The St. Croix County Health and Human Services Board met on January 10, 2003 at the St. Croix County Health and Human Services/Health Center complex.

MEMBERS PRESENT:      Thomas Dorsey, Chair

Leon Berenschot

Chris Bethke

Lois Burri

Fern Johnson-Schmidt

Mary Louise Olson

Ralph Swenson

Esther Wentz

MEMBERS ABSENT:      James Craig, excused

STAFF PRESENT:      Carolyn L. Krieger, Nursing Home Administrator

Judy Ziegler, Accounting Supervisor

Ron Eichstaedt, St. Croix Industries Supervisor

Barbara Nelson, Public Health Supervisor-Health Officer

Deb Lindemann, Public Health Nursing

Geralyn Karl, Tobacco Prevention & Control Specialist

Laurie Cameron, Family & Children’s Social Worker

Norma Vrieze, Early Intervention Director

Malva Berg, Secretary

OTHERS PRESENT:      Chuck Whiting, Administrative Coordinator

Chair Dorsey called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized.

NEXT MEETING:  The next Health and Human Services Board meeting is scheduled for Thursday, February 13 at 8:30 AM. The January 23^rd meeting will not be held unless important agenda items arise. Olson, Johnson-Schmidt, and Swenson asked to be excused from the February 13^th meeting.

AGENDA:  Motion:  A motion was introduced by Bethke, seconded by Berenschot, and unanimously adopted:  That the agenda be approved as circulated.

MINUTES:  Motion:  A motion was introduced by Wentz, seconded by Bethke, and unanimously adopted:  That the minutes of the 12/12/02 Health and Human Services Board meeting be approved as circulated.

REQUEST TO APPLY FOR OTTO BREMER FOUNDATION GRANT:  Laurie Cameron, Family and Children’s Social Worker, requested approval from the Board to apply for a $5,000 grant from the Otto Bremer Foundation to fund a “revolving” housing security deposit fund.  Independent Living youth between the ages of 18 and 21 would be able to access the fund when obtaining housing. Cameron would work with youth to maintain the rental unit and leaving it in good condition upon leaving the rental agreement to better ensure return of the deposit to the revolving fund. Youth would need to provide the first month’s rent at the time the deposit would be released.  Money is received from the Federal Government to fund the Independent Living program but the funds are used to cover salary and benefits and there are no monies left over to fund additional programming. Human Services is mandated to provide services to Independent Living youth until their 21^st birthday.

Motion:  A motion was introduced by Wentz, seconded by Olson, and unanimously adopted:  That the Board approves applying for the $5,000 grant from the Otto Bremer Foundation to fund a revolving housing security deposit fund.

Olson requested follow up information on this project.

CONSIDERATION OF CLAIMS:  The following reports were distributed to the Board:  December cash report and November financial report.

Health and Human Services Board member, Bethke, reviewed the following vouchers:

HUMAN SERVICES:

16959: Beebe Mortuary, $2,880.00, funeral expense.  This funeral expense will be reimbursed in full by the State contract. No County dollars are required for this contract item. 

17289: Shopko Pharmacy, $218.75, LTS client expense. This expense is for a Long Support client in the Community Options Program.  These people stay in the community and utilize the stores most convenient to them.

NURSING HOME:

12742: Sundance Rehabilitation, $1,452.94, physical therapy services/November, 2002. The Nursing Home contracts with this company to provide therapy services to residents of the Nursing Home. The therapy staff have work areas in the Nursing Home building so residents don’t have to leave the premises to receive services.

11029: Centuria Commercial Laundry, $114.50, laundry expense. Cost of supplies used by staff for residents’ laundry. We contract with this company to wash the bedding and towels but do personal laundry in-house. 

Motion:  A motion was introduced by Bethke, seconded by Wentz, and unanimously adopted:  That the following vouchers be approved and be made a part of the supplemental minute book:

Human Services vouchers 16866 through 16953, dated December 19, 2002 in the amount of $359,116.53.

Human Services vouchers 16954 through 16980, dated December 27, 2002 in the amount of $49,515.78.

Human Services vouchers 16981 through 17025, dated January 02, 2003 in the amount of $77,805.56.

Human Services vouchers 17035 through 17199, dated January 10, 2003 in the amount of $189,626.57.

Human Services vouchers 17200 through 17354, dated January 10, 2003 in the amount of $125,096.28.

Nursing Home vouchers 2430 through 2438, dated December 19, 2002 in the amount of $7,378.87.

Nursing Home vouchers 2439 through 2441, dated December 27, 2002 in the amount of $15,203.82.

Nursing Home vouchers 2442 through 2485, dated January 10, 2003 in the amount of $54,318.56.

Human Services and Nursing Home vouchers 671 through 699, dated December 17, 2002 in the amount of $208,598.09.

Human Services, Workshop, Public Health, Social Services vouchers 714 through 743, dated December 17, 2002 in the amount of $317,612.26.

Human Services, Workshop, Public Health, Social Services vouchers 744 through 773, dated December 27, 2002 in the amount of $317,022.50.

Human Services and Nursing Home vouchers 700 through 729, dated January 02, 2003 in the amount of $192,111.09.

FINANCIAL REPORTS:  The following financial reports through November were distributed to the Board:

REVIEW OF WIPFLI REPORT:  The final report from Wipfli was distributed to Board members.  The information in the final report is essentially unchanged however does include three new appendices.  A report from Krieger regarding follow up to the Nursing Home management audit review was also distributed to the Board.  The “template” received from Wipfli does not compare two equal time periods, however, Ziegler developed a new report comparing the appropriate time periods. Swenson said the changes to the report that were requested aren’t seen in the final report. Whiting said Wipfli has only been paid half of their fee and have not received the final bill for the audit. The report prepared by Krieger emphasizes the cost per patient day by dollars and hours. The study felt that the facility was overstaffed and management did not have good control of the staff to resident care ratio. Adjustments have been made in the Nursing Home staffing that resulted in cost savings in the 2002 budget and will continue into 2003.  Krieger prepared a report comparing the first six months of 2001 and 2002.  She questioned pulling out the overtime, orientation/training time hours to give a true picture of the hours worked on the floor to provide patient care. The 2003 budget was prepared using a census of 88.  The census today is 94 with two admissions pending for tomorrow. Krieger said the Nursing Home budget has eight less FTE in 2003 from 2002.

Krieger said the nursing home has experienced admissions of many younger people than it has ever had before and many of these admissions have no pay source. She said residents are accepted only if the Nursing Home can provide their clinical care and work with financial resources. 

Some areas not addressed in the final report include the gradual reduction in staff, CMI-protectively placed population, adjustments made in the nursing department to try to lessen workload.  The five dining areas in the Nursing Home were criticized by the study but was also cited by the State surveyors in the survey process as the increased number of residents in wheelchairs has caused overcrowding in the dining room. Krieger said the private pay rates were increased in December rather than January.  Board members questioned if private pay rates could be increased further. Krieger surveyed other facilities in the area and the nursing department structure in the Nursing Home is pretty much staffed like the other facilities in the area.

It is difficult to know how well the Nursing Home is doing by the financial reports generated.  Loney will be working with Borup, Krieger and Ziegler to make needed changes to generate a financial statement with needed information. Berenschot requested that all County Board members receive copies of the Wipfli report and receive copies of the follow up presentation from Krieger. Borup and Krieger will give a report summarizing the Wipfli report to the County Board on March 18, 2003.

REQUEST APPROVAL FOR NURSING HOME SOFTWARE CHANGE:  The Nursing Home transitioned to the windows version of the Horizon software in September due to the company’s non-support on December 31, 2002. The new version is not an integrated product, which is unacceptable. Krieger is recommending the purchase of American Data because it is an integrated program that works.  It is in 12 County nursing homes and over 140 other Wisconsin nursing homes. Tom Boron and Jim Williams have been involved in this project and share the opinion to move to American Data. 

Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted:  That the Board approves the software change to American Data.

REVIEW AND ACTION ON BIDS FOR 20-PASSENGER BUSSETTE FOR ST. CROIX INDUSTRIES: Eichstaedt said 12 bid requests were sent out and seven bids were received. Eichstaedt reviewed the spreadsheet outlining bids received.  He said the motors and the frames in the bussettes are Ford while the bodies are assembled by a separate company.  There is no one in the immediate area that is familiar with our vehicles. If service is needed on a bussette, an issue arises whether it is a problem Ford should repair or if it is a problem the body company should repair.  Service is an issue.  

Motion:  A motion was introduced by Olson, seconded by Johnson-Schmidt, and unanimously adopted:  That the Board approves bid #3 for $42,560 from Minnesota Body and Equipment in Shakopee, Minnesota.

Borup will send a letter to Finance regarding a loan for these vehicles requesting an “internal loan” be obtained from the Finance Committee for this vehicle with a payment schedule set up over four years.

Berenschot left the meeting at 10:00.

The Board recessed from 10:00 to 10:10.

BIRTH TO THREE PROGRAM REPORT:  Vrieze reported the Birth to Three Program has been mandated since 1987. She said the program has received between 100-110 referrals per year but not all are enrolled in the program. She outlined referral sources, age at time of referral and diagnosis/description of clients in the program.  She also distributed a comparison study of the program comparing 1994 to 2001.  In 2001 there were 64 clients enrolled in the Birth to Three Program.  Wentz announced that she is on the Long Term Support Committee and complimented the help the Birth to Three Program provides to the parents of St. Croix County for the children in this program.

PUBLIC HEALTH PROGRAM REPORT: Lindemann and Karl reported on the Wisconsin WINS Program. This program started in November and the goal is to try to reduce sale of tobacco products to minors. A chart was distributed outlining the outcome of tobacco compliance investigation in St. Croix and Pierce County. One supervisor and two youth visited establishments in these two counties that sold tobacco products.  The minors attempted to purchase tobacco products.  If the sale was not completed, the establishment was rewarded for following the law.  If the sale was completed, the establishment was reminded of the law that it is illegal to sell tobacco products to minors and offered additional training.  This project established positive relationships with both retailers and law enforcement. 

The Wisconsin Youth Tobacco Survey results were recently released and show a definite decline in tobacco use in high school and middle school students. 

A letter from David Gunderson, Wisconsin Tobacco Control Board, was distributed to Board members.  Clean indoor air policy goals to be achieved by 2005 were outlined as follows:

q100 percent of municipal government buildings will be smoke-free;

q100 percent municipalities will pass smoke-free restaurant ordinances;

q90 percent of all workplaces will be smoke-free; and

q70 percent of homes will be voluntarily smoke-free. 

If the County does not work on the policies as outlined above, there will be no funding.  There are currently no municipal ordinances mandating smoke-free restaurants in St. Croix County.  The Board questioned if smoking was allowed on County property.  Borup said there is no smoking allowed in County buildings. 

Public Health is still providing nursing services on a month-to-month basis as the sheriff has not hired personnel.  Interviews are scheduled for the end of January. 

The agenda for the January 20^th, 2003, Legislative Event was distributed to Board members. 

Nelson gave a communicable disease update. She said Pertussis has been seen throughout the State; St. Croix County had its first case this week.  She reported there have been no recent local cases of E coli. Influenza has been at normal levels this year.  She said there was one reported episode of measles in a 22-year-old person in Wisconsin who was not vaccinated for measles and had returned from India. 

There will be a pandemic follow-up tabletop exercise with Baldwin community members the end of February at the BAMC.  Nelson invited Board members to be evaluators for this process. 

Nelson said there are nine counties in the bioterriorism consortium.  She said no money was given to Polk County or any other county to have the consortium. There is no stand-alone money for the consortium, there is only money if the county is part of a consortium and the money is shared by all the counties in the consortium. There are 12 consortiums in the state. Funding received last year by the health department for bioterrorism preparedness has been used for education, training and consortium development.

Dorsey asked if there were any other issues to bring before the Board.

Motion:  A motion was introduced by Wentz, seconded by Bethke, and unanimously adopted: that the meeting be adjourned.

Time:  11:40 AM

Chair: __________________________________

Attest: _________________________________

(Secretary)