St. Lawrence CountyDRAFTServices Committee
Board of LegislatorsMonday, December 12, 2011
Board Room5:30 p.m.
Members Attending:Mr. Bunstone, Mr. Acres, Mr. Akins, Mr. Arquiett, Ms. Brothers,
Mr. Burns, Mr. Lightfoot, Mr. MacKinnon, Mr. Morrill, Mr. Paquin, Mr. Parker, Mr. Peck,
Mr. Putman, Mr. Putney, and Mr. Sutherland
Others Attending: Karen St. Hilaire, Ruth Doyle, Kelly Pearson, Laurie Demers, Mike Crowe, Mike Cunningham, Marty Hassett, Ruth Ayen, Sue Hathaway, Nancy Robert, Chris Boulio, and Media Representative Martha Ellen – Northern New York Newspapers
1. CALL TO ORDER AND APPROVAL OF AGENDA–Chair Bunstone called the meeting to order at 5:42 p.m.Mr. Arquiett moved to approve the agenda as presented, seconded by Ms. Brothers, and carried.
2. APPROVAL OF MINUTES–Mr.Arquiett moved to approve the minutes of the
November 21, 2011 meeting, seconded by Mr. Putney, and carried.
3. COMMUNITY SERVICES – RUTH AYEN
A. Authorizing the Chair to Sign a Contract Accepting the Traffic Safety ProgramGrant 2011-2012 for Community Services (Res) – Ms. Brothers moved to forward this resolution to the full Board, seconded by Mr. Putman and Mr. Acres. Ms. Ayen said this is the Traffic Safety Grant from the Governors Traffic Safety Committee that is funded by the National Highway Traffic Committee. The projects covered this year are safe roads and safe routes to school which includes bike safety and helmet programs, younger driver-risky driving. It also covers projects on used car care, car seats, sharing road with motorcycles, and drunk driving education.
Motion carried.
4. PUBLIC HEALTH – SUE HATHAWAY
A. Modifying the 2011 Public Health Department Budget toPurchase Billing Equipment with ARRA Funds (Res)– Mr. Morrill moved to forward this resolution to the full Board, seconded by Mr. Lightfoot. Ms. Hathaway said the State gave us just over a month from the time they told us about this Grant to have it signed and back to them. Motion carried.
Ms. Hathaway said on Thursday the State passed emergency legislation to allow the creation of new CHHAs in New York State. This goes into effect immediately and it will allow up to 75 to be created. The Medicaid Redesign Team felt it would be better to have competition and more consumer choice. She said she has not heard anything from the Home Care Association on this. The value of existing CHHAs would basically go to zero because CHHAs can come in without buying one. There also could be large CHHAs coming in such as Home Care of Rochester (HCR) and we cannot compete with an outfit like that. They do not have the kinds of benefits the County has and their nurses are paid per visit, not a salary and may do 6 or 7 visits a day. At this point it is a toss up as to where we want to go with this information and it will be a challenge for the task force.
Ms. St. Hilaire said this has caused a lot of concern of both the Health Department and the Administrators. She said the information she is getting from her fellow Administrators is that there are at least three or fourCHHAs that were in the process of being sold and now payments have been discontinued. In essence, the value of existing CHHAs is worth zero and the concern is that it will happen rapidly which will have a major impact on the CHHAs.
Mr. Lightfoot asked if this actionwas a result of legislation or regulation. Ms. St. Hilaire said it is an action of regulation. Ms. Hathaway said there has been a moratorium on the creation of new CHHAs since 1994 and this is what has been lifted. Ms. St. Hilaire said if the County has two or less CHHAs, they would look to solicit CHHAsto come into that area. Ms. Hathaway said we have two in St. Lawrence County. Mr. Lightfoot asked if there were any challenges contemplated to this regulation. Ms. Hathaway said yes and said last week letters were sent to State Officials and Legislators, but it did not seem to have any bearing on the outcome.
Mr. Burns asked if the Task Force had met yet. Mr. Bunstone said no, but there is a Boardof Health meeting tomorrow night at 6 p.m. The presentation will be dedicated to the CHHA, if anyone wants to attend and learn more about it.
Mr. Acres said he didnot understand why this is a toss up. The reason the State is doing this is to create more competition to lower the costs. The State, through Medicaid, is paying the bills so this is the reason they are doing it. He said privately they can do it cheaper than we can do it so this is good news. The bad news is the value of the CHHA; it is not worth anything now and the nurses may not be ableto get the employee benefits as they do with the County. But the CHHA may give more flexibility as far as their day schedule goes.
Ms. Brothers said it sounds like HCR may come here and she asked if they can refuse to care for someone. Ms. Hathaway said no, they cannot. The only reason they may be able to refuse someone is if it is unsafe. Ms. Brothers asked how fast this would happen. Ms. Hathaway said they may come in very quickly since they have administration and a billing system already set up. Ms. Brothers wants to know how rapidly and in what manner does this transition occur.
Ms. Hathaway said she did not know how long because she does not know how long it will take for them to get a certification from the State.
Mr. Morrill said it sounds like it could get costly as we still have to provide services for anyone who decides to keep these services. Ms. Hathaway said we are required by law to provide care for patients and there is a complete procedure as to how they can be transferred. She said she does not know how quickly it will go.
Mr. Parker asked if a private CHHA came into St. Lawrence County and we were to decertify what would the Counties obligations be to provide services for the people who are receiving services now. Ms. Hathaway said our obligation is to provide care until there is someone else to provide that care. At the Board of Healthmeeting tomorrow, we will be determining what the actual costsare of what the CHHA pays verses the money it loses and revenue.
Ms St. Hilaire said there is a particular problem now as there are vacancies in the CHHA. She said Ms. Hathaway thought we should fill positions,but she did not think they should be filled as we do not know the future of the CHHA. This puts added stress on the individuals that are there and trying to carry the caseload. Ms. Hathaway said it is even more complex as she is losing nursing staff from the Prevent too and she is at a point now as she is going to be unable to continue provide mandated programs in Prevent and are at risk to be able to provide care with CHHA as there are not enough nurses. She said there was another resignation this morning and we need to do something.
Mr. Parker said if we have established a relationship with a certain number of caseloads in the program in St. Lawrence County is there still some residual value in our CHHA. He said is there some mechanism that they would have to work through us to get access to the patients.
Ms. Hathaway said they could take some of the patients on care if they wanted to leave us. At this point, if we cannot provide the care, it is possible for the other CHHA in the County to take on some patients. The State would step in if we are unable to provide services. Mr. Parker said there may besome value left in the CHHA in that there may be a subgroups of what we are working with now, smaller groups of patients that someone would have to provide service for. On the other hand, it may be that the ones that are more mobile and require fewer services may move quickly and we may be left with the ones that need more care. He asked if we would have to pay to transfer care over to another provider. Ms. Hathaway said she did not know but it is true that there are different kinds of patients, some are reimbursed better and require more care than others do. Ms Hathaway said they may take people that are financial more desirable. A provider that wants to come into this area may be willing to pay for the caseload. There are so many unknowns at this point.
Mr. Akins said he would like to see all of us do a better job as a Board and to not react to this in a negative way. He said we have an opportunity to help the other CHHA in St. Lawrence County become more competitive against a downstate competitor. If we can keep that structure in
St. Lawrence County such as hiring local people, we are stronger as a community. He said he does not want to embrace this as a bad deal because some of these things we do not have choices on. Ms. Hathaway said there are multiple local organizations that are interested in our CHHA. Mr. Akins said the more the better to keep it local. He said it is advantageous for us to keep it in our community. Ms. St. Hilaire said my philosophy is the same, but we need to be careful on how wefollow our purchasing laws.
Mr. Peck said if we do not know how long it will take for this transaction to take place, and we have nurses leaving, how do we cover the clients we have now with less nurses. Ms. Hathaway said we have provided good service for years and she said she hates to see that destroyed. She said in others Counties that have made decisions to sell theirCHHA, every nurse has walked off the job and if something like that were to happen, she said she would have to call the State and they would make arrangements. Mr. Peck asked what the cost would be to the County.
Ms. Hathaway said she did not know and she would have to talk to the State.
Mr. MacKinnon said he didnot support being in competition with other agencies or with the private sector in providing health care. If they can do it better and do a good job, he doesnot think the County should compete with them. In this situation if someone else can come in and do the job, then it is our obligation to let others do it. He said he can recall years when Public Health was a money maker for the County, but times have changed. The State seems to be saying that they do not want Counties providing this care and he thinks this may bea good thing.
Ms. Hathaway said it will give people a choice of providers. It may be a good thing to have a couple of CHHA in a county this size. It is just a matter of the County deciding what we want to do and moving forward.
Mr. Acres said he echoes what Mr. MacKinnon says and asked if the nurse left because of the CHHA situation. Ms. Hathaway said a reason wasnot given, but the nurses are very nervous because they are hearing all the talk about what is happening with the CHHA.
Mr. Morrill said it sounds counterintuitive to him that we are going to lose out to another organization that pays less and does not have as good of a benefit package as we do and we are losing nurses to higher paying jobs and that does not add up. Ms. Hathaway said the private CHHAs pay more but the benefit packets are not as good. The issue for some of the staff is that there are some nurses that have yearsof service with the County and for them to leave to go to another employer may devastate them. It may mean there will be a lot of bumping in the County.
Mr. Putman asked the Chair if when the committee got together, if they would get information on the clerical staff and otherssuch as how years of services they have.
Mr. Akins asked when the Task Force was going to be held. Mr. Bunstone said a meeting has not been set yet.
5. OFFICE FOR THE AGING – NANCY ROBERT
A. Authorizing Chair of the Board of Legislators to Sign the Annual Plan and SFY 2012 Applications for Funding with the New York State Office for the Aging (Res)– Mr. Morrill moved to forward this resolution to the full Board, seconded by Mr. Sutherland and
Mr. Putney. Mr. Burns asked what that Annual Plan was. Ms. Robert said it is a plan in funding request for how we are going to utilize State and Federal Funds for programs. Mr. Burns asked if Ms. Robert could email that to him. Ms. Robert said certainly.
Mr. Parker asked how much the application amount was. Ms. Robert said the total amount for Federal funds is $639,376 and the State Funds is $711,755. Mr. Parker asked what percent that was of the Office of the Aging Budget. Ms. Robert thought it was a little over one-third of the budget. Motion carried.
B. Transportation Service Information –NYSARCrepresentatives will be present to
provide information and answer questions (Discussion) – Ms. Robert said this information was requested by the Board. She introduced Jerry Filiatrault, Director of Operations for St. Lawrence NYSARC and Sandy Layo, Transportation Manager.
Mr. Filiatrault said a Request for a Statement of Interest was put out for County transportation. The Statement of Interest took into effect the 32 routes thatare already in place. He said by using existing routes and using a dead head drives, initially about 10% of trips that carry consumers. The transportation will not be the same as to what is in place now, but it will certainly allow people to travel.
Mr. Peck asked if we can transfer or lease buses our buses to NYSARC. Ms. Robert said we havesix buses and we could transfer all six to them. Mr. Peck asked if they would be used in the daily business. Mr.Filiatrault said some would be used as spares. Mr. Peck asked if we would have to prepare a lease for NYSARC. Ms. Robert said yes.
Mr. MacKinnon asked Mr. Filiatraultwhat his title was. Mr. Filiatrault said he is the Director of Operations. Mr. MacKinnon asked how many buses, including spares, that he has now.
Mr. Filiatrault said we have 36 buses. Mr. MacKinnon asked how many people were employed to drive these buses. Mr. Filiatrault said we have approximately 100 people on staff.
Mr. MacKinnon said it sounds as if they are all set and it seems like a win, win situation for
St. Lawrence County to be able to continue to provide transportation.
Mr. Akins said he had a request from the Amish community. They would like to be able to get to Canton in time to match up with the Trailways Bus Line schedule and would like a schedule that is permanent. Ms. Robert said they do meet some of the connection right now. Mr. Filiatrault said they are on schedule because it is mandated, but they may have to adjust their schedule to meet ours. They can always contact us to make special arrangements.
Ms. Brothers said do you have plans to advertise these routes. Mr. Filiatrault said we will advertise and we do have a basic schedule already. Ms. Brothers said she thinks there may be people that will use it now that did not use it before and she would like the people to get the information they need. Mr. Filiatrault said we get the information out, but it will take some time.
Mr. Burns asked if NYSARC is a non-profit organization. Mr. Filiatrault said yes and the fee that is charged will only make them break even. Mr. Filiatrault thought the fee would be lower than what is charged now. Mr. Burns asked if there were any provisions on the Gouvernuer route. Ms. Robert said the services for this route would be discontinued. Mr. Burns asked if the buses strictly stay in St. Lawrence County. Mr. Filiatrault said they could go eventually go into other Counties.
Mr. Morrill asked if the fare would vary. Mr. Filiatrault said no, it will likely be $2 no matter what distance you travel. He said in the future, he would also like to do a monthly or weekly rate. Mr. Morrill said it was mentioned that each route should pay for itself, so wouldn’t it make sense to have one passenger on the bus rather than driving an empty bus. Mr. Filiatrault said there have been several meetings with the DOT. It is worth something to us just to make the buses available. Mr. Morrill asked who is responsible for liability. Mr. Filiatrault said they are fully insured. Mr. Morrill said he has heard complaints about the current bus schedule being confusing. Mr. Filiatrault explained the bus schedule.
Mr. Acres asked if they were stopping at individual homes or if they were developing bus stops.
Mr. Filiatrault said they are working on creating bus stops. They have to determine the best locations.
Mr. Putney said he represents the Town of Waddington and he said it appears that the people of Waddington will have more routesthan prior.
Mr. Sutherland said he represents areas that are in the Central, Eastern, and Southern sections of St. Lawrence Countyand it appears as if there are no bus routes in these areas. Ms. Layo said there is a route in Colton and we would go to Pierrepont. She said it would depend on the need of buses in these areas. Mr. Sutherland said if the buses passed through those areas and the people in his district were interested, could they be accommodated. Mr. Filiatrault said theywould think about how they could deviate from the routes, and it depends on the needs. If those needs were brought to their attention, we would certainly do everything they could to work with them.