Continuum of Care Committee Meeting Minutes

DATE: December 29, 2005

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

  1. Called to order at 6:00 p.m. by Paul Endres. The open meeting law requirements were met.
  2. Motion by Fordham, second by Borleske to adopt the agenda. Motion carried.
  3. Motion by Dippel, second by Carlson to approve the minutes. Motion carried. Correct copy of minutes was not received by all members so copy will be sent out.
  4. Public Comment - None
  5. Communications. Letter in support of the Health Care Center remaining open and a county facility was read by Mr. Endres. Letter was from an agency nurse who has worked in many local facilities.
  6. Updates - None
  7. Tommy Davidson canceled. Will try to schedule for a future meeting.
  8. Discussion of policy recommendations
    1. Policy recommendations including criteria for alternatives. Criteria are in ranked order.
      1. Provision of Service
        1. Status quo - Least disruptive, limits expansion of services
        2. Down size HCC - Would free up additional CIP II funds if beds are delicensed, and (per the Keefe Report) downsizing to at least 90 beds would enable us to capture one time downsizing initiative funds. Possible one-time funding through Nursing Home Conversion Project. Limits possible future growth in SNF beds.
        3. Close HCC - Most disruptive, lose control of services to that population, loss of employment.
        4. Privatize HCC - Continue SNF services (as long as an agreement is in place for private to stay in this county), ability to expand community-based services. In long run loss of control of SNF population. Possible equalization of services for SNF residents across the county (lack of consensus on this item).
        5. Build new right-sized HCC with additional services - More efficiency, expansion of services, some services could suffer due to high cost of providing a new building, more self supporting (ability to attract private pay residents) and conversely possibly excluding the most needy.
      2. Cost Feasibility
        1. Status quo - Not efficient, not marketable in the future, increased costs in meeting codes and regulations. (i.e. Need to meet fire code by putting in sprinkler system soon). Will still have an old building that needs constant repair, staffing issues, need to move residents during remodeling, liability issues still there - five stories.
        2. Down size - All of #1 and potential loss of income due to lower census.
        3. Close - Costly for resident placement and staff issues. Still need to deal with existing structure.
        4. Privatize - Highest initial and ongoing savings which could be allocated to other programs.
        5. Build new - Requires bonding, highest initial cost however savings due to more efficient staffing patterns and energy use. Potentially less efficient if beds unused in light of some trends away from inpatient nursing home care; however, beds can always be delicensed. Possible new revenue sources. Passed out Cost Scenario Sheet labeled 3A. Costs comparisons included selling the licenses/beds; close licenses/beds; or continuing SCHCC for 1) placing residents in other nursing homes 2) placing in community settings 3) placing in other nursing homes and community settings 4) placing residents in "build-to-suit" nursing home. Supervisor Montgomery, who was in attendance, recommended that this committee have a meeting at the new Senior Life Center in Reedsburg. Felt many questions could be answered by staff there.
      3. Manageability - all are manageable to some degree
        1. Status quo - Allows for relatively steady service provision while continuum and future initiatives are developed. Once remodeling is started, all building codes must be met. Fire codes require sprinkling of all parts of the building in 2006. As systems deteriorate, we will be faced with making repairs often in an emergency situation. Discussion of the intent of Status quo - some members felt it should cover just doing absolutely necessary repairs while further discussion is going on. All members felt status quo should cover necessary repairs which covers getting systems up to code only.
        2. Down size/remodel - Manageable but with more disruption
        3. Close - Manageable but most disruption
        4. Privatize - Manageable but fear/lack of education are barriers. Residents are fearful but are being reassured. If privatized would not stay in current building. Manageable provided there is a willing partner. County would not have any control. Other departments may have some difficulty working with a "non related" facility.
        5. Build new - Most manageable - could provide some additional services. Time commitment and transitions. Possible fewer funds available for community-based programs and waiting lists in the long run. Dealing with HS waiting list was again discussed.
      4. Public Acceptance - Acceptance of any alternatives dependent on education. All alternatives can be acceptable to some.
        1. Status quo - Acceptable to some of the public.
        2. Down size - Not generally acceptable. May be acceptable if funds can be reallocated to serve those on waiting lists. Public hearings and meetings were held to educate.
        3. Close - Least acceptance
        4. Privatization - Acceptable to some depending on education.
        5. Build - Acceptable to some.
      5. Other county models - Need to look at the whole system and the continuum of care.
    2. Preferred alternatives

      Second phase of discussion would be outline Implementation Strategy and discuss unintended consequences and policy limitations. Also would give guidance to the effected stakeholders. Orth suggested that any scenario chosen would have to give consideration to the continuum of care. Need to consider what levy would cost now and into the future and what possible levy could be diverted into the continuum of care for other needed services.

      1. Final recommendations. Plan is to have a recommendation at this meeting, have another short meeting to discuss final draft wording - not necessarily all agree with recommendation, but wording. Final recommendation then presented to board on the 17th. Tommy Lee suggested alternative No. 5 - Build new for several reasons. Felt if decide to privatize later would have new building to sell, would be more efficient and most acceptable to general public. Judith asked that each member do personal ranking of the scenarios and put all on the board. Wheeler felt members should also make statement on the ranking of their ideas on how to deal with waiting list. Wording on page 10 was suggested - "...efforts will be ongoing to address existing gaps in the Long Term Care Continuum with available resources. The development of a single point of entry system and the transition to managed care." All members agreed to accept the statement. After some discussion decided to rank top three with first one listed being the most preferred and the third one listed as the least preferred. Each member voted with results as follows. (These are votes with weighted amounts added) - 1st choice = 3 points; 2 = 2 points; 3 = 1 point
        Alternative/Member Voting Alt. 1 Alt. 2 Alt. 3 Alt. 4 Alt. 5
        TOTAL 16 14 1 7 28
        Stoeckmann 3 2     1
        Dippel 2 1     3
        Carlson 1 2     3
        Endres 1 2     3
        Volz 1 2     3
        Wheeler 2 1   3  
        Fordham   2 1 3
        Earl   1   2 3
        Haugen 2     1 3
        Bychinski 2   1   3
        Borleske 2 1     3

        Outline for Implementation - Will be arranging a meeting prior to the January Board Meeting. After some discussion it was set for January 11 at 7:00 p.m.

        1. Formation of group - No budgeted amounts for group such as this to continue meeting. Will have to institutionalize Continuum of Care within existing committees. Functional groups will continue to meet and provide input. Department Heads, Supervisors and community members should be members as well as someone to be the facilitator. The community members would not be reimbursed. Kerry and Kathy will look into budget concerns. Felt the committee members should either all be paid or none be paid. Any ideas out of this committee will still have to be sent to the appropriate county board committee before being sent to the full board. Should stress that this group start as soon as possible.
        2. Need to also begin the building projects group. Will need to put a committee together to study the project and put the appropriate resources in place.
        3. Develop time line.

          Unintended Consequences and Policy Limitations

          1. Ability to bond/funding (financing questions)
          2. Legal impediments
          3. Change in State Regulations
          4. Funding changes/MA rate changes

          Guidance to affected stakeholders

          1. Information on how different committees are going to operate
          2. Inclusion of statement that efforts will be ongoing to address the gaps and the continued development of a single point of entry system and transition to managed care. Judith requested a draft copy of the information compiled tonight before the next meeting. Kathy will send out. Brief discussion of holding the meeting in Reedsburg next time. Because of the computer system etc., it was decided to continue at the West Square Building.
  9. Next meeting will be on January 11 at 7:00 p.m.
  10. Motion by Haugen, second by Earl to adjourn.
    Motion carried.

Respectfully Submitted: Joan Fordham, Secretary