HEALTH AND HUMAN SERVICES COMMITTEE FEBRUARY 25, 2004 11:30 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson, Chair; T. Todd; N. Schuler; M. Koplinka-Loehr (arrived at 11:39 a.m.)
Excused: B. Blanchard
Staff: A. Cole, Public Health Director;
B. Crosby, Health Department; P. Carey, Social Services Commissioner; I.
Stein, Office for the Aging Director; W. Skinner, Public Information; S.
Whicher, County Administrator; N. Zahler, Youth Services; M. Dill, Human
Services Coalition; B. Falcao, Health Planning Council; B. DeLuca, Mental
Health Commissioner; R. DeLuca, Mental Health
Guest: Flora Sagan, Mental Health Services Board
Called to Order
The meeting was called to order at 11:30 a.m.
Ms. Robertson distributed copies for information of an
article that appeared in the New York Times entitled “Bush to Revisit Changes
in Medicaid Rules.”
Changes to Agenda
A presentation from Mental Health was added to the agenda.
Chair's Report
Ms. Robertson announced March 4th is the Recreation Partnership's
annual meeting and encouraged Committee members to attend.
Ms. Robertson reported that she spoke to a staff person
in Senator Schumer's office concerning Section 8 Housing. The President's
budget proposes to block-grant the Section 8 housing program and cut $1.6
billion from it. However, it would allow more flexibility for public housing
authorities, permitting them to use the remaining funds for administrative
purposes and not just for vouchers. Other changes are also being proposed
in the program that would have the affect of spreading the money among more
people, but would likely not serve as many of the people most in need.
Ms. Dill commented that a percentage of the vouchers through Tompkins Community
Action have been "frozen". She feels this is in preparation of there
being fewer vouchers available.
Ms. Robertson also reported on a meeting she attended
of the Youth Services Board. A presentation was made by representatives
from the Learning Web together with four homeless youth. A survey was
conducted of other homeless youth and a full report is being prepared.
This presentation was "heartbreaking" and she would like to have the presentation
given to the full Legislature. She said the surveys contain honest
answers; one conclusion reached is that kids use drugs because there is nothing
to do and they are bored.
Mr. Koplinka-Loehr arrived at this time.
Approval of Minutes
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to approve the
minutes of the February 11th meeting as corrected.
Department of Social Services
Resolution
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
to submit the following resolution to the full Legislature for approval.
Ms. Carey explained the reorganization of certain duties and responsibilities
related to this position, including the elimination of one Deputy Commissioner,
and feels a 35-hour per week position was more reflective of the changes
made. She commented that there are now two Deputy Commissioners; she
continues to look at other areas for reorganization and will keep the Committee
informed. Ms. Robertson asked if there was a cost savings; Ms. Carey
replied that the Department is saving approximately $9,000.
Ms. Robertson requested the resolution reflect the cost savings and the Committee
agreed.
RESOLUTION NO. - DECREASING HOURS OF
LEGAL UNIT ADMINISTRATOR – DEPARTMENT OF SOCIAL SERVICES
WHEREAS, the Department of Social Services has recently re-organized certain
work processes involving its Services to Children and Families Division and
its Legal Unit, and
WHEREAS, one outcome of that process has been a reduction in the breadth
of responsibilities associated with the Legal Unit Administrator position,
now therefore be it
RESOLVED, on recommendation of the Health and Human Services and Budget &
Capital Committees, That the hours of the Legal Unit Administrator, Labor
Grade P (16), be decreased from 40 to 35 hours per week with a result of
cost savings of $ 9,830.
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Ms. Robertson said that she is asking all departments
to let her know what issues the Committee should consider discussing this
year and would like to develop a calendar to schedule of presentations.
Ms. Carey said she has shared this message with her senior staff and will
let Ms. Robertson know. Ms. Carey reported she is going to Albany next
week to meet with all Commissioners. The Commissioners will be presenting
their comments and the impact of the State and Federal budgets on Social
Services budgets at the County level, and she will report back to HHS.
Office for the Aging
Resolutions
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
to submit the following resolution to the full Legislature for approval.
Ms. Stein noted the grant is from Assemblywoman Lifton as a member item for
a community wide senior needs assessment. A survey was done following
the 1990 census and the department would like to update the needs assessment.
She said the previous survey raised questions from particular agencies and
Ms. Stein will revise the survey to include those questions. Some of
the core questions will remain in the survey to show a comparison from 1990
to today.
Ms. Robertson asked how the 1990 survey directed the work
of the Office for the Aging. Ms. Stein said there were a number of
recommendations that came out of the survey including the need for more in-home
health care. The friendly-visiting program was expanded to Project
Care as a result of the survey results and due to increased Federal funding,
more volunteers have been trained and the numbers for in-home care have increased.
Another need identified was the shortage of money for low-income people for
home repairs. When additional funding was received from the State,
it was used for contracts for home repairs including the HEAP and WRAP programs.
She said this appeared to resolve the need and they caught up with the waiting
list; however, due to the recent economy and the lack of funds to support
the program, the waiting list has grown again and she feels this will appear
on the survey again. She reported briefly on the Title V program that
provides part-time employment for seniors and said this was also an area
identified as a need. However, due to county funding cuts, this is
an area that received a reduction in the last two years. Workforce
Development One-Stop Center is now providing support for seniors which has
been helpful. In addition the 1990 survey revealed a tremendous need
for health insurance counseling. The Senior Citizens Council now does
this, and COFA supports that work.
A voice vote resulted as follows: Ayes - 4, Noes
- 0, Excused - 1 (Blanchard). RESOLUTION ADOPTED.
RESOLUTION NO. - ACCEPTANCE OF LEGISLATIVE
INITIATIVE FUNDING FOR COUNTY-WIDE SENIOR NEEDS ASSESSMENT - OFFICE FOR AGING
WHEREAS, Office for Aging conducted a county-wide assessment of senior needs after the 1990 census, and
WHEREAS, the results of that survey provided useful information for Office
for Aging and many other agencies and individuals, and
WHEREAS, needs may have changed between the post-1990 and post-2000 census periods, and
WHEREAS, Office for Aging wishes to assess these needs in the post-2000 period, and
WHEREAS, Office for Aging was awarded a Legislative Initiative in the amount of $10,000 for this purpose, now therefore be it
RESOLVED, that on the recommendation of the Health and Human Services committee
that the County hereby accepts this grant of $10,000,
RESOLVED, further, that the Finance Director is authorized to make the following adjustments to his books:
A6783.51000571 Salary
$6,580
A6783.54303
Office Supplies
50
A6783.54330
Printing
150
A6783.54552
Postage
100
A6783.54472
Telephone
150
A6783.54491
Contractual
2,970
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It was MOVED by Ms. Schuler, seconded by Mr. Koplinka-Loehr,
to submit the following resolution to the full Legislature for approval.
Ms. Stein said this grant is from Senator Kuhl to purchase 65 units.
Most of the Department's machines have been used since 1985 and many of them
are in need of repair but because of the age and number of times the machines
have been broken they cannot be repaired. A staff person in the Emergency
Response Department has found machines that are much cheaper allowing the
purchase of 65 rather than 50. Currently, there are over 300 units
in use.
A voice vote resulted as follows: Ayes - 4, Noes
- 0, Excused - 1 (Blanchard). RESOLUTION ADOPTED.
RESOLUTION NO - ACCEPTANCE
OF LEGISLATIVE INITIATIVES GRANT FOR PERSONAL EMERGENCY RESPONSE SYSTEMS
MACHINES-TOMPKINS COUNTY OFFICE FOR THE AGING (COFA)
WHEREAS, Office for the Aging administers a Personal Emergency Response System
(PERS) to help seniors and disabled County residents remain safely in independent
living, and
WHEREAS, many of Office for the Aging’s PERS machines are very old and irreparable, and
WHEREAS, the number of individuals needing and seeking such machines continues to rise, and
WHEREAS, Office for the Aging has been awarded an Initiatives Grant in the
amount of $9,750 to purchase sixty-five (65) machines, now therefore be it
RESOLVED, on the recommendation of the Health and Human Services Committee, That the County hereby accepts this grant of $9,750,
RESOLVED, further, That the Finance Director is authorized to make the following adjustments to his books:
A6787.52219 PERS UNITS $9,750
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At this time, Ms. Stein commented on the impact of the
Governor's proposed budget. She said that as a result of a change in
the funding formula the Department could lose $3,500 to $4,000. This
may cause a shortage in the in-home personal care for seniors.
Ms. Stein also commented about the health care issues
the Committee will be discussing this year and asked that consideration be
given to long-term care issues as well. She feels the Committee will
benefit from hearing how it works and how it does not. Ms. Robertson
asked Ms. Stein to keep the Committee informed on the impacts of the State
and Federal budgets.
Human Services Coalition
Ms. Dill updated and reported the following items to the Committee:
The Coalition is co-sponsoring, with the Council of Community Services
of New York State (CCSNYS), a series of Nonprofit Capacity Building Workshops.
Funding is available for scholarships. Personnel from sixty organizations
have attended these trainings in the past.
The Coalition's annual meeting was held and copies of the 2003 Annual Report were distributed.
She asked that housing remain on the Committee's list of priority goals.
She feels the concentration placed on it last year was valuable.
She reported the Coalition did not do well with the community development
block grant funding last year and she continues to be concerned about what
the impact may be this year. The Coalition continues to work on this
issue.
She reported on the efforts being made to get people into programs they
are eligible for. Some efforts include writing grants, media coverage,
and a greater emphasis on the existing programs and reaching out to the people
who are eligible for them. A web site is being developed to assist
people with understanding the eligibility for programs better. Ms.
Robertson suggested the private sectors such as human resource departments
be contacted. Ms. Dill spoke about the importance of getting information
out such as a food credit card now being available rather than food stamps.
The Prescription Drug Report has been widely distributed and is now going
to be posted to the HSC website. Mr. Whicher said he would talk to
Wendy Skinner about getting a link to this resource added to the County’s
website.
Ms. Dill commented that 50 agencies have responded to the salary and benefit
survery and a summary will be shared with those participating agencies.
Ms. Dill will give the Committee a report when the data are complete.
Ms. Robertson also asked Ms. Dill to let her know what she would like the
Committee to discuss this year and to keep the Committee up to date on State
and Federal budget concerns.
Health Department
Resolution
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
to submit the following resolution to the full Legislature for approval.
Ms. Cole said the amended bylaws were updated in conformance with the County
Charter and the change of Chair to President.
A voice vote resulted as follows on the resolution:
Ayes - 4, Noes - 0, Excused - 1 (Blanchard). RESOLUTION ADOPTED.
RESOLUTION NO. - APPROVAL OF AMENDED BYLAWS OF THE TOMPKINS COUNTY BOARD OF HEALTH
WHEREAS, the Tompkins County Board of Health bylaws have
been revised to reflect additions of information from the Tompkins County
Charter and Code and other changes that parallel New York State Public Health
Law, now therefore be it
RESOLVED, on recommendation of the Health and Human Services
Committee, That the bylaws for the Tompkins County Board of Health be and
hereby are approved,
RESOLVED, further, That a copy of the revised bylaws shall be kept on file with the Clerk of the Legislature.
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Ms. Cole noted that she will be giving a presentation
at a Committee meeting in March concerning home care and the financial shortfall
and repercussions from Medicare.
Ms. Robertson asked if a report could be provided for
the Committee concerning the impact of the Governor's proposed budget.
Mr. Whicher said he is putting together a report from all departments and
will share it as soon as it is complete.
Youth Services
Detention Program
Ms. Zahler explained and updated the Committee on the
detention program. She explained that detention is for juveniles who
are awaiting placement through Family Court, if they are at risk of running
away or committee an offense. She said the Youth Services Department
is required to plan for this need, and they are working with the Department
of Social Services in developing a three-year plan. They are also reviewing
the changes proposed in the Governor's budget that could potentially cap
the amount of state funding.
Troubling Trends
Ms. Zahler distributed a copy of an analysis of data illustrating
that between 1990 and 2000 the distribution of young people by ages changed,
and the number of adolescents in Tompkins County is increasing. .
Not only are there are more teenagers overall, but more are acting out raising
the following concerns:
- PINS referrals have increased 80 percent and the rate youth being referred
is higher than other New York State counties. In 1997, 104 cases were
opened, compared to 188 in 2003.
- The number of PINS and JDs placed out of home has doubled.
- Arrests of 13-15 year olds are beginning to increase and are higher than State rates/10,000.
- Alcohol and drug related arrests are rising among youth under 21.
- Alcohol and drug use among half of our local students is higher than national averages.
- The rate of indicated (proven) cases of child abuse and maltreatment is higher than the 2002 State rate.
- The number of children requiring detention grew in 2003.
- Two suicides in Ithaca District in 2003-2004.
The Youth Services Department has been managing the Drug Task Force grant
awarded to the City of Ithaca and focused primarily on the Ithaca City School
District. The Task Force would like to submit a new grant for an upcoming
four-year period of time and has asked the Youth Services Department to be
the lead agency which means the Department becomes the fiscal agent and the
manager of the grant. The Youth Services Board voted to support Department's
involvement.
Following a brief discussion, the Committee authorized the Department to apply for said grant.
Ms. Zahler updated the Committee briefly on the impacts of the Governor's
proposed budget and said the Department is projecting a cut in state aid
of $9,539; municipalities receiving funding directly would lose $4,776.
2004 Goals
Ms. Robertson presented the list of goals as discussed
and approved at the last meeting and asked if the Committee wished to include
a focus this year on a particular subject such as health, youth services,
and/or mental health. She feels these are some areas that are crosscutting
issues the Committee could look at. She also suggested including the
continuation of housing.
Ms. Robertson added the following information and goals:
DSS:
Better understand Medicaid (track State and Federal proposals for change)
COFA:
Long-Term Care System
Mr. Koplinka-Loehr spoke about the question raised by the Community Advisory
Panel about analyzing what programs we call preventative that are saving
dollars down the line.
Mr. Koplinka-Loehr feels there will need to be some prioritizing at the Committee
level as well as the Department level. In response, Ms. Robertson said
departments could address prioritization and prevention and include measurement
tools.
Ms. Robertson agreed to revise the list of goals and distribute for discussion at the next meeting.
Mental Health
Executive Session
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to hold an executive
session to discuss property negotiations and a personnel matter. An
executive session was held at 12:56 p.m. and returned to open session at
1:20 p.m.
Mr. Todd was excused at 1:05 p.m.
Presentation - County as a Provider
Mr. DeLuca explained that the LGU (Local Governmental Unit) is responsible
for all mental hygiene services. It is responsible for providing and
overseeing services through OASAS, OMRDD, and OMH. The advantages of
having the County go private would include the mental health services payroll.
Private agencies pay less and would not be limited to recruiting from a Civil
Service list. As a private agency, the clinical focus could be on best
practices in treatment. A private agency could more easily partner
with other agencies and would have the ability to partner across disabilities,
such as dual diagnosis.
The disadvantages of going private would be the loss of resources to fulfill
State mandated services, and would result in having to contract for them.
This would include AOT (Assisted Outpatient Treatment) exams and orders,
and all court ordered evaluations. Outreach services do not make money
but have been very effective in meeting liability issues for the LGU.
The Commissioner and LGU cannot control what the agency does, although they
are responsible.
When looking at privatizing mental health services, there are 70 staff people
who would be affected. A private agency could provide services cheaper
but there is no guarantee they can continue to treat the underinsured and
uninsured. There is not enough State aid going to some agencies to
make up the loss of payment. Either fees would increase or services
would be curtailed. Alternatively, the available Reinvestment money
would have to be redirected to pay for basic services to the underinsured/uninsured,
which is 40 percent of the clientele.