DATE: May 8, 2007
MEMBERS PRESENT: Paul Endres, Joan Fordham, Al Dippel, Judith
Stoeckmann, Terri Langer, Linda Borleske, Arthur Carlson, William
Higgins, Henry Netzinger
MEMBERS ABSENT: Larry Schroeder, Lowell Haugen, Scott Alexander
OTHERS PRESENT: Kathy Schauf, Ken West, Marty Krueger, Trish Vandre, Bill Orth
Meeting was called to order at 6:00 p.m. by Joan Fordham. Open
meeting law requirements were met.
Motion by Dippel, second by Carlson, to adopt the agenda.
Motion
carried.
Motion by Endres, second by Stoeckmann to nominate Joan Fordham
to be chairperson for this meeting, that nominations be closed
and a unanimous ballot cast.
Motion carried.
Motion by Borleske, second by Endres to approve the minutes with
the addition of Carlson's statement regarding 80 and 100 bed
cost comparisons and the addition of the statement below.
Motion
carried.
Schauf will provide cost comparison of home delivered meals for
the minutes. Even though last meeting minutes reflected that
it was decided not to provide home delivered meals, this committee
will still continue to discuss dietary decisions after the costs
are studied.
Meals:
No public comment.
Endres passed out an informational sheet from the Alzheimer's Association indicating that in end stages of the disease most people will need nursing home care.
Presentation by John Keefe of WIPFLi. It is essential to de-license nursing home beds, and reposition the bed mix - to develop other options such as assisted living, CBRF's etc. Nursing home use declined for past 20 years and likely will continue to do so. Other options are increasing, seniors see nursing homes as a last choice and they prefer other options. The number of empty beds in nursing homes is increasing. The goal of Family Care is to keep residents in their homes and the state is encouraging this. Seniors are living longer and healthier. The length of stay at nursing homes is decreasing and the prime target (75+ years) population is not growing significantly until after 2030.
Financial reasons - the cost of empty beds. Average construction cost per bed is $125,000. If you build too big and have 10 empty beds means $1.25M spent unnecessarily. The bed tax is paid on all beds whether full or empty and is proposed to increase to $125. Wisconsin's Medicaid program will provide an incentive to facilities who significantly downsize (25% of beds and relocate 15% of residents) - perhaps as much as doubling the amount it will reimburse for replaced facilities at smaller bed capacity.
Staffing reasons - After 2010, current staffing shortages will become increasingly more acute. Will have difficulty in hiring and keeping quality staff. Cost of wages will be increasingly higher and benefits more generous to remain competitive.
The county should, over time, develop a complement of other living options either run by the county or through a partnership with other entities.
Carlson indicated that we have already reduced beds to 110 and our census is consistently over 100. How many of the 300+ on the Human Services waiting list will need service? Will we be allowed to expand if the need arises? Will our returning vets need nursing home services? Assisted living services are mostly private pay. Trends go up and down - we need to consider the baby boomers and that increase in population. Alzheimer's disease is up 10% in the US. Felt a 100 bed facility should be built.
Keefe indicated that with 100 beds we would not qualify for significant downsizing so would not receive the capital reimbursement. Assisted living units have not qualified for MA reimbursement in the past, however Family Care will make assisted living an entitlement. This will be a major incentive for seniors to go into assisted living. Not everyone with dementia has to be in a nursing home until perhaps the end stages. CBRF's can also be used for dementia care if appropriate. Advances in technology and medications need to be considered along with the increase in living choices.
Endres felt that with the increasing population and fewer qualified workers, immigration will have to open up. Bed tax is used to increase our reimbursement however Keefe noted that $13M of that bed tax money was used by the state to fund other MA services (non-nursing home). There is a lag between the start of family care and the building of CRBF's, family care homes etc. But as the money is available they will be built. Fordham indicated that we can't propose building a nursing home that is too big when the experts tell us that the trend is less nursing home use. We do not want to have the Pod - A issue. We need to think about building a continuum of care campus with room to expand and the nursing home as the first piece. Our timing of the building with the family care options which will be available is good. Krueger indicated that these two committees need to recommend that we build something that is operational today and flexible for future use. We need to have room to provide other living options and the current rural setting has the room however the location would not support the CBRF's or assisted living options. Keefe indicated that a continuum of care campus would need close proximity to conveniences and therefore be more desirable to possible partners/developers. MATC site would be close to services and the close linkage to the programs at MATC would be beneficial.
Carlson indicated the current location is also close to the center of the county for workers and resident families.
Borleske has heard comments from the public asking what we are getting for
the money we spend on land that we can't get on the current site. Would prefer
using the money towards the facility not land. Good to be by MATC, however
nurses also do clinicals at other facilities and they drive there, so what
is the difference. Instead of building the locked unit at the HCC, why not
incorporate it into the jail - Pod A. Would like to see the architect describe
the pros and cons of each site as he sees it. Including costs of land, putting
in utilities, access etc.
Keefe indicated we need to look at what we can do on each site and the preferences
of today's and tomorrow's seniors. Krueger indicated that we need to look
at what is best for the future of the facility and the feasibility of having
a campus of services on the site.
toeckmann added that the possibility of a medical breakthrough for Alzheimer's and other diseases of aging are on the horizon. Langer expressed the concern that a long term plan with other options for future development of the site should be developed and shared with the public through market strategies. MATC nursing program is very healthy. This county is not facing a nursing shortage and the new facility will draw new nurses so our workforce should stay consistent. Higgins added that an important dynamic is knowing who your customers are and what they want. Our customers are our residents, nurses, CNAs and other staff, taxpayers etc. Our customers seem to want integration, not isolation such as the current site offers. Integration with the campus sends a signal that we are supporting education as well.
Netzinger suggested that we need to make a decision as to what services we want to offer on the campus - should start identifying some of the things we want to do. If a smaller nursing home is built, enough land should be available to consider other options. Building should be versatile and campus should offer other items such as a walkway. Questioned whether or not that should be a county responsibility or other providers/partners. Fordham suggested that once the resolution is presented to the county board both committees need to support the resolution. We need to do the best we can for the most people. Expect to put the resolution before the board in June that will include site, services and number of beds and also select a building committee. Endres indicated he would support 80 skilled nursing beds with 20 for other purposes.
Carlson suggested building both the nursing home and assisted living at the same time. Stoeckmann suggested that after the family care program begins (mid to late 2008) we should take time to plan for future development. The C of C Committee will continue to meet and deal with the whole stream of services. Orth indicated that from past studies it was concluded that approximately 25% of the residents could be placed in other facilities in the community but weren't because of the money issues as well as lack of placements.
Next meeting date is May 22 at 6:00 p.m. - joint meeting with architect present.
Motion by Carlson, second by Borleske to adjourn.
Motion carried.
Respectfully submitted: Al Dippel, Secretary, Continuum of Care Planning Committee