Special Meeting - WIPFLi Presentation
DATE: December 5, 2006
MEMBERS PRESENT: Paul Endres, Joan Fordham, Al Dippel, Judith Stoeckmann, Lowell Haugen, Linda Borleske, Scott Alexander, Art Carlson, Henry Netzinger, Catherine Horenberger
Meeting was called to order at 4:00 p.m. by Paul Endres. The open meeting law requirements were met.
Election of chairperson.
Motion by Borleske, second by Fordham to nominate Paul Endres for Chairperson.
Motion carried unanimously.
Motion by Dippel, second by Borleske, to adopt the agenda. Motion carried.
None.
Began with discussion of, Medicare/Medicaid, trends, and state and county issues. There is an increasing elderly population who is healthier and more educated consumers than in the past. There are many more alternatives for services so stays in nursing homes are for shorter terms which has resulted in lower occupancies. Typically the % of Medicaid residents is higher for county homes than other facilities but reimbursement is decreasing. Currently, Medicaid reimbursement is from $120 - 125 per day. The amount of (Intergovernmental Transfer) IGT funds available continues to decline and counties have provided tax levy support for nursing homes but that also may decline due to changes in accessing property taxes.
State currently is pushing for more nursing home residents to be placed out in the community with services - push for family care program. Increase in use of technology for in home use (i.e. medication dispensing devices), devices to track wandering residents and other technologies will assist in keeping residents in the home longer. Medication and surgical advances also will aid in preventing some illnesses and slowing the progress of other debilitating illnesses.
Workforce is getting older - average age of nurses now is 50. More nurses are retiring than coming into the workforce. RN's are less trained currently due to the 2 year programs and the challenge of managing a multi-generational workforce continues to be an issue. County boards are faced with concerns regarding the tax impact of supporting a nursing home along with providing other services.
Have a "right sized" facility to meet needs of Sauk County, be responsive to changes in marketplace, have clear roles and accountability for staff and management, and maximize internal expertise. Also recommend realigning reporting relationships to facilitate teamwork and minimize management and maximize care delivery.
As the county increases its programs and services for the elderly, should consider co-locating as many services as possible together. Have a nursing home co-located so that shared activity staff, social service staff, dietary services and nursing staff could be available. As the census erodes in institutional long term care, services are still needed in a different venue (home and community-based services).
Statement from Bill Moberly (Union representative) regarding outsourcing of departments such as housekeeping and the possibility of current HCC staff being rehired by that company at reduced salary and benefits. Also, would lose control over the quality of the contracted services.
Carlson questioned the outsourcing of dietary saying the food at the HCC is great and the cost savings aren't large enough to justify the change. WIPFLi responded that food service is wonderful, but could consolidate services with other county departments or be creative with other options. Oursourcing is just one suggestion. Can also use food service consultation services to help with management of the current system.
Question regarding the new treatments for Alzheimer's and new medications etc. Where did the information come from? Consultants used drug company studies and stressed the importance of early diagnosis, further research and appropriate treatment.
Question regarding behavioral unit and costs per resident. Costs are $600 - 800 per day out of county and WIPFLi stated HCC costs are $245 per day. WIPFLi speaker indicated that because of the need for increased staffing for this population our cost would be closer to $400 - $500 per day plus costs of transportation.
Statement regarding the importance of keeping the Benefit Club Foundation for grant writing. WIPFLi stated that grant writing was important but resources are limited because it is a county owned business.
Kriegl asked about the difference in revenue/cost of therapies between the 2004 and 2007 budgets. Revenue has significantly declined. WIPFLi said they did not look into that. Only explanation given was a possible decrease in Medicare census. Information was passed on to WIPFLi.
White asked about centralizing nursing services. WIPFLi indicated that all nursing services should be decentralized.
Rydberg indicated that the two dementia units were already in the process of moving to the 5th floor as WIPFLi suggested.
Questions regarding the nursing staffing patterns/assignments. Minimum Data Set (MDS) responsibilities would be moved to direct care nursing. WIPFLi said the changes were outlined and things would be moved around in phases.
Question regarding transportation - indicated that consolidating and arranging schedules to accommodate more people and programs would be helpful.
Question regarding use of technology - Were there any estimates in cost? Indicated there is some technology that is not being used to full potential and maximizing what is there. Also is budgeted money to increase technology.
Motion by Carlson, second by Fordham to adjourn.
Motion carried.
Respectfully submitted: Joan Fordham, Secretary, Continuum of Care Planning Committee