Continuum of Care Committee Minutes


DATE: August 10, 2005

PRESENT: Linda Borleske, Larry Volz, Joan Fordham, Lowell Haugen, Judith Stoeckmann, Joan Wheeler, Al Dippel, Art Carlson, Tommy Bychinski, Paul Endres, John Earl, Jeanne Leeck, Gene Wiegand, Diane Keylock, Bill Orth, Kerry Beghin

  1. Called to order at 6:00 p.m. by Paul Endres. The open meeting law requirements were met.
  2. Motion by Carlson, second by Dippel to adopt the agenda.
    Motion carried.
  3. Motion by Volz, second by Borleske to approve the minutes.
    Motion carried.
  4. Presentations - Gene introduced Chuck Wilhelm of the Bureau of Long Term Support, Department of Health and Family Services. Briefly discussed the ICF/MR restructuring created in the 2003 - 2005 State budget. Changed the legal requirements for people with DD and allowed them to live in the most integrated setting that is appropriate to their needs. Eliminates the "funding bias" - lets the money follow the individual. Places stricter criteria for placing a person with a DD in an institution and increases the opportunity for them to live in the community. Court , with much input, makes the decision. State has agreed to pay for the community setting even if it is more costly than the facility provided it is the best setting for the person. Court would allow some time for the county to develop the appropriate placement if one isn't available. Since January 1, 2005, have relocated 144 individuals into the community. Funding is sufficient in this budget to relocate 500 - 600 people. Inspections aren't as frequent or detailed as in nursing homes, however HS is required to visit face to face every three months and there is collateral contact regularly. State is paying on average $177 a day for community placement of DD people. Have some facility phase down funding available for facilities that close down. Time limit is given for phase down depending on census. Have put a priority on assisting counties that want to get out of the business.

    Wisconsin is high in nursing home utilization. Use is going down. Governor and legislature would like to reduce the number of people in nursing homes and serve them more in home and community based programs. Fewer people choose to go into nursing homes and the budget has community relocation initiative. If someone has a long term care need is on MA and resides in a nursing home, they would have the option of moving into the community and the funding would follow them. Governor is assuming that 20% of the population in nursing homes will choose to move into the community if they are able to get the supportive care they need. Decision is up to the individual. The budget assumes savings to Medicaid because community care is, on average, less costly than institutional care - estimated to be $23 less in the community. This also assumes that some care be provided by family, friends, volunteers, charitable organizations etc. State is now looking at larger CBRF's - allow up to 20 beds (for elderly only). Trend is for nursing home populations to go down. No increase in funding in this budget. State will be monitoring the costs of care for community placement and if is too costly won't be able to do it. Nursing homes are becoming more and more post-acute care facilities - rehab care. Number of nursing home residents in Wisconsin from 1998 to 2003 went down by 12 ½%.

    There is funding available if communities want to develop low cost assisted living. Working with WHEDA to come up with a proposal to allow nursing homes to convert their line of business from nursing facilities to low cost CBRF's/residential care apartment complexes. Haven't seen a lot of it yet.

    In Family Care counties there are no waiting lists. The county has to contract with providers to cover all of the services the people need. Basically is managed care for long term care and coordination of the acute and primary care. Partnership model or fully integrated model is one in which the long term, acute and primary care is managed. There are four organizations in the state who are partnering with counties to offer the model. Savings in integrated model is from lower hospital costs. Participants have to be Medicaid eligible. Over the five year period of the Family Care utilization, the counties on average have made money with the exception of Milwaukee County. Milwaukee is doing the program for just the elderly while the other counties cover adults with DD and the elderly. Are currently going out and finding who else may be interested in becoming a Family Care County and gathering information. Sauk County is already involved.

    This committee has to deal with many decisions as far as what we want to provide for our residents. Do we want to continue to provide rehab for Medicare patients, downsize, senior living units etc.?

    If this Committee is interested in finding out more information about closing the facility, contacts for further information were provided.

    Rita Odegaard, retired Area Agency on Aging Director and Nell Mally, former Chair of the Area Agency on Aging spoke regarding the Task Force on the Aging of Dane County report. Spoke on the process followed to get them to the finished document. They looked at the population now and what can all areas of the County do to provide services - education, medical etc. for that population in the future. Their agency does not provide the services, but contracts out for them. They were required to write a county plan every three years and in the plan wrote into the plan that they wanted to do a task force on aging. Population of aging in Dane County is growing. Baby boomers will require different services than the current aging population and technology will be a lot different. The Area Agency board suggested possible members for the task force. Submitted a list of 50 people for membership to the County Executive and she appointed the members. Had a committee of 11 who met 6 times and decided to develop work groups. No funding was available for the project. Brought in a demographer, Cindy Ofstead, who broke down statistics for Dane County specifically. Also brought in Ed jj Olson who has a consulting firm in Milwaukee, talking about the future and technological developments. Dr. Carol Ryff of the UW Institute on Aging also spoke to the group. Came up with six subjects - economics, education and active aging, housing and infrastructure, medical/ health care, public safety and transportation. Also added care giving and case management. Gathered 80 - 100 people who were interested in the topic and assigned them to a group. Each committee member was a chair/CO-chair of a study group. Gave each group a manual with a lot of background information on the baby boomers. Each group was asked the same questions. All information was compiled and put in logical format. Wisconsin Public Radio has taken a big interest in the report and will be doing a documentary on it in mid-January called Almost Home, which is a study of St. John's on the Lake Nursing Home in Milwaukee. Have discussed the report in many different areas around the state. The Dane County HS Board has taken several recommendations and are compiling a list of items to write up in Resolution form to give to the County Executive for action. Gave out copies of the Executive Summary to the committee. Would suggest a plan to do things to support the caregivers, bring a lot of people into the process for a broad range of ideas, and make sure the chair of the committee keeps the members on task. Currently in the process of deciding what the next step is.

  5. Joan Wheeler presented a copy of the letter she received from Tommy Davidson who purchased the Eau Claire County nursing home in 1997. Jeanne will compile the information requested by Mr. Davidson. Paul wanted to make it clear that the County Board has not said that the nursing home is for sale. Jeanne will also contact the state to assure them that we have not put the nursing home up for sale. Will send the Keefe Study along with the other information. Jeanne will have it available in approximately two weeks. Wheeler asked to see the report before it goes out. Three packets will be available in Gene's office for the committee to review. After Mr. Davidson has reviewed the packet a date will be set up for him to visit. Any questions can be referred to Jeanne. He should contact Jeanne for a tour and Paul or Gene to arrange a time to attend this meeting. If other board members would like to go on the tour that could be arranged.

    Judith Stoeckmann had copies of the article Bringing Human Services Into Focus in the March 2003 issue of Wisconsin Counties Journal. Orth volunteered to discuss the article/issues in more detail.

  6. Paul suggested that this committee have a subcommittee to draw up a series of statements/goals of what we are trying to do as a committee. The list could be brought to this committee for discussion. Committee agreed.

    Gene asked if the committee would give him the authority to go ahead with the application for the demonstration project with WHEDA/DHFS to develop funding for low-cost assisted living units which would involve downsizing the number of beds in the Nursing Home. Application has to be submitted if we ever intend to use it.

    Motion by Stoeckmann, second by Borleske to have Gene Wiegand go forward with the application for the Demonstration project with WHEDA/DHFS to develop
    Motion carried.

  7. Future meetings. Next meetings will be on August 24, September 14, September 28, October 11, and October 24 all at 6:00 p.m.
  8. Motion by Dippel, second by Fordham to adjourn.
    Motion carried.

Respectfully Submitted: Joan Fordham, Secretary