Present: M. Robertson, Chair; D. Winch; F. Proto; B. Blanchard
Excused:  D. Kiefer
Staff:  K. Fuller, Deputy Clerk of the Legislature; S. Whicher, County Administrator; Patricia Carey, Tom Herden, Deapartment of Social Services; R. De Luca, Interim Mental Health Commissioner; A. Cole, B. Crosby, S. Connors, J. Andersson, K. Bishop,Health Department; N. Burston, Human Services Coalition; J. Grogan, Administration; N. Zahler, N. Zook, J. Johnson, Youth Services
Guests: P. Mackesey, B. Hawley, Lifelong; J. Tantillo, P. Stonebreaker, SPCA

Called to Order

 The meeting was called to order at 10:32 a.m.

Changes to Agenda

 The following items were added to the agenda:
· Office for the Aging Budget Adjustments
· Minutes of Health and Human Services Special Meeting - May 17, 2005
· Copy of the Committee Work Plan for 2005
 
Health Department

 Ms. Connors reported to the Committee that Ms. Bishop, Registered Nurse with the Tompkins County Health Department has worked for the County in excess of twenty-five years.   She reported that in April at the Annual New York State Immunization Conference held in Cooperstown, New York, Ms. Bishop received the Gerald D. Errion Award, which is given each year to one individual in recognition of outstanding dedication and service in promoting immunizations to improve public health.  Ms. Robertson thanked Ms. Bishop for her dedicated service that earned the award and extended an invitation to Ms. Bishop and/or Ms. Connors to attend the June 7, 2005, Legislature meeting to notify the full Legislature of this honor.

Maternal Care Unit Presentation

 Karen Bishop, RN, reported to the Committee on the Childhood/Adult Immunization programs which have dramatically reduced diseases and noted immunizations have changed tremendously in the last twenty-five years.  She said routine immunizations for children were three vaccines, DPT (diptheria, pertussis, and tetanus), Oral Polio, and the MMR (measles, mumps, rubella); and adult vaccinations were the Td (tetanus, diptheria), MMR, and flu.  Ms. Bishop said over the years there have been many new vaccines introduced such as the Hib, Hepatitis B, Hepatitis A, Dtap, IPV, Pneumovax, Prevnar, and Varicella.  Additionally, new combinations vaccines have been introduced which means fewer shots with more protection against a number of diseases.

 Ms. Bishop then provided historical information on the Health Department's role in vaccinations.  She noted that years ago vaccines were provided by the Health Department rather than physicians due to exclusions in health insurance coverage.  Today, most companies provide coverage for the routine inoculations and are provided by primary physicians.  She noted the Health Department still provides immunization clinics as a service to residents since often parents do not take children to a primary physician, or are unable to go during normal business hours due to other obligations.  The Health Department offers evening clinics on a walk-in as well as assisting parents in obtaining school-required immunizations necessary, often on an "emergency" basis to allow children to enter or remain in school.  Ms. Bishop reported that on any given day the staff handles telephone calls from parents, school nurses, doctor's offices, and others about current immunization requirements for daycare and school or travel to a foreign country, current immunization schedule and spacing of shorts, information about new combination vaccines and the translation of foreign immunization records.

 Ms. Bishop then spoke of flu shots, noting that there is a long-standing history of collaboration with Lifelong (formerly Senior Citizens Center) to conduct community-wide flu clinics.  Traditionally 20-30 flu clinics have been held each fall in churches, schools, and fire halls utilizing senior citizen volunteers for various clinic functions from "greeter" to "form completion" to rolling up sleeves.  She said the assistance of these volunteers has been invaluable.  As an example of a flu clinic, Ms. Bishop said on November 10, 2004 a mass flu clinic was held at the National Guard Armory.  Nearly 90 volunteers and paid staff provided almost 1,100 shots.  Of this number, 300 were given in the first hour.  Approximately 19 of the workers were Health Department Staff, 11 were County employees from other departments, and 54 were volunteers from the Red Cross, Lifelong, Bangs Ambulance, Dryden Ambulance, and the Tompkins County Sheriff's office, while 5 were from the Nurses' Registry.

 Ms. Bishop said the past flu season was a challenge due to the vaccine shortages, however the Health Department provided vaccines to Cayuga Medical Center, Gannett Health Services and Cornell University, Hammond Health Center at Ithaca College, local nursing homes and private practice physicians to ensure that the at-risk population was vaccinated.  She said more than 4,000 residents received the vaccines.

 Ms. Bishop reported two new vaccines will be introduced within the next month, one for meningitis for adolescents ages 11 - 19, and a combined vaccine for acellular pertussis, tetanus, and diptheria for the same age group.

 Ms. Blanchard inquired how immunization records are verified.  Ms. Bishop spoke of day care facilities, schools, and private physicians maintaining records as well as a state-wide database having been established.  Facilities that participate in the database submit the information that is available, with over a million entries last year.  Ms. Robertson inquired about home schooled students records.  Ms. Bishop said that while the Health Department has attempted to work with the home school community it has not been as successful as hoped; however, private physicians would maintain a record and be aware of State requirements.  Ms. Robertson then asked if there are problems with individuals with no vaccinations; Ms. Bishop said although there are some who will not participate in immunization programs it is not a significant number and the Health Department is willing to assist them if they have a record.  Mr. Proto provided information on contacts for Home School programs within the County.  Ms. Robertson asked about foreign student inoculations.  For foreign records that require translation the Department of Health is often contacted and provides information on the appropriate resources available for translation.  Ms. Bishop noted that one particular record had an unusual notation which required the Communicable Disease Center to provide accurate translation.

Position Request - Public Health Sanitarian

 It was MOVED by Mr. Proto, seconded by Ms. Blanchard to approve the request to fill the Public Health Sanitarian position.  Mr. Andersson noted the vacancy is due to a resignation and funding is in the budget for the position.  It was noted the position is two existing half-time positions that will be filled by one full-time position.  Ms. Robertson noted the many duties and inquired if by filling the position the department would be adequately staffed.  Mr. Andersson said his division is entering a very busy time period that requires a lot of work to inspect locations of temporary events and strains the department.  This position will fill the resignation vacancy as well as the half-time vacancy open since January.  He anticipates a lengthy training period involved.  Mr. Proto asked if there are any known candidates and was informed that there is no existing list of potential candidates.

 A voice vote resulted as follows:  Ayes - 4; Noes -0; Excused - 1 (Legislator Kiefer).  POSITION APPROVED.

Preliminary Budget Discussion

  Ms. Cole, Public Health Director, said at this time she is unable to determine budgetary concerns as direction has not yet been provided by Administration.  Ms. Robertson asked if any information was available regarding the State and Federal funding for the department and was informed by Ms. Cole that it appears funding will be stable and that the Bioterrorism Funding has been renewed at the current level.

 Mr. Whicher, County Administrator, said he is still in the process of determining how to best present the requested budget scenario for the Legislature.  He said that the proposed zero percent level means approximately a $1 million cut, however he is having to analyze the best method to do so with the least negative impact.  Additionally, information related to Medicaid costs make be a large factor in his final determination of how to best present the targeted budget; noting that some departments receive more local funding than others and an across-the-board cut would have more effect on those without a revenue stream.  Ms. Blanchard asked if it is wise to create a "one size for all" scenario or should it be what is needed to get to the target.  Mr. Whicher said there is still a lot of work to be done prior to his presentation but noted that hearing there is some stable funding from State is good news.

NYSACHO Letter of Support

 Ms. Cole provided a copy of the NYSACHO letter of support for the proposed State legislation that would provide the ability to increase fees for death and birth certificates at the local vital records department.  Ms. Blanchard noted that the State of Arkansas charges $8 each for death certificates; Mr. Winch said Florida's charge is $5.

Budget Transfers

 A brief discussion regarding the transfers took place, Mr. Proto thought the cost of computers seemed higher than normal.  Ms. Crosby said it is a portable identification system that will allow issuance of identification to staff members at any necessary location.  The communications equipment was for radios that would be used in the event of an emergency.

Tuberculosis Discussion

 Mr. Proto inquired about regulations for Cornell University foreign students relating to tuberculosis testing.  Ms. Connors reported that the university has amended its policy to require tuberculosis tine test to be completed by a licensed United States physician.  She said that while this may lead to a larger number of individuals recognized as having the latent infection, it results it better confinement as necessary.  In response to questions it was noted that presently there are 50 cases of latent TB infection and 4-5 active cases within the County.  Mr. Whicher inquired whether information is available to distinguish which cases are connected to the educational facilities.  He was informed that at this time it is not possible with the information collected at this time.  Ms. Connors also indicated some of the cases are refugees and their families.    Mr. Whicher said it could be useful to obtain the information on number of students served as Cornell University is interested in collecting data that indicates the County's costs relating to the university population.  Mr. Proto suggested an approximate cost be obtained as well.

SPCA Update

 Mr. Tantillo, Acting Director, introduced himself to the Committee, stating he has been on the SPCA Board of Directors for two years.  He reported the new $2.25 million dollar shelter was funded in part through a grant from the Park Foundation.  He said that animals coming into the shelter are first placed at the old facility during which time all intake procedures will be done such as holding the animal for the legally required period.  Following the period the animals are treated medically, with behavioral evaluation, etc.  Once the intake process is complete the animal is then moved to the new facility for adoption.  He also said the SPCA continues to maintain animal control contracts with the local municipalities as well as cat and rabies control for Tompkins County.  Mr. Tantillo introduced Ms. Stonebreaker, the Business Manager for the shelter.

 Ms. Robertson stated she believed the County's contract with the shelter would expire in December 2005 and asked if Mr. Tantillo had any indication of changes that may be requested.  Mr. Tantillo expressed his belief that while the costs are increasing a great deal he feels to continue with the present terms of a 3 percent per annum increase would be feasible.  He stated the Board of Directors would be reviewing the contract but in light of increased costs affecting everyone it could be understood that further increases may not be approved; he feels it is important to continue with the rabies contract as in the past.

 The Committee discussed information relating to the number of animals brought into the shelter and approximate costs associated with this service.  Mr. Tantillo said approximately 640 stray cats were brought to the shelter, with the total number of surrendered cats at 1,200.  The shelter took in approximately 2,800 animals at a cost of approximately $250 each; the adoption fees cover approximately $100, the Health Department funding covers approximately $35/40 per cat, and the balance is funded through donations of the membership.  He explained that organizations that have a no-kill policy have to find ways to cut costs; and sometimes have to limit admissions.  He indicated that sheltering dogs is a State mandate and if a limited admission were necessary it would have to be cats.  He expressed his opinion that he would not like to see this occur and feels it is a public responsibility to shelter all the animals presently served.

 Mr. Proto asked that a copy of the SPCA financials be provided at the appropriate time during the budgetary process.    Ms. Robertson noted that additional information on the number of adoptions broken out by animal type would also be useful.

 Mr. Winch inquired whether projected operational expenses for the new shelter were accurate.  Mr. Tantillo explained the building was designed with energy efficiency in mind.  He said unlike other buildings there is a greater level of air circulation to avoid illnesses, with 10-12 air exchanges per hour to reduce disease and odor.  He noted the construction was such as to utilize geothermal loop design that provides heat in the winter and cool in the summer.  This system appears to be operating correctly and an anticipated payback period is ten years with an annual savings of approximately $20,000.

 Mr. Proto asked if there is any additional information regarding a news report regarding coyotes, concerned of potential rabies infections.  Mr. Tantillo replied the concern would be distemper rather than rabies with coyotes.  He said they are becoming less fearful of humans and there is the potential for increased interaction.

 In response to a question regarding the neuter/release program for feral cats, Mr. Tantillo said it appears that the feral cat problem is more cyclical than random.  He explained there are limited cats that are trapped, treated and released.  It spoke of the need to determine whether it is beneficial to do so based upon surrounds and potential for post-treatment survival.  The approximate cost per animal is $70; it is hoped that an on-site veterinarian may be able to be hired which should assist in operational costs.

Mental Health

 Mr. DeLuca, Mental Health Director, provided a handout to the Committee for review.  He spoke of the potential $170,000 from a grant that has been applied for which will help to offset reductions in other areas by consolidation of programs.  In addition, he spoke of an anticipated $33,000 reduction in State aid upon reviewing the preliminary budget material received to date.  Mr. DeLuca said if all agencies presently funded and vacant positions were to be filled his department would be approximately $100,000 - $150,000 short.  These positions are a psychiatric social worker, Deputy Commissioner, psychiatric nurse, and records clerk.  Additionally, he said an overage of approximately $70,000 from the COPS program is included in this estimated shortfall.  Mr. DeLuca said that while leaving the positions vacant could make up the difference in the budget it would be difficult to continue to operate with them.  The figures reviewed did not include figures for agencies that are presently funded by Mental Health.  The 2005 County funding to not-for-profit agencies is $69,266 to Challenge Industries, $57,780 to the Mental Health Council, $50,000 to the Ithaca Youth Bureau, and $20,260 to Suicide Prevention.  Mr. Whicher informed the Committee that past practice for Mental Health has not to be able to utilize rollover but rather to be held harmless for shortages due to the funding cycles.  He said Mr. DeLuca is attempting to budget as others do along the normal budget calendar.  Mr. Winch said prioritizing the need of the vacant positions would be worthwhile when bringing forth requests to the budget committee.

 Mr. DeLuca said the eleven percent increase in pension contributions has increased his budget significantly without the ability to raise clinical fees.

Youth Services

Update on Youth Services

 Ms. Zahler turned the floor to Ms. Johnson to discuss program services.  The Committee reviewed a handout that provided statistics related to 2004 Youth Participation in Municipal Programs.  She noted each municipality has a committee that determines the programming and the municipality match or over-match funds for programs provided to them.  It was noted that Ulysses is included within the Trumansburg heading.  Mr. Proto asked if the 12-16 year-old youth participated in the Workforce job program.  Ms. Zook said that some have through the youth programs based in the rural schools.  Ms. Johnson said all agencies with employment opportunities meet prior to the closing of school to coordinate employment services to youth.  Ms. Zahler said the positions are municipal funded, federally funded positions, TANF programs, and Ithaca Youth Bureau programs.  The City employment program has provided additional funding for youth employment.  She further said the youth served are not only low-income but those with other needs.   Ms. Johnson said the Joint Youth Commission includes the Town of Ithaca, Village of Cayuga Heights, and the Village of Lansing.

 The Committee was also provided information on participation and outcome for the contracted agency programs.  The Committee was able to see the number of youth who were diverted from detention and foster care programs as well as those able to fine housing; obtain diplomas or GED; developing job readiness skills; found unsubsidized employment; received crisis support, counseling and skills to connect with the community; and matched with mentors to build social skills and connection to school and positive adults.  Mr. Proto asked how determinations were made on such things as improved educational skills.  Ms. Zook and Ms. Zahler said the information is obtained through those involved with their education, often it is due to inability to organize themselves that can be turned around.  It was also noted that not all youth participating are successful, however the norm is eighty-five percent success rate.  Ms. Robertson suggested that it be clarified that the figures are net figures.  Ms. Blanchard said while it is useful information it does not give the information of savings resulting from the programs.

 Ms. Zahler said at this time a study is being conducted of other youths served throughout the state to determine the number of young people served.  She expressed an interest to see if other systems in the State have in place to assist with the planning process to determine if clustering of services would be appropriate.  She will update the information as it is received.

Ms. Blanchard temporarily out of the room.

 Mr. Proto inquired whether the youth employed were from the job readiness group, and whether long-term study on job retention is available.  Ms. Zook said they were from the readiness group and that due to staffing shortages the emphasis is on preparation and obtaining positions, not the follow-up information.  Mr. Proto asked if an individual required additional support for employment in the future if they could return for assistance and was informed it was possible.

Rollover Review

 Ms. Zahler spoke of the rollover funds being utilized in 2006 to assist with funding of programs.

Preliminary Budget Discussion

 Ms. Zahler stated she will be looking for Administration's guidance when preparing her budget for 2006.  She noted at this time it appears that there will be minimal reductions based upon figures received to date.  Ms. Zahler anticipates over-target-requests for 2006 as funding is pass-through for many agencies.  She also stated the municipal programs have received substantial cuts over the past four years.

 Ms. Blanchard returned to the room.

 With regard to the Youth Bureau, Ms. Zahler spoke of the need for $50,000 additional to maintain the 2005 level of service.  She also indicated the Recreation Partnership has indicated the possibility of increasing fees to all partners included.

Social Services

Position Request

 It was MOVED by Mr. Winch, seconded by Ms. Blanchard, to approve the request to fill the Program Development Specialist position.  Ms. Carey explained this is the vacancy being created by Ms. Leinthall's acceptance of the position of Human Services Coalition Executive Director.  She reviewed the duties of the position and its importance to the department.  She also notified the Committee that she is reviewing it carefully to determine what amendments to the job description may be appropriate.  Mr. Winch inquired if there are internal candidates interested in the position that would aid in a quick transition and was told at this time no one has expressed interest.  A brief discussion took place regarding the degree requirements of the position; Ms. Carey felt requiring a Masters may limit the candidate field; Mr. Proto felt the fact that an "or" statement referring to a Bachelor's degree should sufficiently cover her concerns.

 A voice vote on the motion resulted as follows:  Ayes - 4; Noes - 0; Excused - 1 (Legislator Kiefer).  POSITION APPROVED.

Preliminary Budget Discussion

 Ms. Carey, Commissioner, stated that at this time she is unable to provide preliminary budget information.  She explained that some preliminary information on funding is coming from the State such as the child care allocation and Flexible Fund for Family Services (FFFS), however the determination of how the FFFS money is to be spent has not yet been provided.  Ms. Carey also indicated that a recent software modification for Medicaid funding has had operational difficulties that hinder a clear picture of Medicaid spending to date.  Previously the State and Federal expenditures validated each other and the new program does not appear to do this.  While it appears spending is less at this time the final outcome is unknown.
 
 Mr. Herden said the 3.5 percent cap starting in January 2006 will be helpful, and if the expenditures for 2005 are less it will further assist in Medicaid expenditures at the local level.  He explained many individuals submitting claims to Medicaid are having to resubmit them due to the new system that may be why the numbers appear lower.  If the trend continues as it is presently the department may see a final figure $1.2 million lower than the budgeted amount.

 Mr. Whicher said this situation is one reason he is carefully determining how to develop the zero percent budget requested by the Legislature.  He noted the potential decrease of Medicaid expenditures could significantly reduce the need for other cuts to meet the targeted budget.

 Ms. Robertson inquired on the ability to track costs by caseloads and was informed by Ms. Carey that it cannot be done in this manner, the only way to determine expenditures is when a claim is submitted by a provider.

 Mr. Herden said until funding is known it is hard to determine what programs the State will require and whether the funding is going to occur for these mandated programs.  Mr. Whicher said the information should be available in several weeks time.  Mr. Herden said it is also hoped that the programming difficulties should be resolved which will also assist in budget planning.

Housing Concern

 Mr. Winch spoke of working on several HUD grants for repair work to homes he recently participated in.  He indicated that during the grant process he went to various residences involved to review necessary work and was surprised by the condition of some homes.  Mr. Winch spoke of houses that had no flooring, sewer lines emptying into basements, etc.  He thanked Ms. Carey for her rapid assistance in these instances.  Mr. Winch said there is a need to identify the needs of the fragile/elderly before it becomes too difficult to repair homes.  Ms. Carey said it is a challenge to identify a situation such as this; there is a need to respect their rights and desire to stay in their homes.  Mr. Winch reported the youth workers will be present between July 11 - July 16, with much of the work done for the fragile/elderly.  Ms. Carey spoke of formal coordination with intake workers to better help these individuals.  Mr. Whicher thought the Assessment Department could assist to a degree by cross- referencing senior citizen exemptions with assessed value/condition.  Ms. Carey said many of the residents involved do not know what assistance is available to them.

Funds for Transportation

 Mr. Proto asked if the funds previously provided for low-income transportation needs was available.  Mr. Herden said the County received $80,000 in funding for the Wheels to Work.  Mr. Proto said the rural routes are being evaluated and it would be helpful to know.  Ms. Carey said at this time she has not yet received information on the funding for this program.
 

Lifelong Presentation

            Mr. Hawley, Director, spoke of the work that is done at Lifelong, formerly the Senior Citizen's Center.  He reviewed statistics on the variety of programs/activities and participation levels. Lifelong’s tax counseling program served 849 individuals in 2004, saving approximately $63,675 in tax preparation fees and bringing residents an estimated $657,475 in federal refunds.  Mr. Hawley also said that this program provides a point of entry to inform individuals of the other services of Lifelong.  He reported it has been one year since the center became Lifelong and said overall the name has been well received.

            Mr. Hawley spoke of the new "Check-It" program for seniors who require financial assistance.  There are two levels; one with the volunteer going to the home, reviewing and paying bills and performing the bank reconciliation at a cost of $15/month; and the second level a full-service of handling all financial transactions via Power of Attorney to Lifelong at a cost of $50/month.  These services are made possible through grants received from the United Way and Tompkins Trust Company.
Mr. Hawley also spoke of the work done with Health Care Proxy and Living Wills.  He has obtained approximately 2,000 information booklets from Blue Cross and Blue Shield as resources; he will be providing presentations to Social Services clients and all County employees.

 Mr. Winch left the room (1:00 p.m.).

Chair's Report

Committee Work Plan

 Ms. Robertson noted additional items from the calendar were placed on the work plan.  She asked members of the Committee to make suggestions of agencies/individuals to speak at the remaining Committee meetings.

 Mr. Proto recommended a discussion with landlords regarding Section 8 housing might be appropriate as a special topic.  He recommended Mr. Bill Olney be contacted to see if it is possible.

County Administrator's Report

 Mr. Whicher did not have a report, noting the topics he planned to discuss were contained in preliminary budget items previously in the meeting.

Office for the Aging

Rollover Requests

 It was noted there was no 2005 rollover request; funds are requested to be used in 2006.

 Mr. Proto inquired about coordination of home repairs for clients of Social Services with Office for the Aging.  Ms. Carey said the programs are referred through the Adult Protective Services program when the conditions are known.

 It was MOVED by Mr. Proto, seconded by Ms. Blanchard, and unanimously approved by voice vote of members present, to recommend the following budget adjustments to the full Legislature for approval:

Revenue Acct           Title            Amt  Approp Acct  Title(s) _____________
6780-43803 State Revenue       $36,118 6780-54491         Subcontract
Explanation:  Revenue increase permits increase in subcontract for FISEP and Foodnet programs.

 It was MOVED by Mr. Winch, seconded by Mr. Proto, and unanimously approved by voice vote of members present, to recommend the following budget adjustments to the full Legislature for approval:

Revenue Acct           Title            Amt  Approp Acct  Title(s) _____________
6774-43803 State Revenue       $  7,512 6774-54491         Subcontract
Explanation:  Revenue increase permits increase in subcontract for FISEP and Foodnet programs.

Minutes of April 18 and May 4 and 17, 2005

 The minutes of, May 4, 2005, were withdrawn, pending Ms. Robertson's review.

 It was MOVED by Ms. Blanchard, seconded by Mr. Proto, to accept the minutes of April 18 and May 17, 2005, as written.  MINUTES APPROVED.

Request for Agenda Item

 Mr. Proto asked if Mr. Whicher or Ms. Fitzpatrick, Commissioner of Personnel, could speak to the Committee about health savings accounts and how it relates to the County insurance.  Ms. Robertson felt the topic would be more appropriate for either the Budget and Capital or Government Operations Committee.

Adjournment

 The meeting adjourned at 1:17 p.m.

Respectfully submitted by Karen Fuller, Deputy Clerk