Continuum of Care Committee Meeting Minutes

DATE: August 24, 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, Bill Orth, Kerry Beghin, Kathy Schauf, Sue Hebel, Cindy Bodendein

  1. Called to order at 6:00 p.m. by Paul Endres. The open meeting law requirements were met.
  2. Motion by Bychinski, second by Carlson to adopt the agenda.
    Motion carried.
  3. Motion by Haugen, second by Fordham to approve the minutes.
    Motion carried.
  4. Update on WCA article and the future of health care initiatives. Bill indicated that the article gave a good explanation of HS funding with declining state funding and increasing county funding. Current funding depends on block grants from state. Without funding there is no program unless county contributes. Visions program has the state establishing financial and functional eligibility criteria for each service. County and state have to agree on a proportionate share of state and county money in each of those rates, which can cause problems. If state can't come up with their share, they would change the eligibility criteria rather than increase funding.
  5. Selected presentations - Colleen Bates, Chair of the Eau Claire County Human Services Board. Some of the history of our two county facilities is the same - were a county "poor farm" and then a Care Center which was the safety net for low income residents. A new facility was built in 1983. In 1995 the county had to subsidize the nursing home in the amount of $278,000. Large amount of Medical Assistance residents. Eau Claire County has gone through this same decision making process and in 1997 decided to sell the county owned nursing home to a for-profit agency. Has recently received questions from other counties regarding the aftermath of that sale.

    Nursing homes have changed over the years and now residents are older, more needy, more ill, and are dealing with end of life issues. Most clients are on Medical Assistance and are competing for space in nursing homes with clients with higher funding sources. Currently have a nursing home waiting list of 42. In - home client services are used for those on the waiting lists but are far from what they need. Costs which would have been covered by the state in a nursing home environment, have been shifted to county tax payers. Clients are also being placed in homes further from Eau Claire which means families who can least afford it have to travel to see their family members.
    Previously had a floor for the chronically mentally ill patients, however that is now gone. Have a private for-profit contract for crisis mental health services which totals $467,000 of county dollars. Some clients are taken to a local hospital at a cost of $657 - $900 per day (county dollars). If they have to be taken to other hospitals in another county transportation costs of $400 - $650 per day are also added. Clients may also be picked up for emergency detention and taken to emergency rooms for added county costs.

    For-profit homes need to generate a profit. They have necessarily developed policies that leave the county's traditional clients on waiting lists. Developmentally Disabled clients are also aging however the local for-profit and nonprofit nursing homes are admitting more profitable patients.

    Questions to ask before deciding to recommend closing or selling the nursing home.

    The impact of the decision to sell the county nursing home has significantly escalated our county cost and more importantly denied the appropriate level of care to the individuals for whom we are responsible.

    Information from Eau Claire County Department of Human Services regarding impact of closing nursing home beds for persons with mental illness.
    Costs for responding to the needs of MI residents have risen, number of emergency detentions has increased, limited amount of resources has driven the cost factor higher - rising rates.
    Limited resources for placement because of increased scrutiny and regulations.
    Profit realized from the sale of a nursing home rarely ends up providing services to ensure that clients can live successfully in the community.
    Without facilities which can provide some economy of scale in caring for these individuals, counties are at risk of bankruptcy in paying for medical care. Availability of trained workers is approaching a crisis state.

    Encourages members of this committee to think of the rollover from what has been cut by the state to what will happen to the county Human Services budget. Also, look at all of the residents of the nursing and know where they will end up, who will pay the bill, what will be their level of care and will they be better off or worse off. Looking at the financial aspect will help you make the decision. Does not have an issue with what the new owners are doing at the nursing home, just can't afford them. County officials promised that there would not be an issue with getting Medicaid/Medicare residents into the facility, however promise has not been kept. Fee schedule is different for one population than another.

    Eau Claire County has the lowest income per capita for working individuals. Both husband and wife are working, often live paycheck to paycheck, and have no health care. They are unable to care for elderly parents. Farmers find that end of life issues eat up all they have accumulated and children are unable to help. Children no longer live close to home but often are unavailable to care for parents. Eau Claire County is going to build an addition on the courthouse and a new jail at a cost of $51 - $65 million. Have done programming to foster a collaboration between HS and the courts to reduce the gateway to the jail, but need more. We can judge a society by the way it takes care of its aged and children.
    Tried to put the decision to sell on a referendum however it was blocked by some board members. Had a citizen committee look at cutting the cost of government and they recommended selling the nursing home. Our Sauk County survey showed that 85% of the citizens wanted the county to keep the nursing home going. There are a lot of places to live and services for people who can pay for them. It is the low income people that will have the difficulties.

    Counties are the gateway for services and we can shrink down to where the services we give are only those mandated and we determine the degree that we contribute to the mandates or we can put pressure on to have the laws changed and work to reinvent what we do. We need to do business in a more cost effective way. State does not fully fund programs that it mandates. If you really and truly want it, dig your heels in, but get all the facts and get them out to the public. Also, believe your facts. Don't send people out to gather information and then let other people shoot it down. Nursing homes are going to be necessary in the future. People need to come together locally and make it work. Regrets that the nursing home was sold. The successful operations in the state have diversified programs, taken time to read the community, and changed their facilities to meet the needs of the community.

  6. Bill and Sue discussed the cost of providing services to people on their waiting list (300). Looked at the average cost for people currently being served and came up with $6.5M annually (state, county and federal dollars) to place all 300. Looked at 85% costing $42 per day and 15% costing $200 per day. We can only get reimbursement for DD people so with added staff for case management the total tax levy would be $4.8M per year. This does not include the 48 residents already identified by HS to be placed if the HCC should be closed. Will provide report for the committee.
  7. Gene updated the committee on the WHEDA/DHFS demonstration project. Upon further review of the application he could not proceed because the county has to have a plan before we can apply. Are too many variables. Gene will still send a letter of interest and describe our situation.

    Addition - Joan Fordham felt the state's assumption is wrong that charities/churches/volunteers would care for some people and fill the gap that lower state funding leaves. Families are scattered, people are working and don't have time to care for others. Felt the plan is not going to work any better than it does now.

    Gene presented charts on the demographic analysis. Looking for indicators of potential needs in the community. Living status - significant indicator that large number of people (primarily women) over 65 will be living alone in community. Second shows the number of people living in poverty will increase and persons with one or more disabilities will rise even faster. Next shows the number of people requiring self care assistance outside the home is almost double in 2030.

  8. Kathy, Gene and Kerry came up with draft listing of goals/questions. Working document meant to be template for the committee. Questions/statements were from first committee as well as this. Also attached chart of services as well as Sue's chart of care and service needs and past scenarios on placing current nursing home residents in the community. No one response is adequate to meet all needs, the county is not intending to meet all needs but to define a scope/range of services that the county will provide. Kathy summarized the 7 points and will bring the document to each meeting for modifications.

    Joan Wheeler presented list of questions she had compiled and felt the low income elderly and disabled residents should be who we serve. Provision of services has to be for those who need the safety net. Providing services for others would mean the county is subsidizing services for them. Is it the county responsibility to provide services which are provided by private organizations? Gene pointed out a mix of funding sources makes programs sustainable. Should focus on low income people, however also need to include other potential revenue or will never balance the books.

    Paul asked for an explanation of IGT funds. It is funding provided by the federal government under certain circumstances to reimburse county owned nursing homes who are losing money. The deficit between anticipated revenues and expenses is put on the levy. IGT funds are added to the general fund to offset the expense. Any loss quoted for the nursing home should include the amount of IGT revenue which is added to the general fund. Should be a budget explanation regarding this. Some media do not report the nursing home loss correctly and this committee should make clear what actually happens. There could be legislation to do away with IGT money in the future.

  9. Presentations - John Alt of MATC will be coming on October 24. Discussion of presentation by individual regarding the managed care program. Gene felt this committee was not developed to redesign the HC system and the presentation may cover things beyond our issue. Bill felt it may be too early to discuss the program since it is still being developed.

    Gene passed around a description of different kinds of assisted living programs.

  10. Future meetings. Next meetings will be on September 14, September 28, October 11, and October 24 all at 6:00 p.m.
  11. Motion by Volz, second by Haugen to adjourn.
    Motion carried.

Respectfully Submitted: Joan Fordham, Secretary