McHenry County Valley Hi Operating Committee met Dec. 7.
Here are the minutes provided by the committee:
1. CALL TO ORDER
Meeting called to order at: 1:30 PM by Paula Yensen.
PRESENT: Yensen (Remote), Thorsen, Kearns, Doherty, Meshes, Schwartz
ABSENT: Nowak, Jindrich
Also present was: Peter Austin; County Administrator, Scott Hartman; Deputy County Administrator, Tom Annarella; Valley Hi Administrator.
After the Roll Call no vote was needed, however, Mr. Kearns made a Motion, Seconded by Mr. Schwartz, to allow Chair Yensen to join the meeting remotely. The Motion passed on a voice vote of all present members voting aye. As well Vice Chair Thorsen verified all members in attendance could hear and participate.
2. MINUTES APPROVAL
None.
3. PUBLIC COMMENT
None.
4. MEMBERS COMMENTS
Chair Yensen wanted to thank Mr. Thorsen for chairing the committee today, as she stated they are a great team. Unforeseen things happened where she was exposed to covid and she is awaiting her test, but she knows he is going to do a great job running the meeting and she is delighted to serve with everyone.
5. VALLEY HI ADMINISTRATOR REPORT
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the report.
He stated he emailed the committee a copy of the report last evening, he mentioned he corrected a spelling error. He wanted to get a feel from the committee how they want the report presented, at PHCS it was emailed the day before and he would go over the highlights, he inquired on how in-depth they would like him to go.
Mr. Schwartz stated he is looking for a bit more of a detailed discussion on the report and what is going on, he feels he has done a nice job but it is an important part of the County and it should be given a little more attention.
Mr. Doherty stated he would like highlights, it was a great report he read it last night, and he should highlight the areas that are critical that he feels need to be brought up. He does not see the need for going through line by line when they can read it and ask any questions ahead of time or at the meetings.
Ms. Meshes concurs with Mr. Doherty.
Vice Chair Thorsen stated he should do what he normally does, and they can try to keep up, and slow him down as needed.
Mr. Annarella then went into the report, highlighting main areas.
• They still have an active outbreak in the building, one resident who are actively on the covid unit. They have a hallway dedicated to covid at all times, implemented two years ago once covid began and another dedicated as an observation unit. If you have signs or tested positive, they are placed on the active unit. If you have been exposed, they are placed on the observation unit. They are still in the outbreak status in the building, but they are on the tail end of coming out of it.
Dr. Yensen apologized for interrupting but she mentioned a chat was sent by Ms. Jindrich stating that she Is having a hard time hearing.
• They had a covid vaccine clinic on Thursday of last week, which was heavily participated in by staff and residents. They had a small handful of the unvaccinated get their first vaccine on Thursday so that 81% is going to rise looking at closer to 85%.
• They have reopened the building for family visitation, with the set of guidelines that came out a couple weeks ago the visitation restrictions were flipped. Instead of having all these restrictions on the process, it was moved to no longer being able to restrict visitation, regardless of covid status. They are allowed in the building but not common areas. Families come in get screened, fill out the forms, take their temperature, they get a fresh mask and then they go directly to the resident’s room. They can visit as long as they want but they are asked not to come out to the nurse’s station or common areas.
Mr. Kearns inquired about the Covid outbreak, he read that all but two were vaccinated and most of them were asymptomatic, but he wanted to know about those who were vaccinated and if they got sick. Mr. Annarella stated It is counted as an outbreak death because they were within a thirty day window but they were rapidly declining the hospice prior to covid coming into the building and so they ended up with covid and most of the symptoms that they had were related to the reason why they were declining in the first place, and nineteen days later they passed away. It is counted as a covid death because that is the way the State defines it; arguments can be made on if it had an impact or if it did not, but he does not know. The rest of the residents and the staff for the most part was caught with twice a week testing and most only had mild cough but no one was sent to the hospital, everything was managed in the building and they had minimal time in isolation. Ms. Meshes inquired on when the vaccination clinic took place, Mr. Annarella confirmed it was last Thursday. Ms. Meshes then inquired if everyone who wanted the booster was able to get it or if the clinic needs to return, Mr. Annarella stated they will have to return. They had some staff get their first dose, so they will need the second doses next month, some of the residents that wanted the booster were not eligible, so they will have to do another one and he imagines it will happen sometime in mid-January, but it will be smaller.
Dr. Yensen inquired on how covid has impacted holiday festivities at Valley Hi. Mr. Annarella stated there was no impact at all, looking back in December 2020 versus what is known a full year later covid can be managed in the building without having to go to a full-blown lockdown. They are still restricting some things, such as not having a lot of food related events because they are still encouraging residents to keep their masks on but they are still having entertainment and events, as well as eating in the dining rooms. He stated they have been able to amend their protocols as they have learned, so there is a small impact, but they are still planning on doing Christmas gifts and Santa Claus like they have in the past. As well they did have a full-blown Thanksgiving dinner.
• Staffing has stabilized since doing the recruitment and retention. They have hired a few new staff members rather than losing anyone, except for an early retirement. They have capped the census, currently at about 65 residents.
Mr. Schwartz inquired about the 176 number in the report. Mr. Annarella stated it is 176 total staff, that counts people who are on the registry, so they are not part time or full time but are more of a pool, they are called when they are needed. He would not use the 176 as the number, they staff to the census, so they know each day there will be a certain number of CNA’s on day shift, evening and night so the total number of staff is out there but they look at the number of people who are going to be in the building at a scheduled time. He stated if everyone worked the schedule that they have, 65 is where they would be. Ms. Meshes inquired about the 16 openings and the 28 absences and if they were to acquire 16 employees what would happen with the absences. Mr. Annarella stated they track absences and lateness because historically it was an issue for the facility and has gotten a lot better. When there is an absence someone ends up picking up the shift overtime as a registry individual, which would occur additional costs, and what she needs to know is how they gage the overall staffing point. He stated now that they have stabilized staff and applications coming in, they are starting to become positive on the staffing side.
He wanted to give an update on project status, stating that the carpet project is complete, all the carpet is in the central area, lobby area and all the offices, as well they have been repainted. The last thing to do is hang pictures which will happen later in the week. He stated that the therapy room was stalled because they were waiting on materials and an inspection, then everything went into high gear with the items arriving at the same time. On Thursday they will be moving the therapy department out of that room and across the hall to the multi-purpose room which will be their home until May when the new space is ready to open. They are still waiting on the lower guard rail protectors for the dining rooms. Regarding the bathrooms they are on a holding pattern waiting for the tile to come from a boat off the coast of California, they were told January but the way everything continues to be pushed back he would say February. He stated they have four shower rooms total in the building but they have removed two, with half the census there is no impact to them and they still have one on each floor and to have the shower room delayed it does not impact what they can do regarding service and does not slow down the overall project completion target of spring. He stated he did attach the Valley Hi Strategic Plan, which is on the backside of the agenda and everyone has a copy of that.
6. ROUTINE CONSENT AGENDA
7. ITEMS REMOVED FROM CONSENT AGENDA
1. Resolution Authorizing One-Year with Three Option Years Contracts with 22nd Century Technologies of McLean, VA, All American Healthcare Services of Indianapolis, IN, CareerStaff Unlimited of Albuquerque NM, Favorite Healthcare Staffing of Overland Park, KS, Global Empire LLC of Harrisburg, PA, GrapeTree Medical Staffing of Milford, IA, Health Advocates Network, dba Staff Today of Boca Raton, FL, Ondek Healthcare of Killeen, TX, RL Klein and Associates of Long Beach, CA, Vtech Solutions of Washington DC, and Worldwide Staffing of Towanda, NY Starting in FY22
Formerly agenda item number 6.1
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Annarella stated they use Nursing Agencies as supplemental staffing when they cannot staff with their own team, there is full and part time as well as a registry, which is their own staff but they only work as needed and once it has been exhausted they use the agency. The expense is outrageous and there is pending legislation both at the state and federal level to cap the price gouging that is occurring with staffing agencies, as the world of healthcare has entered a hard staff availability the agencies have decided to raise their rates. He stated yearly they go out to bid and ask every agency that they are put into the contract but in a queue meaning they start with the lowest and works the way up to control the costs as best as they can, there are some agencies they can rely on so when they are in a pinch they go for those.
Mr. Doherty stated it seems there is one agency that is consistent out of California, Mr. Annarella confirmed but the issue is the first three in the tier do not have the staff. Mr. Kearns inquired on the show up rate from the agencies, and if once they are called someone shows up, Mr. Annarella confirmed yes because if someone did not show up their name is removed from the list. Mr. Schwartz inquired about the pre covid hourly rate that agencies would charge, Mr. Annarella stated that two months ago due to the rates changing from the December 1 contract, most were at $30 less for an hour end putting it in the $60-$70's rather than $100. He stated that is why legislation is active to deal with the issue because it is very high. Ms. Meshes inquired about which agency he uses, Mr. Annarella stated there are a few that are new so they have not experienced those yet but the two Career Staff and Worldwide Staffing are the current partners that are on the high end of the scale who have quality staff.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Jim Kearns SECONDER: Theresa Meshes AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
Formerly agenda item number 6.2
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Annarella stated this is one of their major contracts as the therapy provider and there is an equipment component to it. There has been a contract with them in prior years, stating they are a top notch company stating they assist with marketing but the biggest part is that the Therapists have been with Valley Hi almost his entire tenure. When they view contracts like these it becomes a matter of if the change is worth upsetting the entire system that is in place, they are right in the mid point but the value that they bring to the table from their corporate perspective is good for Valley Hi and he recommends strongly that they continue the relationship with them going forward.
Ms. Meshes inquired about the cost because it is not listed, Mr. Annarella stated it is not in there because it is an RFP and not an RFQ. Mr. Annarella went on to explain how they get reimbursed, stating they pay Consonus to provide their therapists in the building, they then provide Valley Hi with all the work that they do which they bill to Medicare and Medicare pays for their services. He stated almost of their costs are taken in the Medicare rate, and the Medicare rate also pays for Labs, X Rays, Medications, Room and Board and any further care that gets provided and they are responsible for covering all of the costs out of the per diem rate that comes through Medicare. He stated the biggest line item that takes it is the therapy line item and they also drive the reimbursement rate, the more services being provided or the higher level it increases the rate in which they are reimbursed. As well the rate changes throughout someone's stay based on what is being done and as the changes are being made the costs are getting covered in the rate, so it is formalizing the partnership and not necessarily increasing costs, but they do provide physical speech, occupational and PTA's and other support services as well.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Stephen Doherty SECONDER: Jeffrey Schwartz AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
Formerly agenda item number 6.3
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Annarella stated this is another one of the larger contracts, they have a contracted pharmacy that provides all of the medications to residents which includes pills, liquids, IV's. As well they provide what is called stat services and they have a reset of the medications every month. In long term care the way medications are given out is not in bottle, they are given out on a bingo card and each one has a blister pack for every med for everyday, that way its easy to tell if the medication was given or not. They also provide consultation, they have a pharmacist in the building on a regular basis looking at the residents medication record and assuring things do not contraindicate, as well they check training and participate in the quality assurance committee. Mr. Annarella stated from a partner standpoint they have been great over the years and he recommends continuing to work with them.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Theresa Meshes SECONDER: Jeffrey Schwartz AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
Formerly agenda item number 6.4
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Annarella stated Direct Supply is a supplier of the parts to machines and other items used in the building, every year they are engaged in a new contract to provide those items. He stated the one thing they do different at Valley Hi having its own purchasing department, he is aware the County has a formal purchasing department but Valley Hi has someone dedicated to shopping. That person is responsible to go to the medical supplier and Direct Supply and the market place to search for what is needed, then the best price is what is used, although they use Direct Supply to provide the equipment if they can get it cheaper through Medline that is where the money is going to be spent. He stated they have someone that goes through the process and assures the best prices are found and costs stay as low as possible, partnering with the County purchasing department for bids and RFQ's but the day to day is done within Valley Hi.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Jeffrey Schwartz SECONDER: Theresa Meshes AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
Formerly agenda item number 6.5
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Annarella stated for the members who were on the Public Health & Community Services committee in the prior years they are bringing forward the Dairy resolution again. He stated the dairy market is very volatile right now, part is due to availability another is the need to have local supplies for items that have shorter life-spans and the larger supplies for the bulk items needed for a better price. He stated this is the first time they have done this where they are going to split award the dairy so they can try to mitigate some of the variances that are occurring right now. He stated they are going to split with Bowden who has been a dairy partner of Valley Hi for a long time as well they are going to bring in Prairie Farms, whose pricing tends to be on the lower side, but he does not know that they are going to have the availability for everything. So they are going to manage it and control the costs for dairy is to split award the way it is laid out within the resolution.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Stephen Doherty SECONDER: Theresa Meshes AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
Formerly agenda item number 6.6
Tom Annarella, Valley Hi Administrator, joined the committee to discuss the resolution.
Mr. Anarella stated Dr. Egekeze is the medical director and has been for a while, he is a phenomenal Doctor and is very actively engaged in the success of the building. He stated there are three different levels of medical directors that can be had in long term care, most facilities have a medical director that attends a meeting once a month or quarterly depending on how they set it up. There is a middle section which is where Valley Hi falls having a very active medical director who attends meetings, in the building on a regular basis, has a PA, reviews all the policies and procedures that relate to nursing care and more. Lastly there are the certified medical directors which are the top one percent, he stated Dr. Egekeze falls in the upper end but is not a certified medical director. Mr. Annarella stated he comes to Valley Hi at a very nice price for the amount of involvement that he has in the building, the cost of medical directors have a wide variance so they are getting a great deal for what Dr. Egekeze provides and he is the primary physician for about sixty percent of the residents.
Vice chair Thorsen inquired about how long Dr. Egekeze has been with Valley Hi, Mr. Annarella confirmed about ten years, stating there was a long time medical director when he first started then an application phase occurred and he applied and since he has grown with Valley Hi as things have evolved.
| RESULT: RECOMMENDED [UNANIMOUS]
MOVER: Theresa Meshes SECONDER: Jeffrey Schwartz AYES: Yensen, Thorsen, Kearns, Doherty, Meshes, Schwartz ABSENT: Nowak, Jindrich |
1. Member Goals
Ms. Meshes stated her goal is to work on staffing increases and once that is done she wants to look at a case from a year ago when she was on PHCS committee and wants to ensure Valley Hi is accessible and being sure they take care of people who need help the most.
Chair Yensen stated they need to understand the mission and the vision of Valley Hi and how they came about. That type of history is important to where they are now, stating they are at a time and place where it is different than it began and to have knowledge of that is helpful. She stated she is deferring to Mr. Annarella on his thoughts on that. Mr. Annarella stated that he Dr. Yensen and Mr. Thorsen all had an opportunity to talk and he believes they are going in the right direction, the case mix does make a difference which is how reimbursement comes in and that is something that needs to be looked at and the tax levy history is part of the discussion which is needed to talk case mix. If the Medicaid side is increased, then other revenues need to be as well.
Mr. Hartman stated when the time is right, he and Mr. Annarella will be working on developing the Valley Hi sustainability decision tool, to help visualize the cause and effect of decisions. Mr. Annarella stated it is a powerful tool that Scott put together.
Vice Chair Thorsen referred to the referendum that was passed around 2003 and use it to see what the voters saw and begin on the same page. He is hoping to review that and the detail to understand what was in the heads of both staff and how it was presented to the public so they can have a starting point. Mr. Austin stated Mr. Hartman can get the referendum to the committee. Chair Yensen stated she agrees with Mr. Thorsen because people in the community are aware of Valley Hi but do not know how it all became so everyone has an understanding.
Chair Yensen inquired if in the future Mr. Annarella can break down the private pay to Medicaid eligibility and what those thresholds are, Mr. Annarella confirmed he can put something together and do that as part of next meeting because he thinks that sets the tone for discussing case mix. Mr. Kearns concurs and stated that was one of his member goals, as well he wants to discuss the balances of Valley Hi and where they are financially, and he would like to see that often. Mr. Annarella inquired on how often he would like to see that, Mr. Kearns confirmed quarterly if that works for the committee and Mr. Annarella, so they know where they are. Mr. Kearns also stated he would like to dive into their covid funds and how much can be reimbursed and if the new covid funds can be used toward Valley Hi. Mr. Austin adjusted the question, if they could use the funds the response could be, they could, but he did get off a call with the Bronner Group and Mr. Bueso about using the $59 million in covid dollars and that discussion did not lead to Valley Hi. He stated Mr. Annarella has received hundreds of thousands of dollars in the last twenty months to assist with losses in responding but they have not confirmed anything regarding using the $59 million. Mr. Annarella stated next meeting he will provide the committee with a breakdown of that. The committee continued to discuss previous history on Valley Hi.
Ms. Meshes stated a goal that was discussed in PHCS and how to improve staff, they mentioned programming and there were studies that stated Childcare/Daycare and Senior care both have benefits and she imagined that to be a draw out for attracting more employees. She would like to have a discussion again on the matter.
Mr. Annarella gave the committee an MPA update, he spoke with them within the last 72 hours a bit and they are very close to being done with the written portion. His intention is to get the written portion out and schedule a time to have a zoom meeting with them. He can tell the committee that based on the questions, they’re on the tail end or refining their numbers and data.
2. Private Room Rate Increase
Mr. Annarella gave the committee a chart and explained that annually they sit and evaluate what their private room rate is in relation to all the area facilities. When they say private room rate he does not want that to be confused with one or two individuals in a room, they are talking about who the primary pay source is, it is not Medicare or Medicaid it is the individual privately paying for their care. Every year around mid-spring they do one and then another at the end of the year to see where they are at, and they just have a staff member call the facilities and get their room rate, and that data the committee has on the back of the proposed letter. The market in the last six to twelve months has really moved, costs and labor has gone up, and adjustments need to be made, he stated there are a few things to keep in mind. Due to case mix ratio for private pay being on the lower end of the three tiers, they are not looking to make up a ton of ground on the private pay rate, so they are trying to be sure they are within the market so they do not undercut the private pay facilities. If everyone that is on private pay gets a $5 per day increase, the overall budget impact is nominal, as they are not looking to make up the difference. If they were a private facility and not a county entity, the difference is they would be looking to make up the loss of Medicaid, when they talk about the case mixes the private pay mix would be high and the Medicaid would be low so they can offset the loss. Due to the mission and how they approach things they want to be sure they are charging a fair rate that is reasonable for the services they provide, cover the costs and being aware of all the other factors that come in to play. Based on the review he is proposing that they do two increases in fiscal year 2022, that way no one gets hit for a massive increase at the beginning and that scales as the prices continue to increase. The reason they see two rates is due to a few years prior, a significant jump was made in their rate but they tiered it so if residents were already in the building the bump was not felt it was small, and if they were new to the building anytime after that point they would take the new rate. He believes the increase that is proposed is fair but rather than come forward with a resolution he wanted to inform them of it so they can provide some direction after discussion, and next month he intends to bring forward a formal resolution.
RESULT: PRESENTED
3. Valley Hi Mission/Goals/Strategic Plan/History (Including Levy History)
9. FUTURE TOPICS
None.
10. EXECUTIVE SESSION (AS NECESSARY)
None.
11. ADJOURNMENT
Mr. Doherty made a Motion, Seconded by Mr. Kearns, to adjourn the meeting at 3:27 p.m. The Motion passed on a voice vote of all members present voting aye. -TCMcKinnon
https://mchenrycountyil.iqm2.com/Citizens/FileOpen.aspx?Type=12&ID=4998&Inline=True
Alerts Sign-up