase in Sauk County population in those aged 65 and up and an increase in occupancy. We need to work together to deal with funding cuts we all have.
We all need to be more creative in revenue sources and serve the most people in the most cost efficient way through the most effective use of staff and resources.
Discussion of next steps and future plans. Need of all departments to share data so needs of population are met. Discussion of single point of entry and need for centralized data base to better manage cases. Infrastructure is lacking in the county to manage this as well as funding challenges. Some overlapping services seen such as meals on wheels, transportation, chore services. All nursing home beds are subject to bed tax whether occupied or not. This includes rehab beds and respite beds. We can bill to hold beds for individuals. Locked unit would be for more disoriented, physically aggressive person, threat to self or others. Very costly unit to develop and would be an additional financial drain on this county. Felt it was a very positive thing for the departments to get together and share problems and ideas and an opportunity to work together on more projects etc.
There are a number of other agencies such as hospitals, other nursing homes etc. who also need to be heard. Public hearing also may be in order. Next meeting structure a public hearing with people specifically invited to address the issues and open it to the public for their input. Also look at other data we need to collect to get to the point of decision making. Also was a question brought up at board meeting as to the cost to the county if the Health Care Center were to close. Jeanne and Sue will need to get together and go over our residents one by one and come up with a cost associated with relocating residents and closing the HCC. List of assumptions would have to be made before the costs can be estimated. Also need to include costs of unemployment for 180 workers etc. Need to also understand that the way the HCC budget is presented in the budget book the use of tax levy by the HCC is overstated by $670,000. This is due to IGT payments. Also request made by non member to develop one list of the barriers to providing services seen by different departments.
Motion by Volz, second by Endres to adjourn.
Motion carried.
Meeting was adjourned at 11:35a.m.
Paul Endres, Secretary