DATE: June 22, 2005
PRESENT: Linda Borleske, Larry Volz, Paul Endres, Joan Wheeler, Joan Fordham, Lowell Haugen, Judith Stoeckmann, John Earl, Jeanne Leeck, Gene Wiegand, Kerry Beghin, Kathy Schauf, Bill Orth, Sue Hebel, and Tony Tyczynski ( Veterans Service Officer)
Veterans Service Office - Tony Tyczinski, Veteran's ServiceOfficer. Assists veterans by the use of Federal and State benefits. Have Pension benefits, the VA Hospital System, Health Care Aid Grant and transportation. Interaction with the county is mostly referring veterans to county programs. Hasn't seen gaps in service. Past communication problems with the HCC have been eliminated in that the HCC now advises their office of all veteran admissions. The county provides $4,000 per year for Veterans Relief Trust Funds which are intended to be a one time benefit that provides vouchers for food, car repairs, rent etc. Get some requests they can't fill (1 out of 10 in the last three months). Also are referred on to other agencies. Have some problems with community awareness of the help available for veterans. Mostly help veterans, however some dependent help also available.
Commission on Aging report presented by Kathy Schauf. Services depend on the functional ability of client and financial condition. First tier of services are for anyone that calls, information and referral etc. Second tier of services are for clients who need a few services to remain in their homes - home delivered meals, transportation, chore service, etc. Third tier of services is seniors at risk of losing their independence. Additional services would include home adaptations, adult day care etc. Last tier is clients in need of a long term health care setting. These clients still need some services (i.e. counseling, information etc.). Gaps seen are lack of local adult day care, lack of subsidized housing or assisted living options, limited COP funding to sustain clients in the community. On the horizon is implementation of Medicare Part D - will be less money available.
Committee would like list of individuals served, kinds of services they receive, and waiting lists. Presentation last year included many of these statistics. All services under first tier are no charge to consumer. Some of the remaining services have charges such as home delivered meals (suggested donation), transportation, or chore service. Services are not income dependent but age dependent. Some financial need component so Trish should be asked about that. Also would like list of anticipated future needs.
Health Care Center - Jeanne Leeck. Statistics are basically the same as last time and are from 2003. We currently have triple the Medicare residents now than we had 6 months ago. Short term rehabilitation is one of the areas where we get adequate reimbursement. Population is younger also - baby boomers are now getting old enough to be in need of knee replacements, surgeries, etc. and hospital stays are shorter necessitating the need for short term rehab before they can return home. Drs. are realizing the benefits of short term rehab for many reasons so are prescribing it more. We also see residents who will be long term who have exhausted all HS benefits or dementia people. We get very few who have exhausted benefits and would not need a nursing home if funding were available to help maintain them in the community. Also see some residents who are "tired" of being in the home. Data collection on this population would be very difficult to track.
We do have MDS information available. MDS is a data sheet collected at time of admission which contains all relevant information on that resident. Bill indicated that they have a lot of information available from their current waiting lists. We get approximately 2% admissions who come from assisted living. Daily rehab services are available only in nursing homes - not cost effective in home. Private agencies ( Home Health etc.) cannot provide enough staff or equipment for this kind of extensive daily rehab. Pain management also an issue. Question down the road is does the county want to provide this type of service? Service is available in the for profit agencies.
During the last group of meetings Jeanne provided statistics on our residents to Human Services and they came up with 5 placement categories for those residents. Only difference between then and now may be our increase in short term rehab. Cut off of data is 12/03. We can update as 2004 data becomes available. HS found basic groups - ambulatory with some faculties who can make decisions on their own; ambulatory with some assistance; assistance of 2 at all times -group home is most appropriate for these; person with some dementia - group home with dementia program; 24 hour nursing care needed. Calculated the cost for each resident if they were maintained in the community. Also analyzed the services needed and whether or not they were available in the community.
Human Services - Sue Hebel and Bill Orth. Services are Community Access and Long Term Support Units which serve approximately 425 citizens of which 95 (22%) live in licensed community based residential facilities (CBRF's), adult family homes (AFH), or residential care apartment complexes (RCAC). The rest live alone, with family, or in a supported apartment setting. People served are the frail elderly, people with Alzheimer's or related dementia, developments disabilities, or physical disabilities. Are served by 8 programs funded by federal, state and county dollars which all have an allocation cap. Referral sources are varied. Current allocation for the programs is $8,000,000. Social Workers conduct an assessment to determine eligibility. Client must meet financial eligibility guidelines and nursing home level of care. If person is eligible for services and funding is available a social worker is assigned, a case plan and services are set up. If are eligible and funding is not available go to a waiting list. If not eligible for HS programs, are referred to other resources. Part of the process is also to help them get on Medical Assistance if they qualify.
Types of services provided include payment for any reasonable, community based service that is not funded by Medical Assistance, Medicare or other private insurance. Examples would be supportive home care, chore services, transportation, respite, home modification, etc. Services are obtained from a wide variety of vendors and providers. Case management services are also provided with clients seen at least every three months. Contact with service providers needed every month.
Waiting lists. Currently approximately 320 elderly and disabled persons who have been assessed and determined program eligible but who are waiting for funding. Forty five of these individuals are requesting care in a licensed CBRF, AFH or RCAC.
Gaps. Cost-effective living choices - group homes, adult family homes, supported apartments etc.; short-term respite setting for persons with mental health diagnoses; respite and/or adult day care for elderly and DD; facility that offers "steps" of care from less supervision to more supervision to more intense medical management; transportation; more Dementia NH beds; short or long term treatment for persons with DD. Also see difficulty with staff turnover for chore workers etc. because of low pay, lack of benefits.
Often get referrals on people that they have never heard of - have been cared for by family up until this point. Usually a crisis that brings them to HS. There are no statistics on people who are not getting services. Sauk County population data may be helpful. Of the nursing home residents looked at, 38 could still be in the community if there were places to put them. No funding is available. If we foster the development of more group homes etc., we still would have to pay for operating expenses.
Gene asked Bill to comment on the business of Human Services. Some counties provide the CBRF/group homes for their residents while others contract out for the services. Bill indicated that fewer and fewer counties are operating CBRF's or adult family homes. As to whether or not the county wants to look into operating group homes, the staffing, funding etc. become issues. In the area of funding there are developments on the horizon - short term is a plan to move a significant number (1/4 to 1/3) of nursing home residents into the community. In the long term the State is looking for entities on a regional basis to manage acute, primary and long term care of individuals. Want these entities to be able to provide care management in a way which would eliminate waiting lists. State looking for input into how this regional care might be organized.
Sauk County Housing Authority is often a point of referral by HS as well as them referring to HS. New apartments in Baraboo were built with some federal funding (low interest loans etc.) so part of the complex will be subsidized housing. Paul indicated that the numbers we were given from the Housing Authority indicate that 3,000 people aged 55 or over are low income. Will have a major impact on Sauk County.
Wheeler felt the committee should find out the needs that our elderly/disabled have, where we are able to serve them and finally where gaps may be. Worksheet may be helpful in this regard. Would like to find out what needs are not being met for whatever reason. People who are on waiting lists for a long period of time may have changing needs from when they were first assessed. COP Coordinator sends each person a letter every 6 months and they frequently call. Even with all funding available there still may not be the resources for the population. Department Heads should look at the list, check what they provide, and whatever waiting lists they may have. People on the waiting lists may need more than one service so should take that into consideration. Access to services could be lack of transportation to the service, lack of eligibility for the funding of the service or lack of providers. Discussion followed regarding method of filling out the form.
Wheeler asked if is a person out there to advise the board on methods of promoting private industry to build a CBRF etc. Sue indicated that HS puts out public notices regularly asking for people who may be interested in providing a certain kind of housing situation, provide outdoor maintenance, transportation etc. Need to have the funding available.
Respectufully Submitted: Joan Fordham, Secretary