| Board Meeting Minutes- April 14, 2003 |  |
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Meeting Held at Members Present Peter L. Sheras, Ph.D., Chairman Members Absent Rev. David M. Cameron
James R. Peterson, Executive Director Evelyn Cotton, Mental Retardation Residential Services John Beghtol, Director of Community Relations, Western
Dr. Sheras, chairman, called the meeting to order at 6:03 p.m.
Dr. Sheras noted that the minutes of the Executive Committee reflected that he would need to leave the board meeting no later than 8:00 p.m, but the situation has since changed so the time is not imperative.
Dr. Sheras asked if there were any comments from the public. There were none.
Dr. Sheras asked if there were other items to add to the agenda. No items were added to the agenda.
It was noted that Mr. Caruso Brown was in attendance at the March 10 meeting, but not listed as such in the draft minutes. ON A MOTION BY MS. BARRETT, SECONDED BY MS. REBHOLZ, THE MINUTES OF THE MARCH 10, 2003, BOARD MEETING WERE UNANIMOUSLY APPROVED AS REVISED.
Mr. Peterson distributed copies of the tables of input that were required to be submitted to the Department of Mental Health, Mental Retardation and Substance Abuse Services last Friday. Based on the highly restrictive rules for who may be included in these waiting list reports, the numbers are very low. The board will need to certify at the May board meeting that it has received these reports, even though the board may not modify them. Mr. Peterson then distributed copies of the first draft of the section of Region Ten’s local Strategic Plan which addresses the need for new or expanded services. This draft was produced using input from the staff, and future drafts would incorporate input from interested individuals and organizations. Ms. White asked if the projections included services for persons relocating from state facilities back into the community thorough the Governor’s reinvestment initiative. Mr. Peterson responded that they did not, but since only several consumers would likely be affected for the Region Ten area, and since the services would be fully paid for through the reinvestment initiative, it would not materially impact the plan for needed services. Ms. Barrett asked why the state so severely limited the kind of data gathered. Mr. Peterson responded that they only wanted information on identified consumers who had actual plans in place calling for specific services rather than general projections or other needs identification approaches. Region Ten’s local strategic plan can address the true need. Ms. Johnston asked if the identified service needs for the strategic plan would be prioritized, and Mr. Peterson responded that they would. Dr. Sheras asked the board members to familiarize themselves with the information in preparation for the upcoming board meetings and the possible retreat.
Dr. Sheras welcomed Mr. John Beghtol, director of community relations for Western State Hospital (WSH). Dr. Sheras pointed out that Mr. Beghtol has come before the board in the past to give periodic updates on developments at the hospital and working with Region Ten. Mr. Beghtol distributed copies of a number of reports during his presentation (1) a map of the service area for WSH, a chart of figures comparing the average hospital census by Community Services Boards for the month of February in 2001, 2002, and 2003, a listing of how many patients for Region Ten are served in each of the hospital’s treatment malls, and a comparison of the number patients from Region Ten in February 1995 and February 2003; (2) a listing of all of the courses offered at the hospital’s Psychosocial Rehabilitation Center (treatment malls); (3) an article from the national journal, Advance for Nurses, which features a cover story about two of the nurses at the hospital entitled, “Innovative Psych Care/Treatment Malls at Western State Hospital, Staunton, VA”; (4) a listing of the tours of the hospital from March 1998 through April 2003 given to various dignitaries and media representatives, and a copy of an article from a consumer’s point of view; and (5) the “Grade Cards” which the hospital prepares by soliciting feedback on the effectiveness of its services from community Services Boards staff members. Mr. Beghtol said that the hospital serves 13 Community Services Boards, eight of which are primary (there is no back up hospital) and five in Northern Virginia for which WSH serves as the backup facility. The hospital census peaked in 1963 with 2,300 beds. This number has been reduced over the years to the point it is now at 281 beds. Mr. Belair observed that this dramatic reduction has occurred in the context of an ever expanding general population. Mr. Beghtol said that he came to WSH in 1977, and at that time the census was 1,354 with many long-term patients who had been in the hospital from 30 to 50 years. He discussed the downward trends, but noted that for Region Ten, the census actually increased between 1995 and 2003. Mr. Beghtol described the treatment malls which were initiated
by Dr. Jack Barber, Mr. Beghtol reported on the many tours of interested persons from other states (including Hawaii), media representatives, politicians, parents and others. He concluded by showing the grade cards that the hospital had initiated in order to get feedback from the Community Services Boards on the quality of service provided at WSH. The hospital has achieved its true role as a treatment center, not custodial housing. Ms. Wernstrom asked how the visits for board members would be arranged, and Mr. Beghtol responded that they should call him and he would set up visits of no more than two or three persons at a time. Ms. Barrett said that the Virginia Protection and Advocacy board had met at WSH on April 2, and she was amazed at the good appearance of the hospital and was very much impressed with the staff and the patients. It demonstrated how things can be done right. She encouraged everyone to visit. Ms. Rebholz said that she was impressed by the number of programs offered and the extent of skills development. Dr. Sheras asked how decisions were made with regard to treatment assignments, and Mr. Beghtol replied that it is up to the treatment teams. New patients participate in the Harvest Mall, and then after 48 hours are encouraged to participate in classes. Then they move on to the large, Stribling Mall, and at every step, the key questions is, “What are your needs?” Records of all of this are maintained electronically, and the officials from the Department of Justice said that they had never seen this elsewhere. Dr. Sheras reflected that Mr. Beghtol had mentioned earlier that every Community Services Board is different and has its own personality, and he asked for more specifics as to how Mr. Beghtol saw Region Ten’s personality. Mr. Beghtol responded that WSH serves a very diverse region, with such variations in population and affluence from Fairfax County to Highland County. Region Ten’s high admissions are a result of the lack of other willing local hospitals. Ms. Wernstrom asked about the visiting hours which Mr. Beghtol had said were from 9:00 a.m. to 9:00 p.m., and how this fit in with the treatment mall classes. Mr. Beghtol said that this is worked out with the social workers, but most visiting occurs in the late afternoon and evening after the treatment malls are completed for the day. Mr. Belair said that he was intrigued by the term, “mall,” and Mr. Beghtol said that they adopted that from a New York hospital--a shopping mall with many classes. Ms. White asked if there were many empty facilities on the hospital grounds, and could they be somehow utilized. Mr. Beghtol said he has shown the available facilities to many local and state officials because he would like to see a mixed use campus develop. Dr. Sheras asked if Mr. Beghtol would give his perspective on what we as a board could be doing better. Mr. Beghtol responded that Region Ten has an ongoing struggle because it does not have access to willing private hospitals that would accept all patients. Region Ten has high admissions and a high census, but short lengths-of-stay. He said the lack of local beds is a real dilemma, and he was at a loss as to what advice to offer on this. He noted that the Rappahannock Area Community Services Board (RACSB--Fredericksburg and the surrounding counties) has two psychiatric hospitals who want to be involved, and for that reason, RACSB has very low admissions and utilization of WSH. He supervises the three admissions staff at WSH, and he knows from their experience that UVa is getting more restrictive. In comparison, Northern Virginia cut from 252 admissions to 41 by contracting with five local private hospitals utilizing new dollars provided by the state. He said it costs $187,000 per year at WSH. Ms. Wernstrom said that UVa provides short term treatment, and so some of the patients get more appropriate treatment at WSH for longterm illnesses.
Dr. Sheras said that a Nominating Committee is appointed in April to report out a proposed slate in May for the chair, vice chair, secretary and member-at-large of the Executive Committee. He added that the fifth member of the Executive Committee is the immediate past chair, and as to this position, the nominating committee has no say! Elections are then held in June and the new officers begin their terms July 1. He has asked Mr. Murphy to chair the Nominating Committee, and asked Rev. Cameron and Ms. Rebholz to serve on the committee. He also asked that if any board members have an interest in being considered for one of the officer positions, that they let a member of the nominating committee know of their interest.
Dr. Sheras said that the largest part of the meeting dealt with the report from the Personnel Committee, and so he suggested that they move on to that report.
Ms. Johnston said that the committee had looked at ways to reduce the subsidy to employees with families, but that it was extremely complicated because there are four insurance plans each with four subscriber classes. Therefore, the committee looked at the standard plan and the two categories of individual and family subscribers. Various scenarios were examined, but all assumed an 18 percent increase in premium the first year, followed by four years of 12 percent increases. The actual increases could be more or less. Ms. Johnston then reviewed the spreadsheet which showed seven scenarios with the first and fifth year projected rates for both the employer and the employee. She said that the committee selected Scenario “G” which would begin the first year with the single subscriber paying one percent of the premium--projected to be about $26 and the employer paying $242. The family subscriber would pay $182 with the employer paying $577. The committee felt that the other scenarios resulted in such drastic increases for families due to the compounding effect, that they wanted to put a cap on the amount of the annual increases, which for Scenario “G” would be 30 percent per year. The committee then met again to discuss if they really wanted to move in the direction of reducing the family subsidy. They felt that the single subscriber should pay 10 percent of the premium, but that the difference in the subsidy should not be reduced. This is a system that has been working well at Region Ten, and in the long term, it is in the best interest of the organization to retain the subsidy. If over time, the costs increase substantially, then the board can look at the question again, but for now, this is what is best for the employees and their morale. Ms. Johnston concluded by saying that what the committee is recommending is that the board not try to reduce the subsidies, but if they do, then the committee would recommend Scenario “G.” Roxanne sought clarification on whether or not the committee was recommending “G,” and Ms. Johnston responded that only if the board felt it must reduce the subsidy. Mr. Murphy distributed copies of a spreadsheet he had developed. He said that he had looked at all of the plans, and from his viewpoint, it wouldn’t be too complicated to look at all the plans. He said that his choice would be Scenario “D,” but he could accept “E” or “F.” He referred to the spreadsheet he had prepared and said that at the current rates, a family subscriber in effect receives $2.11 per hour more than a single subscriber. In the first year of “G,” the amount would reduce some (to $1.93), but in four years, it would only have reduced by 42 cents, and it would take 26 years to get equivalent to the individual subscriber. Mr. Murphy said that to him, that wasn’t nearly aggressive enough. A single person would have to work 35 days to get the equivalent of the same compensation, and if someone came to the board and proposed that family members get an extra five weeks of vacation, that would be considered ridiculous. Ms. Wernstrom responded that the problem with that statement is that the $2.11 does not go into the pocket of the employee--it goes to pay for the insurance, and families just can’t afford to pay this. She also pointed out that there are other considerations for families, such as the higher income tax deductions accorded tax payers with dependents. Families earning $30,000 per year could not afford to pay $9,000 per year for insurance, and Region Ten’s salaries are lower compared to others. Mr. Murphy said that Region Ten’s salaries are now on a par or above other local government salaries. Ms. Johnston said that what bothers her is that this issue was brought up by a board member, not from staff, and that board members had received may e-mails from staff two years ago about benefits of all kinds, but this was never mentioned as an issue. Ms. White said that what was missing from the analysis is the fiscal impact on Region Ten. Mr. Peterson referred to the spreadsheet with the scenarios and indicated that at the top--for the current plan--all of the 16 combinations and permutations had been calculated--and each of which involved numerous additional assumptions as to how the subsidies would be applied, and the total annual premium given the assumptions of the first year 18 percent increase followed by four years of 12 percent increases, the total annual premium would increase from $1,406,763 to $2,212,012. The total at five years for all the scenarios would be $2.2 million, but the shares between the employer and the employee would be vastly different depending upon how the subsidies were applied. An estimate of the fiscal impact on Region Ten can be derived by applying the ratios of employee-pay vs. the subsidies for each of the scenarios. However, the impact of the actual increases in total premiums would have a much greater fiscal impact. If the assumptions about the increases is greatly reduced, then that would greatly reduce the impact on both Region Ten and the employees. Mr. Peterson also said that in his opinion, the board wouldn’t see increases of 12 percent per year, that something would have to be done if that were the case. Ms. Barrett suggested that single subscribers pay the same percentage as family subscribers. Ms. Johnston said that would have the opposite effect of what Mr. Murphy was seeking. Ms. Barrett then asked Mr. Murphy how he would fix it, and he replied by selecting “D.” Ms. Wernstrom said that would cost the families $813 per month, and how could they pay 40 percent of their salary for insurance, to which Mr. Murphy responded, “Just look around; everyone’s doing it.” Ms. Wernstrom suggested that the board vote up or down on whether or not the subsidies for families would be continued. Dr. Sheras said that the proposal of the committee is to maintain the family-friendly subsides and for single subscribers to pay 10 percent of the premium. Mr. Murphy said that this would not be a continuation of the current plan because it was a year ago that the single subscribers were paying toward the cost of their insurance. Dr. Sheras agreed that was correct, but he added that the committee was arguing for enhanced family support. If you vote for “G,” then you are voting for something that is less family-friendly, but it would moving very slowly in that direction. The other scenarios result in a more rapid convergence of individual and family subsidies. Dr. Sheras added that all of this consideration is taking place in the context of not having actual premiums to deal with. Mr. Belair asked if the payment by single subscribers would lessen the impact on the families. Mr. Murphy said yes, that the individuals would be subsidizing the families. Ms. Johnston responded that the individual’s payment actually goes to Region Ten, and that the committee is recommending that the families also pay the same $26 in addition to the current $140. Ms. Wernstrom said that this did not mean that the subsidy for the families would be increased to the extent that the families would pay the same percentage as single subscribers, to which Ms. Johnston responded, “Correct.” Mr. Belair asked why the increase would also be applied to the family coverage, and Ms. Johnston replied so that everyone would be paying the same increases. Ms. Barrett said that in this case, then, the individuals would not be paying for the families because everyone would be paying the same increase. Ms. Cotton said that the board needs to look at five years out, that the entire country is in a health care crisis, and that a cap is probably needed in coming years. Dr. Sheras asked if board members had any further comments before a vote was taken on the committee recommendation. He added that he had received one e-mail from a staff member, and it said that families were in a very precarious situation and would probably have to leave Region Ten. Dr. Sheras called for a vote on the committee recommendation, that the single subscriber pay 10 percent of the premium and the families pay the same increase. Mr. Murphy said that he would like to clarify that this was Ms. Johnston’s recommendation, not of the committee, that the committee had recommended Scenario “G.” Ms. Johnston replied that the committee had met subsequently, just prior to the board meeting, and this is the committee recommendation. Dr. Sheras then said that if you want some other option, you should vote against the committee recommendation. Ms. Barrett asked Mr. Peterson to restate the motion, and he said that the single subscriber pay 10 percent of the premium and the families pay the same increased amount. THE MOTION CALLING FOR INDIVIDUAL SUBSCRIBERS TO PAY 10 PERCENT OF THE HEALTH INSURANCE PREMIUM WITH FAMILIES PAYING THE SAME INCREASED AMOUNT PASSED, MR. MURPHY VOTING NAY.
Ms. Wernstrom summarized the committee’s recommendation for the board to hold a retreat on June 9. Mr. Murphy and Dr. Kibler both indicated that they would be unable to attend on that day. Dr. Sheras said that it was important to select a date that would provide for maximum participation among the board members, and so the two issues for now are to select a date and discuss the agenda. Ms. Wernstrom said that the committee members also recommended that community members be invited to provide their special perspectives, and that the roles of the standing committees also be addressed. Mr. Belair said that the intent was not to open the retreat to the public, but rather to invite specific individuals. Ms. Wernstrom added that the retreat would provide a very different environment from that of the board meeting, and we have not received very much input from the public on service needs. Mr. Belair gave the example of inviting someone from the Blue Ridge Family Alliance. He also said that the committee recommended using a board member or executive director from another Community Services Board to serve as a facilitator. Ms. Barrett said that she was against the idea of inviting representatives from other groups because the strategic plan is intended to be an internal process. Rather, the board could have public forums to gather input from others. Ms. White said that the strategic plan should be based on the needs and input from the public, but it is not a good idea to base the plan on just who attends the meetings. Ms. Barrett suggested that the board could take what information they gain from the forums and plug that into the plan. Dr. Sheras said that it would be awkward if only a couple of outside representatives were involved in the retreat. Mr. Belair referred to an earlier mention that the health insurance issue be added to the retreat agenda, and he said emphatically that discussing health insurance was not part of the strategic plan, but rather we must look at what we are doing for mental health, mental retardation and substance abuse services, and how we are organized to meet the needs. Ms. Wernstrom said that if the board members want to hold the retreat, then the committee can work on the agenda. Dr. Shears agreed, and asked if the members wished to go forward with the retreat, and if so, when. Ms. White said that she was not sure she agreed with the third item in the committee recommendations--to seek a board member or executive director from another Community Services Board to serve as the facilitator--because you may become mired in information. Ms. Wernstrom responded that the committee did not want a generic facilitator, bur rather someone who knows something about the field, but not with the intention that the facilitator would take the lead. Dr. Sheras said it would be useful to find someone who both knew the field but also had the necessary facilitator skills. Mr. Murphy suggested that outsiders should not be invited, but rather have the executive director and division directors bring in information that would be helpful to the board in conducting the strategic planning. Dr. Sheras asked if there was agreement to hold a day long retreat which would include the regular board meeting business. The date of the regular July board meeting--Monday, July 14, from 2:00 p.m. to 9:00 p.m.--was accepted by all the members present.
Ms. Barrett reported that the committee did meet and has scheduled another meeting. XIV. DIVISION UPDATES Dr. Sheras asked if there were any pressing items to report at this time, and the directors responded that there were not.
Ms. Rebholz reminded the members that the next VACSB meeting will be held in Williamsburg on May 7, 8, and 9, and that Dr. Sheras, Ms. Barrett, Mr. Belair, Ms. Garrett, Ms. Wernstrom and herself would be in attendance along with several staff.
Dr. Sheras suggested that these reports could be carried over to the next meeting. Ms. Rebholz said that it had been reported to her that the volunteers who helped with the Blue Ridge House landscaping really would prefer not to have an event to recognize their efforts, but rather a letter from the board would suffice. Ms. Barrett said that a documentary would be shown on Cinemax on May 14 which involves a person with developmental disabilities, age 60, who goes around and collects money for other charities, and in the process his neighbors become his support system.
Dr. Sheras announced that a request has been made for the Board to enter into a Closed Meeting to receive information on personnel matters. The Meeting is warranted and complies with Section 2.1?344 of the Code of Virginia, 1950, as amended. ON A MOTION BY MS. BARRETT, SECONDED BY MS. WHITE, IT WAS UNANIMOUSLY VOTED TO ENTER INTO A CLOSED MEETING TO RECEIVE INFORMATION ON PERSONNEL MATTERS. Dr. Sheras reconvened the board in Open Meeting at 8:15 p.m. He stated that no resolution, ordinance, rule, contract, regulation or motion was adopted, passed or agreed to in Closed Meeting. The Region Ten Community Services Board hereby certifies that to the best of each Member's knowledge, (i) only public business matters lawfully exempted from Open Meeting requirements by Virginia law pursuant to Section 2.1?344 of the Code of Virginia, 1950, as amended, were discussed in the Closing Meeting to which this certification applies, and (ii) only such public business matters as were identified in the motion convening the Closed Meeting were heard, discussed, or considered by the Region Ten Community Services Board. Dr. Sheras asked for a role call from all members certifying to the foregoing. Dr. Kibler and Ms. White exited the meeting. MEMBERS VOTING AYE: MS. BARRETT, MS. WERNSTROM, MR. TRIPPEL, MR. MURPHY, DR. SHERAS, MR. BELAIR, MS. REBH0LZ, AND MS. JOHNSTON; NO MEMBERS VOTING NAY. Dr. Sheras asked if there was a motion on the annual renewal of the employment contract with the executive director. ON A MOTION BY MS. JOHNSTON, SECONDED BY MR. TRIPPEL, IT WAS UNANIMOUSLY VOTED TO RENEW THE EMPLOYMENT CONTRACT WITH THE EXECUTIVE DIRECTOR FOR THE PERIOD JULY 1, 2003, THROUGH JUNE 30, 2004. The meeting was adjourned at 8:20 p.m.
I. WHEREAS, the Commonwealth of Virginia, Department of Housing and Community Development, has issued a Notice of Funding Availability and requested applications under the Application for Fiscal Year 2004 Funding. II. WHEREAS, assistance is needed to effectively and adequately address the needs of homeless persons, including families, individuals, and/or children in the city of Charlottesville and the counties of Albemarle, Lousia, Fluvanna, Greene and Nelson(enter name of locality). III. WHEREAS, an application for a grant(s) under the Application for Fiscal Year 2004 Funding has been prepared. IV. WHEREAS, the Region Ten Community Services Board (enter name of unit of local government) agrees, if an award is received, to provide coordination of safe and sanitary shelter and/or supportive services to homeless persons in conformance with the regulations and guidelines of the following programs: [Indicate applicable programs] V. WHEREAS, James R. Peterson, Executive Director (enter name and title) may act on behalf of the Region Ten Community Services Board (enter name of unit of local government) and will sign all necessary documents required to complete the grant transaction. VI. WHEREAS, any required match under the program guidelines will be provided. VII. NOW, THEREFORE, BE IT RESOLVED THAT the Board of Supervisors, City Council, or other authorizing governmental body of the city of Charlottesville and the counties of Albemarle, Fluvanna, Louisa, Nelson and Greene (enter name of locality) hereby authorizes James R. Peterson (enter name) to apply for and accept a grant award under the programs indicated above (see IV.) and enter into a Grant Agreement with the Department of Housing and Community Development and perform any and all actions and responsibilities in relation to such Agreement.
April 14, 2003, BOARD MEETING MINUTES Members Present Peter L. Sheras, Ph.D., Chairman
Rev. David M. Cameron
James R. Peterson, Executive Director
Dr. Sheras, chairman, called the meeting to order at 7:59 p.m.
It was noted that Mr. Caruso Brown was in attendance at the March 10 meeting, but not listed as such in the draft minutes. On a motion by Ms. Barrett, seconded by Ms. Rebholz, the minutes of the March 10, 2003, board meeting were unanimously approved as corrected.
Mr. Peterson circulated a copy of the “Preliminary Architectural Feasibility Report/Region Ten Nelson Counseling Center,” prepared by Sheeran Architects for submission to the Rural Development Fund of the Department of Agriculture. The architects will now begin preparing the complete drawings and specifications for the facility. IV. Group Home for Persons with Mental Retardation Mr. Bob Smith is continuing to seek potential sites for the group
homes. Mr. Belair asked about the type of location sought, and Mr.
Peterson responded that rural sites would be preferable, but city
sites would also work. Respectfully submitted, Paul Belair
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