BOARD MEMBERS PRESENT:  Glenda Pecka, R.N., M.S., President; Steve Kuhn, P.A., Vice President; Carl Heinisch, Secretary; Julia Fullerton; Mike Groark, J.D.; Rosemary Lane, M.D.; Fred Peltz, D.D.S.; Debra Schelkopf, D.V.M.; Mary Beth Shear, M.D.; Steve Wolf, R.N.  

BOARD MEMBERS ABSENT: Russell Bishop, Psy.D.  

MINUTES 

On a motion by Dr. Peltz, seconded by Mr. Groark, the minutes of the Board of Health meeting of September 23, 2003, were approved.  Motion carried. 

DIVISION REPORTS 

Due to the time constraints of a lunchtime meeting, Board members were asked to review the division reports included in their packets and contact Mrs. Grush with any questions. 

FINANCIAL DATA 

Mrs. Grush reviewed the expense line items requiring transfers from the agency’s fund balance that were necessary because of the purchase and installation of the generator and payment for the services of physical therapists and psychiatric nurses in the Home Care Program.  She added that more information would be provided at the January 2004 Board of Health meeting.

Mr. Wolf moved to approve the Financial Statements for the months of September and October 2003 and the Claims for the months of October and November 2003, seconded by Mr. Kuhn.  Motion carried. 

NEW BUSINESS 

FY2004 Staff Compensation 

FY2004 Increases

Mrs. Grush reported that the County Board approved a 2.4 percent cost-of-living allowance (COLA), effective November 30, 2003, and a merit increase of 0 to 2 percent, effective May 30, 2004, for non-union employees.  While Mrs. Grush had originally recommended a 3 percent COLA and a 1 to 2 percent bonus, she prefers to follow the recommendation of the County at this time.   

Salary Range Adjustments

Salary range adjustments were proposed to nursing classifications to remain competitive in the local market.  Mrs. Grush pointed out that a couple of long-term nurses have reached the top of their salary range and, by expanding this range, they would be able to receive a merit increase.  This recommendation also increases the entry level range, which is very, very low and prohibits any employment of nurses at that level.  Mrs. Grush added that, years ago, she was authorized by the Board of Health to establish the salary of a nurse at whatever was necessary to hire them, which has been done. 

Classification Change

Mrs. Grush presented a request to the Board to change the classification of Vicki Faivre from Secretary to Accounting Clerk A.  Ms. Faivre was hired with the intent that she would assume responsibilities in the accounting department.  She has been in the position for approximately four years, and also provides backup to other programs. 

Mrs. Grush requested that the part-time HIV Case Manager position be changed to that of full-time Prevention Specialist. This request is due to the increase in HIV Case Management clients and that the agency has been granted the funding for the increased position.  Either a nurse or a social worker was sought for the position, and a social worker has been hired because of no nurse applicants; however, the Case Manager salary range was too low to recruit the individual, so it is necessary to change the classification to that of Prevention Specialist.

Salary Adjustments after COLA

Each year, Mrs. Grush reviews the agency positions to determine if an employee’s salary is out of line based on new hires.   She requested that the following salary adjustments be made after the COLA increase.  All increases are effective November 30, 2003.

            Patti  Burke, R.N.            Current $17.94 + $1 per hour

            Beth Busching, R.N.        Current $17.82 + $1 per hour

            Linda Gletty, R.N.            Current $17.18 + 94¢ per hour

            Jean Zucker, LPN            Current $12.73 + $1.50 per hour

            Vicki Faivre                      Current $12.22 + 49¢ per hour

Addition of Public Health Nurse Position

Mrs. Grush presented the deliverables of the $94,420 Bioterrorism Grant that is based 80% on population and 20% on risk factors.  One area where our agency is short-staffed in meeting these requirements is in Communicable Disease (CD), which is the surveillance and epidemiologic aspect of the Grant.  Mrs. Grush is requesting the addition of a nurse in the Communicable Disease Program to assist Mrs. Carroll, coordinator of the program.  Since grant money is not received in that department, it has never been possible to add staff in that area, but this grant will help fund the majority of that position.  The grant also includes one-time supplemental monies toward the purchase of computers and some of Mrs. Zanellato’s time spent working with this grant.

Mrs. Pecka asked if no one was applying for this position or if they were applying but were not qualified.  Mrs. Grush responded that this position is somewhat different since most people don’t have communicable disease experience.  Advertisements have been placed for a nurse with such experience, but no applications have been received.  She feels it is due to the nurse shortage, as well as the fact that they would make less in this position than in a hospital setting.  Mrs. Grush added that our agency is having difficulty competing with local clinics, as well as they now pay more; however, our agency does have better benefits.

Mrs. Pecka asked if training was available from CDC for this position.  Mrs. Grush responded that it is available, adding that the employee also learns much of the job over the years of working in the program.

Mr. Kuhn asked if additional funding was expected in the future for this position.  Mrs. Grush responded that she did contact State staff and was told that the money for Homeland Security should be available for a number of years. 

Mr. Kuhn asked what our agency’s response would have been to the recent salmonella outbreak from green onions that occurred on the East coast.  Mrs. Grush responded that Mrs. Lux, Mrs. Carroll and she would respond with assistance from the State’s Rapid Response Team that would be called out immediately to assist with public relations and directing our agency staff.  She cited the example of the recent meningitis outbreak in Chicago where 8,000 people were vaccinated in a short period of time.  She pointed out that this is what Public Health is for, but staffing in such situations are very limited as no one has the resources to staff for emergencies.  Somehow, the work just gets done. 

Extra Compensation

Mrs. Grush requested that Mrs. Carroll receive $2,500 in extra compensation for providing the case management requirements and services in the HIV Case Management Program since September 2, 2003, with the resignation of the previous employee. 

Mr. Kuhn made a motion to accept the proposed FY2004 Staff Compensations, as presented, seconded by Mr. Heinisch.  Motion carried. 

Kishwaukee Community Hospital (KCH) Home Care Lease

Mrs. Grush reported that a meeting of the Long-range Planning Committee of the Board of Health was held in November.   

Mrs. Grush presented a document recapping renewal of the Home Care lease, which requires that notification of renewal be submitted to Kishwaukee Community Hospital (KCH) by December 1, 2003, if another five-year lease is being requested.   She reported that, in the spring, she suggested that consideration should be given to building Home Care their own facility.  Reasons for this included program growth, anticipated continued growth during the next five years, the limitation of expansion in the current space, the financial stability of the program, a sound history of annual excess revenue over expenses, and KCH’s willingness for a shorter lease not requiring a five-year commitment. 

Mrs. Grush presented the number of patients served by year, and reviewed the reasons for program growth.  Rockford School of Medicine was asked for projections on the elderly population, and they responded that, after 2010, there will be overwhelming growth in the population of those 65 years of age and over.  Mrs. Grush also reviewed this past summer’s phenomena with decreased patients.  She reported that a 4.6% increase in patients is expected in 2003 over 2002.  While she does expect growth in the program over the next five years, she does not feel it will be overwhelming.  The biggest challenge will be finding nurses to provide the care.

Mrs. Grush reported that the program has been and continues to be financially stable.  Since considerable revenue over expenses has occurred under the PPS method of reimbursement for most providers, as well as the fact that Medicare is designed to be non-profit, it is a target for reimbursement cuts.  In addition, the federal government needs revenue sources to pay for the upcoming pharmaceutical benefit.  While co-pays are not being implemented at this time, the home care reimbursement rate is being decreased. 

Mrs. Grush reviewed the 2003 Budget and revenue sources.  Revenue of $1,930,000 was budgeted and revised to $2,135,000 in June 2003, and is now projected to be $1,980,000, the reduction primarily due to the caseload reduction in the summer.  Because of this, expenses could exceed revenue this year.  If the Home Care caseload sustains itself, 2004 revenue of $2,275,000 is projected.

The current Home Care space of 2,225 square feet was reviewed, which includes space for staff, medical records and supplies.  One-half of 4,862 square feet (2,431 sq. ft.) is shared with Hospice for restrooms, break areas, conference rooms, computer/phone room, mechanical room, hallways and common areas for a total of 4,656 sq. ft.  Based on this, Mrs. Grush reported that 7,087 sq. ft., at its current space, would be needed if a facility was built and occupied only by our program.  She estimates erecting a 10,000 sq. ft building projection for growth is estimated at $2,000,000 at $200 per sq. ft.  This calculation is based on figures for the recently constructed Legislative Center in Sycamore.

Building options were reviewed and included building our own facility on our site and owning it or requesting that the Public Building Commission (PBC) erect the facility and we rent or lease from them.  She did state that should the PBC erect a building, they may not want the building on our site.  If our agency did build and own the facility, the County could be asked to finance it interest-free for 20 years.  Expenses of building maintenance, phone maintenance, utilities, maintenance of the yard, parking and drives would need to be added, which would add significant cost.  Mrs. Grush estimated paying off a 20-year lease, interest-free, and the additional costs would be approximately $168,000 per year.  She is not comfortable with the current information that Home Care can sustain financially the annual cost, as well as putting money aside for unexpected emergencies for a building it owns.

The practicality of launching into a building program at this time was presented and included that changes are currently occurring in home care that make financial projections somewhat uncertain, the design of a building may be altered with the move toward laptops, government projects take much longer to build than private projects, and our agency is not in a management staffing position to begin a building project with the many challenges facing Public Health today.  In the end, the timing to begin a building project is not right.

Mrs. Grush reported that she met with Kevin Poorten, KCH CEO, three times regarding renewal of the lease.  KCH hired consultants to conduct a space study, and have announced plans for a new hospital to open in 2007.  Plans for the existing hospital have not yet been studied.  Mr. Poorten indicated that he is willing to renew the lease for less than a five-year period.  Costs of a five-year lease were presented using a 2.5 percent annual increase.  Costs of a three-year lease were also presented, reflecting an increase of 12 percent as offered by KCH.  Mrs. Grush reported that everything remains the same in the new lease except that Hospice may move into a future cancer care center.  This would free up space in the current building, and Mr. Poorten has given our program first right of refusal for that space.  If this should occur, the program would be better off building a facility as the cost to rent would be increase significantly as we would be expected to pay 100 percent of the current shared space.

Mrs. Grush presented her recommendation to renew the current lease for five years and place $1,000,000 in a special fund designated for a building for Home Care with the long-term goal being relocation to its own or county-owned space.. 

Mr. Groark asked if unused space in a building could be rented out if the program was located in a 10,000 sq. ft. building.  Mrs. Grush indicated that she would need to check on the restrictions of a government agency renting to non-governmental organizations.  Mr. Groark asked if building plans should not proceed with the length of time involved in the process, but Mrs. Grush feels a decision should be postponed for a couple years based on the rationale presented previously.  Mr. Kuhn feels that a three-year lease would not allow enough time for construction of a building, while five years allows adequate planning, as well as time to continue to increase revenue. 

Dr. Lane stated that she thinks the current hospital will eventually be torn down because of design flaws and inefficiencies.  Mrs. Grush stated that she has heard it is the intent, at this point, to keep the existing building but redesign the use of it. 

Mr. Wolf asked how much empty land there is at the Health Department site.  Mrs. Grush responded that she is unsure, but will find that out for the next Board meeting.

Mr. Heinisch stated that building rent on Sycamore Road is high, and he feels that the rent for the Home Care space is reasonable. 

Mr. Heinisch moved to renew the Home Care lease for a five-year period, as presented, and place $1,000,000 in a capital fund for construction of a Home Care building, seconded by Dr. Peltz.  Motion carried.

Home Care Laptop Implementation 

Mrs. Grush reported that Mrs. Baj, Director of Home Care, has worked on the project of implementing laptops for over a year and has done an excellent job.  While Mrs. Baj has always been supportive of the use of laptops by nurses, Mrs. Grush is now also in agreement and realizes the program needs to move forward with this technology.

Mrs. Baj presented the reasons to proceed with laptop implementation, focusing on patient care issues, staff satisfaction, productivity, and computer, regulatory, billing and financial issues.  While time may not be saved in the nursing area, it will save time on the clerical end.  Mrs. Baj reported that, at this time, two-thirds of home care client files are on laptops and, nationwide, laptop technology increased from 38 percent to 45 percent last year.  She did check with the State and it is not necessary to maintain paper copies of a patient’s chart, but it must be possible to print it out, if requested.  While charts still must be maintained because of signed consents, physician orders, and lab reports, it will not be necessary to print all the information at the end of the day.  Bills will be sent much sooner as data entry occurs quicker and the notes will be present, rather than having support staff search for that information, if necessary.

A report on the return of investment was presented.  Mrs. Baj provided McKesson with information and data.  After a review of our processes and current staff, McKesson projects a return of investment in 1.7 years. Since laptops also make for a more efficiently operated agency, money will also be saved in the future.

Dr. Lane asked if the program was sufficient to withstand hackers, viruses and worms.  Mrs. Baj responded that McKesson’s standpoint is that they are protected.

Mr. Kuhn asked if dedicated lines would be installed in nurses’ homes for uploads and downloads.  Mrs. Grush stated she is not planning on this expenditure, adding that the nurse can plug into a regular phone line, either at home or at work.  It will be necessary to purchase a switch for the Home Care office, but the data jacks are already present and need only be activated.  Ms. Fullerton asked if the information was backed up by a server at Home Care.  Mrs. Baj responded that all input is done over an Internet connection so will be backed up on the server at Springfield, Missouri.  McKesson anticipates no problems as things have operated smoothly thus far with them.  Mrs. Grush stated she has been told McKesson will be doing most of the work since the data is transmitted via the Internet.

Mr. Wolf asked for an explanation of McKesson.  Mrs. Grush responded that they are the largest technology supplier to home care programs.   Mrs. Baj added that they have software packages for physicians and many other divisions of the company, as well as the package we would use for the implementation of laptops.  Mrs. Grush indicated that they are the current vendor for our Home Care billing.  Mr. Wolf asked if they were also the hardware vendor.  Mrs. Baj responded that they are recommending Jujitsu laptops with touch screens, and have assured us they will work to make sure their prices are the lowest.  Mrs. Grush stated that the estimate for hardware is $37,304, and she will have Mrs. Baj check on government pricing.

Mrs. Grush stated she does not expect this process to be pain-free, and realizes there will be some difficult months ahead.  Once staff is through with the training and implementation, she feels it will be well worth it and does believe the nurses will adapt and, eventually, not want to get rid of them.  $180,000 was budgeted as a special project in this year’s budget, and it seems that January 2004 would be a good time to launch this effort.

Mr. Wolf moved to proceed with the implementation of laptops in the Home Care Program, seconded by Mr. Groark.  Motion carried. 

Board of Health 

Board of Health Membership Appointments

Mr. Kuhn presented the following re-appointments to the Board of Health: 

Mr. Groark, J.D. for a three-year term of 12-1-2003 through 11-30-2006

Ms. Fullerton for a one-year term as County Board representative from 12-1-2003 through 11-30-2004 

Nominations of new members to the DeKalb County Board of Health are: 

Mr. John Olson, D.D.S., from 12-1-2003 through 11-30-2006

Ms. Jean Gastiger, R.N., N.P., from 12-1-2003 through 11-30-2006

Slate of Officers

The slate of officers for 2004 was presented as: 

Mr. Kuhn, President

Mr. Heinisch, Vice President

Mr. Groark, Secretary

Dr. Peltz moved to accept the appointments to the Board of Health and the 2004 slate of officers, as presented, seconded by Dr. Lane.  Motion carried. 

Recognition of Retiring Board of Health Members 

Mrs. Pecka stated that it has been a wonderful experience working with the Board members and Health Department staff, and she has enjoyed meeting new people.  She added that the Board of Health is an easy board on which to serve, and it gives one the opportunity to inform acquaintances what is going on at the Health Department, and that is a gift. 

Dr. Peltz stated that the efficiency and dedication of the staff is amazing to him.  He feels they have a wonderful view of life and a dedication to working with this agency, adding that it is appreciated.  Mrs. Grush agreed that Health Department staff is very special and work very hard, and that DeKalb County is very lucky to have them in their employ. 

CORRESPONDENCE AND ANNOUNCEMENTS 

Newspaper articles for this two-month period included flu clinic activities, a press release from the Office of the Governor stating that Illinois is the first state to be awarded the highest rating for bioterrorism preparedness, a county man affected by West Nile virus, November as National Home Health Care Month, October as Breast Cancer Awareness Month, the effectiveness of mammograms in detecting cancer early, and curbside recycling for DeKalb County residents. 

Correspondence for the months of September and October 2003 included a letter from J. Dennis Hastert, Speaker of the House of Representatives, thanking Mrs. Baj for contacting him with her concerns about home health payments under Medicare.  Mrs. Heal, Home Care nurse, received a thank you from Peter Fitzgerald, United States Senator, for her correspondence regarding the Medicare home health benefit.  

ADJOURNMENT 

On a motion by Dr. Peltz, seconded by Mrs. Pecka, the Board of Health meeting adjourned at 1:12 p.m. Motion carried.

                                                                                   
Carl Heinisch, Secretary
DeKalb County Board of Health