Continuum of Care Committee Meeting Minutes

PRESENT: Linda Borleske, Joan Fordham, Joan Wheeler, Art Carlson, Paul Endres, Jeanne Leeck, Bill Orth, Kerry Beghin, Kathy Schauf, Larry Volz, John Earl, Lowell Haugen, Judith Stoeckmann, Sue Bodendein, Trish Vandre

ABSENT: Tommy Bychinski, Al Dippel

1. Called to order at 6:00 p.m. by Paul Endres. The open meeting law requirements were met.
2. Motion by Haughen, second by Carlson to adopt the agenda.
   Motion carried.
3. Motion by Fordham, second by Borleske to approve the minutes.
   Motion carried.

   Agenda item 6 was moved up to accommodate the presenters.

4. Phone conference/Power Point presentation by Eau Claire County representatives. Howard Ludvigson, County Board Supervisor and Keith Zehms, Corporation Council made the presentation. General authorization to sell the facility was done on 07/96 with the authorization to sell to Dove Healthcare on 11/96. Total of sale was $6.5M. No surveys or referendums were done before this decision. At the time of sale the nursing home was 15 years old and 3 stories. In May of 1996 the nursing home was at 74% occupancy with a 1st quarter loss of $200,000. Projected 1996 loss was at $800,000 with ITP offset of $448,000. Also decertified 21 beds to eliminate MA reimbursement reduction of $314,000. The MA % was increasing and private pay was decreasing. (Did not have statistics available for this). Group from the county visited a facility in Lake Wales, Florida owned by the proposed buyers. Were very impressed with all aspects of the facility. Had outside legal council aid in the purchase. Asset Purchase Agreement had many provisions, however some of particular interest were:
   • Agreed to operate the facility for at least 5 years
   • Would accept all existing residents
   • Would accept Medicare and Medicaid for 5 years

   Administrator of the facility was kept on as well as many other employees. Were asked what cost was shifted to Human Services as a result of the sale and weren't sure there were any. Felt in the long run it may have saved the county money since the new owners have put a lot of money and more programming into the facility. (i.e. assisted living and adult daycare) County Board has never looked at a correlation between the Human Service budget increasing and the nursing home sale. Generally felt the county board wouldn't have put a lot of money into the facility with additional programs, buildings etc.

   Labor considerations included complying with Plant Closing Law and bargaining severance packages - handled internally. Made provisions to assure quality/continuity of care including giving employees that stayed higher severence packages. Were unsure of the total closing costs, severence pay costs were approximately $200,000 with 160 employees. Had a master agreement with AFSCME with posting rights. Did not have bumping rights. Not sure how many employees stayed with the purchaser. Agreed to interview all staff who were interested in staying. Old facility did have staffing issues before the sale, as well as severe survey problems including fines/litigation. Current Administrator of the facility could answer more of these questions - Jim Deignan.

   Dove Healthcare recent surveys have been very good. Have created a 6 person Alzheimer's Unit and a 30 bed assisted living facility. Now have 30 Medicare residents, enhanced pain management program, mood care, behavioral management, palliative care, creation of "Dove's Nest" adult day care and resident's choice dining program. Have received the Wisconsin Health Care Association award for the past 7 years - Facility of the Year 9/2003. Was voted the best place to work by a regional business publication. Feel it now is a facility to be proud of. Weren't sure of the private pay rates or whether or not the facility has a union. County board members are on their advisory board. Felt the county board would not have maintained the same amount of beds, approved expenditures for a locked mental health wing or given preference to MA patients over private pay patients.

   Sale proceeds were used for several things including paying off prior service retirement, general bond obligation, Huber facility construction etc. Also summarized Dove Health Care property taxes received over the last 7 years. 2004 - $123,227.11. Have had no repercussions from the sale - are generally satisfied. Total time from vote to sale agreement was 4 months. Colleen Bates voted against the first resolution authorizing the sale but voted for selling the facility to Dove. Those against the sale at the time were concerned about the quality of care, availability of beds etc. People were resisting change. Felt some people assume that their county would be spending a lot less in Human Services if the county owned a nursing home. This assumes the county would have spent a lot of money to upgrade the facility (including mental health services) which they do not feel the board would have authorized. Dove could take the beds and move out of the area if they wanted to, however they feel this will not happen. Both felt the county board was not equipped to manage the operations of the facility with all of the changes that would have had to be made - private sector has done better job.

   Bill Orth agreed to contact the Human Services Director in Eau Claire County to see what impact the sale has had on the HS Department and budget. Also Kathy will contact Colleen Bates who indicated they were working on some information in that regard. Other items which board members would like included would be the patient mix (MA, Medicaid, Private Pay), waiting list, wages, staffing patterns, is there a union now, and how many employees stayed with the new owners. An explanation of the low severance costs as well as any changes that had to be made in the NH for it to show a profit should also be included. More information about the assisted living unit would also be appreciated.

5. No Communications were received
6. Update on comparison of Sauk and Columbia County's Health Care Centers. Information gathered from Amy Yamriska, Administrator of Columbia County Health Care Center. Major differences are that Columbia County has no FDD unit. Our FDD census is expected to be 7 next year and therefore cost is quite high per resident. Columbia County also has a newer one floor facility with a mix of MA - 65%; Medicare - 10% and Private Pay 25%. Sauk has MA - 85%; Medicare 11% and Private Pay 4%. Rates are Sauk - $158; Columbia - $174. Water and sewer rates were Sauk - $7000/year and Columbia - $55,00/year. Our major cost would be if our current waste water treatment plant failed. Columbia also contracts out all therapies (Sauk provides OT) and has developed some "light care" rooms as well as large, private rooms which are double rooms for people wishing to stay together (husband and wife). The light care beds are licensed as skilled nursing beds but have a lower staffing level. Staffing levels were compared - Sauk: 154.89 total FTE's (146.44 without FDD staff). Columbia - 127.69 FTE's. Operating expenses - Sauk; $10,274,210 (which includes $500,000 of contingency for major repairs funded by fund balance): Columbia; $7,039,677. Property tax support - Sauk - $1,499,206; Columbia - $693,000. Columbia uses the fund balance to help pay for operations which will eventually become exhausted. The changes which have made a difference for them include 46 Alzheimer beds, the large private rooms and "light care" rooms. Ms. Yamriska also spoke to the many inefficiencies of operating an old 5 story building vs. a newer 1 story building. Columbia County has made changes to reflect the changing needs of the population they serve. They are making money from the specialized units not the regular nursing home residents. Private pay residents are making up for MA loss. Copy of the report and the discussion tonight will be given to the full board and Mr. Kriegl.
7. Review and discussion of goal statements. Chart was updated. Goal is for all committee members to agree with what is on the chart and that it is consistent with their understanding of what the continuum of care looks like. Some changes were made. Paul indicated that with all of the information gathered, the committee needs to start making conclusions/recommendations to meet the January deadline.
8. The next meeting will include the presentation by Mr. Alt of MATC and further discussions as time allows. Final report and recommendation is due to the full board in January.
9. Next meetings will be on October 24, November 10 and 22, December 15 and 29 all at 6:00 p.m.
10. Motion by Carlson, second by Wheeler to adjourn.
    Motion carried.

Respectfully Submitted: Joan Fordham, Secretary