Office of County Administrator
County of La Crosse, Wisconsin
County Administrative Center
400 4th Street North • Room 3300 • La Crosse, Wisconsin 54601-3200
(608) 785-9700 • Fax (608) 789-4821
www.co.la-crosse.wi.us

Aging & Long Term Care

Health & Human Services

Internal Departments

Memo To:  La Crosse County Board of Supervisors

From:  Steve O’Malley, County Administrator

Date:   September 2, 2009 

Re:  September Monthly Report to the County Board 

Attached is the September Monthly Report to the County Board, providing monitoring information about department activities to the full County Board instead of reporting only to governing committees.  

REMINDER   Monthly Reporting by roughly half the organization every other month.  While you will receive this report each month, the reports do not cover every department each time. 

“OF INTEREST”   

2010 Budget Priorities & Issues  

The County Administrator’s budget is nearing completion and will be printed in time to be distributed to the County Board later this month.  I will provide an overview and levy summary to the Executive Committee at their next meeting September 9th, before the books are completed.   

Policy Planning Agenda on September 21, 2009

At the September 21, 2009 County Board Planning meeting, the items we have so far for the agenda are: 

• Update on preparations for Pandemic flu

• Review & discussion of Lakeview Health Center Strategic Plan

• 2010 Budget summary and overview of significant issues

 If you have any questions, feel free to contact me by phone or e-mail as soon as possible. 

County Administrator direct line:   785-9789,   cell phone  608-385-3316

or e-mail  steve.omalley@co.la-crosse.wi.us

MONTHLY REPORT TO THE COUNTY BOARD

Aging & Long Term Care

September 2009

Lakeview Health Center

ADVANCING EXCELLENCE CAMPAIGN

1)      In 2006 the federal government implemented a voluntary program (Advancing Excellence) in which they invited long term care facilities to participate.  The purpose of this initiative was to improve the quality of care and the quality of life of nursing home residents.

2)      Lakeview Health Center signed on as a charter member and agreed to participate in the following areas:

·         Improving Pain Management of Residents

·         Assessing – Satisfaction with Quality of Care

·         Increasing – Nursing Retention

3)      This campaign provides us with valuable resources to assist us in improving care to our residents.  It also gives us a mechanism to report and track our progress.  Most notable, our turnover rate is currently 20.8% compared to an average turnover rate of 45.4% in Wisconsin nursing homes that participate in Advancing Excellence.

La Crosse County Aging Unit

• STRAP Grant (Supplemental Transportation Rural Assistance Program) has been completed for funding for 2010.  It includes continued service for the Shared-Ride expansion into Town of Holland, Bangor & Rockland, Find A Ride,   www.findaridewisconsin.org , and the advertising campaign and service for Hmong riders.  Vernon County Feeder Route and transportation from Galesville and Trempealeau to Onalaska & Holmen is included.

• We are most appreciative of the $13,950 awarded to the Aging Unit for the Hmong elders program from the La Crosse Community Foundation.

• $30,000 in Stimulus Funding will be used for the Congregate and Home-Delivered Meals Programs.

• We have also received additional funding through a MIPPA Grant (Medicare Improvement for Providers and Patients Act) in the amount of $27,000 over two years, to conduct outreach regarding low-income options to help Medicare recipients take advantage of benefits available to them.

• Frozen Home-Delivered Meals are delivered on Fridays for the weekends.  We have more than 40 people receiving these weekend meals. 

• The La Crosse School district is pre-packaging the home-delivered meals, saving time and effort at the meal sites.  Holmen School district, serving the Holmen and Onalaska sites will begin prepackaging Home-Delivered Meals by October 1.

Veterans Service Office

• On August 1^st the U.S. Dept. of Veterans Affairs began a new veterans’ education program called the “Post 9/11 GI Bill.”  This program will eventually replace the current Montgomery GI Bill that has been in place since 1985.  The new GI Bill assists with payment of tuition, has a book allowance, and service members do not have to contribute financially to enroll like the current program.  The program is modeled after the World War II GI Bill and may be used at both public and private schools.  With an estimated 500-600 students at La Crosse County’s 3 colleges, we are making every effort to insure that veterans are informed of their options regarding both the current and new education programs.   Veteran students eligible for the new GI Bill will be required to switch to that program in most cases by January 2010. 

• Applications for VA health care have increased as the economy has slowed down in the area.  We are working closely with unemployed veterans with applications for health care, education grants and other programs that may be of help until things pick up again.

• The 2^nd “Freedom Honor Flight” was completed on June 20^th and another 100 World War II veterans had an opportunity to visit the World War II Memorial and other monuments on the Mall in Washington, DC.  The one-day trip began at 5:30 AM, and a sizable crowd was waiting for them upon their return to the La Crosse Airport at 10:30 PM.  Almost all participating veterans find this to be a moving experience (and a rather long day).  The next flight is scheduled for October 2009.

• La Crosse has been approved for one of 28 new Vet Centers in the U.S.  Vet Centers provide readjustment and family counseling to wartime veterans.  I am hopeful that the program will be in place when the 32^nd Brigade Combat Team, Wisconsin National Guard, arrives back in February 2010.  A Vet Center is a federally funded VA program that is not part of either VA health or benefit programs.  In addition to the counseling they will be doing outreach in La Crosse and surrounding counties in Wisconsin, Minnesota and Iowa. 

MONTHLY REPORT TO THE COUNTY BOARD

Health & Human Services

September 2009

Health Department

Mission:  Improve the quality of life and health of all people in La Crosse County.  The following five goals were approved by the La Crosse County Board and Health and Human Services Board for special emphasis in 2009.  A brief summary of some of the activities completed over the last several months to accomplish these goals is included.

Goal 1:  Provide Public Health Services to meet changing needs.

• Environmental Health inspections occurred at several Farmer’s Markets in the County on a random basis.

• The slowing economy is resulting in a reduction in the number of septic and well permits requested and related inspections.

• A survey of 500 persons in the community was completed to learn about ways to help change the current culture of alcohol and tobacco use to a more healthy state.

• Home Health Aide visits were down, while demand for Home Health RN visits continues to be more than what can be handled by the Department.

• Health Department consultation to the Human Services Department regarding Clinic Nursing Services ended after several months.

• Lab testing of beach and outdoor pool sampling has been conducted as normal this spring and summer.  Fortunately, there continues to be low occurrence of water borne illnesses because of the routine pool inspection and education provided by the Department.

• The normal quarterly sampling of landfill ground water was completed.

• Health Department staff enrolled over 300 families in the Badger Care Plus program.

• Significant training of WIC clients, WIC food vendors (grocery stores), and others occurred through the summer to enable the smooth kickoff of the new Women, Infants and Children Food Package that began August 1.

• The Health Department has been notified that it will be receiving funding to implement it’s H1N1 immunization plan this fall. The exact amount of funding coming is not yet available.

• Significant effort is being put into TB monitoring for approximately 10 persons who although they are carrying the TB infection will not become infectious to others with continued treatment.

• Mosquito control monitoring activities are finding high levels of a new invasive mosquito that is able to carry a number of different human diseases.

• As of the end of July with 58% of the budget year completed, the total revenues collected to date are at 68% of budget and expenditures were at 50% of budget.

Goal 2:  Utilize Technology to Improve Public Health Services

• Health Department staff is participating in planning to expand upon the CONNECT software being developed by the La Crosse County IT department and Human Services Departments coordinate data handling needed to provide high quality services to families and individuals in the County.

• The Health Department tested it’s satellite phone communications equipment.  This equipment will be used as a backup in the event a significant emergency would shut down other normal communications.

Goal 3:  Maintain the Current State of Wisconsin Designation as the Highest Level Public Health Agency

• A mid-year audit of WIC, Lead Poison Prevention, Immunization, Public Health Preparedness, Maternal and Child Nursing, Pre-natal care coordination, Women’s Health and other State funded programs was successfully completed.

• Health Department staff has been participating on a committee convened by the State Health Officer to identify ways to coordinate Public Health services on a regional basis.

Goal 4:  Expand Partnerships to Develop Public Health Services in High Priority Areas

• The region communicable disease control coalition met to continue planning for coordinated H1N1 service delivery in the fall.

• Health Department staff participated in the successful Missions of Mercy free dental clinic that served over 1500 persons in late June.

• Health Department staff is participating in the effort with the Health Science Consortium to create a plan for improving the health status of La Crosse County residents that would enable the County to be the healthiest County in the State by 2015.

Goal 5:  Hire and Retain High Quality Staff by Providing a Positive Work Environment

• All Health Department staff participated in a Business Continuity planning orientation and training session to help assure that the Health Department would be able to operate in a significant emergency.

• Health Department staff was invited to give a presentation at the National Conference of Tobacco and Health in Phoenix, Arizona regarding the local efforts to reduce tobacco use among binge drinkers.

Human Services Department

New Names/New Look:

          For well over a year, the Clinical Services Section of the Human Services Department has been involved in several Process Improvement Initiatives focused on better customer satisfaction and clearer mission and purpose for the section.  In addition to this, the entire Human Services Department began a longer range strategic look at what the Department would look like following the regionalization of Family Care.

          As a result of these planning efforts, the Department made 3 strategic changes in the way it was organized.  These included:

(1)  A move of Adult Protective Services and Court Intervention, which was in the Clinical Section of Human Services, into the Aging and Disability Resource Center of Western Wisconsin.  This move was done to enhance the ongoing relationship that these two units have with one another, to further enhance supervision in the Department and to determine if federal or state funding could come in to support some of the functions within Adult Protective Services.

(2)  The AODA unit of the Department, dealing with people with substance abuse concerns, was merged into the Justice Sanctions Section.  This will allow for more consistency between the Drug and OWI courts and the assessment and treatment functions provided with AODA services.  Supervision is also enhanced and the potential of bringing in federal or state revenue to Justice Sanction is what is being sought after.  The new section will be called “Chemical Health and Justice Sanctions.”

(3)  In an effort to further define the county’s role in behavioral health, the Department made significant changes within the various units of the Clinical Section.  The 3 units created will have specific focuses:

a.    The Crisis or Intake unit will focus on the various functions of mobile crisis and the new Crisis Assessment Center as well as the flow of intake into the Section.

b.    A unit will focus on those requiring care management which is likely to be more long term for those with a mental illness.  Programs like Comprehensive Community Services (CCS) and the monitoring of the Community Support Program (CSP) will fall under the supervision of this unit.

c.    There will be a 3^rd unit which has more of a medical function in that prescription medication monitoring, psychiatric services, nursing, etc. will fall under this unit.  The goal is to have a nurse trained in various aspects of behavioral health to supervise this unit.

With these changes, the Clinical Section will have a new name – “Mental Health Recovery Services.”  Details of this plan have been woven into the 2010 budget.

Another positive aspect for these changes occurred last week when the county hired its first Nurse Practitioner in our new Mental Health Recovery Services Section.  This addition will allow the county to attempt to control the cost for psychiatric services and consultation which is required for this section.  A new supervisor was also hired to be over the care management functions of the former Clinical Section.

 Update on the Development of the Crisis Assessment Center:

          Attached is the most recent newsletter on the ongoing planning being done to create a new Crisis Assessment Center to handle psychiatric crises in the community.  The Request for Proposals will be coming in during the first several weeks of September and the goal still is to have CARE up and running early into next year.  Further information on the CARE can be made available by contacting Melissa Gilbert at 785-6093 or gilbert.melissa@co.la-crosse.wi.us. 

2010 Budget Process:

          The Department has worked with Finance and the County Administrator on a very difficult budget for 2010.  In addition to the state cuts this year in human services, the Department had to work with the county on the levy limits that have been imposed and make further cuts in the 2010 budget to address this.  The monitoring of the budget in 2010 is going to be essential if the Department is going to be able to absorb the various cuts that occurred this year.  More information will be shared on the budget as the County Administrator works with the board on his final budget for 2010.

MONTHLY REPORT TO THE COUNTY BOARD

Internal Departments

September 2009

County Clerk’s Office

Elections

Election Training:  There is no General Election scheduled for this Fall, so it is my intention to hold a training for the Municipal Clerks and their Election Inspectors regarding the documentation required and procedures to be followed before, during and after an election.  With the many security requirements and form changes mandated by the GAB/Election Division there is a lot for them to remember and much of it is new.  This is only in the planning stages at this time.

Early Voting:  GAB and the legislators are considering some form of “Early Voting”.  We can only monitor the situation at this time, keep GAB and our legislators informed (WCCA does a good job of that) and keep our fingers crossed that no unfunded State Mandates come out of it.  There is concern that they are looking at the Counties to play a big role in early voting and if that happens, it will likely have a severe and negative impact on our budget.  Originally they talked about a pilot program in September but now it sounds like that may be pushed back since their “listening sessions” did not result in a consensus on a best option.

GAB Listening Session: I sent my Deputy to a GAB “Listening Session” regarding the mounds of memos the State sends to all the County, City, Village and Town clerks.  We are encouraged that the new Elections Division Administrator is interesting in hearing what the clerks have to say about the best way to disseminate important information and changes to those who of us who need and use it.

Marriage Licenses/Domestic Partnerships

August 3, 2009 was the first day Domestic Partnership applications could be taken in Wisconsin and most of the clerk’s were prepared for “rush week”.  However, the turnout was nothing like expected anywhere in the State.  We only had 4 couples apply on the first day (218 Statewide with 62 of 72 counties reporting) and 8 during the first week.  As of August 28th, we have taken 22 applications.   This will generate some extra revenue for us, but I don’t expect it to be significant.  The cost is the same as a marriage license ($70) and $45 of that is revenue.  Currently we are using word-fill documents supplied by Vital Records; our I.T. department is making progress working on adding the Domestic Partnership forms and deposits to the Marriage Program.

County Board

Appointed Supervisor:  Monica L. Kruse, has been appointed District 29 County Board Supervisor and was sworn in on August 20, 2009.  I have met with her, given her information, had the necessary forms completed and signed and she will soon have a County email address.  She is replacing Brad Pfaff who has been appointed to a State position.

Open Supervisor District Seat:  Tom Rauk, District 34 Supervisor, also resigned, effective August 20, 2009.  A request for letters of interest for that seat has been published in the newspaper and interviews will be held next month; Chair Doyle expects to fill that seat at the September Monthly Board meeting.  Both Brad Pfaff and Tom Rauk will be missed.

Training Budget:  Due primarily to the number of supervisors attending the WCA convention, the training budget is overdrawn.  I will be working with Finance to bring an account transfer to the Executive Committee in September.

WCA: Supervisor Arlene Benrud and retired County Clerk Marion Naegle are working with the La Crosse Center to host the WCA convention here September 13-15.  I will be attending WCCA meetings all day Monday and Tuesday morning in conjunction with that.  We will be meeting with representatives from the GAB/Election Division and Vital Statistics. VitalChek (a company offering point of sale counter payments) will tentatively be addressing our group.

Dog Licenses

I reported in July that we sent out citations to 795 dog owners for 967 unlicensed and/or unvaccinated dogs.  We had licensed and/or updated over 500 of them by the end of July and another 300 by the August 13^th court date.  Only 2 of them appeared in court.  The rest have now been issued warrants by the Clerk of Court.  It is now out of our hands; all phone calls are now referred to the Clerk of Court and the only the judge can dismiss a citation at this point.  Some think this system is overkill, but due in part to our aggressive approach the cititzens can be confident that the majority of dogs in La Crosse County have current rabies vaccinations and the monies generated ensure that animal control can be provided through our contract with the Humane Society.

Respectfully Submitted,

Linda Stone, County Clerk 

Treasurer’s Office

The July Tax Collections went well and the people liked getting the reminder notices but we have more delinquent taxes this year, about 14% more higher than 2008. (However, approximately 58% of this is from delinquent Special Assessments, so the impact to the county is $164,000, an increase of 6% in delinquent taxes.)  With the 5 day grace period we were collecting the taxes through August 7^th. All the settlements were finished by August 20^th.  We have been working hard to get to where we have the information and reports on the unpaid specials so that we will be able to settle with the Municipalities each month as we collect the specials and interest for them. September we will run the Tax Certificates and send out Delinquent Tax Notices. We let the people know that December 31^st we publish all delinquent taxes in the La Crosse Tribune.

See TAX Collections below.

DELINQUENT 

MONTH/YEAR  TAX              INTEREST                        TOTAL

Jan-09                    188,943.60    49,746.85                238,690.45

Feb-09                    114,917.76    27,907.26                142,825.02

March-09                 134,409.82    48,146.30                182,556.12

April-09                     85,134.79    24,218.63                109,353.42

May-09                     76,145.75    23,894.18                100,039.93

June-09                    61,785.54    20,633.57                  82,419.11

July-09                    112,570.35   44,483.82                157,054.17   

CURRENT YEAR

MONTH/YEAR  TAX              INTEREST                TOTAL

Feb-09                    307,303.69      2,967.34               310,271.03

March-09                 583,683.22    11,946.90               595,630.12

April-09                   303,123.45      7,345.52               310,468.97

May-09                   300,489.60      7,272.73               307,762.33

June-09                1,094,118.72      6,154.90             1,100,273.62

July-09               12,583,771.28     12,752.06           12,596,523.34

Reported by Donna Hanson, County Treasurer