The Health & Human Services Committee of the DeKalb County Board met on Monday, April 3, 2006, @ 5:30p.m. in the Legislative Center’s Gathertorium.  Chairman Robert Rosemier called the meeting to order.  Members present were Marlene Allen, Eileen Dubin, Sally DeFauw, Julia Fullerton and Ruth Anne Tobias.  Eric Johnson was absent.   There was a quorum present.  Others present were Mary Olson, Haley Murray, Sue Plote, Marshall Hayes, Karen Grush, Tom Zucker, Ellen Rogers, Michael Flora, Roger Hopkins, Karen Hagen, Charlene Riefler, Peggy Nichols, Bob Shipman, Ruth Michaelson, Chanette Smith and Ellen Tyne.

APPROVAL OF THE MINUTES

            Moved by Ms. Tobias, seconded by Ms. Fullerton, and it was carried unanimously to approve the Supplemental Minutes from the Joint Meeting with the DeKalb County Community Services Administrative Board from February 2006.

            Moved by Ms. Allen, seconded by Ms. Fullerton, and it was carried unanimously to approve the minutes from the March 2006 meeting.

APPROVAL OF THE AGENDA

            Moved by Ms. DeFauw seconded by Ms. Dubin, and it was carried unanimously to approve the agenda.

SENIOR SERVICES TAX LEVY HEARINGS

            Chairman Rosemier reminded the committee members that the agencies were only going to be allowed 15 minutes each for a question and answer period.  After the meeting tonight the committee will then reconvene on Monday, April 17, 2006 at their regular time of 6:00p.m.to discuss the monetary awards to the various agencies chosen.  Chairman Rosemier wanted to remind the committee that even though these agencies received a certain amount of money last year that the committee was not tied to giving them the same amount or even funding them this year.  Each year stands on it’s own merits.

Family Service Agency of DeKalb County

Request:  Family Service Agency is requesting $112,800 to continue homecare service for the low-income elderly residents of DeKalb County.  The other source of income to be used for this portion of the Assisted Living Program is through the Illinois Department of Aging (IDOA).

            IDOA pays for Assisted Living services at a rate of $12.62 per hour.  As they have not been notified that there will be a change in that amount for FY07, they are assuming that that amount will remain.  The cost to Family Service Agency for providing these services is $22.02 per hour.  The difference between these hourly rates is $9.40 per hour - this is the per hour rate that Family Service Agency is requesting from the Senior Tax Levy funds.

            They provided 12,594 hours to IDOA clients in fiscal year 2005.  Based on the service level through January 2006, it is estimated that 12,000 service hours will be provided in FY07, and the $112,800 that they are requesting from the Senior Tax Levy will pay for those service hours at the rate of $9.40 per hour. County funds will enable low-income older adults to receive the care, which they desperately need, and allow Family Service Agency to continually meet emerging needs for assistance with the tasks of daily living. 

            Ms. Sue Plote, Executive Director of the Family Service Agency was present to answer any questions that the committee may have.  Ms. Mary Olson, Director of the DeKalb County Community Services Department and the Administrator of the Senior Services Tax Levy reminded the committee that Family Service Agency did not use all of their allocation last year.  They had projected that they would work 14,000 hours, Ms. Plote doubts that they will reach that.  She looked at December 2005 figures and is projecting that they will reach 12,000 hours, which is the figure that she is using for next year, too.

            Chairman Rosemier asked Ms. Plote if there was a lack of staff or the number of clients?  Ms. Plote said that the reason for the reduction in hours was because of the number of clients they served last year.  The number of their clients was reduced and that over 5 years the numbers have reduced by 30%.  Now about 120 people are served, but they are doing more hours for one person. There are more difficult cases for older adults.  

            Ms. Dubin said that she felt that the needs of the people are changing rapidly.  How do you deal with it?  Ms. Plote said that the Senior specialist that they hired does more clinical work with older adults.  She does mental health cases and helps with the outreach program.

            Ms. Tobias asked Ms. Plote what the salary was for a DCP?  Ms. Plote said that the average wage is $7.25 because they get new people all the time.  The number of staff still varies.  She gave the Coordinator a nice salary boost and she would like to go back and supplement those people that have been there for a long time at the end of this fiscal year so that they would be where they should be. 

            Chairman Rosemier asked if they have any benefits?  Ms. Plote said that her full-time staff does get benefits but the employees that get paid $7.52 an hour can begin to get benefits once they reach 1,000 hours of work in a year.  They can also get vacation time and sick time after that amount of hours.  That breaks down to about 20 hours a week, she further stated. 

            Ms. Plote said that there are two full-time staff people for this program only, the Coordinator and Assistant Coordinator.

            Chairman Rosemier asked Ms. Plote how many of their clients are private-pay?  She said it was a very small amount.

Ms. Tobias asked that when the County opens its Supportive Living Facility, does she see any impact on her services?  Ms. Plote said that the landscape for this community is changing for a lot of programs and services and that there will be an impact. 

            Chairman Rosemier said that he was confused by the numbers on their submitted budget narrative.  The income does not add up to $262,240, it adds up to $264,240, which is a $2,000 difference.  Under the expenses- they add up to $247,456, not the $264,240.  It looks like your expenses are $7,000 less than what you say they are and your income is $2,000 more than what you say.  Ms. Plote said that her assistant did talk to Mary Olson about a couple of problems with it and she apologizes for them.  She would be happy to fax the correct numbers. 

            Chairman Rosemier then asked, on page 6 of your narrative you have ½ of 20% of ED and DBO Salaries?  What is ED and DBO?  Ms. Plote said that ED is for Executive Director, which is her position.  DBO is for Director of Business Operations.  Chairman Rosemier asked so, you have their salaries built into the budget in addition to the 2 ½ positions?  Ms. Plote said yes, ½ of 20% of their salaries.

DeKalb County Health Department

Request:  DeKalb County Health Department is requesting $26,000 to subsidize approximately 325 home care medical visits to 40 medically indigent DeKalb County senior citizens.  Medically indigent individuals are those not covered under Medicare and who are non-insured or under-insured.

            In 2005, Home Care costs per visit are estimated at $138 for skilled nursing, physical, speech and occupational therapy, $160 for medical social service and $65 for home health aide services.

            Full charges for skilled nursing, physical, speech and occupational therapy are $140 per visit, $180 for medical social service and $75 for home health aide visits.

            The maximum to be billed to the grant award per visit would be a reduced fee of $100 for skilled nursing, physical therapy, occupational therapy and speech therapy, $50 for home health aide, and $150 for medical social service.  All available sources of revenue are pursued prior to billing Senior Grant dollars.

            Ms. Karen Grush, DeKalb County Public Health Director, said that their request is for the medically indigent individuals that are not covered under Medicare and who are non-insured or under-insured.  She said that they are asking for $1,000 more than they did last year.  She said that Public Aid only pays about half of their costs and she has billed some of the other half to the grant, but they have now run out of money.  They now have moved to only billing those that are uninsured.  It takes a very long time to get paid by Medicare.  Last year it took anywhere between 6 to 12 months to get paid.

            Ms. Dubin asked if they are seeing a larger number of people that are uninsured coming in?  Ms. Grush said clearly the majority are, and yes, it’s the trend with everyone, if you lose your job, you can’t afford coverage.

            Chairman Rosemier asked Ms. Grush if they were treating any Veterans?  Ms. Grush said that she really didn’t know.  Chairman Rosemier said that now that the County has another funding source with the Veteran’s Commission, every little bit helps.  Ms. Grush said yes, absolutely.

Elder Care Services – Case Management and Elder Abuse

Request:  Elder Care - Case Management is requesting $25,000 to provide additional case management services in DeKalb County.  Other Sources of income include reimbursement from Illinois Department on Aging.  Their request will be used to support services to 350 clients in FY07.  Elder Care will be providing 5000 units of case management services to these clients. They are requesting support in the amount of $5 per unit of service.

            Elder Care – Elder Abuse is requesting $25,000 to provide additional elder abuse and neglect services in DeKalb County. Other sources of income include contractual reimbursement from the Illinois Department on Aging, requests to DeKalb United Way/Sycamore United Fund and DeKalb Township.  Their request will be used to support services to 90 elder abuse victims in FY07.  The funds will be used to provide 1250 units of service to those clients.  They are requesting support in the amount of $20.00 per unit of service.

            Mr. Marshall Hayes, Executive Director, of DeKalb County Elder Care Services said that the Medicare Part D has been a lot of work for his office.  He said that they received that extra money from the County for Medicare Part D, approximately $11,000 and he feels that they spent an additional $40,000 in allocated time. 

            Chairman Rosemier asked Mr. Hayes if they send elder abuse cases to Prairie State Legal Services primarily?  Mr. Hayes said yes, they usually do.  They used to send around 1 or 2 cases a year on elder abuse to Prairie State, but this past year they have sent around 6 or 7 cases, so the numbers are rising.  He anticipates that they will see about 90 people for elder abuse and 15 years ago they saw about 12 people for elder abuse.

            Ms. Fullerton asked Mr. Hayes if they refer any seniors for mental health care?  Mr. Hayes said yes, they refer between 30 to 40 seniors for depression. 

            Chairman Rosemier asked Mr. Hayes if he has seen a decrease in numbers for home health referrals?  Mr. Hayes said no, they are about six (6) home health providers this year and because of the way the State is doing bidding now, there is more competition.

Voluntary Action Center – Transportation and Meals on Wheels

Request:  Voluntary Action Center – Transportation request is for $77,000 for FY07 transportation services (Trans Vac and Med Vac).  This request will fund 6,815 rides at a cost of $11.30 per ride. Costs were calculated by dividing total transportation costs by total number of rides provided.

            Gasoline prices are nearly 100% higher than they were two years ago.  Vehicle insurance premiums increased by 4% this year, while they expect yet another double digit increase in health insurance premiums.  Expenses for labor, vehicle maintenance and vehicle repair have continued to increase as well.  The vehicle fleet continues to age. They have nearly 30 vehicles that qualify for replacement under IDOT’s established criteria.  The State of Illinois did not fund the IDOT GRF capital program last year, and as a result they will not get any new vehicles until possibly next year.  They will continue to increase vehicle maintenance expenditures in order to perform needed maintenance and repairs on this aging fleet.

            Voluntary Action Center – Meals On Wheels request is for $87,000 that will be used to provide 12,000 meals, which will purchase 20% of Meals on Wheels services for DeKalb County residents.  Service will include a combination of noon, evening and weekend meals in addition to dietary supplements.

            An additional request of $2,500 is also being made for the purchase of 100 shelf stable meal kits.

            During FY2005 for the Senior Luncheons, 32,241 meals were provided for 777 persons.  This service experienced a 7% growth at a time when most programs across the country continue to experience a decline in attendance.

Mr. Tom Zucker, Executive Director of the Voluntary Action Center, and Ms. Ellen Rogers, thanked the committee for continued support of their services and for the Senior Services Tax Levy. 

            Mr. Zucker explained to the committee that the gas prices are rising again this year. 

            Chairman Rosemier asked Mr. Zucker to share with the committee where they provide the service, to whom do you provide the service to, and if there is any redundancy in the services that you provide that you are aware of.

            Mr. Zucker said that they are a countywide service and they do provide Trans Vac rides to and from local destinations and Med Vac service is for out-of-town medical appointments.  They operate a south county route in Sandwich in the non-urbanized part of the county that serves the communities of Sandwich and Somonauk.  Much of the demand that they are seeing now in Sandwich is to get people up to DeKalb and Sycamore and then back to Sandwich. Their North County Route covers Genoa, Kirkland and Kingston for the same type of services s the South Route and it runs Monday through Friday.  They have a route that runs between Sycamore, DeKalb and Malta that people use to get back and forth from Kishwaukee College and the Tri-County Health Clinic.  The rest of the service provides transportation for Cortland, DeKalb and Sycamore and to the Adult Day Care Center in DeKalb.  Currently they are not providing transportation to Fox Valley Older Adults Day Care Center, because they have not been asked to yet.

            Ms. Tobias asked what impact would the Downstate Operating Program have?  Mr. Zucker said very positive.  It replaces a federal grant that went away, which helped them to expand service in urbanized areas by a couple of routes.  They just created a new demand response route.  Currently, their transportation services are made available to people that can call 6 days in advance. The routes fill up fast and it is difficult to get a last minute request scheduled.   This new route can only be booked 24 hours in advance and cannot be master scheduled. The intent is to address the last minute request that people have. 

            Ms. Ellen Rogers, Director of Meals On Wheels, said that they serve about 300 people now and that they do have a waiting list.  Unfortunately, it is in Sandwich, because they have run out of volunteers down there.  The cost of a meal is about $7.25.  They have paid drivers that deliver the meals throughout the County.  Gasoline prices are still a problem for them too.

Ben Gordon Center

Request:  Ben Gordon Center is requesting $83,018 to fund their Psychiatry, Counseling and Case Management Program for citizens aged 55 years and older.  They state that almost 20% of that population experience specific mental disorders that are not part of “the normal aging” process.  The total cost breakdown is as follows:

Program            Units            FTE            Cost/Hour      Total               Medicare         Senior Tax

Psychiatry          300      0.22            $200.00          $   60,000            $22,250            $37,750

Counseling         687          1            $80.00             $   55,000            $24,732            $30,268

Case Man.          230      0.24            $65.00             $  15,000 $-0-                  $15,000

Total:              1217            1.46                            $130,000            $46,982            $83,018

Mr. Michael Flora, Executive Director of the Ben Gordon Center, explained to the committee their request for an expanded outpatient program to meet the mental health and substance abuse needs of older adults in DeKalb County.  This program will provide psychiatric evaluation, treatment and monitoring, diagnostic evaluation and consultation with primary care physicians, as well as, home based case management and outreach services to area residents.  They have recently added a psychiatrist who specializes in older adults and nuero-psychiatry to the team of behavioral health professionals.  Her services will be included in multidisciplinary collaborative team of professionals to assist in providing care to older adults in their homes, as well as, rehabilitative consultation to area nursing homes so older residents may be able to return home in a more expeditious manner.

Mr. Flora stated that out of the 100,000 people who live in DeKalb County, based on 65 years or older adults in the county is well over 12,000.  Looking at severe persistent mental illness, one out of five individuals will suffer from this for a lifetime.  They currently see 240 seniors, of which 40% are self-referred and 11% are from primary care physicians.  Elder Care Services does refer some elders to them.

Ms. DeFauw asked how many people would they need to hire for staff?  Mr. Flora said 2 full time employees will be added.  They do have case managers on staff, but they are at capacity in workload.

Ms. Tobias asked if they had any provisions for low-income seniors?  Mr. Flora said that the majority of the seniors are on Medicare/Medicaid.  Medicare does not pay for case management services. 

Chairman Rosemier asked how they would feel if the pilot program was started only on the identification part.  Would we be mistreating the people by identifying the people and then not being able to provide a certain service to them?  Mr. Flora said yes. 

            Ms. Tobias asked Mr. Flora, what would happen if the committee could only appropriate half of the requested amount for the pilot program?  Mr. Flora said that they would have to scale back and that they would still be able to offer treatment but not to as many individuals.

Hospice

Request:  Hospice is requesting the amount of $4,300 to support an average of ten (10) senior home-based Transitions clients per month.  The average time spent by the Transitions Coordinator on case management and volunteer supervision per client is two hours per month at $17.50 per hour.  The request also includes $100.00 for the Transitions portion of the Direct Care Volunteer training (two trainings/year).

As mentioned before, no Medicare reimbursement money can be used for Transitions.  The Transitions program depends solely on donations, grants and fund raising for funding.  DeKalb County Hospice’s affiliation with Kishwaukee Health System (KHS) has made it possible for DCH to be Medicare certified, as the Medicare reimbursement does not come close to covering the cost of providing hospice care.  This continues to be a nationwide phenomenon.  Since our Medicare certification, KHS has augmented the DCH budget.  It is the goal of KHS and DCH for DeKalb County Hospice to become financially self-sufficient, even with the discrepancy in the reimbursement amount.  Fundraising, grants and donations alone have not made up the Medicare reimbursement discrepancy. The staff of DCH has worked hard to lower costs and increase funding.  They have been successful and are closer to having expenses and revenues being equal.

            Ms. Karen Hagen, Executive Director, DeKalb County Hospice, said that the program is the same as last year. 

            Chairman Rosemier asked Ms. Hagen that if someone, one year prior from now was getting treatment and then at the six month point approached Hospice to sign up for their services, could they do that?  Ms. Hagen said yes, but that most of their patients seek Hospice help about two weeks before they pass away.  They hardly get anyone coming to them at the six-month point. 

            Chairman Rosemier said that this program is very easy for the Kishwaukee Foundation to pick up and fund it.  This would free up the $4300 and allow this committee to give to other agencies that do not have the Foundation out there to back them up.  Ms. Hagen said that the Health System, when they became Medicare certified in 2000, made a commitment to support the Hospice Program hoping that there would come a time that they would become self-sufficient.  They are already helping supporting them in other ways. 

Chairman Rosemier asked, you say that you are at the point of breaking even, why do you need $4,300 dollars?  Ms. Hagen said that she doesn’t know how to answer that question.  This is the first time ever that they have ever had a positive number at the bottom, said Ms. Hagen.  There was a large patient census last year, but that doesn’t mean that there will be this year, it varies month to month.

Prairie State Legal Services

Request:  Prairie State Legal Services is seeking $5000.  These funds will be used as match and supplemental funding for the $4,985 grant from Northwestern Illinois Area Agency on Aging and funding from Legal Services Corporation.  Funds are used for salary, benefits, and pro rata share of telephone, mileage, supplies, insurance, occupancy and related costs.

In their budget narrative they mention that the City of Aurora provides funding for housing advocacy, 708 Boards provide funding for services to persons with mental illness in designated areas of Kane County, and funding for services to senior citizens is designated by Area Agencies on Aging to specific counties.

            Ms. Charlene Riefler, Project Attorney for Prairie State Legal Services, said that the senior service work has increased in DeKalb County regarding elder abuse. She said that they had about 7 elder abuse cases last year. Chairman Rosemier said that in the proposal the $4895 from NIAAA needed to be matched, does it have to be matched?  Ms. Riefler said that she does not know that answer, but that she will get the answer for him. 

            Ms. Fullerton asked if they received any other funding from anyone in DeKalb County?  Ms. Riefler stated that she wasn’t sure which 708 board they do receive money from, but she did not think that it was from DeKalb County.  The other funding that they get from DeKalb County is from Kishwaukee United Way. 

Chairman Rosemier said that is correct, that he spoke with Ms. Carney at the DeKalb County Mental Health 708 Board.  He further stated that Ms. Carney told him that they are not supporting you at all.  They would certainly entertain an offer, so it might be something that you might want to pursue. 

Fox Valley Older Adults

Request:  Fox Valley Older Adults Services Agency is requesting $50,000 to provide 20,000 units of service to DeKalb County residents.  The facility in DeKalb currently has a client base of 13 residents per week and our facility in Sandwich services 7 DeKalb County residents weekly.  In 2005, we provided 20,280 hours of service plus 1,200 one-way rides for total service units of 21,480.  Under last year’s grant, however, they were reimbursed for 12,000 units of service.  They are growing and therefore are hopeful that this year’s grant will recognize their increased service to the community.

            The funds will be used to support reimbursed costs of the FVOAS Adult Day Services program.  DeKalb County’s Senior Services Tax Levy support benefits clients who do not qualify for state assistance, yet cannot afford the cost of the care.  In addition, the financial support is utilized to meet the needs of those clients who receive some assistance from the state, but it does not begin to cover their care.

            Ms. Peggy Nichols, Vice President of Fox Valley Older Adults Board, said that they have two facilities in DeKalb County, one in Sandwich and one adult day care center in DeKalb.  They have 13 seniors at their DeKalb location and 7 seniors from DeKalb County in their Sandwich location.  She said that TransVac transports the seniors to their DeKalb location. 

            Chairman Rosemier asked Ms. Nichols that in 2005 the salary wages were $184,000 and in 2006 they were $225,000, which was a $41,000 increase.  That is surprising to him.  As far as DeKalb is concerned, you have the same number of clients, yet the salaries and wages are $41,000 higher. 

            Ms. Nichols said that she felt Mr. Alan Zaeska prepared the budget and he would be better able to answer that question.  She would have Mr. Zaeska call Chairman Rosemier with the answer on Monday when he is back in town.

            “Last year you were asking for 12,000 units of service and this year you are asking for 20,000 units of service and I don’t see anything from DeKalb to support that request”, said Chairman Rosemier.

            Ms. Nichols said that when they initially opened DeKalb last year, although they had roughly the same number of clients, a lot more of clients were part-time and were coming only 4 hours, once or twice a week. Now the majority of their clients in DeKalb are there 5 days a week, 8 to 9 hours a day.

Opportunity House

Request:  Opportunity House is requesting $30,019 for their specialized senior program that will help seniors with developmental disabilities to remain in their present living arrangement and prevent or delay referral to a nursing home. They provide training and activities, Monday through Friday, which address health and fitness, socialization, maintenance of daily living skills and recreation.  They engage these individuals in community activities, as their health and stamina will permit.

            They make services available to all 11 individuals.  The availability of the program will remain a constant.  Staff will develop schedules, plan and implement the senior training and activities.  Staff hours of direct service to elderly clients will be the outcome measure.

            The Department of Human Services reimburses them on a fee-for-service basis, at a rate, which provides for 1,100 hours of annual service and is based on a client-to-staff ration of 5 to 1 for individuals served in our Developmental Training Center – including those enrolled in their Senior Program.  The scheduled hours of program operation are 1,690 staff hours per client on an annual basis, based on a 6.5 hour day.  The gap between hours funded and hours provided is funded in part by a grant from the DeKalb County Community Mental Health (708) Board.

            They are requesting the $30,019 of annual funding from DeKalb County Senior Tax Levy Fund that represents staff compensation and benefits for one additional full-time staff person for 37.5 hours per week at an average salary of $10.76.  The addition of this one person will make it possible for them to provide continuous programming to their seniors, while ensuing specialized services are available for each individual served.

            Chairman Rosemier asked about the 5 to 1 ratio, isn’t that what is to take into account, personal hygiene assistance and feeding assistance.  Isn’t that normal routine for the staff to do?  So you are not asking for money to do additional things, you have the same number of clients, but you are saying, either we weren’t able to do it with the hours we had last year, or we didn’t have enough time to do it well enough?  If you have the same number of clients why do you need 1/3 more hours?  Asked Chairman Rosemier.  Last year you asked for 1250 hours and this year you are asking for 1950 hours. Why do you need a full time staff person?  Chairman Rosemier continued to ask.

Mr. Shipman said that it is normal routine for the general population but this program is for people who need a lot more assistance, said Mr. Shipman and that they have two people on staff now to take care of these seniors.

Barb City Manor

Request:  Barb City Manor is requesting $7,956.00 in funds that would assist an average of 3 residents per month for 1 year of service (36 months or units of service) at an average cost of $221.00 per service unit.  Cost of service will vary with financial need of the senior.  Current Section 8 subsidies vary from 466.00 per month to $371.00 per month.  The number of residents assisted and the dollar amount of assistance would not be so great as to exceed the requested amount in the year’s time.  Residents must be able to pay for the majority of their monthly cost of living at Barb city with an average cost of $1,052 per month.  This is done ghrough monthly social security, pensions, interest or savings.  Assistance from Barb City Manor’s Resident Endowment Fund may also be requested.  Barb City’s Endowment Fund is currently $79,000. Residents are receiving $475.00 a month from this fund, which is over the amount the fund is earning in interest.  Residents with very low income or those who have outlived an annuity or other investment sometimes need assistance from more than one source.

            Ms. Ellen Tyne, Administrator of Barb City, said that they have added two (2) new residents that will be coming soon to them for help.  They have three (3) more residents on their waiting list who will also need assistance this year.  She explained that they take in people where they are on the waiting list and that currently there are 900 people on the Section 8 waiting list.  They first serve DeKalb City residents, the rest of DeKalb County residents, and then people outside of the County. 

Chairman Rosemier asked Ms. Tyne how many vacancies does she average a month?  Ms. Tyne said right now she has none, but that through the winter months of December, January and February, she averages about 2 ½. 

            Chairman Rosemier thanked all of the agencies and the committee for their very hard work with the hearing this evening.  Ms. Olson reminded the committee that there is some money left from last year’s unspent money balance from Family Services Agency.  She did not know the exact amount but that she did want them to be aware that they have that money, too, that they can allocate to an agency.

            The committee agreed to reconvene on Monday, April 17, 2006 to allocate the funds to the various agencies.

ADJOURNMENT

            Moved by Ms. Tobias, seconded by Ms. Fullerton, and it was carried unanimously to adjourn the meeting.

                                                            Respectfully submitted,

                                                                                                                                                            _____________________________________  

                                                            Chairman Robert Rosemier

_________________________________________  

Mary C. Supple, Secretary