|
|
DeKalb County, Illinois |
Minutes of the
|
BOARD
MEMBERS PRESENT: Fred Peltz, D.D.S.,
President; Glenda Pecka, R.N., M.S., Vice President; Steve Kuhn, P.A.,
Secretary; Russell Bishop, Psy.D.; Steve Wolf, R.N.; James Cole, M.D.; Mike
Groark, J.D.; Sonja Conway, Ph.D.; Debbie Schelkopf, D.V.M.
BOARD
MEMBERS ABSENT: Carl Heinisch; Darrell
Wiley, M.D.
Board
members and Health Department staff introduced themselves with four new board
members in attendance.
On
a motion by Mrs. Conway, seconded by Mr. Kuhn, the minutes of the Board of
Health meeting of November 27, 2001, were approved, as presented.
Motion carried.
The
Health Department FY2002 budget began on December 1, 2001.
Mrs. Grush indicated that public health is beginning to experience
cutbacks at the state level in terms of funding.
The Illinois Health and Wellness Grant, which the department has received
from the Illinois Department of Public Health (IDPH) since 1983, was terminated
effective December 31, 2001. The
grant of $13,400 provided funding for health education initiatives, but has been
unstable and unreliable over the last several years.
In addition, Medicaid payments from Public Aid have been received more
slowly over the past few months, and this could expand into the Home Care
Program. Mrs. Grush expressed
concern that funding allocated to tobacco programming would be reallocated to
offset the state budget shortfall.
The
Health Department is scheduled to receive a $34,200 increase per year for the
next three years in the Family Case Management Grant, which is the first
increase in the program that was implemented in 1993.
Mrs.
Grush reported that she continues working on the agreement with Kishwaukee
Community Hospital (KCH) to provide newborn home visits through our Home Care
Program to babies born at their facility. She
stated that the Health Department entered into a similar agreement with KCH in
1997. At that time, in order to
provide a follow-up home visit to mothers with only a 24-hour hospital stay and
bill insurance, the Illinois Department of Public Health (IDPH) advised KCH that
they had to be a licensed home care agency.
Since they did not wish to do that, an arrangement was established where
the service was offered through our home care program.
The Home Care Program had a contract with KCH utilizing specialty OB
nurses to provide the visits. Health
Department support staff completed the paperwork and the billing.
After the program was established, IDPH advised KCH that they did not
have to be a licensed home care program, and the agreement was discontinued.
During KCH’s most recent JACHO accreditation, they were once again
informed they must be a licensed home care agency to continue providing this
service. They have asked our agency
to consider renewing the previous arrangement.
This is being pursued with some modifications in previous procedures.
The
bioterrorism events that occurred in the fall have brought to light major
deficiencies in the public health system nationwide. Mrs. Grush was at a meeting on Friday and was informed that
the State of Illinois has approved $16.9 million for bioterrorism to include
$6.5 million for public health, $2.3 million for laboratory equipment to detect
anthrax in 2 hours versus 48 hours, $2.5 million for a state stockpile of
antibiotics to be used until a federal supply can arrive, and $1 million for
computer equipment/networks for local health departments.
The State is requiring that each health department develop a plan for the
distribution of antibiotics countywide.
Dr.
Cole asked if a bioterrorism plan was currently in place and if it involved more
than just anthrax, smallpox, and decontamination.
Mrs. Grush responded that health departments are just beginning to
develop plans. A lot of planning
and quick implementation was done in October during the anthrax occurrence on
the East Coast, but plans are just now beginning to get written.
Decontamination will be part of the plan, but this will be the
responsibility of first responders. Mrs. Grush indicated much needs to be done in the
coordination of responsibilities among all entities involved.
The
Health Department still has flu vaccine available. The agency usually receives their supply a month before
private providers so individuals would come to our clinics and receive their
shot early, but this year it was received at the same time as other providers.
Also, Aurora VNA expanded some of their clinics into DeKalb County and
Lehan Drugs also offered flu shots at their pharmacy.
Mrs. Grush reported that every health department has vaccine left and
drug companies are no longer allowing vaccine to be returned.
Dr. Peltz asked the shelf life of the flu vaccine.
Mrs. Carroll, Communicable Disease Coordinator, responded that it expires
in June 2002.
Mr.
Groark asked if the money slotted for bioterrorism could be used for other
purposes, for example, a computer with programs that are not primarily for
bioterrorism. Mrs. Grush responded
that the State would update computers they currently have in agencies and add
programs, as this is the means by which they communicate with agencies with some
of the money. However, to purchase
equipment not related would not be allowable.
Mr.
Drake, Director of Environmental Health, stated that, with the good weather this
winter, the Environmental Health Division has been busy with septic systems
still being put in because of the temperate weather.
He announced that Dan Berres, the Animal Control warden, recently
assisted the police in the capture of six individuals who had stolen a van full
of formula.
Mrs.
Lux, Director of Personal Health Services, stated that the phone calls regarding
anthrax died down suddenly with the lack of coverage in the media.
As of November 2001, the WIC Program has been at 107% of assigned
caseload, which represents an additional 100 clients.
A formal request to increase the assigned caseload was submitted, which
would also increase revenue, allowing the addition of staff hours to serve
additional clients. Mrs. Lux
provided the Board with an overview of how grant requirements affect staff and
the amount and type of work needed to be in compliance.
These requirements are often added without additional funding and require
more staff time, which is often a struggle.
Mrs. Lux stated that she is thrilled that, for the first time since
having the Family Case Management (FCM) Program and due to the reallocation of
funds, additional revenue will be realized for the first time in ten years with
more staff able to be added to that program.
Mr.
Kuhn asked if a basic metabolism index (BMI) was completed on all children.
Mrs. Lux responded that it is completed on all 2 to 5 year olds during
WIC clinic, with the BMI calculated by the computer.
Mr.
Kuhn asked if the Health Department was involved in treating any students
exposed to the NIU student who died of meningitis. Mrs. Carroll stated that the hospital treated all those who
needed treatment quickly. She
indicated the meningitis vaccine, Metamune, would have covered that particular
strain of the disease, and she feels strongly that should be encouraged.
Mrs. Grush added that the vaccine is expensive, with the Health
Department charging $70, which is our cost plus a $10 administration charge,
which is one reason why college students do not get it.
She indicated that the Health Department was involved with NIU in
releasing a statement to the paper, and felt very fortunate it was just the one
case. Mrs. Carroll stated that the
student presented with a fever and upper respiratory illness, and died within 12
hours. Mrs. Conway wondered if it
was clear what students should do as she had a grad student who went to the
Health Service, was not offered the vaccine, and was not advised where he could
go for the vaccine or for help. Mrs.
Grush stated that Health Department staff would advise students to contact the
health service, who would provide the same information the Health Department
would. She added that the health service should be the ones dealing
with the students as that is their role. Mrs.
Carroll reported that she did have a good visit with the student’s roommates
and the people across the hallway a couple of days after the student’s death.
She encouraged them at that time to follow-through with the health
services on their vaccinations. Mrs.
Pecka asked if there were other cases this year.
Mrs. Lux stated she had not heard of any other cases, and added that NIU
did provide meningitis clinics in the dorms and offered the service to their
students at a cost.
Dr.
Peltz asked how this disease was reported.
Mrs. Grush stated that the initial preliminary report was received at the
Health Department, who in turn reported it to the health services at NIU.
Mr. Wolf asked how many students take advantage of the Metamune vaccine
each year. Mrs. Grush stated that
the vaccine and information is available, but, generally, not many students take
advantage of it. Mr. Wolf stated that most colleges send the information out
to freshman students. Mrs. Grush
stated that the vaccine is not a required immunization and she does not think
most families realize the severity of the disease.
Mr. Groark asked if only freshman could contract the disease.
Mrs. Grush responded no, but living in close quarters put individuals at
higher risk and usually freshmen live in dorms.
Dr.
Peltz asked Mrs. Lux to review the T.B. outbreak of this summer for new board
members. Mrs. Lux stated that a
report was received of a Hispanic gentleman, who was very, very ill, that was
hospitalized with TB on July 20. He
was seen at TriCounty Community Health Center, had a positive TB test, was sent
to KCH and was admitted by Dr. Thornton. He
remained in KCH until September 24. The
patient, an undocumented citizen who was uninsured and had lived here for two
years, was moved from KCH to Kindred Hospital in Sycamore.
Mrs. Grush worked closely with the administrator of the Public Aid office
to obtain health care coverage for the individual so Kindred Hospital would
accept the transfer. The contact
investigation involved 39 people who were very resistant to our services.
Another problem that presented was that the original patient was INH-resistant,
which is the main medicine used to treat TB.
As a result, a treatment regimen of two other medicines, Rifampin and PZA,
were used for all contacts. Dr.
Manam, infectious diseases specialist who is at KCH weekly, examined all
contacts and placed them on the medications.
She pointed out that the preferable way to provide treatment is through
directly observed therapy (DOT), which is actually watching the patient take
their medications. Hispanic staff
was hired to make home visits to observe that the pills were being taken by the
individuals. Mrs. Carroll stated
this also involved blood draws every two weeks for liver function tests for
individuals on short-term. Five of the active cases will complete therapy in February.
The index case is no longer contagious but continues to need extended
therapy.
Mrs.
Baj, Director of Home Care, explained that the program provides intermittent
home health care versus private duty home health care.
Visits are made to the home as often as daily or twice daily, with
Medicare as the major payment source. She
explained the services in the program. She
described the main problem over the past year as having enough nursing staff,
but added that 2002 is looking up in this area.
Nurses who were out on medical leave have returned and new nurses are on
board and have been oriented. She
reported that she did learn this week that one of the part-time nurses with
three children under the age of 6 is now pregnant with identical twins.
Mrs.
Zanellato, Director of Health Education, reported that her program operates
under several state grants. The
Comprehensive Health Education Grant includes the “Second Step” program, an
anti-violence program implemented at Clinton-Rosette Middle School last year.
Final approval was recently received to expand the program to three more
grade schools in DeKalb. Those
staff will come to the Health Department for a training day and the program will
be implemented. The Tobacco Grant
is sponsoring a counter-marketing project at Genoa-Kingston and Hiawatha High
Schools with training held on December 8. The
tobacco prevention programs also encourage smoke-free restaurants , with a
current total of 45 in DeKalb County.
Mrs.
Grush explained that a recap of revenue, expenses and cash flow is provided at
each meeting. The Health Department
has an account balance of $1,620,144 as of December 31, 2001.
The agency also has a CD for $213,724.
She explained that part of the reason the cash flow of the agency has
improved is that Medicare is paying more promptly and the state is providing
grant money in advance rather than the agency billing for it after services are
provided. She added that January is
typically the month when less revenue is received, with increased revenue in the
spring and summer because of licenses due at that time.
Dr.
Peltz asked how much revenue should be maintained in the bank account.
Mrs. Grush responded that expenses run around $250,000 per month and the
agency needs to have three or four months cash available for routine
expenditures. Mrs. Grush stated the
County Treasurer has left sweep account balances much higher than normal because
interest in these accounts are the same as CDs and the money is not tied up.
On
a motion by Mr. Kuhn, seconded by Mrs. Pecka, the Financial Statements for the
months of November and December 2001 and the Claims for the months of December
2001 and January 2002 were approved as presented. Motion carried.
Mrs.
Grush explained the Financial Statement for the period ending November 30, 2001.
She reported that, in terms of revenue, almost all line items generated
close to the anticipated amount. The
Medicare – Home Nursing line item received more revenue than budgeted, with a
part of that money (approximately $100,000 to $150,000) from FY2000, a result of
switching from a cost per visit reimbursement to Perspective Payment System
(PPS) where payment is made per episode.
Mrs.
Grush reviewed the FY2001 Expenditures, with the Salaries line item being the
largest. She added that the audited
financial statement would be available at the March 2002 board meeting.
Mrs.
Grush stated that a second Animal Control warden will be hired, with plans for
the individual to work afternoons and evenings. When the FY2002 budget was developed, there was discussion
regarding purchasing a used van rather than a new vehicle.
Since the Health Department is a government organization, the issue of
bidding out for a used vehicle became more complicated.
She added that purchasing a new van through the state contract would only
be about $1,000 to $2,000 more. Mrs.
Grush stated that consensus is needed from the Board of Health to buy a new van
instead of purchasing a used vehicle.
Mrs.
Conway moved to approve the purchase of a new van for the Animal Control
Program, seconded by Mr. Wolf. Motion
carried.
Mrs.
Lux stated that Deb Hall, coordinator of the Family Planning Program, was unable
to be present at this meeting due to family illness.
Mrs. Lux began her employment at the Health Department in 1980 in the
Family Planning Program and spent ten years in that program.
A brief overview of the program was provided.
The Family Planning Program exists to prevent unintended pregnancy and
serves women of reproductive age in general, with the target populations of
low-income women and sexually active teenagers.
Routine gynecological exams and methods of birth control are provided, as
well as pregnancy testing and options counseling.
Also, as part of exams, sexually transmitted disease testing and some
treatment is provided. Another
component of the program is community education and outreach.
For many of the women receiving these services, the Health Department is
the primary health care provider. Nurse
practitioners and local OB/GYN physicians are contracted with to provide
services. The program has 5.79 FTE serving as direct staff.
Mrs.
Lux presented data on the historical utilization of the program, which has grown
each year. There is constantly more
demand for the services and clients must often wait several weeks for an
appointment. The program attempts
to add services as funding is realized and staff is available. The
computer system of the Family Planning Program is able to provide demographic
information. Mrs. Lux pointed out that the main change in this
presentation from that of three years ago is the increase in services to the
Hispanic population, from 12.2% to the current rate of 20.1%. Fees for services are based on a sliding scale charge with
clients charged based on income.
State
and Federal Title X Program Priorities were presented.
Mrs. Lux stated that the Family Planning Grant has the most requirements
to address of all grants in the Personal Health Services Division, with many and
varied issues. New requirements are generally added each year, with the
newest being preconception awareness. Education
is provided to every client about preconceptional health.
Another requirement just added to the program is the provision of colo-rectal
screening for any client age 40 to 50. If
risk factors exist, screening and testing annually must be provided to clients
over the age of 50.
31%
of Family Planning clients are under the age of 20. While Title X programs do encourage family involvement,
parental permission is not required, but is encouraged, and the client makes the
decision whether to involve an adult or not.
Mr. Wolf asked the percentage of clients that are NIU students versus
DeKalb natives. Mrs. Lux responded
that it is not that high a number since there are similar services provided at
NIU Health Services. Mrs. Grush
added that the program has always ensured that our fees are in line with those
of the Health Services so as not to encourage students to use our clinics as we
cannot possibly serve the entire student population and meet the needs of county
residents. While the Title X Grant
does not allow denial of service to anybody, it can be two to three weeks wait
for an appointment and the agency preference is to serve county people since NIU
students do have another resource available to them that other county residents
do not have. She estimates that 10
to 12% of the caseload is NIU students, and most of them are probably DeKalb
County residents who are attending NIU.
Mrs.
Lux reviewed data on DeKalb County teen births, which shows the number of births
to teens (under 20 years of age) with a further breakdown by age and percentage
for DeKalb County as compared to Illinois. DeKalb County has always been in the lower third of the 98
counties in Illinois as far as teen births.
In the spring and summer of 2000, a committee was convened to study teen
births because it had been stated that the trend for local teen births was not
following that of the state and national trend. Several area providers were concerned and felt they were
seeing more pregnant teens. A
series of meetings were held and the data studied more in-depth, reviewing what
was being done overall in the county and resources available. At that time, the committee developed five priority
recommendations which included services to Hispanic youth, increasing the
awareness and accessibility of the program, development of programming to
alienated youth, networking of community resources, and the development of
programs targeted to male involvement. A
meeting was held the following year to review the data and discuss the progress
of the priorities. Because of the
work of this committee, family planning services have been implemented in
Sandwich at the Valley West Community Hospital. Mrs. Lux added that, in conjunction with the Adolescent
Health Grant in the Health Education Division, some funding was available for
the “Life Skills” curriculum piloted in the DeKalb School District this
year. She stated that the committee
does want to meet annually and review the data.
Currently, over 400 clients are seen each month in the Family Planning
Program, with approximately 15 per month seen in Sandwich at their two afternoon
clinics.
Mrs.
Grush provided an overview of program funding and staffing with a 10-year
Historical Revenue Review. Revenue
is received from grants from the state and federal government, fees based on a
sliding fee scale based on income, and Public Aid. Revenue in 2000 and 2001 averaged $298,971, with costs
reported to the state at $362,868. Of
that $362,868, the Health Department funds $325,520 through grants, fees and the
Public Health Levy. The county paid
IMRF and Social Security for staffing the amount of $37,348.
There are 4.9 FTE direct staff in the Family Planning Program, a total
staff of 5.79 including administration, which is 11% of all Public Health staff.
Mrs.
Grush introduced Elizabeth Carney, Family Case Management coordinator. Mrs. Lux
presented the historical perspective of the program, stating that Illinois was
very poor in terms of infant mortality at 43rd in the nation.
In the 1980’s when the infant mortality rate was fairly high, an Infant
Mortality Reduction Initiative of Governor Thompson led to a program called
“Families with a Future” in at-risk communities, which actually resulted in
a large reduction in infant mortality. An
18 percent reduction in infant mortality from 1990 to 1992 was seen as compared
to other communities. The FCM or
Healthy Moms Healthy Kids Program, proposed in April 1992, was modeled after
Families with a Future and was an initiative of Governor Jim Edgar to improve
the health of low-income families by improving access to prenatal and pediatric
care. By 1994, infant mortality
deaths in DeKalb County were down to nine.
Software has been developed where actual outcomes have been developed
comparing the women who have participated in HMHK with women who are Medicaid
income-eligible and have not participated.
The 2001 Birth Outcome Study reports that women enrolled in the programs
had a 74 percent lower infant mortality rate and a 65 percent lower premature
birth rate. On an average, if a
woman participates in the Department of Human Services Program, it is expected
that the cost of services for an infant in their first year of life will be
reduced by 42 percent.
Mrs.
Lux presented a chart of Infant Deaths and Rate in DeKalb County from 1980
through 1999. Case management
services and home visits were implemented with the startup of the HMHK Program,
and Medicaid eligibility was expanded for pregnant women and infants so more
low-income women would receive coverage for their pregnancy.
Rates paid to providers improved, as did the speed at which providers
received payment.
Mrs.
Carney presented a summary of objectives and services provided.
She described a typical family in the program as an unmarried mother
between the ages of 18 and 24 years of age, with no income or income at or below
200% of the federal poverty level. The
client most likely has little ongoing or preventive medical care, poor
nutrition, little knowledge of community services and little or no skills to use
them. There is frequently poor
social support and unreliable or no transportation causing the client to
experience difficulty in accessing services, and they may or may not have a high
school education or GED.
Program
objectives are to increase access to primary care providers for prenatal and
pediatric care, increase utilization of routine medical visits, assist clients
to utilize community resources, and assist clients to improve their social
support systems. Mrs. Carney stated
that case managers are thought of as a bridge between the very needy persons and
the community and medical services available to them.
Case managers assist the clients in accessing the services and learning
how to use them appropriately. This
involves a great deal of referral and advocacy, the development of care plans,
the expansion of Medicaid services through KidCare and the opportunity to teach
the client how to utilize available services.
There are various levels of Medicaid services available and a pregnant
woman can provide proof of pregnancy and proof of income for 30 days and be
signed up at the Health Department for medical coverage, be referred to an
obstetrician and have an appointment before the intake process is even complete.
Timely entry into prenatal care is a very important facet of the program.
Mr.
Wolf asked what the usual entry point is in the client’s pregnancy.
Mrs. Lux responded that a high percentage, approximately 80 percent, is
admitted in their first trimester. Mrs.
Carney added that the program receives many referrals in-house from the Family
Planning Program whereby a client is walked down the hall after receiving a
positive pregnancy test and is able to be referred, make appointments, and be
admitted to the program.
Mrs.
Carney reported that all maternal child health services are coordinated to
provide as many services as possible within one client visit.
Integration of services is an ongoing goal for all MCH programs to
increase client satisfaction and meet IDPH standards.
She stated that an intake and continuing contacts through home visits are
conducted throughout the time the client is active.
Education is provided on pregnancy, infant and toddler care, and other
issues. KidCare applications are completed for children, with the
initial application done here rather than sending the client to the Public Aid
office. For children that are
developmentally delayed, an appointment can be initiated at the Health
Department. When case managers are
involved with a client, a comprehensive assessment is completed, as well as a
medical history, review of pregnancy and child development issues, and a social
assessment. Deficiencies and areas
of need are identified so clients can be put in touch with available and
appropriate resources. Staff is
always looking for barriers to medical care and treatment.
The
FCM Program also provides medical case management for wards of the Department of
Children and Family Services (DCFS) who are placed in DeKalb County foster homes
through HealthWorks. This program
provides a standard case management system so there is one body of knowledge of
that child’s needs that follows them as they move around.
The Adverse Pregnancy Outcome Reporting System (APORS) provides medical
case management for pregnant mothers and infants with a qualifying diagnosis.
Infant assessment is completed at least four times the first year and then at 18
and 24 months of age. Mrs. Grush added that any county resident can be referred to
the APORS program if the mother and/or infant are considered high-risk.
Mrs.
Grush stated that $26.25 is received per month for eligible families, which
includes a pregnant woman or an infant up to his/her first birthday.
$12.50 is received each month for older children over the age of 12
months, and reimbursement is only received up to the maximum grant allocation.
There are 8.91 direct service staff in the FCM Program, and a total of
10.8 including administration, which is 24 percent of Public Health staff.
Dr.
Peltz asked if clients had to leave DeKalb County to obtain an abortion.
Mrs. Lux responded that they do need to leave the county and
transportation can be a problem. She is aware that Voluntary Action Center (VAC) provides
transportation for medical appointments outside DeKalb County, but is not sure
they would transport for this purpose. Mrs.
Grush pointed out that VAC is geared more toward medical transportation for the
elderly and for the indigent that have no other means of getting to
appointments.
Mr.
Wolf asked how many children are currently enrolled in HealthWorks.
Mrs. Carney responded that there are 30 wards up to the age of 6.
Mrs. Grush added that this program involves a great deal of paperwork and
meeting requirements with constantly changing regulations.
Dr.
Peltz presented Board of Health committees for FY2002, as follows:
Finance:
Mrs. Pecka as Chair, Mrs. Conway and Mr. Kuhn
Bylaws:
Mr. Groark as Chair and Dr. Cole
Personnel:
Mr. Heinisch as Chair, Mr. Groark and Dr. Schelkopf
Nominating:
Dr. Wiley as Chair, Mr. Wolf and Dr. Bishop
Correspondence
was received from the Department of Human Services regarding the Teen Pregnancy
Prevention Program and a letter from Dr. Lumpkin at IDPH with a certificate of
award from the National Association of County and City Health Officials
recognizing the agency’s effort in completing the CDC preparedness survey in
March 2000.
Newspaper
articles focused on bioterrorism, World AIDS Day, foodborne illnesses during the
holidays, extra care of pets in winter weather, the death of an NIU student
contracting meningitis, flu vaccine clinics, America Recycles Day, the Great
American Smokeout, and the reaching of an all-time high for the life expectancy
of Americans.
On
a motion by Mrs. Conway, seconded by Mrs. Pecka, the Board of Health meeting
adjourned at 9:15 p.m. Motion
carried.
Steve
Kuhn, P.A., Secretary
DeKalb
County Board of Health
| Home | Return
to top | A-Z Index | Return
to minutes |