proceedings human services committee · proceedings of the brown county human services committee...

PROCEEDINGS OF THE BROWN COUNTY HUMAN SERVICES COMMITTEE

Pursuant to Section 19.84 Wis. Stats., a regular meeting of the Brown County Human Services Committee was held on Wednesday, January 25, 2012 in Room 200, Northern Building, 305 E. Walnut Street, Green Bay, Wisconsin

Present: Pat Evans, Jesse Brunette, Pat LaViolette, Steve Fewell, Pat Moynihan, Pat Wetzel,

Carole Andrews Also Present: Supervisor Dantinne. Sunny Archambault, Brian Shoup, Tim Schmitt, Judy Friederichs Barbara Vanden Boogart, Steven Deslauriers, other interested parties, news media.

I. Call Meeting to Order:

The meeting was called to order by Chairman Pat Evans at 6:00 p.m. II. Approve/Modify Agenda:

Motion made by Supervisor LaViolette and seconded by Supervisor Wetzel to take items 3 and 13 before item 2. Vote taken. MOTION APPROVED UNANIMOUSLY

III. Approve/Modify Minutes of November 17, 2011 and December 21, 2011. Motion made by Supervisor Moynihan and seconded by Supervisor Andrews to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

Comments from the Public Report from Human Services Chair, Patrick Evans 1. Review Minutes of:

a. Aging & Disability Resource Center (December 1, 2011). b. Children with Disabilities Education Board (November 15, 2011). c. Community Options Program Planning Committee (November 28, 2011). d. Transportation Coordinating Committee (September 12, 2011 and December 12, 2011). e. Veterans’ Recognition Subcommittee (December 20, 2011 and January 17, 2012).

Motion made by Supervisor Moynihan and seconded by Supervisor Wetzel to receive and place on file items 1a‐e. Vote taken. MOTION APPROVED UNANIMOUSLY Although shown in proper format Item #3 was taken at this time. Communications 2. Communication from Supervisor Evans re: That Brown County support the WI Citizens Safe Wind

Siting Guidelines and send the appropriate resolution to the Governor, State Senators and Representatives, and the State PSC to request the Public Service Commission to stop the wind siting rules from going into effect at the end of the legislative session. Referred from December County Board. Deslauriers stated they wanted to focus on the people, the purpose of the resolution (item #13). The second was to address the problems at the State level that created PSC128 and the rules that will be coming law at the end of this legislative session around March 15, 2012. Last year the Board of Supervisors signed resolutions that were extremely helpful, as they are the fourth largest county in

Brown County Human Services Committee January 25, 2012

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the State. Their voice was incredibly important and they appreciated it. When they saw the PSC128 rule that was completely arbitrary created by a majority of people with large financial interest in the wind industry they took it upon themselves as citizens of the State to come up with what they believed was science based, referenced, quality rules that protected people first and still allowed for a development of wind if the State so choose. The critical part, which the wind sighting guidelines truly addressed, was not for or against wind, it was to sight them appropriately around people and their homes and property. Motion made by Supervisor Andrews and seconded by Supervisor Wetzel to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

3. Communication from Supervisor Dantinne re: To have the meals for the Senior Centers and Meals on Wheels looked into for the meals that are served (cold‐short on food‐poor quality food). Supervisor Dantinne explained this was brought to his attention from the President of the Denmark Senior Center Association; it had been discussed at their meeting. Dantinne was informed that the vendor had been changed and there were complaints with regard to meals being cold and/or they had been short on meals. He questioned if they changed vendors to save a small amount of money, sacrificing service, nutrition and a decent meal. He wanted to make sure the Aging and Disability Resource Center (ADRC) were following up and watching the vendors. ADRC Director Sunny Archambault thanked Dantinne for bringing it to their attention. She informed that they had a new provider as of January 2, 2012 which was Aramark. Aramark had saved $1/meal less than the previous provider. Obviously they had wanted to make sure that with the lower cost they challenged them many times stating they were going to monitor for quality meals stated they needed to deliver according to the program guidelines. They had guidelines established by the Federal Government with regard to portion control and things they needed to serve. They had a dietician that reviewed the menu and they met the guidelines. They were also concerned about the quality because this was an important meal for most people. Archambault informed that there was a six‐week cycle of menus. In 17 days they had received seven consumer phone calls, two from the same person, five on the day they had pea soup which she informed they will never serve again. Anytime you have a huge change there will be issues. They serve 550 meals a day. The issue in the ADRCs perspective would be that complaints aren’t coming to them so they can’t keep track. With Aramark they set up at each nutrition site a complaint list and her staff would call daily to monitor it. The first week, there was a problem with that heat at one of the sites. To their knowledge, temperature was taken when meals were delivered, and they met the temperature requirements. There were steam tables at the Denmark site to keep the meals warm. They have had a few issues and met with Aramark three times in the first week. Aramark had been very cooperative, bent over backwards to meet with them and to address the issues. They have been working very hard and have substantially improved over the last few weeks. This was something they plan to continue and hopefully at the end of the six‐week cycle they will have the bugs worked out. This was not unusual for them to receive complaints when they serve 500+ people, someone will end up not liking the food and when a majority of the complaints are over pea soup they don’t see it as a huge issue. They have staff eating the food every day to check the quality. They are doing their best to address the issues and encouraged people to call (920‐448‐4300) so they could monitor what’s going on. Supervisor Moynihan questioned if these issues continue over the next six week cycle was there an opt‐out scenario. Archambault responded that the contract allows a 30‐60 day notice however the


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issues were basically serving issues and not for the consumer. If they don’t serve enough meals they had to deliver the balance of meals. She was confident that they will work this out. It was a low ratio. Evans questioned if there were other organizations that had meals on wheels. Archambault responded that all of the organizations left and all of the folks over 60 years old came on to their program. Evans questioned if people had been intimidated to complain. Archambault responded not in her experience, they will tell the volunteer drivers or call in. Evans entertained a motion to have this come back next month to get a report regarding meals, cost, and the funding source. Dantinne questioned how this program was paid for, if it was a Federal program. Archambault informed that there were county levy in the new meal program but a majority was Federal dollars and donations. A meal is about a little under $3.00. Motion made by Supervisor Andrews and seconded by Supervisor Wetzel to hold for one month to obtain a report and any further issues. Vote taken. MOTION APPROVED UNANIMOUSLY

Items #13 and #2 were taken at this time. Human Services Dept. 4. Executive Director’s Report.

Human Services Director Brian Shoup gave a brief report on the following items: Family Care Update: The Governor announced that he had found Family Care to be cost effective and the expansion including Northeast Wisconsin could proceed. Shoup reported that he had expressed concerns to several legislators about the lack of communication coming from leadership of the Department of Health Services over the past year regarding Family Care. That prompted a phone call from Kevin Moore, from the Office of the Secretary, to Shoup. They had a good discussion. Wymore seemed to be quite responsive and concerned that Brown County had found there to be lack of communication from the department. He assured Shoup that they wanted to rectify that. He agreed that the office would stay in touch. This gave Shoup an opportunity to express that he supported the expansion of Family Care but because it was stalled if they were to avoid unnecessary costs in the transition, they will need ample time to plan for this transition which started up after it was stopped essentially. They know the first year the transition will cost one time only dollars. They didn’t want this transition to unnecessarily result in loss of jobs for their workers that will be affected by this. They want to make every effort that there will be jobs for them in Family Care. Furthermore it’s going to be very challenging as they look at post‐waiver world at Human Services. They are going to have to figure out how they are going to reorganize the department and cover their various overhead costs. That was the challenge they were working on for 5 years before they actually stalled. Moore assured Shoup that the department would be very sensitive to that and would work with them. Shoup indicated that he was concerned that if they are given that ample time to make those plans they needed some assurance in the Family Care district that they would have continuation funding to bridge that gap that could be sizable. Rolf Hansen, the CEO has had to stretch dollars well past the first years grant to keep a minimal staff of himself and his assistance. Shoup felt good that they had some of those assurances. Emergency Detentions: For the past several years they had struggled with emergency detentions and issues involving unnecessary bypasses of their crisis center which they contract to do triage on people who are detained who might be in need of emergency detention. Several months ago Shoup issued a memorandum to all components of their system including law enforcement agencies indicated that they will no longer accept or authorize any detentions to


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Nicolet Psychiatric Hospital or CTC if they weren’t first assessed/triaged by Crisis Center. He further sent a second memorandum to the two State mental health institutes, Winnebago and Mendota, advising that that unless they heard from the Crisis Center, they would not pay for any placements done. He felt the good news was that people were getting used to this. You will see in the report that their admissions to the CTC have gone down in this regard. He appreciates the corporation of everyone in the system including all law enforcement agencies. They have the system going in the right direction at this point. He thanked all parts of the system, the Crisis Center, law enforcement agencies, etc. Bay Lake Consortium, their economic support consortium with Door County, Oconto, Shawano, Marinette, went live the 1st of the year. This was a serious undertaking with the leadership and work of their management team that really did it, Economic Support Administrator Jenny Hoffmann and Human Services Finance Manager Tim Schmitt were very instrumental in putting this together, Brown County led it. For the first month they had been the most productive of the 10 consortia in the state. Their efficiency ratios are higher than any other consortia, doing more with less staff. They will have to keep that going and be that productive to make this work. Shoup informed that Supervisor Miller was presenting a communication to the Administration Committee tomorrow evening asking that their department and Child Support report to their respective oversight committees showing steps taken to ensure security for employees. Shoup will report next month on that issue. They had undertaken a review of their security late last year and started to review. Probably most importantly than signage had to do with the protocols that they had in place and needed to modify. That is what they were focusing on. With regard to Family Care, Supervisor Fewell stated that when you can spread the cost of care over a larger number of people you can minimize the administrative cost. Some people are concerned that in Family Care they are dictating the prices. The concern among vendors is when you have very large vendors they can spread those costs across the state that some of the smaller local venders can’t complete. Then those venders are too big to fail and then they can come back and say they can’t do it for that rate. Shoup responded that he agreed that managed care will place pressures upon small vendors and agencies to be more efficient. He felt he was correct and it certainly is going to be the case. If anyone is thinking Family Care will not focus on driving the costs down and retaining the value they are naive because that is the whole premise behind Family Care. He has had conversations with vendors over the past year and encouraged them to explore possible affiliations and mergers. If he were a small vendor he would be looking at that. It’s difficult because it involves people in leadership jobs like to retain what they are doing. He felt they were fortunate in Brown County, some of the significant vendors that they have had a long partnership with, he’s had that discussion with and they had a positive reaction to that. He felt they had vendors that were open to those possibilities. All he was doing in those conversations was making suggestions. It’s possible they are looking at that sort of thing. Evans informed there is also an outreach program that Family Care would go through to reach out to the smaller vendors. Shoup added that he had been hearing talk that there might be some consideration, interest in opening up the competition of districts to compete against each other. Evans felt it will be interesting to see where it all goes. Shoup added that there are a lot of different directions that this can go, it will evolve. LaViolette complemented Shoup highly on his communication with all of the smaller agencies and making good recommendations to them. Communication is key.


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Motion made by Supervisor La Violette and seconded by Supervisor Fewell to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY

5. Third Party Beneficiary Contracting Practices.

There were questions asked about how the contract process works. Brian felt it would be appropriate to have Contract & Provider Relations Manager Jill Rowland come and talk about the regulatory environment that governs third party beneficiary contracts. HSD at various times seek consultation from Corporation Counsel. The third party beneficiaries are HSD clients. When HSD contracts for services we are in effect saying that HSD is not going to directly provide the services, we will outsource and purchase services on behalf of the clients. The contracts carry an additional legal duty, not only through the regulation but HSD is also acting in the interest of the clients. HSD has many constituents regarding the contracts; first and most important are the clients, second would be to the taxpayers. We need to be as cost effective as we can since we could be using taxpayer dollars to fund services. Third would be the vendor; HSD wants to be a partner with the vendor in hopes to be able to offer them business that they can hopefully sustain as they go forward. Rowland stated in 2012 we have issued approx. $66 million in contracts for many different services. Purchase of services consist of adult residential which can be traditional or corporate adult family homes, CBRF’s, apartment programs, home health services, fiscal agent services, children’s residential programs which would consist of treatment foster homes, residential foster homes, group homes, day service or work service programs, transportation, crisis services, autism services. Our area also handles the network agreements for the Community Treatment Center. The HSD had different methods of rate reimbursement. We have rate based contracts which have an hourly or daily rate. In a few programs such as the Crisis Center or Diversion facility we utilize a program budget because they are 24 hour, 365 day a year programs. In 2006, BC HSD was recognized by the Dept of Health Services as a model county for the Contract and Budget process. A group of BC Supervisors went to different regions throughout the State and put on presentations on the budget and contract process. Many counties throughout the State have followed Brown County forms and practices. The Contract Area has many policies and regulations that need to be followed. Some of those are: Allowable Costs Policy Manual, Provider Agency Audit Guide, and State and Federal Mandates. A couple months ago there was also an investigation in Denmark in one of the adult family homes that they use and she worked closely with the Drug Task Force and they did end up having to move six clients from the home and that investigation is still ongoing and pending. Shoup interjected that it was Rowland’s involvement that pushed this investigation. Had she not done that he felt they would have six clients still at risk in this facility. That’s incumbent upon them to lookout for their client’s interest. Sometimes it was a challenge. Brunette stated that he had heard some things regarding foster care. The better a foster family does in reaching certain targets with the child, such as doing better in school, adapting, the foster home would then receive less money from the State. The child was considered not as much in need and the rate going to the foster family is reduced. Rowland stated that in the big corporate facilities the State does set the rates on those. In the individualized, when they go into the consumers’ homes they are based on the level of care. There had been concerns about that. She doesn’t set those or work with them, the state handled it. Shoup stated for a lack of a better word there was an acuity index. The more difficult children with various behavioral problems, there was a higher compensation to foster families for that. So to be able to find foster families that can take these more challenging children, there was a higher rate that they are paid. Presumably, in some cases Shoup believed that it was possible that the behavior, once that child improves over time requires


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less attention, less work by the foster families, conceivably that rate could go down. You could state it another way that the more successful the foster parents are, the less money they will get for reimbursement. To give you info in terms of how often that might happen, Shoup would have to get that info and bring it back. These are State rates. Brunette stated from the perception of a foster family, that the way he stated it was the way it seemed. Families are doing everything they need to do yet they are getting less. He felt that once the child reaches a point, those funds could be invested in the child to even go further. Motion made by Supervisor Brunette and seconded by Supervisor Andrews to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY

6. Financial Report for Community Treatment Center and Community Programs. Human Services Finance Manager Tim Schmitt informed that the forecast for the CTC for 2011, which was based on actual results through November, they showed an expected deficit of $674,000. They budgeted a deficit of $513,000, keeping in mind the majority of that was depreciation. The forecast levy effect was a deficit of $160,000 and they budgeted about $5,500. The major reason was a revenue issue at the CTC in that their hospital out of county revenue was lower than their budget and they will continue to monitor that. They do expect a surplus in their Community Programs of about $500,000. That was really due to cost controls in their children and family unit. They continue to treat higher cost clients in lower cost settings such as in‐home settings. They have realized savings there. Motion made by Supervisor La Violette and seconded by Supervisor Wetzel to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY

7. Monthly Inpatient Data – Community Treatment Center and Bellin Psychiatric Center. Motion made by Supervisor La Violette and seconded by Supervisor Andrews to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY

8. Approval for New Non‐Continuous Vendor. Motion made by Supervisor Wetzel and seconded by Supervisor Moynihan to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

9. Request for New Vendor Contract. Motion made by Supervisor Fewell and seconded by Supervisor Moynihan to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

10. Monthly Contract Update. Motion made by Supervisor La Violette and seconded by Supervisor Wetzel to receive and place on file. Vote taken. Abstain: Andrews. MOTION PASSED

Aging and Disability Resource Center

11. Operating Expenses, Contracts and Revenue Reports, November 30, 2011. Motion made by Supervisor Fewell and seconded by Supervisor Andrews to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY


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Health Department 12. Resolution Re: Change in Table of Organization Health Department Addition of Grant Funded

Position. Motion made by Supervisor La Violette and seconded by Supervisor Wetzel to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

13. Brown County Board of Health Resolution Requesting Emergency State Aid for Families Suffering Around Industrial Wind Turbines. Evans informed that the Board of Health had supported both motions with regard to the resolution (item #13) and the WI Citizens Safe Wind Siting Guidelines (item #2). He added that this committee as well as the entire Brown County Board of Supervisors had been supportive in the past with regard to the wind turbine issues. Evans turned the meeting over to Barbara Vanden Boogart – 7463 Holly Mor Rd, Greenleaf and Steven Deslauriers – 2889 Wayside Rd, Greenleaf to give a presentation. Presentation to the Brown County Board of Health, January 10, 2012 is attached. Vanden Boogart thanked the committee for allowing them to express their concerns for the people in the Glenmore/Shirley Wind Project. Recently they had become aware of several symptoms that were quite concerning and at least eight families were suffering significantly. These families are more public, other families are suffering quietly. There had been a study done that was published December 2011 that was done at another large industrial project. There were investigators that came to check for low frequency sound levels and within20 minutes of their checking and setting up their equipment they became ill. It took many of them a week to recover from the symptoms; one investigator took seven weeks to recover. They are concerned that that same thing was happening in Glenmore. Vanden Boogart informed that they had also hired an expert in electrical pollution, David Stetzer. She read an excerpt from documents which was provided and attached. Deslauriers stated the wording of the resolution that the Board of Health passed they were making a clear connection between the actions of the State in 2009 and the situation that led to the undo burdens that the Glenmore residents are experiencing. The resolution was carefully worded to show that connection of negligence and their election of duty at the state level and why they are in some fashion accountable to these people in Glenmore. It accompanies a list of references that support the conditions they are experiencing in Glenmore and why they are experiencing them. Deslauriers thanked the committee for their time. Evans informed that he had the opportunity to go to the Ashenbrenner and Enz home and farm and stated it was eye opening. In the Enz home, when you went upstairs and you stood in the middle of their second floor, 10‐12 minutes later you start getting nauseous. He said it could be psychosomatic but he felt the headache and nausea it was very real. He informed that State Representative Andre Jacque also went and had the same experience. It was unfortunate. Evans had also been to the farm where stock was dying off and stillbirths, the owner was completely distraught. Brunette stated he agreed with Andrew’s motion, he’d like to see Corporation Counsel condensed it into something basic to have more effect. Motion made by Supervisor Andrews and seconded by Supervisor LaViolette to approve the


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resolution and send to Corporation Counsel to have it placed in proper Brown County format replacing “Board of Health” with “Brown County Board of Supervisors”. Vote taken. MOTION APPROVED UNANIMOUSLY

Item #2 was taken at this time.

14. Budget Adjustment Request (12‐06): Increase in expenses with offsetting increase in revenue.

Motion made by Supervisor Andrews and seconded by Supervisor Wetzel to approve. Vote taken. MOTION APPROVED UNANIMOUSLY

15. Director’s Report. Health Director Judy Friederichs provided handouts (attached) re: Community Health Assessment Report and Public Health Emergency Preparedness. With regard to the Community Health Assessment Report she stated by statute that had to do a periodic reassessment of the health of the community looking at the data and getting community partners together to set priorities after they review the data. The hospitals also have to do that with public health and partners. Together they had worked on the process of doing the assessment over about a six month period. They had 35 partners from the community that participated in going through all of the data and they had selected three priorities: safe and adequate nutrition, oral health and alcohol/substance abuse. The compelling data that resulted and choosing the priorities was in the brochure. Right now in each of the priorities there was an action group that had been organized and is being facilitated by the health care networks. Bellin was facilitating the nutrition and alcohol groups. St Vincent and St Mary’s are facilitating the oral health group. They have broader partners that are coming in to those individual action groups based on their expertise. Right now they are working on picking strategies, pulling in other data in the community and looking at what exists already in terms of services. They are also trying to tie in benchmark data from the State so they are matching the State 2020 Plan as well. They also have some set ways of measuring their progress. So once they have their plans out which they expect the whole process in terms of developing strategies and benchmarks will be done by summertime. They will be handing out a whole plan as far as how this will be approached and who the members are, committees, etc. It was interesting with the alcohol group, some of the partners in the community who had typically worked with the alcohol issues and some of the church groups have been very happy to have the health care partners pulled in because typically it had more within the human services. The Public Health Emergency Preparedness handout shows the different standards that they have to follow and some of the things they have been doing. In terms of communicable disease activity, already this year, there had been some active cases of tuberculosis that they have been working with. Staff has had to go out at least the first two weeks daily (thereafter twice a week for about 6‐9 months depending on what the conditions are of the individual) to administer medication because they had to observe them taking it. Some of the relapses people have had from inactive bacteria because medication they took in past, they abandoned taking it. Years ago they used to bring a months’ worth of medication, that’s what they did nationwide. They figured out quickly that they weren’t complying. Years later they have relapsed into active TB. They have probably another 100 people that receive medication protectively. They may have been contact to active cases or they have found out about their reactivity through other sources. Those are inactive but still need the protection. Talk about Pertussis had been heard more in the last month or so. They have been a little more fortunate the last couple of months because it had been a little quieter for them. It was very busy last year and especially the third quarter. They had over half of their cases in the third quarter of last


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year. They did a mailing to health care providers updating them on treatment protocol and sent letters to parents to the schools in October. November was a high month but December and January had been lower activity months in this area. It’s a common time of the year through the holidays and early winter to have Norovirus and often hits long term care facilities in particular, probably because they have visitors coming in. The typical illness was being hit suddenly with both vomiting and diarrhea. Long term care facilities have more pressure on them from the State to contact public health so that they can assist them with management strategies. The past year they had about five different long term care facilities that they were working with and they had been very diligent working to control it with staff and residents. They were approached by DePere Health Department to assist them with their most emergent needs for environmental health while they are recruiting for a vacancy. BC Health contracted with them, assisting after hours as they were short on staff as well. DePere was reimbursing Brown County. Motion made by Supervisor Fewell and seconded by Supervisor Brunette to receive and place on file. Vote taken. MOTION APPROVED UNANIMOUSLY

Syble Hopp, Veterans Services – No agenda items. Other 16. Audit of bills.

Motion made by Supervisor Andrews and seconded by Supervisor Fewell to pay the bills. Vote taken. MOTION APPROVED UNANIMOUSLY

17. Such other Matters as Authorized by Law. Motion made by Supervisor Moynihan and seconded by Supervisor Brunette to adjourn at 7:13 p.m. Vote taken. MOTION APPROVED UNANIMOUSLY

Respectfully submitted: Alicia A. Loehlein Recording Secretary

proceedings human services committee · proceedings of the brown county human services committee...

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