BOARD MEMBERS PRESENT:  Glenda Pecka, R.N., M.S., President; Steve Kuhn, P.A., Vice President; Carl Heinisch, Secretary; Russell Bishop, Psy.D.; Julia Fullerton; Mike Groark, J.D.; Fred Peltz, D.D.S.; Debra Schelkopf, D.V.M.; Steve Wolf, R.N.

BOARD MEMBERS ABSENT: Rosemary Lane, M.D.

MINUTES

On a motion by Mr. Heinisch, seconded by Mr. Kuhn, the minutes of the Board of Health meeting of March 25, 2003, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that this is the time of year when grant awards for the coming year are announced.  A $4,900 increase was received in the WIC Grant, Family Planning will remain level at $179,500, $17,631 more will be received in Family Case Management, and an increase was received in the Illinois Breast and Cervical Cancer Program Grant from $21,000 to $25,725.  The HIV Counseling and Testing Grant award is $36,000, but the expectation is that more clients will be served.  We have been unofficially told that the Comprehensive School Health Grant, in the amount of $30,000, will end on June 30, 2003.  No information has been received on remaining grants.

The Health Department received $25,000 that was requested from the Senior Services tax levy.  This funding is used in the Home Care Program to pay for individuals age 55 to 65 that do not have resources to pay for service.  

The DeKalb County Board held a policy workshop on current and future policy issues that will affect the future of DeKalb County Government.  One of the policy issues discussed was if the proceeds of the Senior Services tax levy should be reserved for non-governmental service providers.  Since the Health Department has received this funding since its inception, a couple of the board members felt it should be reserved for non-governmental organizations and that our agency should request funding from other taxing sources within the county.  Mrs. Grush attended the meeting and presented her opinion as to why it should not be restricted.  A “straw vote” indicated that a clear majority support both governmental and non-governmental entities being allowed to apply and be eligible for the Senior Services tax levy funds.

Mrs. Grush reported that the State’s smallpox program has experienced extreme setbacks and is currently an “all but dead” issue.   Three Health Department staff have been vaccinated: Peg Carroll, coordinator of the Communicable Disease Program; Jane Lux, Director of Personal Health Services; and Gary Judd, HIV Prevention Specialist.  Another individual recently hired received the smallpox vaccination while in college in ROTC.  No staff from Kishwaukee Community Hospital (KCH), Valley West Community Hospital, or Kishwaukee College received the vaccine.  Mrs. Grush indicated that she never received the vaccine because clinics were suspended the day before she was scheduled to receive it due to possible cardiac complications.  She expressed frustration in that agency staff spent hours preparing for this program and its implementation was short-lived.  She added that Phase 2, the administering of vaccine to other agency staff and first responders, is not being discussed at this time by IDPH.  Our agency still has 70 doses left in the one bottle that was opened.  Mrs. Grush stated that 242 individuals in the State of Illinois have received the vaccine.

Mrs. Grush reported that the County-wide Bioterrorism Committee conducted a tabletop drill at KCH in April.  Communications surfaced as a major problem.  Kevin Hickey of the DeKalb County Sheriff’s Department recommended that the Health Department and the hospitals be on the Illinois Radio Emergency Assistance Channel (IREACH).  This, along with a HAM radio system, will give us a method to communicate with police and the State should we experience an event.  DeKalb County Emergency Services Department will assist us in getting the communication plan in place.

HIPAA policies and procedures were implemented on April 14, 2003.  Home Care has experienced only a couple instances, while Public Health continues to communicate with schools and physician’s offices related to the release of immunization records as there seems to be a difference in interpretation of the law. 

Work on building projects continues.  Installation of the new generator is progressing and should be completed by the end of June or early July.  Work on the Invensys controls for the heating and air conditioning system is expected to begin in June.  A number of shingles were lost on the roof from the winds of May 11, and these have been replaced.  We continue to experience problems with the closing and locking of the front doors, and new mechanical hardware has been installed.    A heater on the rooftop unit failed and damaged a compressor that had to be replaced.  Mrs. Grush reported that the building maintenance budget line item has far exceeded what was budgeted. 

Mrs. Grush reported a difficult time in maintaining staff in the Personal Health Services Division.  Mrs. Pecka asked if there were factors contributing to the turnover.  Mrs. Grush responded that a couple staff were terminated during their probationary period and a couple others were experiencing family problems and were unable to continue their employment.  Mrs. Pecka pointed out that a lot of nurses are attritioning out of the profession, adding that she knew of nurses that were being paid $300,000 to fly into this area to work as managers. 

Dr. Peltz questioned why the agency received a visit from OSHA.  Mrs. Grush reported that the individual inspects government facilities and visited our agency following an inspection of the DeKalb County Rehabilitation and Nursing Center and the Sycamore complex.  Her main concern was our handling of bloodborne pathogens and hazardous waste and whether the appropriate posters were displayed.  Mrs. Grush credited Mrs. Carroll with her work on policies and procedures, resulting in no deficiencies cited.

Mrs. Pecka asked Mrs. Grush to explain Senate Bill 1045, a public health bill to distribute Local Health Protection Grant money based solely on population.  Mrs. Grush responded that this Bill is based on formula.  The “Big 8” health departments in northern Illinois hired a lobbyist to get this grant funding distributed based solely on population.  Also included in this Bill is the regionalizing of health departments based on population.  This Bill has caused a huge division of health departments in the state.  An emergency meeting of the Illinois Association of Public Health Administrators was held to discuss the pending legislation.  At this time, several amendments have been made and some rewording of the Bill, which neither side are happy about.  These amendments change the wording so funding is not based solely on population, but also on need, and proposes incentives for smaller, not all, health departments to regionalize. 

It is expected that Governor Blagojevich will sign into legislation a bill authorizing a person 18 years of age and over to purchase up to 20 syringes without a doctor’s order.  Illinois is one of the last five states to require a physician’s order.  It is believed this legislation will slow the spread of HIV and other bloodborne diseases as studies have shown that almost half of all new HIV infections result from the use of an injected drug or sexual contact with a drug user.  Mrs. Grush indicated that the Board of Health did submit a letter of support to this Bill approximately four years ago.

Mr. Drake, Director of Environmental Health, reported that some children in Sandwich chased a deer in town, which went into Art’s supermarket and ended up getting locked in a bathroom causing serious damage to the facility.  The deer was tranquilized by our Animal Control warden and released in a farmer’s field.

Mrs. Grush announced that Neilly Berger, Animal Control warden, has resigned her position, effective June 6, due to problems with child care.  The agency is currently advertising for her replacement. 

Mrs. Lux, Director of Personal Health Services, reported that she has an interview tomorrow with a nurse for the Family Case Management position who is a recent graduate of Northern Illinois University that did her clinicals at Boone County Health Department.  She added that this position is difficult to fill because it is a non-traditional role for a nurse involving social work.  This position has been vacant for six months and the pay is substantially lower than that of the hospital.

Mrs. Baj, Director of Home Care, reported that her program is running smoothly, with staffing stable and preparing for summer vacations.

Mrs. Zanellato, Director of Health Education, reported great success with two pilot programs: the Future is Ours program for Latino students and a pregnancy prevention program that has real potential for future development and funding.  Evaluations of these programs have been incredibly positive to this point.  Mrs. Zanellato announced that DeKalb County now has 55 restaurants that are completely smoke-free. 

FINANCIAL DATA

Mrs. Grush pointed out that a great deal of grant money is outstanding, however numerous Illinois Department of Public Aid payments were received today.

Dr. Peltz moved to approve the Financial Statements for the months of March and April 2003 and the Claims for the months of April and May 2003, seconded by Mr. Heinisch.  Motion carried.

NEW BUSINESS

Renewal of Lease with KCH for Home Care Space

Future Home Care Space Concerns

Mrs. Grush presented a History of Home Care, which shows a relatively stable program in the first 30 years.  However, in the 1990’s, the Home Care Program began to grow as people began living longer and wanting to stay in their own homes, managed care came into being and Medicare was forcing patients out of hospitals quicker.  Prior to 1995, Medicare reimbursed on a cost-based method, and the federal government began to research alternative methods of reimbursement to reduce home health spending.  In 1995, three consultants were hired to advise our agency on whether or not to consider selling the Home Care Program, with all three recommending to sell.

In 1997, plans began to be developed for the new Health Department facility and, at that time, it was decided that the Home Care Program would not be included in those plans due to limited space for potential growth for Public Health and Home Care.  Kishwaukee Community Hospital previously expressed interest in entering the home care business.  This, along with their assuming ownership of DeKalb County Hospice, resulted in the best alternative location being the Kishwaukee Health Care building.  A five-year lease agreement was entered into.  Because of the potential for KCH to enter the home care business, which would have significantly affected the viability of our program, the Home Care Program was offered for sale to KCH.  Due to many of their recent expansion/acquisition efforts at the time and the Medicare interim payment method, KCH declined the offer to purchase.

In 2000, the Interim Payment System with a per beneficiary limit method of payment was implemented by Medicare.  This proved to be disastrous to many home care agencies.  In October of 2000, Medicare’s Perspective Payment System with reimbursement based on patient’s diagnosis and condition method of payment went into effect.  Our agency has faired very well with this method of reimbursement with increased patients and decreased visits.  Mrs. Grush estimates a profit of approximately $300,000, according to the 2002 Cost Report.

A chart of KCH Health Care Building Rental was presented, which shows a current rent of $67,469 annually at $14.49 per square foot.  According to the lease, KCH must be advised by December 1, 2003, if the agency wishes to renew for another five-year period.  Mrs. Grush did meet with the new administrator at KCH and explained our space issues.  He indicated he would consider a lease of less than five years.  KCH has recently hired a consultant to evaluate their space needs as this is also an issue to them; consequently, this is an appropriate time to discuss space. 

A copy of the current lease agreement with KCH was presented.

A drawing of the space at the Kishwaukee Health Care building was presented.  She pointed out that the program recently assumed another 100 sq. ft.  She suggested that the next Board of Health meeting be held at that facility.  Dr. Bishop asked what the projection of space needs was, and Mrs. Grush responded that she did not know that at this point.  She indicated she would need to gather statistics from the Department of Aging to determine potential future needs.  Mr. Heinisch pointed out that this business would surely grow when the “baby boomers” came of age for such services. 

A report, DeKalb County Policy Position Involving Leasehold versus Ownership of Real Property, as prepared by Gary Kobes of Landside Resources, Inc. and project manager for the Public Health building, was presented.  This August 7, 1996, report to the DeKalb County Finance Committee states that it costs more in the long run to rent space rather than to build.  It is Mr. Kobes’ opinion that leases should be short-term and that it is financially wise to own a building.  Mrs. Grush also pointed out that county facilities do not pay property taxes.

Graphs of Home Care Patients by Year showed a decline in 1996 and then increases in 1997 and 1998.  2000 showed a significant increase in patients with the closing of Allen Home Health Agency and Alpha Christian Registry.  A graph of Home Care Visits by Year from 1992 through 2002 was presented, showing an average of approximately 19 visits per patient, which is the national average.  A graph of Income All Sources by Year shows that revenue has increased steadily, except for 1999. 

A chart of Revenue, Expenses, Fund Balance and Average Annual Cash/Investments from 1982 through 2002 was presented.  Mrs. Grush reports a balance of $600,000 to $700,000 between cash flow and accounts receivables.  At the last County Board meeting, the auditors gave a presentation and stated that an organization should have a fund balance between 25% and 40% of operating expenses.  Mrs. Grush pointed out that, while our agency has a fund balance of less than 40%, it does receive money regularly.  She stated that the Board needs to think about the amount of cash that is needed for emergencies and how much could be contributed to a new building.  Mrs. Grush added that two cost reports have been submitted under the PPS payment method and she would want a little more experience with this method of reimbursement before feeling comfortable with revenue projections before entering a building program.  She pointed out that this complex would be the least expensive place to build since we already own the land.  Also, it is a goal of the county that all health-related county entities be located on this campus. 

Mrs. Grush stated that she is simply asking for direction from the Board of Health at this time on whether to proceed with gathering information in terms of space and the option of building as a potential or if the Board simply wants to renew the lease for another five years.  Mrs. Grush pointed out that she feels, in five years, the current space would be an issue if the program continues to grow at the current rate.  Mr. Wolf pointed out that the hospital could not establish their own home care service while we were renting from them.  Mr. Kuhn wondered if the Health Department could purchase the Kishwaukee Health Care building.  Mrs. Grush responded that she did not think so as KCH uses a part of that facility for storage and they are also experiencing space problems.  KCH would most likely not want to give up their Sycamore Road exposure, and it most likely would be cost-prohibitive.  Mr. Heinisch stated that there is potential space downtown DeKalb and that DeKalb Main Street has been very active in attempting to locate renters for vacant buildings downtown.  In addition, he stated there was space in the old Farm and Fleet building and both of these should be pursued as possible options.

Mr. Kuhn suggested that a planning committee of Board of Health members be formed as he feels there are long-term issues to consider and discuss. 

Mr. Groark made a motion that a Planning Committee of the Board of Health be formed, seconded by Dr. Peltz.  Motion carried.

Members of this Planning Committee will be appointed at the July 2003 Board of Health meeting.

Mrs. Grush announced that the Illinois Department of Public Health is holding a workshop for Board of Health members in Elgin on June 9, 2003, from 6:00 to 9:00 p.m.  She asked that those interested in attending contact her.  At this time, Mr. Heinisch and Mr. Wolf expressed an interest in attending.

UNFINISHED BUSINESS

Physician Board of Health Member Replacement

Mr. Kuhn announced that Dr. Shear, physician at Kishwaukee Medical Associates, Ltd., has expressed an interest in public health and has indicated she would be interested in serving on the Board of Health. 

Dr. Bishop made a motion recommending Dr. Shear as a member of the Board of Health, seconded by Mr. Kuhn.  Motion carried. 

The recommended appointment will be forwarded to the DeKalb County Board.

CORRESPONDENCE AND ANNOUNCEMENTS

Correspondence for the months of March and April included a thank you letter and contribution from the family of a Home Care patient.  Newspaper articles featured homeland security, the celebration of Public Health Week in April, the suspension of smallpox vaccinations, a review of landfill and recycling programs, the awarding of an Earth Day flag to Cortland students, a Health Care Spotlight on Christel Springmire (sanitarian), Teen Pregnancy Prevention Month in May, and DeKalb County Cares for Kids Week in April.

ADJOURNMENT

On a motion by Dr. Peltz, seconded by Dr. Bishop, the Board of Health meeting adjourned at 9:00 p.m.  Motion carried.

Carl Heinisch, Secretary

DeKalb County Board of Health