DATE: November 10, 2004
PRESENT: Arthur Carlson, Larry Volz, Linda Borleske, Tom Bychinski, Paul Endres, Al Dippel, Joan Wheeler, Joan Fordham, Lowell Haugen, John Earl, Cindy Bodendein, Kerry Beghin, Jeanne Leeck, Lisa Buttonow, Bill Orth, Carol Jeffers, Sue Hebel, Bev Muhlenbeck, Diane Keylock, Kathy Schauf
Mark Scoles, Administrator of Greenway Manor of Spring Green. 60 bed for profit nursing home and 24 apartment RCAC. Similar comments to Mr. Graves. Close to being filled in both units. Keefe reported that the SCHCC average cost is $194 per patient day compared to $136 for others. Staffing hours are reported to be 6 hours per patient day compared to 3.5 for others. That is why the HCC has to be subsidized by 3+ million per year. Recent finance committee report with a current tax levy of 2.4 million; two years ago was 1.4 million. IGT for 2005 is $670,000 plus transferring funds of $469,000. Are short approximately 3.5 million dollars from what Medicare and Medicaid reimburses. Greenway Manor makes a profit on what are paid. Private enterprise should take over. There is a need out there but private enterprise will fill the need. Even if the beds are given away it would be a dramatic savings. Building should be the last resort if private industry doesn't take over. Other agencies could use the savings for their programs.
Q & A: No one has been turned away from Greenway Manor because of pay source.
Lisa clarified that private industry gets higher reimbursement rate for Medicaid. IGT payments are not used to lower the tax levy of HCC. Medicaid reimbursement does not cover costs but with Medicare Greenway Manor makes a profit. Keefe study indicated that only a slight decrease in staffing would be seen with a new building. HCC also has other high costs such as pension and insurance. Linda stated that the study has some discrepancies which may be clarified at a later date.
Ron Schaetzl and Sandy Anderson of St. Claire. St. Claire is licensed as a 100 bed hospital with 56 beds staffed. Part of SSM Health Care of St. Louis. Primary care facility. Branching into tertiary care. Are currently constructing a radiation/oncology unit. Affiliated with Home Health United, Meadow Ridge (CBRF) and St. Claire Meadows (Nursing Home). Technology will impact the number of patients needing certain services in the future. This area has a faster growing elderly population than either national or state average. Feels Home Health Agencies do compete with Nursing Homes. Previously, residents had to go to nursing homes for services they now get in their homes. We need the nursing home beds that are at SCHCC to care for our aging population. Look at creative ideas that other markets have done. Always will be declining reimbursements and demand for better care. St. Claire is committed to work with the county towards that goal. Ron Schaetzl, Administrator of St. Claire Meadows Care Center. 102 bed skilled nursing facility with 25 bed CBRF attached and part owner of another 24 bed CBRF. Business has changed dramatically. Have a higher Medicare mix - 16%. Get a lot of very sick people. Medicaid is 60%. 25% is private pay. Full most of the time. Plan a future 4 bed hospice unit attached to St. Claire Meadows. Renovation to facility to get more private beds. Also looking at building 16 bed Alzheimer unit attached to Meadow Ridge. Have a good working relationship with SCHCC. Residents move back and forth. Outagamie and Calumet counties have recently undergone building projects which should be looked at. Staffing is 3.5 hours per patient day - close to state average.
Q & A: Have some residents who can not take because of dementia/behavioral issues. Can send to Clarion Center for short time. Have sent some of those to HCC or to Madison. Hospice center is being built partly through charitable donations. Locating NH in the city has the benefit of being easier for staff to get to work and easier for relatives to visit. St. Claire would be interested in at least evaluating the possibility of working with the county for future building of long term care unit. Have very low turnover rate - good leadership and benefits.
Clare Gaston , Social Worker at St. Claire Hospital. Very long term employee of St. Claire. Can't imagine doing her job without the HCC. People can't get into St. Claire Meadows and the alternative is SCHCC. Need the beds in Sauk County. Have a short time to make a decision as to where people will go when discharged.
Q & A: Having a single point of entry for services after discharge would be easy, however their department usually does all of the "shopping" for services for the family. Have a discharge planning team so preliminary plans are already made for the patient.
Brenda Reisdorph, Snyder Nursing Home. Snyder's is a 50 bed not for profit facility and became Medicare certified within the last two years. 98 - 100% occupancy. 20% private pay and Medicare and 80% Medical Assistance. Acuity levels are higher than in previous years. Staffing ratio is 1 RN to 25 patients and 1 CNA to 10 patients. Majority of residents come from the hospital but have transferred to and received residents from the HCC. In same area have Independent Senior housing of 63 units. Are currently building a new nursing home of 50 beds -same size. Will also include 24 assisted living beds and 2 hospice rooms. Opening in October of 2005. Also in past discussions regarding the HCC and possible joint planning - Syndic's does not want to inherit union problems. Are in competition with HCC however each serves a function such as dementia care at HCC. HCC has staffing issues because of union affiliation and a multilevel building. In future need to access and use our resources better. Need for sharing and collaboration. Started a Sr. Share Group - resources out there etc. We expect to have many more older people in Sauk County to care for in the future. SCHCC has provided excellent care in the past and had cite free surveys the last 2 years.
Question/Answer: Would have cost just as much to renovate as to build new. Strategic Plan calls for a Senior Care Campus concept - Assisted Living, Senior Apartments and Nursing Home.
Wade Welper of Dungarvin. Support people with disabilities and related conditions. Run three homes in Sauk County for people with disabilities. Person centered philosophy. Money is currently tight so are trying to develop two person homes. Develop plans to best meet the needs of the person. Trying to do things more efficiently in these times of tight money.
Q & A: State is trying to get rid of/downsize ICF/MR's. In Sauk County work with the county case manager. Either provide support services in clients own home or ( in this county) provide services for high need clients. Cost varies depending on the needs of the clients from $200 per day to $700 per day. Funding provided by federal/state/county.
Dawn Simonson from VARC (Vernon Area Rehab Center, Inc.) a private non profit corporation. Have an operation in Viroqua and in Reedsburg serving DD, mentally Ill or brain injury clients. In Vernon County have an 8 bed CBRF, two homes with 24 hour assistance available with 2 residents in those, and 12 people in their own homes getting in home support. Currently serving over 200 adults with disabilities. Have a staff of over 300. Contract with businesses and employee people with and without disabilities. Focus on employment. Total budget supported by 45% production dollars and 55% federal, state and county dollars. 24 hour care homes are $126/day, CBRF is $101/day, 24 hour home is $126/day, supportive apartment program is $26/hour for services.
Q & A: Some clients from the HCC have spent part of the day at VARC. Some clients become unable to spend the day of programming so are referred to the HCC. Sauk County Social Workers are case managers. When HCC FDD unit is no longer open the clients would be referred to the County Social Workers. Are interested in developing a place for this population. Some clients can go into the nursing home, would utilize the day services program, some will have to remain in a facility of some sort. Long waiting list for funding and mandate to care for them. Court will annually review clients who remain in a facility.
Janet Pearson, Bureau of the Blind. State run program providing free vision services to area citizens. Visit people wherever they are to help them stay as independent as possible as it relates to vision. Go to the SCHCC frequently. Recommend lighting changes, environmental changes, magnification, etc. Also refer to other professionals for services.
Joan Wucherer, Baraboo Senior Center. Are located in the Baraboo Civic Center. Provide programs and activities for senior citizens in the area. Hoping to move to larger quarters soon. Have medical screening programs such as blood pressure, vision etc. Would welcome anyone to come and speak to the group.
Shelly Parrish, Rural Respite. Program of Northwest Dane county Senior Services, Inc. Provide day services to seniors in the area on sliding scale basis. Have social interaction, therapeutic activities designed to improve or maintain mental and physical well being and independence. Provide services one day a week in Mazomanie, Mt. Horeb, Baraboo, Sauk City/Cross Plains. Have 23 Sauk County residents enrolled. Paul attested to the fine service provided by this agency.
Jane Zwart, Bethesda Lutheran Home (non profit) head quartered in Watertown. Established 100 years ago. Provide primarily residential services to the DD population. Have branched out to vocational, day services and supported employment. Have one group home in Reedsburg and one in Baraboo and some in-home support. Bethesda began down sizing after 2000. Starting Jan. 1, 2005 will be a different funding source. Clients who have moved out of ICF/MR's have blossomed in the community. Can not receive the level of care outside that they can receive in an institution, however we work to provide as many services as possible in the community. In the process of developing mental health clinics for people with disabilities. Currently have one in Watertown. Barriers are lack of accessible housing. Have built 6-8 bed CBRF's and adult family homes. DD residents with challenging behaviors need houses which have sturdy physical surroundings so are building those also. Have 23% turnover rate for staff. Funding - have found help through down sizing state initiatives and CIP funding. Would be very interested in working with the county and the HCC. Have recently gone through a major remodeling of older buildings. Currently at 200 residents. Looked at many ways to reduce costs.
Q & A: Adult day care is more medically oriented. Day services/vocational programs are more work oriented. Can retire also and provide services at home for those individuals. Mental health clinic will be open the beginning of January. Hope for this program to grow.
Rita Mead, Patient care manager of Home Health United. Private non profit home care organization. Provide the usual home care services along with hospice and durable medical equipment. Disciplines include skilled nursing, home health needs, PT, OT, Speech Therapy, Social Work and Respiratory Therapy. Are expanding their tele-health program. Monitors in the home to check heart rate, etc. Information sent to office directly to cut down on the number of visits needed per week. Rating is consistently high. Funding is mainly Medicare, Medicaid, private insurance and then private pay. Office in Reedsburg serves between 105 - 110 patients. Sauk County serve 120 - 150 residents. Works in partnership with the SCHCC. HCC is well known for excellent rehab. One of 4 Home Health agencies in the county. Need for them all and give the residents a choice. Appreciate the HCC being there and support the building of a new one story facility. Provides wonderful care.
Q & A: HCC is often the only facility with room to place residents. We need the beds in this county.
Joel Gaalswyk, County Supervisor. Appreciates the discussion and information provided. Goal is to gather information on his own to work towards a discussion on whether or not the county should run the nursing home. Important to have an exchange of ideas among supervisors. He is not convinced that the county should be in the nursing home business. Thank you to the staff for setting up this meeting.
Kathy summarized the meeting however felt that gaps in service were not addressed. Handed out written presentation by Pat Hamilton of Baraboo Community Development. Mr. Kriegl felt further discussion is needed on changes in technology and its impact on long term care. Joan Wheeler asked where FDD residents go now if there aren't facilities out there for them. Mr. Orth stated that after January 1, there will be a review and the judge makes the decision on placement. Will go to the most integrated placement possible. Some residents will go to the nursing home. Will be some residents that will have to remain in a facility and the state hasn't planned for that yet. CBRF's have a lot of different licenses for providing different levels of care. Joan proposed that we have a public hearing and invite people getting services or their relatives and also hear from other counties who have made the decision recently. Invitation to counties will be the next meeting in approximately two weeks and public hearing in one month. Bill and Sue have met with Jeanne and looked at residents of the HCC and are in the process of estimating the costs associated with closing the HCC. Could have that done for the next meeting. Paul indicated that the full board approved the transfer of funds to be used by the ad hoc committee as they need. Would not be available until next year.
Meeting was adjourned at 11:40a.m.
Paul Endres, Secretary