BOARD MEMBERS PRESENT: Steve Wolf, R.N., President; Russell Bishop, Psy.D., Vice President; Deborah Schelkopf, D.V.M.; Jean Gastiger, R.N., F.N.P.; Mike Groark, J.D.; Linda Liston, M.D.; Jesus Romero; Mary Beth Shear, M.D.; Stephen Slack

BOARD MEMBERS ABSENT: John Olson, D.D.S.; Scott Starkweather

Board of Health members and Health Department staff introduced themselves to Jesus Romero, new Board of Health member. 

Mrs. Grush requested that the agenda item under New Business, “Personnel Policies Revisions,” be removed, and that “Pay Overtime for Compensation for Emergency Preparedness Activities” be added under New Business.

MINUTES

On a motion by Dr. Shear, seconded by Mrs. Gastiger, the minutes of the Board of Health meeting of January 24, 2006, were approved.  Motion carried.

DIVISION REPORTS

Mr. Wolf noted that HB 4223 was due to come out of committee last week and wondered if Mrs. Grush had heard anything about it yet.  She responded that she did not have additional information at this time on this Bill that would provide a phased-in rate increase for Medicaid home health care. 

Mrs. Grush announced that a newly formed group, County Animal Controls of Illinois (CACI), is establishing a task force to examine the Animal Control Act and make comprehensive written recommendations for change.  She added that most of the Bills submitted this session are dead at this time.  No rules and regulations for HB 315 have yet been published.

The Emergency Preparedness exercise at the Convocation Center is scheduled for this Thursday, March 30.  Mrs. Grush pointed out that untold hours have gone into planning for the exercise, and it has gotten much bigger than planned.  A number of community partners are testing segments of their plans.  NIU is testing the calling in of their staff to set up the entire Convocation Center for medication distribution.  Our agency is testing the number of patients able to be processed and provided with medication in a one-hour timeframe.  All agency staff will be trained in a position to fill at the exercise and will actually be doing one of the jobs they would do in a real event.  A mock news conference will be held as if this were a real event.  Ray Bockman (DeKalb County Administrator) and Ruth Anne Tobias (DeKalb County Board chair) will represent the county, and Mrs. Grush the Health Department, Others involved include Kishwaukee and Valley West Community Hospitals, the Emergency Services and Disaster Agency (ESDA), the Sheriff’s Department for traffic control and parking, as well as the investigation of the criminal aspect of bacteria (Tularemia) release.  Mrs. Zanellato added that the DeKalb Fire Department will be at the Convocation Center for transport of injured patients.  In addition, various communication systems will be tested.

Mrs. Grush reported that it was more difficult than thought to obtain 300 volunteers to participate in the event, even though community organizations were approached.  A public request for volunteers was not made because of the potential for too many people showing up for the limited timeframe of the exercise.  Volunteers will be given a card and playing the role described.  Mrs. Grush invited Board of Health members to attend, even if they did not have time to play a role.  A forward command site will be at the Center and communications will be tested between the Convocation Center, the Health Department, and the hospital, as well as the Emergency Operations Center.

Mrs. Zanellato stated that this will also be a test of the media.  Emergency protocol was sent to county Emergency Preparedness committee members requesting that they respond that the message had been received.  She added that there has been a lot of media interest in the mock news conference that was set up as training for us. 

Mrs. Grush stated that there will be a meeting Thursday afternoon to obtain feedback from staff that participated, and a briefing on Friday morning with partners for their input.

Mr. Drake, Director of Environmental Health, stated that it has been an exciting two months in his division.  A deer went through a sliding glass door in the basement of a residence, a bird head was found in a can of beans and a lizard in a package of fresh green beans.  There has been no word yet from the Food and Drug Administration on these findings. 

Mrs. Grush presented the Solid Waste Annual Report for 2005.  She cited the overall recycling rate of 55%.  Removing construction and demolition debris, a 49% rate is achieved.  The State’s recycling goal is 25%, which our program far exceeds.  One point of note is the increase in grease that is due to the reopening of Cavel, the horse slaughtering facility.

Mrs. Gastiger questioned the big jump in landscaping waste.  Mrs. Grush responded that there is no explanation for this other than it is all self-report, so is not consistent from year to year.  Mr. Drake stated that all information is voluntary, with approximately 80 recyclers and waste haulers surveyed.  Mr. Wolf asked what is considered demolition and debris.   Mr. Drake responded that this figure includes concrete and road materials.  All of Sycamore Road was recycled in 2005.  Elmer Larson LLC grinds the concrete and reuses it. 

Mrs. Lux, Director of Personal Health Services, presented her board report.  Mr. Wolf stated that he read a release from CDC with summary results for 2005 that tuberculosis is at the lowest rate it has ever been due to the work of public health around the country. 

Mrs. Gastiger asked about the mumps outbreak in Iowa.  Mrs. Carroll, coordinator of the Communicable Disease Program, reported that there are currently over 200 cases in one geographical area in Iowa, but no reason has been identified.  Most of the students were vaccinated and are of college age and adolescents.  

Mrs. Lux reported another positive HIV test in January, with two in January and five in 2005.  Mr. Wolf stated that, at the last meeting, it was reported that none of the positives were IV drug users and this was not a problem in DeKalb County.  He wondered if there was another trend of which the Board should be aware.  Mrs. Lux responded that there were no trends of which she was aware, and added that no particular risk has been identified at this time.  Mr. Wolf  asked if any of the positives were immigrants from another country where the disease is more rampant.  Mrs. Lux reported that one man had been living in another country and came back to America, so probably acquired it while abroad.  Mr. Wolf stated that he feels this is something to watch.

Mr. Slack asked if the higher number for Chlamydia was at all unusual.  Mrs. Lux responded that it is status quo and is the most common STD infection.  DeKalb has a high rate because of the college students in the community.

Mrs. Baj, Director of Home Care, thanked everyone for reading the blue notebooks.  She reported that a great deal of work goes into producing these policies. 

Mr. Wolf questioned if there was someone else in the area that could provide speech therapy services as we have been unable to employ a therapist.  Mrs. Baj reported that patients now must go to Unlimited Performance or NIU Speech and Hearing Clinic, with no speech therapy services provided in the home at this time.  She reported that she interviewed an occupational therapist last night, and she is hopeful that he is interested in the position as it has been vacant for over a year.  Mr. Slack asked if NIU Speech and Hearing Clinic would provide in-home care.  Mrs. Baj stated that they do see patients in nursing homes and some at Kishwaukee Community Hospital (KCH), but not in their homes.  There is also a period of time there when they, as students, are not available because of the school calendar.  These students are serving the patients under the supervision of a licensed speech therapist.  Mrs. Grush added that speech therapists that provide services in the home require additional qualifications and certifications.

Mrs. Zanellato, Director of Health Education, stated that this has been an unusually busy time period.  The program is in the third year of the Comprehensive School Health Education and Services Grant, and she has heard that this will be extended for one year.  Last year, the Adolescent Health Grant conducted a three to five day Postponing Sexual Involvement program, and one school decided it was so valuable that they are funding one of our health educators to go into their school to do that program.  Mrs. Grush stated that the agency has had this grant for 13 years, and it has been pulled from all local health departments with all the funding given to Chicago.  Mrs. Zanellato stated that she was glad to see the school picking up this program, and some schools are adapting it to a three-day program for their seventh graders.  A letter was sent to the schools explaining the process since schools were signing up to be scheduled. 

Mr. Wolf asked if there was any more information from the State on the smoke-free proposal.  Mrs. Zanellato responded that she had not heard anything recently.   

FINANCIAL DATA            

On a motion by Mrs. Gastiger, seconded by Dr. Schelkopf, the Financial Statements for the months of January and February 2006 and the Claims for the months of February and March 2006 were approved.  Motion carried.   

NEW BUSINESS

FY2005 Audited Financial Statement

Agency Fiscal Review

Mrs. Grush presented the FY2005 Year-End Financial Statement, with a summary of Home Care and Public Health revenue and expenses with a comparison between FY2004 and FY2005.  Medicare revenue received in Home Care was 2.8% less than last year and Medicaid (Public Aid) was down by 23%.  Private Pay reflected an increase of 20% over FY2004.  Overall, revenue in Home Care was $32,937, or 1.4%, less than last year.  Home Care expenses were about 6% greater than 2004.  Overall, the difference in Home Care revenue and expenses was $78,811 in direct expenses.  Mrs. Grush reported that the program had excess revenue over expenses, but the calculations of the consultants for the Medicare Cost Report may reflect a loss as they compute the expenses based on a formula rather than assigning direct costs to the Home Care program as Mrs. Grush does.  Accounts receivables were one-third what they normally are as a result of the recommendations of the consultants hired earlier this year. 

Mrs. Gastiger asked how the current federal budget affects the agency.  Mrs. Grush responded that a 2.5% cut is being proposed in the Medicare Program.

In Public Health, revenue was $2,950,533 and expenses were $2,908,743, a difference of $41,790.  Overall, Public Health revenue was 3% greater than FY2004 and expenses were about 4.5% greater. There were slight increases in the line items of Property Tax, General Fund, Public Building Commission, Environmental Health fees, and Animal Control.  Private Pay Clinic Services was up significantly by 13% as immunization fees increased by $2 each last year, generating an additional $15,000.  Planning and Preparedness revenue increased by 20% due to one-time supplemental funding that will not be received again in FY2006. 

Mrs. Grush did voice concern that revenue at both Home Care and Public Health, percentage-wise, are not keeping pace with expenses.

A chart, Revenue Comparison 1996 to 2005, was presented.  Mrs. Grush reported that 44% of the revenue comes from grants.  These grants have remained stable for years, but at some point, this is going to be a serious issue for local health departments.  She pointed out that the Local Health Protection Grant has not increased in ten years, and public health administrators have been extremely vocal to the Governor and legislators that new public health programs should be not be started when the foundations of basic public health services are crumbling in many areas of the State.  Mr. Slack asked if we are unable to access the grants because of the inability to write the grant.  Mrs. Grush responded that there are new grants every year for which we could apply, but they only provide start-up money and then expect the local health department to fund them in following years.  Mr. Slack reported that there is discussion at the County level on increasing the ability to search for and apply for grants and asked if this would be a benefit to the Health Department.  Mrs. Grush responded only if operational money was available.  Mr. Wolf stated that grants can be helpful for the purchase of capital goods.  Mrs. Grush agreed and cited the Bioterrorism Grant being used initially to purchase equipment. 

A chart of Average Cash Investments for FY2005 was presented, which provided general information for the Board. 

A table of Revenue, Expenses, Fund Balance and Average Annual Cash/Investments from 1982 through 2005 was presented.  In 2005, $172,930 was added to the Fund Balance, with a total Fund Balance of   $3,095,021.  Approximately $700,000 is needed for cash flow.  Average annual cash/investments for 2005 was $2,382,217.  This generated $52,962 in interest this year, which will reduce substantially as more than half of the cash available will be spent on the Home Care building.  She added that the County pays for utilities for the Public Health building, the IMRF and Social Security of Public Health employees, and the tax levy, which is 15 to 20% of the agency’s operating expenses.  Mr. Slack expressed concerned that some members of the County Board may look at the large Fund Balance.  Mrs. Grush responded that this will be discussed later in this meeting, and cited the purpose of the fund balance as to keep the agency financially viable, as well as provide capital funding for the proposed building. 

Capital Project Update (Home Care Building)

Mrs. Grush reported that Wold Architects and Engineers were hired last year to determine the cost of a new building.  They estimated that a 21,000 sq. ft. building would cost $5.1 million.  The proposed building is proposed to house the Home Care Program, Veterans Assistance Commission, Mental Health Board and the Regional Superintendent of Schools, with another small meeting room for the County.  Mrs. Grush pointed out that passage of the Veterans referendum was significant and will determine the size of the building, as they now have money to pay for their own space.  Our portion of the project is estimated at $2.6 million and a commitment of $2 million has been requested from the County by the Health Department.  Currently, $1,200,000 has been designated for the new Home Care space located on our campus.  Mrs. Grush is requesting to designate an additional $300,000, for a total of $1.5 million to go into the building of the $2 million needed.  This would leave the agency $500,000 to pay off over a period of time.  She reported that those in the building will be expected to pay the expenses of the building from the revenue they receive.  Mrs. Grush is recommending that the Board of Health officially support being part of this building project and that it be a Public Building Commission (PBC) building.  She recommends this since they have the ability to levy to pay for the building upkeep and maintenance should the Home Care Program, in future years, not be able to financially sustain the program and building expenses.  

Mrs. Gastiger asked what the downside of such an arrangement would be.  Mrs. Grush couldn’t think of any negatives with such an arrangement.  She pointed out that the PBC can put up a building without obtaining the approval of the tax payers to do so.  The PBC is not under a tax cap and they can levy what is needed to operate county buildings.  Mrs. Grush stated that funding requests have been made from the Mental Health (708) levy and the Veterans Assistance Commission levy, and from our fund balance.  Should the Superintendent of Schools relocate to the building, she assumes the county will fund this portion as they have no means to generate money for capital projects.  Mrs. Grush reported that the PBC will also select the architects, which would relieve the Board of Health of this. 

Fund Balance Designation for Building

Mr. Groark made a motion that $300,000 be added to the Building Fund, increasing the balance to $1.5 million, seconded by Mr. Slack. 

Mrs. Gastiger moved that the new building be a PBC project, seconded by Dr. Liston. 

Motions carried.

Mrs. Grush presented the 39^th Annual Report of the DeKalb County Health Department and pointed out that it does include the money being set aside for the building project.  The agency started in 1966 when Medicare came into existence with a couple of school nurses and the Home Care Program. 

Home Health Program Annual Review

Administrative Review

Mrs. Grush explained that an annual review of the Home Care Program is a requirement of Medicare, in addition to a review of Personnel Policies, Home Care Policies and Procedures and Board of Health Bylaws. 

Mrs. Grush pointed out that revenue was down a little this year because of the charges for service and the cost of providing that service.  The episode payment was up a little, which indicates that the patients being seen are more severe.  The number of patients served was down a little with 17,815 visits provided in 2005, an increase of 9 from 2004.  Mrs. Grush stated that the School of Medicine was engaged to study our data when considering renewal of the lease with Kishwaukee Health System, and they predicted that our numbers would remain stable for ten years and then significantly increase because of the “baby boomers.”  As the program is relatively status quo, that has appeared to be accurate.  Since there is no space for growth in the current building, other space is needed, especially with the projected increase in patients.  Hospitals are the largest referral source, with KCH our largest source.

A Clinical Record Evaluation Summary for 2005 was presented and indicates that our program is doing everything it should do.  While there are some home health agencies performing better than ours, we are close to where we should be in terms of the outcomes of patients.  Information was also provided on why some patients were not accepted for service. 

Personnel Policies Revisions

Mrs. Grush requested that the proposed Personnel Policy revisions not be considered at this time.  She indicated that this is the meeting in which Personnel Policies are revised, but in light of the development of the Union, she recommends tabling any changes at this time as a contract will most likely require additional changes as well.

Home Care Policies Revisions

New and revised Home Care Policies and Procedures were presented.  These have been reviewed by the Director of Home Care, the Clinical Coordinator and Home Care management staff.  They report that these additions and revisions meet the standard of practice that is needed and request Board of Health approval of them. 

An updated organizational chart for the Home Care Program was provided. 

Mr. Groark moved to accept and approve the Home Care Policies and Procedures, as presented, seconded by Dr. Bishop.  Motion carried.

Mr. Groark moved to approve the revised Insurance Case Management/Home Health Aide/Outreach Coordinator job description, seconded by Mrs. Gastiger.  Motion approved.

Bylaws

No changes were recommended for the Board of Health Bylaws at this time.

Reappointment of Agency HIPAA Security Officers

Mrs. Grush reported that HIPAA security officers must be reappointed annually, and she requested that Mrs. Hills be reappointed for Public Health and Mrs. Baj for Home Care.  The Security Team members will remain the same for this year.

Mr. Groark moved to approve the reappointment of Mrs. Hills and Mrs. Baj as HIPAA security officers and the Security Team, as outlined, seconded by Dr. Shear.  Motion carried.

Collective Bargaining Update

Mrs. Grush reported that the AFCSME bargaining unit of the Health Department voted 62 to 2 in favor of one bargaining unit.  Names of the negotiating individuals have not yet been released.  She is anticipating that negotiations will begin at the end of April or first part of May. 

Compensation for Comp Time

Mrs. Grush reported that an additional $20,000 has been received in the Emergency Preparedness Grant to offset the expenses of conducting required exercises.  She would like to pay staff for the many extra hours spent on this project rather than in compensatory time, if the employee so chooses.  Since all members, but one,  of this committee are salaried staff, Board of Health approval is required to authorize such a payment.

Mrs. Gastiger moved to approve the expenditure of Emergency Preparedness funds for compensation of actual hours worked by salaried staff involved with the exercise, seconded by Mr. Romero.  Motion approved.

Executive Session – Personnel Issue

At 9:00 p.m., on a motion by Dr. Bishop, seconded by Dr. Shear,  the Board of Health moved to enter into executive session for the purpose of discussion of a personnel issue.  On a roll call vote, those voting aye included Dr. Bishop, Mrs. Gastiger, Mr. Groark, Dr. Liston, Mr. Romero, Dr. Schelkopf, Dr. Shear, Mr. Slack and Mr. Wolf.  Motion carried.

At 9:16 p.m., Dr. Shear made a motion to reconvene to regular session, seconded by Dr. Bishop.  On a roll call vote, those voting yes included Dr. Bishop, Mrs. Gastiger, Mr. Groark, Dr. Liston, Mr. Romero, Dr. Schelkopf, Dr. Shear, Mr. Slack and Mr. Wolf.  Motion carried.

Dr. Bishop made a motion that the Board of Health appoint and empower the Personnel Committee of the Board of Health to act on its behalf with regards to the grievance on a personnel issue that has been filed.  Dr. Shear seconded.  Motion carried.

Mrs. Grush clarified that Dr. Olson is actually the third member of the Personnel Committee, but since he was going to be absent from this meeting, Mr. Groark was asked to replace him in hearing this personnel grievance.  Dr. Schelkopf and Mrs. Gastiger are other members of the committee, and Mr. Wolf joined the group as president of the Board of Health.

CORRESPONDENCE AND ANNOUNCEMENTS

Correspondence for the months of January and February 2006 included a letter to Governor Blagojevich regarding Mrs. Grush’s opposition to the proposed 2007 budget because of its failure to address the long-standing inadequate funding for the delivery of core public health services.  A letter was also received from a DeKalb resident for the agency’s help in getting him the rabies series due to a bat in his apartment.

Newspaper articles were on the smoking ban for the City of DeKalb, promoting HIV/AIDS awareness, the agency’s “Postponing Sexual Involvement” Program, the American Heart Association’s “Go Red” campaign with Health Department staff contributing to the YMCA scholarship fund, a DeKalb woman finding a dead bird’s head in a can of beans, February as American Heart Month, Electronics Collection Day on April 22, West Nile virus surveillance and prevention in Illinois in 2005 and physical therapy drastically helping incontinence.

ADJOURNMENT

On a motion by Dr. Bishop, seconded by Dr. Shear, the Board of Health meeting adjourned at  9:19 p.m.

Deborah Schelkopf, D.V.M., Secretary

DeKalb County Board of Health

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