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:  March 3, 2009 

Re:  March Monthly Report to the County Board 

Attached is the March 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

February, April, June, August, Oct. & Dec.    January , March, May, July, September, November

Planning, Resources & Development

Public Works & Infrastructure 

Judiciary & Law Enforcement

Corp Counsel & Child Support

Health & Human Services

Aging & Long Term Care

County Clerk, Finance, IT

Printing, Personnel, Treasurer

Please note that we have now added the internal departments that were not reporting in the past.

 

“OF INTEREST”   

I won’t be in attendance at committee meetings March 9 & 10, since I’ll be attending the NACO legislative conference in Washington D.C.   The Deputy County Administrators Gary Ingvalson and Jerry Huber will be attending on my behalf.  I return for the Executive Committee meeting March 12.   

State Budget impact still being analyzed    Governor Doyle’s budget proposal is still being analyzed to identify the specific impact on La Crosse County departments.  While yet to be confirmed, the negative impact will be $100’s of thousands per year.  I will provide a preliminary update of the dollar amounts during the Administrator’s report at the County Board meeting on March 19, 2009.  Recommendations for responding to the budget cuts will be provided over the next several months as the Management Team develops our strategy for Board consideration – and as the legislature moves toward State budget adoption for the biennium July 1, 2009 through June 30, 2011.   

Economic Support Impact  During an economic downturn, the impact on worker caseloads is first felt by our Economic Support staff in the Human Services Department.  At my direction, the Human Services and Finance Department are analyzing these caseloads and trends in order to keep abreast of meeting client needs.  We expect to have recommendations for the Board to consider in April. 

 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

March 2009

  

Lakeview Health Center

 

Update on Mississippi Valley Health Services

 

We are currently working on the “conversion” of MVHS “Inc.” to MVHS (a commission of member counties).  This format of a multi-county collaboration meets the approval of the Department of Health Services which then allows us to not only collect from member counties, but it still protects our ability to capture our share of the federal funds we receive as a result of our losses.

 

Member counties are currently in the process of passing resolutions establishing this commission (like you did at your January 2009 meeting).  Once that process is completed, we will then apply for licensure under this newly formed commission.

 

Hopefully now that we have completed this hurdle with the state, we can continue on with our mission of providing services to our unique case mix of residents than very few other providers offer services to. 

 

Hillview Health Care Center

Carroll Heights

Carroll Heights Census  With new housing options we are having a difficult time getting back to full apartments. Carroll Heights had many people discharge to nursing homes or the other new assisted living complexes. We have advertised in the newspaper, the aging unit senior newspaper, and contacted the CMO to fill these apartments.

 

Hillview Health Care Center

Census Hillview Health Care Center set a record for admissions in 2008 with 329. Our nursing home acuity is very high and the average length of stay in a nursing home is very short, we often discharge people back home with in days almost two thirds of admission return home. 

 

Reimbursement Activity

Governor Doyle unveiled his proposed 2009-2011 State Biennial Budget recommendations, and Hillview Health Care Center will receive a decrease in the Medicaid reimbursement 1n 2009-10.  Hillview and Lakeview administrators were able to meet with most of our legislators in Madison last week. The main topic was our reimbursement, and we continue to monitor the developments with the State budget and the potential impact on the operation of the nursing home. We will keep you advised of changes that would be significant as the State budget deficit mounts.

 

Perfect survey

 

Hillview Health Care Center successfully met both the federal and the state strict requirements to receive a deficiency-free state survey evaluation. This “perfect survey” is the state of Wisconsin’s highest accolade for nursing homes. These unannounced surveys include a thorough evaluation of the entire facility, resident health and satisfaction, staffing requirements, personnel training, administrative procedures, dining services, and resident rights. The survey is a valuable evaluation tool for seniors, their families and health care professionals who refer older adults to skilled nursing homes. We are very proud of our success.  This Hillview Health Care Center third straight deficiency-free survey, the average number of violations in Wisconsin per survey is 7.

 

Hillview named a four star nursing home by CMS

 

CMS has started a new federal rating system for nursing homes. A few weeks ago the CMS (the agency in charge of nursing homes) came up with a rating system for nursing homes.   Hillview received four out of 5 stars, the highest in the area one of the few in the area that received four stars.  The system is very subjective system based on and is based on different categories, including survey history, quality measures, staffing. The best way to see what nursing is like is to ask people who have a relative in the nursing and to take a tour yourself.  

 

La Crosse County Aging Unit

 

  • The County Health Department & the Aging Unit are working cooperatively to reduce falls in Wisconsin with The Stepping On program.  The first class begins at Carroll Heights on March 26 to May 7, 2009 and continues on Thursdays 2-4PM. 

  • Home-Delivered Meals expansion.  We have purchased a freezer to begin delivery of frozen weekend meals for the homebound. 

  • The La Crosse School district is pre-packaging the home-delivered meals for the meal sites for efficiency.

  • The La Crosse County MiniBus contract was awarded to Abby Vans, Inc., a statewide provider of specialized transportation, beginning February 1, 2009.  Unfortunately, they have informed us the service requires a larger commitment of time and resources than they are prepared to provide.  We hope to have the problem resolved at the Aging & Long-Term Care Committee meeting with approval to return to First Transit, Inc., the previous provider.

  • Find A Ride calls have been increasing as we have helped an average of 16 riders per day find appropriate transportation.

  • A $250 Stimulus Payment will be made to most people receiving Social Security or low income Social Security payments.


 

MONTHLY REPORT TO THE COUNTY BOARD

Health & Human Services

March 2009

 

Human Services Department

 

There have been several key initiatives with the Department of Human Services over the first few months of 2009.  These are outlined below with key contacts if anyone wishes to obtain additional information.

 

(1)  Impact on human services with the Governor’s biennial budget

The Human Services Fiscal Section has begun to do an analysis of the impact on funding related to the Governor’s budget that was just announced in mid-February.  Early analysis shows that the Department could receive as much as a $400,000 cut in various state funding to programs within the Department.  Since the Governor’s budget was prepared before the final federal stimulus bill came out of conference committee and was signed by the President, some of the cuts within the Governor’s budget could be restored. 

       The Department will be doing a thorough analysis of where these cuts would take place in specific programs and how the cuts could impact particular service areas.  In discussion with the County Administrator, the Department realizes that it is too early to do drastic measures in addressing these budget cuts and the Department will be working with the CA, Finance and organizations like Wisconsin Counties Association (WCA) and Wisconsin County Human Services Association (WCHSA) to have input on the state budget as it moves through the legislature.

 

(2)  Planning process to address behavioral health crisis interventions

One of the largest single costs to the county is for placements of individuals with mental health crisis into inpatient settings, either at the state institutions or in local hospitals.  Recently, one of the local hospitals has indicated that they will be downsizing their inpatient capacity substantially over the next few months. Other hospitals in the Western region that have psychiatric inpatient capacity have indicated the same intention.  The primary reason for this is the significant loss behavioral health units have on health care settings due to rates of reimbursement.

      Due to the concerns of the lack of community capacity to address the needs of those in psychiatric crisis, the Human Services Department has begun planning with the community to assess the feasibility of a crisis assessment center for emergency mental health crisis assessment and “social detox” interventions with those with substance abuse issues.  Melissa Gilbert has been the Project Coordinator for this initiative and she can be reached at 785-6093 pr gilbert.melissa@co.la-crosse.wi.us.  This project fits into the Governor’s budget initiative to develop more community capacity to address behavioral health crises with less dependence on state institutional placements. 

 

(3)  Current Economic Crisis and its Impact on Economic Support

The Department of Human Services is beginning to see the impact that the current economic crisis is having on individuals and families in our county.  More families and individuals are coming into the Economic Support Section seeking financial and health care assistance.  This increase in need is having an impact on the Economic Support caseload and is likely to grow as the economy continues to struggle.

     This month, the Department will be reporting to both the County Administrator and the Health and Human Services Board an analysis of what is being seen in the Economic Support section as a result of the economy.  In addition, the Department will likely be making recommendations to the board to both address the need within the community for assistance and also to address rising caseloads in the Economic Support Section.  An early analysis of what is being seen will be available to board members by accessing the Health and Human Services Board minutes and prepared documents to this committee.

     Additional information on this topic could be obtained by contacting Lorie Graff, Economic Support Manager, at 785-6061 or graff.lorie@co.la-crosse.wi.us.

 

(4)  Human Services “of the future” or “life after – Family Care”

The Human Services Department for several months has begun the process of long term planning for the purpose of looking at our mission and organizational design following the regionalization of the Managed Care Organization last year.  The Department has looked at models all over the country and look at trends in human services and public administration from both research and actual practice models.  One of the models that interests the Department the most is in a small county in Pennsylvania called Tioga County.  Over the last 25 years they have built an organizational model which focused on full integration of various services.  The Department realizes with the current economic situation and the likelihood of cuts in funding, the model created will need to look at available resources and capacity to deliver in the future.

     More on this initiative is available by contacting Jerry Huber at 785-6094 or at huber.gerald@co.la-crosse.wi.us.

 

 

Health Department

 

Mission:  Improve the quality of life and health of all people in La Crosse County.  The following five goals and 36 objectives were approved by the La Crosse County Board for special emphasis by the Health Department in 2008.  Of the 36 objectives, 25 were completed, 4 are dependent upon state and other data are not yet available to determine the accomplishment and 7 objectives were not met. 

Objectives not met include the following:

 

  • One objective called for 75% of infants being fully immunized by 24 months.  We actually reached 74%.

  • The Health Department strategic plan for 2009 through 2014 was not completed pending the La Crosse Area Health Summit which will be occurring on April 24, 2009, sponsored by the Medical and Health Science Consortium.

  • The Health Department Business Continuity Plan was not tested.

  • Cost benefit analysis of specific programs utilizing the County’s cost benefit analysis format was not completed.

  • The department wide electronic Health record system planning was delayed.

  • The objective calling for 25% of persons covered by MA receiving dental care was not reached, 19% were actually served.

  • A small percentage of Health Department performance reviews on staff was not completed on time.

 

LA CROSSE COUNTY HEALTH DEPARTMENT

2008 OBJECTIVES – YEAR END REPORT

 

 

GOAL #1 Provide public health services to meet changing needs.

 

DIV

OBJECTIVE

Objective Met

Admin

1.a.  Maintain La Crosse County Annual Years of Potential Life Lost among the lowest third in the state.

Yes

Admin

1.b.  By Dec. 2008 over 200 persons complete a Consumer Satisfaction Survey of 4 HD services.

NA

Envir

1.c.  By Dec. 2008 conduct at least 100 consultations, inspections or orders for homes suspected to have radon, lead or mold exposure.

Yes

Various

1.d. By Dec. 2008 complete over 900 communicable disease follow-ups on 83 reportable diseases or conditions.

Yes

Home

1.e.  By Dec. 2008 provide home health nursing and Personal Care services to 75% of persons for which referrals have been received.

Yes

PHN

1.f.  By Dec. 2008, 75% of infants residing in La Crosse County who turn 24 months of age during the contract year will have received the primary series of immunizations.

No

Lab

1.g.  By Dec. 2008, have the monthly testing of 10 area municipal drinking water systems show the systems to be safe.

Yes

Nutr

1.h.  By Dec. 2008 less than 5% of women participating in the WIC Program for 7 or more months will give birth to a baby weighing less than 5.5 pounds.

NA

PHN/ Nutr/

Ed

1.i.  By Dec. 2008 provide employee wellness services to 25% of all La Crosse County employees.

Yes

Vector

1.j. By Dec. 2008 less than 3 reported cases of mosquito borne West Nile or La Crosse Encephalitis.

Yes

Admin

1.k.  By Dec. 2008 meeting the 2008 budget goals for the dept.

Yes

Admin

1.l. For the year ending Dec. 2008 in an effort to receive 95% of signed doctor’s orders within the 20 calendar day limit, clerical staff will attempt three contacts with physicians’ offices to request return of the orders to the Health Department.

 

 

GOAL #2 Utilize technology to improve public health services.

 

Env

2.a.  By Dec. 2008 determine the feasibility of electronically linking Env. Health inspection program to the WI data system.

NA

PHP

2.b  By Dec. 2008, establish an electronic reportable disease-case report system.

NA

Vector

2.c.  Continue to use long-term larvicide’s and bacteria to control disease-carrying mosquitoes.

Yes

All

2.d.By Dec.2008 the Business Continuity Plan will be tested.

no

 

2.e.  By Dec. 2008 complete cost/benefit analyses on two dept. programs using the County Cost Benefit Analysis (CBA) forms.

No

Admin

2.f.  By Dec. 2008 complete initial planning for a department-wide electronic  health record system.

No

 

GOAL #3 Maintain the current State of Wisconsin designation as the highest level public health agency.

 

Admin

3.a.  Report each quarter on the range of high priority services needed to maintain status of Level III HD.

Yes

Admin

3.b.  By August 2008 update the HD Strategic Plan for 2009-2014.

No

 

GOAL #4 Expand partnerships to develop public health services in high priority areas.

 

All

4.a.  By July 2008 complete with community partners a plan to meet needs identified in the community-wide public health needs assessment.

Yes

Admin

4.b. By Dec. 2008 expand the current partnership with dentists to increase persons covered by MA that receive dental care to over 25%.

No

 

4.c.  By Dec 2008 HD employees will participate in the following partnerships:

 

PHP

Coulee Region Public Health Preparedness Consortium

Yes

Ed

La Crosse Area Health Initiative

Yes

Lab

WI Public Health Laboratory Network

Yes

Nutr

Coulee Region Childhood Obesity Coalition

Yes

PHN

La Crosse Area Immunization Coalition

Yes

Various

La Crosse Area Communicable Disease Coalition

Yes

Home

La Crosse Long Term Care Council

Yes

Admin

Dental Care Advocacy Coalition

Yes

Admin

ECO-County Plan for Sustainability

Yes

 

GOAL #5 Hire and retain high quality staff by providing a positive work environment.

 

All

5.a.  By Dec 2008 all staff will have had a performance review.

No

All

5.b.  By Dec 2008 all staff will have the opportunity to meet with mgmt at least quarterly.

yes

All

5.c.  By Dec 2008 all staff will have the opportunity to attend 30 hours of continuing ed.

yes

All

5.d.  By August 2008 all staff will have an opportunity to offer suggestions for the 2009 budget that could improve the potential to reach the HD Mission.

Yes

All

5.e.  By Dec 2008 assure that all staff meet basic licensing certification and accreditation requirements.

Yes

Admin           Administration

Ed                Health Education

Env              Environmental Health

Home            Home Care Nursing

Lab               Laboratory

Nutr              Nutrition

PHN              Public Health Nursing

PHP              Public Health Preparedness

Vector          Vector Control

 

 

MONTHLY REPORT TO THE COUNTY BOARD

 Internal Departments

March 2009

 

 

County Clerk’s Office

 

Elections

February 17th Primary Mandated Publications:  After reading the publication instructions and discovering that we were entitled to the reduced “Legal” rate, I questioned why we have always published election notices as “Retail”.  I contacted the Tribune for more information and cost comparisons.  I discovered that I was able to publish the Spring Primary Type A & Type D notices under “Legals” rather than “Retail” for a considerable savings.  The Type A is the instructions, candidates and sample ballot; the Type D is the Polling Places.  The retail rate, in this situation, would have been at least 3 times the legal, which ended up being about $460.  Since we shared this publication with the City of La Crosse, we will each see a savings of close to $500.  There may be some circumstances where publishing Legal versus Retail may not be an option, but I will continue to look closely at each publication and use the least expensive method available.

Election Turnout:  Historically there has been little interest in the State Superintendent of Public Instruction, which was the only contest on the ballot.  Outside of the City of La Crosse, the turnout was only 3.27%, even lower than I predicted.  Still, the ballots alone cost $3636.41.  We will recoup some of that back from the City of La Crosse but I haven’t had an opportunity to calculate that yet.

April 7th Spring Election Ballot Preparation:  We have already compiled the contests and candidates from all the Municipalities and School Districts and created our draft ballot proofs.  There will be 55 ballot styles this election.  The State has until March 3rd to send us the certification of candidates and March 16th is the deadline for us to deliver the ballots to the Municipalities.  We expect to be able to meet that deadline, which hasn’t always been the case.  My Deputy, Ginny Dankmeyer, is a real whiz at maneuvering through the very complex Optical Imaging software we create the ballots with.

 

Marriage Licenses

This is traditionally a slow time for marriage licenses.  We issued only 39 licenses in January and February.  Even though Valentine’s Day was on a Saturday this year, only 4 couples were getting married that day.

 

County Board

Appointed Supervisor:  I met with Bradley Konkel, our newly appointed District 5 County Board Supervisor, on February 25th to present him with his Certificate of Appointment, to discuss the agenda and packet process, supply him with travel reimbusement requirements and forms, have him sign Ethics Statements, etc.  He is a very pleasant young man.

County Board Publications:  I brought to Corporation Counsel’s attention the fact that we have not been publishing the Planning minutes.  This was fine when they were Policy Planning meetings, but since the Ordinance change to Planning Meetings, business can be conducted and sometimes is.  The Bond resolution that was passed at the February 9th Planning meeting is a good example.  Therefore, it was Corporation Counsel’s opinion that all Planning meetings need to be published in the future.  This could cause us to go over budget, but I am doing everything I can think of to reduce the size of these publications while remaining within the requirements of the law regarding public notice.  I firmly believe that anyone who is really interested is going to go to the web site to view the full minutes and/or listen to the proceedings.

Corrected Meeting Minutes:  At Steve O’Malleys request, Bill Shepherd and I have revised the method for making corrections to the minutes.  Currently the following disclaimer was a permanent part of the minutes: “The above minutes may be approved, amended, or corrected at the next Board meeting.”  That will now be changed on the hard copy and on the web site after they have been approved to:  “The above minutes were approved at the (date) Board meeting.”  If there was a correction, the correction is made in the body of the minutes and it will now read: “The above minutes were approved as corrected at the (date) Board meeting.”

 

Dog Licenses

We just mailed about 5500 Courtesy Reminder notices to La Crosse County dog owners (outside of the City of La Crosse) who have not licensed their dogs yet.  We used to send this notice out in late December or early January but waiting until late February saves printing and postage for about 2500 dog owners who have already purchased their 2009 tags.

 

Filling our Vacancy

We welcomed our new employee to the office on January 26th.  Her name is Jamie Marquardt.  She is a graduate of UWL and was working in the County Human Services Department in Winona.  Jamie is bright and has a wonderfully upbeat personality.  She is catching on quickly and I am confident she will be an asset to the office.

 

Respectfully Submitted,

Linda Stone, County Clerk

 

 

Treasurer’s Office

 

The February Settlement with the municipalities went will. The County is now collecting the current 2008 taxes except for City of La Crosse.  The current year’s taxes to collect are $19,356,894.27. The Delinquent Taxes at this time are $1,921,011.11. In March we will send out delinquent notices for both the current year and the back year’s taxes.

 

See TAX Collections below.

 

DELINQUENT  

MONTH/YEAR  TAX              INTEREST                TOTAL

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

                  

CURRENT YEAR

MONTH/YEAR  TAX              INTEREST                TOTAL

Feb-09