Health Care Center Ad Hoc Committee Meeting Minutes

DATE: February 28, 2005

PRESENT: Arthur Carlson, Linda Borleske, Larry Volz, Tom Bychinski, Paul Endres, Al Dippel, Joan Wheeler, Joan Fordham, Judith Stoeckmann, John Earl, Jeanne Leeck, Sue Hebel, Diane Keylock, Lisa Buttonow, Gene Wiegand, Kerry Beghin, Kathy Schauf, Bill Orth

1. Called to order at 6:30 p.m. by Art Carlson. The open meeting law requirements were met.
2. Motion by Borleske, second by Volz to adopt the agenda. Motion carried.
3. Motion by Earl, second by Fordham to approve the minutes. Motion carried.
4. We did not have public comment on the agenda, however several people in the audience wished to speak. Gene indicated that per Todd (from county board meetings) we can accept comment if it is voted on and approved by the members of this committee.
   
   Motion by Stoeckmann, second by Borleske to grant approval to hear from supervisors who are not members of this committee as well as the public. Motion carred with the direction to limit the comment to 5 minutes.
   
   Art mentioned that Chairman Wenzel asked him if this committee would have a special meeting with the board members.
5. Public Comment:
   Rose White spoke in favor of keeping the HCC open and wanted to see what direction the committee was going to take.
   
   

   Tom Kriegl presented a handout to the committee regarding his concerns. Felt this committee did not complete the assignment that it was given. Need to get more information to the county board and give them a longer period of time to study it.
   
   Judy Ashford felt the committee needed to focus on the continuum of health care and it focused on building a building. Felt some key pieces of information were missing from the summary report.
   
   Jeanne answered some questions posed by Judy. Rates comparison as of 12/31/03 - Snyder's - SN=$174; Greenway Manor - SN=$156; Maple Ridge - SN=$160, ISN=$204; St. Clare Meadows - SN=$175, ISn=$240; Pine Valley - SN=$155, ISN=$182; SCHCC - SN=$148, ISN=$158, SCHCC is mostly MA - 87%. Average loss per patient per medicaid day is $20. This is only an average. Available beds in the county varies from day to day. Gene reminded the committee that facilities can't by law accept residents for whom they cannot provide appropriate care. Also, there are many other problems associated with admission.

6. Evaluation of data, committee recommendations:
   Judith S. felt the services, gaps etc. need to be discussed further. Kathy indicated that after the meeting regarding county services available, the consensus of opinion was that the only gaps were caused by lack of funding/facilities. Some overlap of services due mainly to overlap of populations served. We do have waiting lists for services and some services that we need such as dementia units, respite services, specialized treatment units, residential services and adult daycare. Paul indicated that the committee came to conclusion that this committee was not going to try to determine what kinds of services were needed but rather do we stay in the business. All departments are now more aware of how they interact and is a continual process of working together. Judith wants to see how residents flow through the system.
   
   Gene felt tere was a fundamental misunderstanding about the charge of the committee. Committee was charged to look at the long term care services at the HCC. Find out if they were a necessary part of that continuum. The Committee mostly feels that they have done that and their services are necessary for the support of all of the other elements of the continuum. Bill Orth explained that when all options are exhausted or the money isn't there the only place that MA will pay for care is the nursing home. There is a significant need for nursing homes in any county. What is unique about the HCC is the Alzheimer's Units and the ICF/MR. All nursing homes will take Alzheimer's residents, however we have a specific unit set aside with an appropriate environment and specially trained staff. Orth stated the funding is not there for the services needed, especially in the community. Tommy stated that the committees ultimate decision was whether or not to stay in the health care business. It was voted on at the last meeting 10 - 1 that the county stay in the health care business. Joan Fordham indicated that the county will need X number of nursing home beds in the future. The question is who is going to operate the nursing home - Private or does the county retain control. Continuum of care is going to be an ongoing discussion. The resolution we sent to the board stated that we think the county should continue to operate the NH. Felt the county board did not understand/agree and voted it down. We eventually will need 2/3 majority of the county board. Need to pull the board together. Questioned the role of the Chairman's Advisory Committee, timing of when we need to get this done and need 2/3 of board with us.

   Gene indicated that in 2007 the debt on the West Square building and the Huber Center expires and we could take advantage of the gap in financing. An alternative would be to place the item on a simple majority vote to proceed and proceed to referendum for the voters to decide. A concern would be that there are some significant systems in the current facility in the building that are in danger of failing.

   Joan Wheeler also had the impression that our mission was to look at the entire spectrum of care. We don't have enough money to provide all of the services necessary. Need to look at where the HCC fits into the entire spectrum of care and look at the other services we could provide if more money were available from the county getting out of the nursing home business. Feels the assumption that no corporation/company will fill the gap left if the county closes the HCC is wrong.

   Linda agrees with Joan Fordham that the committee has done what it was charged to do but some questions are still out there. Felt we need an open forum type meeting with county board members for them to ask questions. Need information such as Private Pay rate comparison, census of where our residents come from, but we first need to have the resolution ask the question of whether or not we should stay in the business. Should have allowed the board one month to analyze the information. Larry indicated that he has talked to a lot of people from the Baraboo area and they are all supportive of the HCC. It doesn't just benefit the Reedsburg area. We should listen to our constituents and the general public from the public hearings and support it.

   Art quoted several articles from the State Journal in which private for profit homes put corporate profits ahead of the needs of the residents. Also quoted a Dr. who studies long term care saying that "we are going to have to spend more if we want quality care". The incompetence of our state government doesn't necessarily mean that our county must act the same. On page 7 of the final report gives results of a study done by the Legislative Audit Bureau in 2000 documents that a county operated NH tend to have a higher percentage of residents demonstrating challenging behaviors on a statewide basis. Page 10 - closure would quickly overload the existing bed supply and waiting lists for care would increase significantly. Page 22 - when looking at privatization, there was no one interested in taking the current population, only one would take some of the residents. No provider interested in taking over the whole business. Two Physicians that spoke to Art recently, indicated the importance of keeping the HCC open.

   7. Gene summarized the Resolution. 1) Should continue to operate a skilled nursing facility. 2) A Health Care Services and Planning Committee be formed to study mix of services that should be provided within this facility. 3) The HC Services Committee include representatives from those committees, commissions and boards representing departments and agencies most likely to provide services to the elderly and disabled. 4) Encouraged to examine a range of alternatives to recommend solutions.

   5) That the HC Services Committee have roughly a year to report to the board. Discussion followed.

   Joan Fordham asked about the Chairmen's Advisory Committee and where it may fit in this process. Gene explained that it meets at the call of the chairmen. Is a forum in lieu of having a special board meeting to hash out all of the information. The fiscal note was read and is the same as on the old resolution. This resolution does not change the current budget so does not need a 2/3 majority.

   Tommy Bychinski called the question.

   Motion by Bychinski, second by Volz to support the resolution recommending that Sauk County continue to provide inpatient skilled nursing services to the residents of Sauk County. Roll Call vote: Aye - Bychinski, Endres, Volz, Fordham, Borleske, Earl, Dippel, Carlson. Nay - Wheeler, Stoeckmann. Motion Carried.

   8. Motion by Bychinski, second by Endres to adjourn. Motion carried.