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06098606/09/1986 1 Review department budgets, increase in insurance line item NO/AC RANDOLPH COUNTY BOARD OF COMMISSIONERS MINUTES June 9, 1986 The Randolph County Board of Commissioners met in a special session at 7:00 p.m. on June 9, 1986. Commissioners Frye, Langley, Davidson, Petty and Comer were present. The purpose of the meeting was to review proposed departmental budgets and to ask questions of and receive comments from department heads. County Manager commented that the insurance line item showed a big increase because of increased premiums since last year. There is a possibility of getting coverage through NCACC's self-insurance pool. Mr. Willis will attend a meeting in Raleigh next week concerning the self-insurance pool. Annette Lineberry, Director of Computer Services, reported that our computer system manufacturer has recommended that we upgrade our hardware, as our system is being phased out of manufacturing. Mrs. Lineberry indicated that, in her opinion, an upgrade is not necessary at this time. The company will service our system for at least two years. Billy Chilton, Tax Supervisor, discussed the Tax Department's request and need for a computer for the mapping program. He explained that building inspectors and sanitarians would be able to use this system also. Mike Stalvey, Maintenance Supervisor, requested an additional maintenance tech- nician because of the increase of building projects the maintenance staff is handling rather than contracting them out. Major Larry Emerson of the Sheriff's Department explained that a replacement station wagon is needed for transporting prisoners to Raleigh and that 11 replace- ment vehicles are needed for deputies who are driving cars with very high mileage. A brief discussion was held on the need for a security fence and alarm around the transmission system on Dave's Mountain. Neil Allen, Director of Emergency Services, discussed his requests for 2 new ambulances and 2 mechanical CPR machines. With these 2 additional ambulances, the department will have 2 back-up vehicles and will be able to practice pre- ventive maintenance for the first time. A new line item has been included in the Emergency Services budget for the Safety Coordinator. Mr. Willis praised the Safety Committee's accomplishments in the last year and a half and told Commissioners that they have made a real difference in the safe working environ- ment of the County employees. George Elliott, Health Director, discussed problems with the dumpster program and told the Board that close to $100,000 is being spent in a year for the Sophia site alone. He recommended that the dumpster program be phased out as the lease for each site expires. He also mentioned the possibility of charging a landfill fee for dump trucks, as some other counties charge. Mr. Elliott said that his department needs the public health nurse and community health assistant which were cut from the manager's proposed budget. Talmadge Baker, Chairman of the Agricultural Extension Service, indicated that his department may combine the 12 different newsletters they send out into one big newsletter, since many citizens receive 3 or more of the newsletters currently being sent out. Marion Smith, Director of Social Services, discussed his department's urgent need for microfilming equipment and an additional eligibility specialist which Commissioners Minutes June 9, 1986 Page 2 were cut from the proposed budget. Mr. Smith said his department has over 600,000 sheets of paper to be microfilmed. They have run out of space to store these files, which must be kept for a long period of time. Mr. Smith also stated that because of an additional nursing home coming into the county and the more stringent state guidelines associated with nursing home patients, an additional eligibility specialist will be needed to handle the caseload. Nancy Brenner, Director of the Public Library, told the Board that an increase in state aid accounts for most of the overall increase in her budget. The state stipulates that their funding cannot replace local match but must be added to it. The meeting adjourned. LONG TERM CARE FACTS In the past few years there has been an increasing effort by the state social services office to make counties aware of the costly affect of errors in the long term care category. The tolerance rate for Medicaid errors has been set at 3%. At the last review period the state's error rate was 3.8% which exceeds the tolerance level and places the state at a severe risk of federal penalties. To help prevent these errors, the state has strongly recommended procedures to follow in the verification process. These procedures result in more extensive verification and more time to be spent on each case. Procedures we are to Follow I. Interview the client at home or at the nursing home) to determine if they are capable of communicating and reviewing their eligibility requirements. 2. Interview a responsible relative in addition to the client. 3. Contact at least one other relative in addition to the responsible relative. 4. Confer with the nursing home facility to see what information they have about the client. These procedures on top of all other required verifications have increased our case activity drastically. Caseload Facts Our caseload size is growing. We had 284 cases in July 1984. June 1986. We had 311 cases in This is a constantly changing caseload as we are terminating clients who have died as fast as we are putting on new cases. Changes in client's situation require a great deal of time to process such as clients going from nursing home to hospital, changing nursing homes, changes in income, and death of spouse. Our applications and inquiries have almost doubled in the last 6 months. Our average number of applications taken from July - December 1985 was 13.8. For January - May this number jumped to 22.8. Application and Review Facts - It takes close to 2 hours to make a long term care application. - Every application takes between 35 and 40 forms. - Reviews must be completed every 6 months on all 311 cases. - We have to conduct reviews for other counties whose clients live in nursing homes located in our county. Projections - The new nursing home to open in our county will greatly increase our workload. - The aging population will increase our workload. - Another worker is greatly needed! We currently have 2 eligibility specialists that take nursing home applications, process the cases and conduct the reviews on 311 cases. The cost of care in a nursing home facility for skilled care is over $2,000.00 a month. Errors are costly. Our county has an excellent quality control record. We hope to keep it that way but we need more help to do so.