Waterloo, Iowa June 1, 2017
The Board of Supervisors of the County of Black Hawk, in the State of Iowa, met in special adjourned meeting at the Courthouse in Waterloo, County Seat of said County, at ten o’clock (10:00) a.m., pursuant to law, to the rules of said Board, and to adjournment. The meeting was called to order and on roll call there were present: Frank Magsamen, Chair; Linda Laylin, Tom Little, Chris Schwartz and Craig White.
Unless otherwise noted, all actions were approved unanimously.
Moved by Little, seconded by White that the AGENDA be received and place on file with the County Auditor as approved. Motion carried.
The Board of Supervisors discussed the financial condition of Country View. Finance Director Susan Deaton said that she estimates that expenditures will exceed revenues for Country View by about $712,000 in Fiscal Year 2018, and that the deficit in FY19 will likely be $1.5 million, not including depreciation or capital purchases. Country View Administrator Dennis Coleman and Assistant Administrator Genevieve Schafer explained how Medicaid rates aren’t covering the costs for residents, especially since they aren’t able to get an enhanced rate for residents with a diagnosis of persistent mental illness who are under 65 years old. Schwartz asked why the privately-owned Harmony House can profitably accommodate residents on Medicaid. Coleman said it was because Harmony House is part of a 30-home system that can spread its expenses. Little asked how other counties closed their nursing homes without encountering the same cost issues as Black Hawk County. County Social Services CEO Bob Lincoln said it was because other counties moved their residents to residential care, while Black Hawk County decided to be a safety net for individuals with complex diagnoses who need specially trained staff. He said that some Country View clients would be addressed in other counties under support for the poor. Coleman said that Country View takes individuals that other facilities will not, and 70-75% of its residents are from Black Hawk County. He said that Brighton Consulting Group, which contracts with the county to provide essential business services, has recently explained Country View’s uniqueness to the Iowa Department of Human Services, which could conceivably put Country View in the same class with two specialized facilities in Polk County that receive $500-$700/day reimbursements for residents.
Coleman said there is a plan to reduce the facility’s population so that staffing can be reduced, thus reducing costs. Schafer said that wages and benefits will continue to rise, and while reimbursement rates may rise as well, there is no certainty of it or any way to estimate the amount. Schwartz asked about overtime usage. Coleman said that the union contract requires that overtime be offered to county staff before outside agencies are contacted, and that some employees are creative in earning overtime pay. He said that Country View employees make greater use of the Family Medical Leave Act than any other facility he’s worked at. He said that use of outside agencies hasn’t been reduced as much as planned for in the FY17 budget, but it has dropped from $650,000 in FY16 to an estimated $370,000 in FY17.
Lincoln said that if the county made a proposition to the County Social Services (CSS) consortium to realign Country View for CSS purposes he would champion that proposal to the CSS Board. He said that board would need to be approached soon, and it would need time to determine the vision, investment, return and the benefit for the 22 counties. He said that with a $1.5 million investment from the region, the population went from 95% Black Hawk residents to 75%, and if they doubled down on their investment, they would focus even more on a region-wide population. He visualized Country View as a campus where CSS would serve all needs not as a placement but as a rehabilitation center that would focus on getting residents back in the community. He said Iowa has lost the balance between public institutional support and a private network. The supervisors agreed that the state and federal government levels were abdicating their responsibilities to and passing the cost to the counties. Lincoln said the facility would need to have private rooms. Coleman agreed that that would be the way to go, but a lot of costly reconstruction would be needed at Country View to realize this. Schwartz and Laylin asked if CSS’s $11 million reserve, which is supposed to be spent down to $3-4 million in the next three years, could be used for building renovation. Lincoln said it was a possibility, if the 22 partners saw it as valuable to the region.
Shirley Patchin, resident advocate at Country View, said that paying overtime to the employees was less costly than paying outside agencies, and the county employees were more familiar with the residents. Tom Eachus, director of Black Hawk/Grundy Mental Health, said he has watched the debate on Country View for 29 years, and his point is that a certain number of people there can’t get the care they need anywhere else, and if the attitude at the federal level trickles down to the local level, we will need more jails, because that’s where those people will end up. Joann Finkenbinder asked if Lincoln’s plan was adopted whether there would be any long-term care at Country View. Lincoln said the license would be for long-term support services, but the focus is now how to rehabilitate people to the point where they have the least supervision possible.
Schwartz asked how long a transition to the plan presented by Lincoln would take. Coleman said two to three years. Lincoln said the decision to change is taking the most time, and once that is done, things can move quickly. Magsamen said that the Iowa legislature says that the counties need to address individuals with complex issues, and he hoped the state will look at the situation and reflect the legislature’s intent. He asked to meet with Lincoln and Coleman the following week to work on a proposal for the CSS board. He and the other supervisors expressed their gratitude to the employees at Country View.
On motion and vote the meeting adjourned.
Frank Magsamen, Chair, Board of Supervisors
Grant Veeder, County Auditor
Black Hawk County Board of Supervisors – June 1, 2017
Waterloo, Iowa June 1, 2017