HEALTH AND HUMAN SERVICES BOARD
Tuesday, May 6, 2008
Administrative Center – Room 3220
6:30 p.m.
MEMBERS PRESENT: Sharon Hampson, Jill Billings, Margaret Wood, Loren Kannenberg, Tammy Gamroth, Bill Brockmiller, Robert Erickson
MEMBERS EXCUSED: Dr. James Glasser, Al Thompson
GUESTS AND STAFF PRESENT: Jerry Huber, Doug Mormann, Dean Ruppert, Mary Ellen Prinsen, Sara Koopman, Dave Geske, Al Graewin, Bill Adams, Lorie Mueller, Maryellen Paudler, Donna Gunnarson, Jane Deal, Gary Priem, Pam Bendel (Independent Living Resources), Renee Weston, Jane Klekamp, Steve O’Malley, Connie Eide, Linda Lee
CALL TO ORDER
Sharon Hampson, HHS Board Chair, called the meeting to order at 6:35 p.m. Tammy Gamroth, Bill Brockmiller and Robert Erickson were introduced and welcomed as new members to the HHS Board.
ANNOUNCEMENTS
Sharon advised that Dr. Jim Glasser had a bad accident, fell down some stairs in St. Paul and is in the hospital there. Sharon also thanked the Health Department for their letter of appreciation. The Transportation Committee needs a member of the HHS Board to join their committee and Sharon asked that any volunteers contact her. This committee has a meeting on Friday at 10:00 am.
Joint Meeting with ALTC: A joint meeting with HHS Board and Aging and Long Term Care Committee is scheduled on Monday, June 9, 2008, from 5:00-6:00 pm in HHS Building Basement Auditorium. If anyone has any items for the agenda, please let Sharon know; we are looking for items where the missions of these two committees overlap.
Board of Health Education Session: Board members are invited to attend the Board of Health Education Session sponsored by the Western Region of the Wisconsin Association of Local Health Departments and Boards on June 6, 2008 in Eau Claire. Sharon advised this is a very good training. Please let Sharon or Doug know before June 2 if you want to attend; carpooling is available.
PUBLIC COMMENT
None requested.
ORIENTATION FOR NEW BOARD MEMBERS
A contact information sheet of HHS Board Members was circulated and members were asked to review for accuracy and note any corrections needed. Each board member also received an updated Orientation Manual.
Doug Mormann introduced the Division Managers of the Health Department: Dave Geske-Vector Control; Al Graewin-Health Education; Connie Eide-Home Care Nursing; and Linda Lee-Nutrition.
Jerry Huber noted the “Human Services At-a-Glance” collage in the orientation manual and also made introductions of key staff in Human Services: Section Managers: Bill Adams-Clinical Services; Lorie Mueller-Economic Support; Mary Ellen Prinsen-Family & Children’s; Jane Klekamp-Justice Sanctions; Maryellen Paudler-Care Management Organization; and Dean Ruppert-Operations Administrator and Manager Aging & Disability Resource Center. Fiscal Managers: Jane Deal and Sara Koopman. Managed Care Organization Cabinet: Gary Priem-Finance Director; Beverly Monahan-Human Resources Director; John McDonald-IT Manager; and Tim Garrity who has been hired as Executive Director to start May 27. Administrative Assistant: Renee Weston.
Margaret Wood went through the orientation manual table of contents and discussed the information contained. It was noted that the 2007 annual report for each department will be available on line in June and board members will be notified when this is available.
BOARD EDUCATION
Policy, Practice, People of Home Health Care
This item was moved up on the agenda for the convenience of the presenting guest. Connie Eide referred to the brochure in the packet outlining the home care nursing services available through the county: skilled nursing, physical therapy, occupational therapy, speech pathology, and home health aide. Char Jones shared her success story about her grandson Izayah. Char’s daughter died two years ago, leaving two sons without a mother. One son, Izayah, who is 4 years old now is disabled and is unable to do anything for himself, requiring 24/7 care. County nursing comes into the home to provide services so Char and her husband have been able to keep Izayah living with them. Home health workers come in their home for a couple hours about 4 days a week, 2-3 days in the summer. Char said they would never have been able to keep Izayah without the help of this county program. Char heard about the county services through Izayah’s doctors.
RESOLUTIONS/PROCLAMATIONS
Resolution Re: Support Increase in State Tax on Alcohol for Alcohol Treatment and Prevention –
MOTION by Wood/Brockmiller to approve the resolution as presented. Doug Mormann stated that the Public Health Counsel appointed by the Governor identified three major goals for Wisconsin, and one is to work on alcohol abuse. This resolution reflecting our support for an increase in state tax on alcohol is one way to fund an increase in programs for alcohol abuse. Informational graphs are included in the packet. If approved, the resolution would be sent to the Governor, local legislators and the Wisconsin Counties Association to show our support for the increased tax. This resolution only signifies our support for taxation on alcohol products in general; details regarding amount of taxation and what products would be taxed would be worked out by the legislature. MOTION by Kannenberg/Billings to add the words “to be used to offset costs associated with alcohol use” to the Now Therefore Be It Resolved paragraph on the resolution. Motion for amended language carried unanimously; Glasser and Thompson excused.
Steve O’Malley suggested providing background/history information on taxing alcohol vs. beer along with this resolution to the County Board. Margaret Wood also suggested including the Culture of Risky Drinking Behavior report. Doug will also include some brief local information. Robert Erickson does not feel that supporting this resolution to increase the alcohol tax will reduce the amount of drinking in La Crosse. Other members noted that this resolution is to fund treatment, not reduce drinking. Motion on Resolution carried on 6 to 1 vote: Erickson-no; Glasser and Thompson excused.
Resolution Re: Authorization to Transfer Funds from Health Department’s Reserve Fund Balance to be used for increase in staff time, contracted services, and equipment for Public Health Preparedness Programs – Doug Mormann advised the Health Department is requesting authorization to spend $75,000 in preparedness dollars that had previously been set aside for future preparedness spending. This request is a result of a determination last fall by the federal government that counties cannot carry funds forward. If these funds are not used by the end of 2008, they will need to be returned to the government. There are various public health preparedness activities that we could put this money toward in 2008 if this resolution is approved. MOTION by Kannenberg/Wood to approve the Resolution as presented. Discussion on fiscal note that increasing hours of part-time staff is for temporary staff. This money cannot be used to supplant other programs. A total of $300,339 was collected through a multi-county effort and only $75,000 of it will be allocated for use by La Crosse County if authorized. Motion carried on 6 to 1 vote: Erickson-no; Glasser and Thompson excused.
Resolution Re: Creation of La Crosse County Long Term Care Coordinating Committee – Jerry Huber advised that the Long Term Care Council (LTCC) was created as required by statute with the inception of Family Care. With the creation of a regional long term care management organization, the existence of the LTCC is no longer a statutory requirement. The members of the LTCC would like to maintain a local coordinating committee for long term care interests by creating the La Crosse County Long Term Care Coordinating Committee to be advisory to the HHS Board as requested in this resolution. MOTION by Billings/Wood to approve the Resolution as presented. Discussion on proposed membership of the new committee as noted in numbers 1 through 7 on the Resolution. Dean Ruppert advised that upon review of a draft of this resolution, the LTCC asked that number 7 be amended to read “Consumers and/or consumer advocates of various aging and disability groups being served”. MOTION by Brockmiller/Kannenberg to change item number 7 on the Resolution as suggested. Motion carried unanimously; Glasser and Thompson excused. Vote on the Resolution as a whole resulted in Motion carried on 6 to 1 vote: Erickson-no; Glasser and Thompson excused.
Proclamation Recognizing La Crosse County Aging & Disability Resource Center (ADRC) – Dean Ruppert presented the Proclamation recognizing the ADRC for being in operation for 10 years. The ADRC assists adults who are aged or disabled by providing information/assistance, options counseling, emergency response services, and prevention services to over 9,000 individuals a year. The ADRC is expanding as Family Care expands and in Summer/Fall 2008 will join with three other WI counties (Jackson, Vernon and Monroe) to form the Aging & Disability Resource Center of Western Wisconsin (ADRC-WW). The HHS Board will be receiving a resolution next month in connection with this expansion and the creation of an advisory committee which is required by statute. MOTION by Wood/Brockmiller to approve the Proclamation as presented. Sharon thanked Dean for the work he put into this effort. Loren noted he has been watching the ADRC grow over the last 10 years and stated it is a terrific program that improved the way we serve the aging and disabled in so many ways. The ADRC should also be commended for their major role in the creation of Western Wisconsin Cares. Motion carried unanimously; Glasser and Thompson excused.
POLICY ISSUES
Juvenile Justice Consultation Proposal – Jerry Huber contacted Mark Carey to provide a recommendation for our Juvenile Justice program, and The Carey Group proposal is in the packet. Jerry feels the proposal is very good. We now need to provide Mark with some assumptions so he can give us a cost estimate, which will be solidified at the June HHS Board meeting. The board asked Jerry to provide a continuum of services currently available in our Juvenile Justice program at the June meeting. If there are certain components of the proposal (big ticket items) that HHS Board members feel are a must, please let Jerry know by next week so this can be relayed to Mark Carey for consideration in his cost estimate. The earliest Mark can commit to do the work is sometime late this summer and it will take about six weeks for Mark and his staff to complete the project, depending on how big the scope is. There is consulting money in the Human Services budget that can be used for this project we well as $100,000 that is currently set aside to start the Adolescent Center. (We have asked Mark to address the Adolescent Center in his recommendations as well.) If this is not enough to cover costs, we will discuss using reserve funds or carry the project over into 2009 and include it in the budget.
Memorandum of Understanding on Utilization of Crisis Services – Jerry Huber stated that in 2001 we started our mobile crisis program to respond to crises after hours. In this program, law enforcement (LE) has the ability to contact one of our crisis workers to do an assessment and provide interventions for people in a mental health crisis in an effort to reduce the number of Chapter 51 inpatient detentions. There is a large number of Ch 51 admissions per capita in La Crosse; by far we have highest ratio in the state of Wisconsin. (For example Dane County has about double our population and less than half as many Ch 51 cases each year.) Ch 51 is imposed if a person is believed to be dangerous to themselves or others. Their civil rights are taken away and they are brought into an inpatient setting at a state institution or one of the hospitals by LE. A big factor is having the services or a crisis facility alternative to the hospitals that is “convenient” for LE to use, otherwise it will not be utilized. We have two conveniently located hospitals in the area which is a privilege, but hinders the use of our crisis services. It was noted that 80% of those placed in 51 detention do not proceed to probable cause hearing within 72 hours, which makes us question whether appropriate alternatives could have been successfully used to avoid the Ch 51 detention altogether if they were available and utilized by LE.
It costs the county $700/day to hold someone on Ch 51 in the hospital or state institution. A copy of the continuum of services that were put into place when the crisis program was started and which are available in lieu of Ch 51 detentions was provided to the board. Jerry has also created a Memorandum of Understanding (MOU) which is in the packet this month. This MOU has been proposed to LE and the two local hospitals and indicates that we would be the payer of Ch 51 detentions as a last resort, that we would have the ability to prior authorize, and also that our crisis staff would be notified when LE is involved in a crisis. We feel there is no use having a crisis unit if it is not being utilized. We have received resistance from one of the hospitals to this MOU due to their concerns about the county prior authorizing Ch 51 detention placements. We have been working closely with LE and providing training to officers including crisis intervention training, mental health stigma education, the crisis program and alternative responses. Our Ch 51 numbers have not been reduced as a result, but we do feel we are making progress and moving in a positive direction.
BOARD EDUCATION (cont)
Policy Practice People of Crisis Mental Health - Donna Gunnarson presented on the Crisis Mental Health Program which was started in 2001 (history information was included in the board packet). Crisis services available 24/7 were developed to provide alternative resources to meet consumers’ needs in the least restrictive manner possible, some at the time of emergency, and some after a person is in the hospital (planned placement). We work closely with people working through a crisis with a step-down process to get them back in their home setting as quickly as possible with supports in place to prevent future crisis. “Crystal” was unable to make it tonight to present to the board, but she gave Donna authorization to tell her story. She is a young mother in her 20s with four children under the age of 6. She stopped taking her meds for a few months and her bipolar disorder caused her to go into severe depression; she threatened to hurt herself and was admitted to hospital. She went from Ravenwood at Lakeview Healthcare Center where she harmed herself again, back to the hospital, and on to Mendota for one-on-one observation. Through the crisis program we were able to place Crystal in a crisis apartment (Hope House) for about 10 days and, with daily contact, she got back on her meds and was stabilized. Crystal was grateful to be placed in a supportive location other than the hospital, and with the resources we provided she is doing much better now.
POLICY ISSUES (cont)
Discussion re: House Search and Options for Women’s Community-Based Program – Jane Klekamp advised that a year ago The Carey Report recommended we close the women’s jail by reducing the population, keep a few beds in a separate part of the men’s facility and open wraparound services in the community for women. In December after a Request for Proposal (RFP) process was conducted, the YWCA was contracted to provide this program. The La Crosse Community Foundation awarded $50,000 for housing for this program and we are considering an appropriate housing facility to lease at this time. Recommendations will go to the full County Board in June and we hope to have a house by July. Zoning is an issue in choosing a location. We are looking for a large facility, but all residents (approx. 10) cannot be located in one residence all together. We’re considering a tri-plex type facility. The women housed in this facility will all be on electronic monitoring; there will not be staff on premises 24 hours a day, but we will conduct camera monitoring and random checks to control who is coming and going from the home. No unapproved guests will be allowed. Outside agencies will conduct group meetings with the residents at the home, and the goal is to have them employed through a contract with Workforce Connections. Once a location is determined, we will contact and meet with all neighbors in the area to explain our plans and answer any of their questions.
In choosing residents, we will focus first on sentenced women (usually for property type crimes or drug use). This housing is an expansion of services to women we would be placing back in the community anyway, but it will provide an alternative to sending them back into the community without supports. The YWCA will provide ongoing mentoring to the residents after they leave, as well as a connection to other existing programs they have available that these women can utilize on an ongoing basis. We are looking for a catchy title for this program, so if anyone has ideas please contact Jane.
BOARD EDUCATION (cont)
Day in the Life Planning/Menu of Options – Human Services and Health Department provided a list of potential Day in the Life shadowing options in the packet. If there are other shadowing interests not reflected on these lists, board members are asked to contact Jerry and Doug so they can be added. The HHS Board agreed to schedule this event on July 1 and legislators, media and County Board members will be invited to participate. We will try to have a debriefing session at the end of the day to talk about the day’s experiences. If anyone is interested in a shadowing experience, but cannot participate on July 1, please let Jerry or Doug know and they can make these arrangements for you on a different day.
HHS Board Retreat Planning – This year the HHS Board Retreat will focus on budget development and setting priority goals on what we will be looking at in the 2009 budget. The retreat is scheduled on July 16 from 5:00 – 7:00 pm. in the Basement Auditorium of the Health & Human Services Building, dinner included.
WRITTEN DIRECTORS’ REPORTS
Health Department – Correction on the last page of the Director’s Report (back page of the Home Health Care Summary): Should indicate the total cost of the Home Health Care program is about $750,000. Doug noted from the last paragraph of this summary that the Department is working on a plan to generate revenues to offset the reduction of home health care services provided to the Care Management Organization (CMO) as a result of the creation of the Managed Care Organization (MCO). Increasing pediatric care is an option and info is being gathered to see if this will be a sufficient offset to make up for the reduction in services currently being provided to the CMO.
Doug also noted that a paper written by Jerry Huber has been published in the Wisconsin Counties publication on protecting children. If board members are not receiving this publication and would like to, they can contact Cheryl Stephen and she will make these arrangements.
Human Services Department – No discussion
MOTION by Kannenberg/Wood to approve the Directors’ Reports and Consent Agenda. Jerry noted that the CMO financials reflect that we have been in a deficit spending mode over the past few months due to start-up costs associated with the development of the MCO. This was expected to happen, and the state has indicated that we will be made whole when capitation is set. It is planned that this deficit spending will continue most likely until October 1 when the MCO officially breaks off. No county levy is being used for this spending; all monies have come out of capitated funding. Motion carried unanimously; Glass and Thompson excused.
CONSENT AGENDA
Minutes:
§ Health and Human Services Board 4/8/08
§ Long Term Care Council 3/7/08
§ Consumer Advisory Council 3/14/08
§ West Central Consortium Steering Subcommittee 3/25/08
§ Family Policy Board-Management Council 3/20/08
§ Criminal Justice Management Council 4/16/08
§ Criminal Justice Executive Committee 4/9/08
Fiscal:
§ 2008 Vendor Contract Approvals
§ 2008 Vendors Contracts Exceeding 2% Increase in Rate
§ Vendor Audit Policy Update
§ Summary of Revenue and Expenses for Care Management Organization (handout)
Department/Board Reports:
§ Health Department Quarterly Fiscal/Activity Report
§ Human Services Quarterly Fiscal/Activity Report
§ Health Department Quarterly Goal Reporting
§ Human Services Quarterly Goal Reporting
ITEMS FOR FUTURE AGENDAS
NEXT MEETING
Tuesday, June 10, at 6:30 p.m.
ADJOURNMENT
There being no further business, MOTION by Brockmiller/Wood to adjourn at 9:30 pm. Motion carried unanimously; Glasser and Thompson excused.
Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting.
Renee Weston, Recorder