Continuum of Care Committee Meeting Minutes

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

1. 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 Borleske to adopt the agenda.
   Motion carried.
3. Motion by Stoeckmann, second by Wheeler to approve the minutes.
   Motion carried.
4. Communications: Kathy received contact from Mr. Alt indicating that he would not be able to attend this meeting and have rescheduled for November 22. Also received e-mail from Supervisor Gaalswyk, responded to it and also discussed with Paul. Tommy Davidson was contacted to ask if he would present to this committee. He will be presenting on November 10 to clarify his level of interest and intentions. Is expected that he will bring presenters with him including Jim Deignan, Administrator of Dove Healthcare.

   In the conversation with Jim Deignan, Kathy was able to gather a lot of information. Was CPA for Eau Claire County and CPA/Controller for Nursing Home prior to becoming the Administrator. Became Administrator when county decided to privatize the nursing home. Decision to sell came as a result of the needed tax levy as well as the fact that the nursing home was not well managed. Several citations etc. First things Dove did was made sweeping changes in health care benefits and they no longer had to fund the Wisconsin Retirement program. Downsized the nursing department and reduced some pay according to market conditions. Were unionized before the sale however aren't now. Payor mix was changed so that they were able to double their Medicare residents by gaining better access to hospital discharge list. Short term rehab stays were increased. Are now at a 55% Medicaid rate. Nursing home did not have a good reputation in the community which has improved. Have no waiting list. Census has declined. Assisted living was added by taking 2 wings and converting it. Also added a new assisted living wing which has just been completed. Will be converting assisted living wings back to the nursing home. Private pay rate ranges from $157 - $197, depending on room. Eau Claire has 5 nursing homes within 10 minutes of each other - Physician and location go into the decision as to which home residents utilize. County board was not willing to put in dollars necessary to make changes to make the NH profitable. He has greater ability to manage and be flexible with private company. Was a huge process of change, first 5 years were difficult. Great deal of turnover and staffing issues. Currently have an adult daycare however is not licensed. Area in NH devoted to adult daycare for residents only. Has improved the quality of life for the residents. Did not ask how daycare is funded. Winnebago County is in process of building a new health care center.

   Questions were given to Kathy which weren't addressed in her information including: an explanation of the cites received; pay scale before and after sale; total FTE's; funding for adult daycare; assisted living connected to building; why daycare is not available to community. Will ask Howard why board chose not to do market surveys before the decision was made. E-mail any more questions to Kathy.

   Bill Orth talked to Human Services Director and was referred to Patty Schultz who is the financial person. Also to Margaret Hansen who is the adult services person. Prior to sale the nursing home was used to provide care to persons with mental illness and substance abuse and now is not. Have to be place in adult family homes or CBRF's and shifted payment from MA to tax levy which is more expensive for the county. No beds were decertified so no CIP II slots were received so no funds could be used. Most proceeds from sale were used in other departments. Stopped being a resource for difficult to place individuals.

   Paul toured the Reedsburg Senior Life Center and was very impressed with layout. Handed out extra programs. Also was able to get financial information. Joan F. also toured and asked director if would see a new Sauk County nursing home as competition and he said no, that the beds are needed. Also felt adding assisted living would not compete with their units.

   Gave committee copy of letter sent to Wendy Feinside and received a positive reply from her regarding the demonstration project.

5. Goal statements were updated and clarified. Committee looked over and discussed corrections. Focus was on point 6, "Determination of areas of need/levels of participation that county should have in each of those areas. (define problem statement, draft list alternatives)." Problem statement will be statement around which you as a committee work. It should define the problem. Question bolded on page one begins to define the problem. "How can Sauk County strategically position itself to provide a fiscally sustainable long term care solution without sacrificing the quality or availability of services needed by residents?" The statement would be two pronged - 1. How to address the aging facility 2. Long term effects on the provision of long term care. All have to agree with the problem statement before we can proceed. Discussion followed regarding the services that should be looked at, how they should be paid for, and what other entity could provide some of the services. After discussion the following statement was proposed.

   Statement of Problem: "Definition of the scope and depth of services that Sauk County will provide in the continuum of long term care." All members voted aye in support of this statement.

   Policy alternatives: options available as viable alternatives.

   Items that committee wanted to include in scenarios:

   1. Only what is mandated by state law - does not address how those are provided.
   2. Increase staffing of Public Health Department nursing service to address the waiting lists of HS. Increase levy dollars.
   3. Increase the number of providers of in-home health services - increase tax levy
   4. Additional placement options - more assisted living etc.
   5. Support universal health care - managed health care
   6. Adult daycare
   7. Aging and disability resource center
   8. Using existing facilities/resources - meals
   9. Increase transportation
   10. Providing services for high cost behavioral residents
   11. Crisis placement plan for DD people
   12. Hospice care - End of Life Care
   13. Continue with rehabilitation - increase home care providers
   14. Funding source for therapies at home for those who do not have a payer source
   15. Durable medical equipment

   Examples of scenarios - Status quo - we would not change anything or whatever your vision would be.

   Human Services would like to see 1. A state of the art Health Care Center that would care for dementia as well as behavioral residents - locked unit. 2. Closing of beds to increase tax moneys to provide in-home/community care.

   Demographics page of handout indicated that there will be more people needing care, however the workforce may not be available at that time. By the year 2020 the 60+ population is going to double. As we develop more community placements/services more staff will be needed.

6. After the different alternatives are developed, the committee will discuss them based on cost comparison, future consequences, constraints, political feasibility and other county models. Also need to come up with a recommendation - in which alternatives are recommended and a description of our preferred alternatives are stated.

   Group has 4 meetings left in which a recommendation has to be made. Art asked if Colleen Bates could return and answer some unanswered questions. After some discussion it was decided that this committee should refer back to her written report. Any questions you may have for Mr. Deignan should be forwarded to Kathy before Wednesday.

7. The November 10 meeting will include the presentation by Tommy Davidson of Dove Healthcare, November 22 will be presentation by John Alt of MATC and further discussions as time allows.
8. Next meetings will be on November 10 and 22, December 15 and 29 all at 6:00 p.m.
9. Motion by Bychinski, second by Carlson to adjourn. Motion carried.

Respectfully Submitted: Joan Fordham, Secretary