Draft Minutes for January 11, 2006
DATE: January 11, 2006
PRESENT: Linda Borleske, Larry Volz, Judith Stoeckmann, Tommy Bychinski, Al Dippel, Paul Endres, Joan Wheeler, Diane Keylock, Kathy Schauf, Kerry Beghin, Sue Hebel, Joan Fordham, Lowell Haugen, Art Carlson, John Earl, Cindy Bodendein, Bill Orth, Jeanne Leeck
Motion was made by Carlson second by Stoeckmann to approve the minutes.
Motion carried.
A description of "Preference" was given by Schauf and the discussion started on Page 14 of the report. Schauf started the discussion with offering that the purpose of this meeting is to ensure that the intent of the committee is accurately portrayed. That the preferences, outline for implementation, consequences and stake holders in this report are a correct representation before it goes to the Full Board.
Clarification was requested and given by Schauf -Social capital is defined as the resources available to individuals and groups through their social connections to communities.
Schauf explained that the verbiage and the definitions are also carried over into the draft of the resolution, and that there was a need for existing oversight committees to continue to study the needs and the gaps as defined by this committee.
Next discussed in the second paragraph were the goals that were developed during the committee process. Stoeckmann felt that there was no in-between or beginning-that the only topic addressed was the end result. Wheeler agreed with that statement. Hebel suggested over verbiage and that it might better be stated to include wording regarding the continuum of care. Wheeler felt that it was false and wanted the entire second paragraph struck because it isn't consistent with goals, only addresses the end result. Endres disagreed. Wheeler stated that she was giving her opinion. Schauf said that it did discuss the impact of one part-the end, the nursing home, but that it also allowed for consideration and review of all the needs. That the intention was that we aren't just going to build a nursing home, but are going to expand the discussion and assessment of other services that can be provided in the nursing home, and elsewhere depending on how the next committee determines the services and design of the new system. That it is not just a "one response only" option. Borleske stated that if you go back to the alternatives and how they are spelled out, it does explain this more. Schauf asked if anyone had any suggestions for a clarification. Stoeckmann said that as the next committee addresses the needs, it is possible that not all of those services would be provided at the center. That the "integrated seamless services" may not all be provided at this facility. Hebel suggests that the model may not guarantee that it is a perfect model for everything. Stoeckmann wants the message given that there are many other options and we are not going to meet them all in the one "brick and mortar" building. Hebel wanted to delete the word "programming" suggested "operation" instead because people will be looking for an efficient and effective model. This option acknowledges that there are many options which require additional exploration. That the model will be consistent with providing an integrated service model that will allow for exploration of many designs, models, and programs. (Beghin made the corrections) Stoeckmann wanted to make sure that the building wasn't listed as the only model or option when presented to the full board.
Hebel and Schauf added the revisions for the rewrite of the second paragraph.
Fourth paragraph-Hebel wanted to add end of life care or anything else that can be a service provided in the SNF. They added rehab and end of life
Third paragraph-delete medical assistance and just leave it "funding" because there are other funding sources that may be utilized at the request of Leeck.
(Endres added a comment on being responsive to the constituency.)
Outline for Implementation: (refer to the draft resolution)
Schauf referred to the Resolution. In the second "therefore" she felt that the idea of 2 committees would be too cumbersome and should be one committee to oversee that the gaps and services identified by this committee and that it continues to address and prioritize goals/gaps, researching it, collecting data-so that it is all responsive to a central group that will then address the full board.
The next "therefore" bridges the gap between where we are and where we want to go, how to do it better.
The next "therefore" is where the work is being done to identify best practices and how to do the work.
It all comes back to the central group that coordinates the activities.
It is all subject to change depend on the committee.
The next "therefore" identifies who is going to be on this central committee.
The next "therefore" defines the outcome which will include the number of beds, the services, more than just a skilled nursing facility-whole package of services.
The next "therefore" incorporate citizen and specialists.
This is the implementation strategy, the resolution defines the implementation process.
Fordham states that all department heads necessary including Commission on Aging, EMBS, need to contribute where their department is most qualified to do so. Fordham stated that even though we won't be able to address all the problems now with this committee, that there will be an ongoing process to continue to study the gaps.
Page 2 of the resolution is actually the process for implementation. Borleske had a comment that the word "will" be changed to "may include but not limited to." Leeck's suggestion was that the possible services could be listed but saying that they will be provided may limit the committee when it is formulating the service provisions. This will be addressed again when reviewing the Resolution Draft.
This is the area where the centralized resource center, managed care/philosophical shift that needs to be done in the county from the existing model to the new model, is discussed. It will be consistent with the ongoing efforts to address the gaps. The shift is to a different model of delivery of services where it is still client focused, but addressed as a whole rather than departmentally.
Further discussion was made in regards the cost estimates given in the report. Orth felt it was well stated, and though it was an estimate, he felt it was accurate. Schauf asked for anything that the committee felt was overlooked. Hebel felt that what was not stated was that the effects of any change or design may not automatically be reflected in revenue or census changes and that this was what was reported by the Manitowoc County Administrator in his presentation. She referred to that happening in the new Reedsburg complex currently. The next committee will need to be aware of this and take it into consideration when making the evaluation of the design determined by the committee. Schauf felt that this could best be accomplished by adding it to the draft resolution. This would include the means of measuring the appropriateness of the design established and will be a measure of whether the right services were provided. It would help to determine if, per Orth, the best or right design was decided upon to fit the need.
Another area that Orth felt was worth noting was that the decision regarding the number of beds in the facility was a risk and that it was a critical part to make that determination based on the complexity and demographics. He feels that there is a real risk that there would be too many-or too few beds. This may be an unknown that will have to be carefully considered when completing the design.
This is the area where the committee has the opportunity to speak to the stake holders. It takes the resolution and goes a step beyond. Departments will be assigned some of the identified gaps. The different departments will be informed that as a stake holder, they need to investigate thoroughly and report back to the new planning committee their ideas and solutions for the gaps, the design of a facility, and other services that could be provided or arranged elsewhere.
The philosophical change is the key to success per Schauf. It will take time and effort from all areas to change the traditional ways and barriers. Oversight committees will be informed of their role. Schauf stated that this concept was captured in the report and in the draft resolution. This is a key point that this committee is relaying to the board.
Endres felt that "potential" should be added to the development of the single point of entry and managed care because it isn't a given. Schauf stated that the county will then have to decide how to provide it. Bill supported that.
Schauf suggested bullet points of hopeful outcomes for the current committee to the new planning committee. These are listed in the "Whereas's" in the draft resolution. It is hoped that these will feed into some type of a building committee that will then determine the implementation. Schauf and Beghin will compile these outcomes/expectations from the committee to reiterate what the new committee is expected to provide the full board.
Carlson brought up a proposed date for the draft resolution that the new planning committee should be expected to report their design to the full Board. Schauf felt that a date certain needs to be in the resolution. It was agreed that it should state "The December board meeting of 2006."
The document is done.
Paul asked that the reference to the HCC should always be the HCC or "a facility."
Fordham wanted to assure that the title stated what the committee wanted it to. She suggested some changes and clarifications. Endres summarized by saying that the committee is recommending that the county continue to provide the skilled nursing and that a second committee will be developed to address the needs of the county for long term care services.
Schauf suggested the words "cost shifting" instead of "shifting of cost" for semantics. Earl suggested it say "some cost shifting."
Fordham requested that the 4th "whereas" should read "...cannot be readily cared for in SAUK County." It is important that it is realized that they may be able to go elsewhere for services, but this committee wants it to be within SAUK County.
The 6th "Whereas" is where the other alternatives are discussed, not simply the HCC issues, but that it reaches beyond simply building a building.
5th "Whereas" add "SAUK County" after the word "abdicates" from Earl.
(Endres back to the title) Is the title saying that the recommendation to build is this committees recommendation? Hebel didn't feel that the title reflected that, but the "Therefore be it resolved" did but not till later. She was concerned that the title would not be interpreted as misleading. Fordham suggested that the title include wording that would recommend the creation of a committee to incorporate the building of a building. Then Orth suggested that it say that there would be a redesign to include building a new facility. Schauf suggest wording for a new title to the draft resolution that included the development of a new facility and that it would include a redesign of the system and not be limited to building a new facility. Orth suggested that in the first "Whereas" it would include a development of a full continuum of long term care.
The date was added "December 2006 board meeting"-second to last paragraph.
The last "Whereas" addresses the goals established by the committee.
The fiscal note includes how to pay for it. Including the balance of the committee funds. Also added the $1 million already designated. Will tap into the million for the design and building phase for contracting the design. The committee will be funded by the left over from the current committee.
Earl had a few semantic changes-remove the word "skilled" from the first "be it resolved" and just read "a facility." In second to last "be it resolved" to delete the number of beds, etc. to just define services.
Fordham asked Stoeckmann if the proposed changes met her concerns and she expressed that she had a concern that there were 2 members from the HCC and only one from the other oversight committees. She felt there should just be one member from each committee and one "at large." Carlson disagreed with her because of all the work done by the HCC. Stoeckmann felt that that representation factor should come later when it does come to the structure. The HCC isn't any more important to the group than other departments at this stage, was Stoeckmann's comment. Endres called for a vote. Volz felt that 7 was a good number for a committee. Stoeckmann stated that it would still be 7 with the member at large. There was a written vote regarding having 2 members from the HCC or 1 member of the HCC and one member at large. The ballots were taken and counted by Lombard. The vote was that 2 members of the committee would be from the HCC and eliminated the member at large. It was 6 for 2 members and 5 for one member plus a member at large.
Beghin added to the draft resolution the wording for evaluation of the design that was suggested earlier.
The full board will be getting the Resolution and this report before the January meeting. It will be presented at the special meeting on Feb. 9th to the full board. Efforts continue to set up a time with Tommy Davidson but are not successful. There will be a request for the date change of the special February meeting, this will generate a new petition and if it supports the date change, then the date can be changed.
Fordham asked about pursuing Davidson to present. She asked if this may impeded the process established. She also stated that he has had 5 or 6 opportunities. Volz feels he had had opportunity and shouldn't be asked to present. Carlson agrees and so does Dippel with this. Borleske suggested that he may not be interested, and Endres and Schauf were not able to answer for him. Fordham stated that a matter of process would indicate that he not present. Endres presented the option of Davidson not presenting.
Motion by Carlson, second by Dippel to not invite Mr.
Davidson to present to the committee.
Motion passed.
Endres stated that Bill McClary has created a synopsis of what is going on in the building. Carlson explained that McClary was the maintenance Supervisor. Endres wanted McClary to present the condition of the building to the full board. Stoeckmann asked why that needed to be presented and Endres said that it was to assure that the board knew the true condition of the building and because there had been questions asked and it is hard to tell from the outside. Carlson stated that this is an effort to better communicate with the full board.
Motion made by Bychinski to approve the draft resolution
with the changes made, seconded by Carlson. No discussion.
Motion carried.
Endres summarized that this motion included the draft resolution (action in the February meeting) and the report.
Further discussion included that there will not be public comment opportunities at the special board meeting on February 9, it is not a public hearing, it is just a presentation to the board. The board meeting on the 21st in February will be at an earlier time than usual due to voting. The time will be announced at the January meeting.
Dippel asked for clarification that this will be presented at the special meeting on Feb. 9th and will be voted on Feb. 21st. Clarification that the February 7th meeting will be on Feb. 9th if is passed.
Respectfully Submitted: Joan Fordham, Secretary