DATE: May 22, 2007
MEMBERS PRESENT: Paul Endres, Joan Fordham,
Al Dippel, Judith Stoeckmann, Terri Langer, Linda Borleske, Arthur
Carlson, William Higgins, Henry Netzinger, Lowell Haugen, Scott
Alexander
MEMBERS ABSENT: Larry Schroeder
OTHERS PRESENT: Kathy Schauf, Ken West, Marty Krueger, Bill
Orth, Staff, Media
Meeting was called to order at 6:00 p.m. by Joan Fordham.
Open meeting law requirements were met.
Fordham indicated that "Reconvene in open session after the closed session" was not included in the agenda so committee will move item 9 to the beginning of the agenda and immediately adjourn after the closed session.
Motion by Netzinger, second by Carlson, to adopt the amended
agenda.
Motion carried.
Motion by Borleske, second by Stoeckmann to approve the minutes
of the last meeting.
Motion carried.
Motion by Endres, second by Dippel, to nominate Joan Fordham
to be chairperson for this meeting, that nominations be closed
and a unanimous ballot cast.
Motion carried.
Public Comment - Ed Brooks, Reedsburg Town Chairman spoke in favor of building the new nursing home at the current rural site.
Communication - Had previously thought that the resolution to choose site, services and size as well as appointing a Building Committee would be presented at the June meeting. Several required resolutions could be presented together at the June or July meeting and still be within the time frame. By presenting several resolutions at the July meeting, the policy document for board review could be presented at the June meeting. Schauf handed out a copy of the County Board Reporting Format for major or significant issues and the beginning of that report for the Board of Supervisors.
Stacy Clement, Lisa Greenwood and Diane Reinfeldt from MATC expressed their concerns about the possible shortage of health care workers in the future and the importance of keeping the MATC program strong. The group spoke in favor of building the HCC near the MATC campus. They would use the nursing home as an opportunity for training experiences and clinicals. Students that have participated in clinicals at the SCHCC are very positive about the experience and therefore tend to stay in the area. Are many allied health programs at MATC that could benefit from this collaborative relationship as well. Nursing program has many clinical sites in the area however they have to compete for those sites with many other nursing programs, some of which are out of the area. Do not have a dedicated classroom in the clinical settings. Building a dedicated classroom for students at a new facility if it were located on the current site would not be utilized as much as if it were near their campus.
Dietary usage for home delivered meals was again discussed. Fordham clarified that considering the cost comparison, the HCC would not be providing the meals for home delivery but perhaps will look at providing specialty diets in the future. Committee all agreed with this statement.
Group previously discussed the development of a continuum including the nursing home as well as other living units. Would like to see this as a formal statement on the continuum drawn up by Schauf and presented at the next meeting. This would eventually be worked into the long-range capital plan for the county. Family Care will have an impact on what types of other living units the county needs to develop in the future and we need to be prepared but flexible.
Discussion of the "behavioral unit". Some misunderstanding of the level of behaviors that would be included in the unit. Orth stated that the unit would not be people with serious mental illness or developmentally disabled. Only the elderly who are significantly demented and have behavior problems. This type of unit would be better staffed than a regular nursing home, designed better and have psychiatric time available. Separate licensure is not necessary. Columbia County model has "semi secured" dementia unit that cares for Alzheimer residents as well as other behaviors including wandering, anxiety, disrobing etc. Have 8 hours per month of psychiatric services. Discussion followed regarding the possible size of a semi-secured unit and whether or not to include it in the 80 beds. To secure the downsizing money we would have to downsize to 82 beds minimum. Several committee members felt that to include the semi-secured unit in the 80 bed number would severely limit the number of available nursing home beds. Question asked about how this unit would be different from the Clarion Center in Baraboo. No one was able to address the question. Consensus was that we do not want to be an "acute intervention" facility. Stoeckmann asked West to communicate with Winnebago regarding admission criteria they use for their "behavioral unit" also staffing and number of admissions. Orth will speak with Lakeview regarding their special unit. Stoeckmann also asked that West and Human Services review the recent cases that were placed in other facilities because the HCC was unable to care for them and see where we are currently. Orth indicated that residents placed out of county are being paid for mainly by MA but starting next year, Lakeview is setting up an arrangement that we would need to buy into and that would allow them to charge us the money that they are losing on each resident. That would be $40 per day. West presented his cost comparison assuming we were to add a 10 unit "locked unit". This information is based on taking the cost of 110 residents and figuring what 10 would cost. Can't project what the actual cost of the behavioral unit would be since staffing, psychiatric care etc. is unknown at this time. Cost per patient day was $288 approximately. With MA paying $128.96 per day the loss is significant. There are also many unknowns such as psychiatric care needs, therapies, duration of stay etc., however we can be sure that there will be significant losses. HCC is working very hard on being more financially stable and with the addition of this unit, would be an impossible task. Schauf clarified that the consensus seems to be that we are not looking at a full fledged "behavioral" unit. Will wait for Orth's report next meeting regarding those already placed and costs and the possibility of bringing them back. Also will get a clearer picture of the behaviors of residents at Lakeview
Carlson asked for the numbers for both an 80 and 100 bed facility. 80 beds x $165/sq ft = $12,800,000.00
100 beds x$165 sq ft - $15,260,000.00. Wood frame, 970 sq ft for resident rooms. This does not include land purchase, furnishings or any downsizing money that may be available if we downsize to 80 beds. Schauf will obtain the exact downsizing amount for the next meeting. Langer will check with the Clarion Center for type of residents admitted.
Moore shared site information with the committee. Down to
three sites. If we are looking at a Continuum of Care campus,
they work best in an urban rather than rural setting. Residents
prefer to be close to church, bank, grocery store etc. Visibility
for marketing purposes and access is important. Krueger site
- 27A adjacent to Hwy. 33 and near MATC, good access, flat,
visible, utilities accessible. Creekview site - 50A, adjacent
to MATC and residential street - no other access to Hwy. would
need to bring in, fairly flat, space is OK, visible to Hwy.
K. To bring in road and utilities would be approximately $750,000.
Either of these two provide the kind of requirements needed
for a viable Continuum of Care campus. Carlson indicated that
most constituents and HCC staff he surveyed prefer the current
site. Moore stated that with selling approximately 460A of
the current site for $1.2M, would gain taxes and not have to
bond for that amount. By using the selling price to purchase
other land for the HCC you would come out about even. Utilities
for existing site per Carlson (figures from West) would be
about $24,000 and if in Reedsburg would be $42,000 per year.
Borleske indicated current site is visible from Hwy. 33 and
more centrally located in the county. Would like comparisons
of all of the sites with figures to further explain the reasoning
to choose one over the other. Moore explained that the HCC
has existed at the current location for many years. We are
embarking on a Continuum of Care and marketing is very important
as is traffic/visibility. Will have an easier time marketing
and keeping the facility full in an urban setting. Krueger
indicated that the expansion pattern of Reedsburg is North
and East, not South or West. Moore indicated that the staff
felt they have spent 25 years shedding the mental health image
and trying to be like other nursing homes. He didn't sense
a problem from staff in moving into Reedsburg. Schauf indicated
that shedding the image of the "poor farm" would
be accomplished with a move into town. West indicated that
the larger costs associated with the HCC are operational, not
startup costs. Krueger related that we need to explain to our
constituents the idea of a Continuum of Care Campus, not just
a nursing home. He asked that the members not do a disservice
to their constituents by not explaining the continuum idea.
Fordham indicated that a matrix should be developed of which
a part will be start up costs, cost of operation etc. Guideline
for reporting to the Board of Supervisors was discussed.
Will begin working on this document at the next meeting.
June 26th meeting will look at final resolutions and corresponding
background documents. Schauf on vacation so may not have
a meeting on July 10. Both the June 12th and 26th meetings
will be joint. Next meeting date is June 12 at 6:00 p.m.
Motion by Haugen, second by Higgins to move into closed session
pursuant to Wisconsin Statutes Section 19.85 (1)(e) "Deliberating
or negotiating the purchasing of public properties...whenever
competitive or bargaining reasons require a closed session".
Property appraisals.
Those staying for the closed session: Diane Gade, Ken West, Rick Moore, Marty Krueger. Motion carried by roll call vote: Fordham, aye; Haugen, aye; Higgins, aye; Endres, aye; Langer, aye; Stoeckmann, aye; Alexander, aye; Carlson, aye; Dippel, aye; Netzinger, aye; Borleske, aye.
Meeting was adjourned immediately following the closed session.
Respectfully submitted: Al Dippel, Secretary Continuum of Care Planning Committee