MINUTES

STATE OF NORTH CAROLINA BOARD OF COMMISSIONERS

COUNTY OF HENDERSON FEBRUARY 22, 1999

The Henderson County Board of Commissioners met for a special called meeting at 2:00 p.m. in the Commissioners' Conference Room of the Henderson County Office Building.

Those present were: Chairman Grady Hawkins, Vice-Chair Bill Moyer, Commissioner Renee Kumor, Commissioner Don Ward, Commissioner Marilyn Gordon, County Manager David E. Nicholson, Assistant County Manager/Interim County Attorney Angela S. Beeker, and Clerk to the Board Elizabeth W. Corn.

Also present were: Budget Analyst Selena Coffey, DSS Director Liston Smith and the members of the DSS Board.

CALL TO ORDER/WELCOME

Chairman Hawkins called the meeting to order and welcomed all in attendance. He stated that this is a Pre-Budget Workshop and Policy Meeting, a joint meeting with the Board of Commissioners and the Dept. of DSS and the Health Dept.

Chairman Hawkins stated that during the retreat the Board of Commissioners had last month, they decided to try to get a little more information from various departments and decided to start with the ones who had the highest dollar involvement, to be better prepared for budget deliberations. He asked the two departments present today to discuss their programs and the costs associated with them and some of their personnel issues.

DEPARTMENT OF SOCIAL SERVICES (DSS)

Brigadier General Frank Blazey, Chairman of the DSS Board, introduced his Board members:

Grace Poli

Savie Underhill

Bill Lapsley

Jack Brill (who was absent)

These five members contribute about 1,500 hours annually.

Mr. Blazey stated that the DSS Board is the Board of Commissioners= Board. They work for the County Government and are agents of the State administering State-wide programs for funding for human services in the community. They are guided mainly by State and Federal regulations. There are a number of mandates. They have a direct and involved relationship with DSS which is a people oriented organization whose primary mission is to be responsible for administration of many public assistance and social service programs.

Mr. Blazey explained that the Board has direct authority, selection, and retention of the Director of DSS. They advise the Board of Commissioners and others on the methods to resolve and improve social service conditions in our community and they consult, guide, direct, and supervise Liston Smith (DSS Director) on a wide range of his operation. They respond to state and county requests to study, evaluate, propose, and suggest solutions to the human service needs.

Mr. Blazey stated that one of their key interests is children. Savie and Grace closely monitor that children are fairly represented in courts and protected from neglect and abuse. The Board members serve on numerous organizations within our community.

He reviewed their established 1999-2000 goals:

1. Concentrate on a variety of children concerns

2. Increased productivity

3. Long-term care

There are five general areas that DSS concentrates on in the social service program:

1. Public Assistance

2. Social Work

3. Child Support

4. Employment and Training of Employees

5. Day Care Operations

He turned the floor over to Liston Smith, Director of DSS.

DSS Director

Liston Smith introduced his key staff who were present:

Sandy Morgan, over all the public assistance programs and medicaid

Shannon Allison, his Administrative Assistant

Peggy Rutledge, his Business Officer

Karen Couch, over all the social work programs

Jan , Dispute Settlement Center (a Contractor)

Liston explained that they have about 27 different programs which are all mandated. Over the last 10 years they have let go of every non-mandated program. He stated that he has been fortunate to have a strong Social Services Board.

Funding Sources for FY 1998-1999 for the Department of Social Services:

64% is Federal

27% is State

9% is County

The total DSS budget for 1998-1999 is $61,300,000. The State has sent the budget estimates for next year and the amount is up to $67,000,000 in one year.

Mr. Smith explained his program costs for next year:

Medicaid 77% $47,500,000

Public Assistance 12% $ 7,300,000

Administration 4% $ 2,500,000

Social Work Services 4% $ 2,300,000

Child Care Subsidy 3% $ 1,700,000

He stated that medicaid is growing at 14% per year. Child protective services are growing rapidly also. Much of the services are provided without regard to income.

Mr. Smith explained a goal for Social Services to partner with Child Care Resource & Referral and the Family Resource Center:

C Social Services is administering the Child Care Block Grant, Head Start Wrap Around, and

Smart Start funds.

C Child Care Resource and Referral (private non-profit) provides information & referral/other

C Both can outpost and/or relocate to the Family Resource Center; thereby establishing a

single portal for childcare services:

C One place for customers to go.

C Social Services autonomous outposting service.

C No new county funds required.

C Requires new county position established:

C new programs

C outposting

C awarded Smart Start grant

He discussed the Child Support Program Highlights. They are serving in excess of 2,200 customers with 10 staff. The services provided are: absent parent location, paternity establishment, court order establishment, collections, and related type services. Performance of the program is in the mid-range to just above. Through court orders: medical support provision, enforcement, and modification. It is also a key role in the Work First Program.

Mr. Smith discussed his anticipated goal to privatize Child Support Services:

C Benefit(s) of competition

C Service Design, Inc. has high performance

C Service Design, Inc. are Child Support Aexperts@

C Less government staff

C More service to customers

C Service Design Inc. are ACTS (Automated Child Support Tracking System) Aexperts@

Liston Smith discussed long term care and statistics to back the need in our county for continued long term care.

Government & Long Term Care:

C Medicaid largest public payer

C Medicaid now funds 76% nursing home beds

C Medicare small public payer, and

C Baby boomer numbers likely to precipitate lower costs, Medicare legislated to smaller

public payer/player; thereby

C Increasing Medicaid costs

C 80% of baby boomers not Medicaid eligible

C In-home services 2.5% of Medicaid cost, compared to

C Nursing homes 28% of Medicaid cost

C State action to hold Medicaid yearly increase to 8% (averaged 14% a year the last 10 yrs.)

C WARNING: State wants capitated managed care risk regional programs statewide

He briefly discussed the Proactive Henderson County Goal:

C Form community leadership team for planning

C Endorsed by County Commissioners

C Co-lead by Social Services in facilitator role

C Theme: Successful Aging at Home

C Establish consultant/project employee:

C research

C coordinate local process

C represent county in regional process

C liaison with DHHS

C Objectives:

C balanced public/private participation

C develop/promote in-home services

C develop/promote local service delivery changes

C increase customer knowledge and awareness of Achoices@

C community-based

C get ready and act Aour way@ prior to State requiring Atheir way@

DEPARTMENT OF PUBLIC HEALTH

Chairman Hawkins turned this part of the meeting over to the Director of the Health Department, Tom Bridges.

Tom Bridges introduced the people who were with him from the Health Department:

Robert Smith, Environmental Health

Barbara Stanley, Nursing Director

Keith Dale, was absent due to laryngitis

Mr. Bridges briefly discussed his organizational chart as well as the NCGS which address the mission and the central services statements concerning public health essential services.

Commissioner Moyer was called out of the meeting at about 3:15-3:20 p.m. He returned at approx. 3:45 p.m.

Mr. Bridges reviewed their budget process:

Progress:

1. Have involved supervisors more directly in budget process. Daily monitoring. Program planning includes supervisor knowledge not only service delivery but knowledge of the resources required to do job. Aim is better planning and efficient operation of programs.

2. Board of Health involved in budget process by budget committee (3 Board of Health members to include Chair and County Commissioner member). This is followed with full board review and approval.

3. County Commissioners preliminary review of program/budgetary issues with Health Department.

Additional activities suggested:

4. Budget planning retreat to include department heads.

5. Service contracts annualized and reviewed by County Attorney. Contracts co-signed by Board of Health Chair. One contract for example has been in existence for eleven years that should be eliminated. It costs the county $60,000 annually.

Board of Health

1. Would like more informed Board of Health by inviting more involvement in programs. Next year to include training opportunities. Should Board of Health be paid for efforts ($20.00 per meeting attendance)?

2. Annual joint meeting in fall of Board of Health and County Commissioners to receive report from Health Department staff on previous year=s activities, goals, objectives.

County has health services mandates required by State Statutes that these services must be assured. Some unresolved issues remain involving public delivery of services vs. private delivery of services. Should local government be allowed opportunities to compete with private sector, and what considerations should be made so that the field of competition is equitable? It is important to note that the Henderson County Department of Public Health has long standing partnerships with Hendersonville Pediatrics and the local OB-GYN practices throughout the county.

Public Health certainly goes beyond the health department building. Throughout the community the health department provides services daily in local restaurants, building sites, home visits, schools, organizational meetings, etc. It is important that the whole community has a sense of ownership in its health programs for there to be improvement in health status. No one agency, no matter how many dollars they can muster can make any appreciable change unless the community is sold on the benefits. To this effort it is important that the health department promote community collaborations including the Western NC Health Network (hospital and health departments), Partnership for Health, Partnership for Children, and the Juvenile Justice Council. These groups must win the trust and cooperation of its citizens.

We must continue to realize the inter-relatedness in all our endeavors in public health. Improved education, employment opportunities, community development, and livability for our citizens can have direct and positive improvements in health status. Public health also needs a strong voice in these areas.

Issues:

1.Staffing: Need flexibility to hire new staff.

Considerations:

a. Is position revenue generating?

b. Is position/service required by mandate?

c. Are local revenues required?

d. Does the position offer a needed service?

Problem A: New Animal Control Ordinance could mandate additional services which will need additional staffing. This will likely require local tax dollars to support.

Solution: Additional county funding for:

Extending hours: Hire secretary and animal attendant (both at lower cost than an Animal

Control Officer). Place 4 existing Animal Control Officers on flex schedule so hours are extended to 9:00 p.m. During regular hours, secretary can handle routine paper work and answer phone calls. Attendant frees up Animal Control Officers to patrol community.

Cruelty Cases: This may require at least one new Animal Cruelty Investigator.

Training Costs: Certification of staff is necessary and this budget line needs to be increased.

Problem B: There are various outside revenue sources which include local fees for services, grants (private, state/federal), donations (foundations). It seems, however, that even though no local tax dollars are required, it is difficult to add new positions. This makes it difficult to respond to increasing demand for services, and may even jeopardize whole programs.

Solution:

1. Health Department pursue new opportunities for outside revenue if services:

a. generate revenue and require no local tax dollars (exception: 5% local Medicaid match)

b. meet local/state/federal mandate or

c. may not be mandated but provide a needed/necessary service.

2. Health Department develops new policy and procedures regarding Areduction in force@ to assure County Commissioners that local tax dollars will not be involved to sustain a program that has lost its outside funding.

Mr. Bridges stated that he would like to run the Health Department more like a business is run.

This calendar year 1999 requests will be made for:

Position Funding Source Service Area

2 public health nurses Smart Start nurse screening licensed day care centers and homes

1 dental health educator Smart Start dental education services to young parents/children and

dental screening and referral young children

1 public health nurse Medicaid Child Services Coordination (service caseload size)

1 Spanish translator Medicaid earnings general area translation services

1 public health educator state/federal funds provide health promotion programs and evaluation of CVH

3 school health nurses Duke Endowment grant provide full-time school health nurses in 3 middle schools

A Health Department goal in the next five years is to become accredited in its public health programs. This will provide greater service/program consistency among local health departments as an indicator of service quality. Some initial efforts in this process include improving cost accounting of program services. Health Department will be working with Board of Health, Finance Office and County Manager to accomplish this.

2. Need for Vehicle Replacement Policy:

Problem: Increased vehicle maintenance on older vehicles cuts down on efficiency of staff operations.

Solution: Policy on replacement of vehicles on a regular schedule will assist budgetary planning and possibly keep fleet in better condition. One consideration would be to lease vehicles.

3. Mosquito program:

Problem: Funding for this program ($11,000) has not changed since 1982. This program is funded jointly with state and local dollars at a 50:50 match. Chemical spray costs have continually increased. A barrel of the chemical now costs $2,500 and last year (dry summer) we used 4 barrels, leaving $1,000 for paying a college student to spray plus vehicle maintenance).

Solution: Abolish program if it cannot be adequately supported, however, program may need to be reinstituted in future should harmful mosquitos appear. Should the program continue, the state has offered to furnish new sprayer.

4. Housekeeping:

Problem: Current contract not being met C paying too much for service currently given. Cleaning requirements for clinic facility may actually cost more than current contract. Have received consultation from Pardee Hospital about this. Health Department staff is involved in cleaning.

Solution: Need full time service and cleaning staff should be instructed in hazards communication standards and OSHA blood borne pathogens regulations, plus receive appropriate vaccinations, and meet security consideration (confidentiality of medical records and computer access). Improved contracting mechanism can help. County workers who are assigned to various agencies.

5. Facility:

New Animal Shelter

Gas Chamber replacement?

Incinerator?

Health Department Building

Solution: Need plan and a time line. Planning needs to consider efficient service delivery.

Funding Source: While some end-of year revenues have been realized from Medicaid earnings, these funds should not be relied on for mandated/essential services. Policy changes in Medicaid from fees for services to capitated payments for services are expected to decrease these funds substantially. The bulk of these current funds may be best used to meet some of the Health Department=s short term information technology needs and capital projects. This is one way provision of services by the Health Department invests some of its revenues back into the county.

There being no further business to come before the county, Chairman Hawkins adjourned the meeting at 4:25 p.m.

Attest:

Elizabeth W. Corn, Clerk to the Board Grady Hawkins, Chairman