Health and Human Services Board - Regular Meeting

Unfortunately, there is no public comment or communications on our agenda. So I'm glad to see there doesn't seem to be anybody that needs to speak. So we'll make sure that we take care of that for next month and get that back on the agenda. A roll call, please. Where are you, Jules? Okay. Good morning.

Joel Baraka. Paula Hodeck, here. Robert Kopisch, here. Hattie Stephens, excuse. Dennis Orko, here. Nicole Kowicki, here. Sally Hommel, here. Stacey Pomeroy, here.

Gerald Swenson, here. Thank you. All right, and thank you. So we have our vouchers. They should be going around. Chris Ann is not here to answer any questions, Bob, so. Oh, she did, okay, good. All right, so have they gone all the way around? And they have, thank you. Can you take this back to Chrisanne's office? Okay, all right. So I need a motion to approve.

Mr. Kopisch?

Approve the vouchers.

I'll second that motion.

Mr. Brodka, second that. Any discussion? Hearing and seeing none, all those in favor? Those opposed? Everyone needs to use your microphones because we have a little competition down the hall here.

Oh, well.

All right, so that has passed.

New workers introductions. Chana, I believe you have someone to introduce to us. Would you please come to the microphone and speak into it, please?

So we have filled another position in our unit for children's waiver and comprehensive community services, and then she will also do crisis. This is Christy Kosterman. Hi, Christy.

Christy, would you like to give us a little bit of a bio? Sure. So I grew up here. I know some of you. And then when I graduated, I moved to Los Angeles for college. And then I was a special ed teacher there. Ended up moving to Phoenix, where I was also a special education teacher. Stopped teaching, opened my own business to take the special ed kids when they graduated high school. So I had a day program and a group support employment. and then i ended up moving back here this past august so very grateful to be here to be able to help everybody and it feels good to be home back by family and surrounded by people i know and have the four seasons and not the 123 degree heat well thank you very much and we welcome you back thank you i appreciate it it feels good to be back well good well we're glad to have you in the family thank you guys welcome thank you chauna

And the minutes of first our August 12th meeting, our regular meeting. And you'll notice a couple of things that were scratched off of there, redlined, only because we were looking at setting up the agenda and these were not going to be on the agenda. So somehow they're still on these minutes and they really don't have to be there. But we'll make sure that when we print the copy for them. We'll make sure that gets fixed, Jules.

Thank you.

Okay, so what's your, we could probably do them both. We have the public participation meeting also that same day, and that one was for five minutes and seven seconds, only because we had a, I like to say that because we get through that one pretty quickly, although we did have one public comment at that time, just a comment on a non-agenda item. So, What is your pleasure for these two minutes? If we could put them together.

Okay.

Mr. Orko. Mr. Swenson. I'm sorry. And any other discussion? Okay. Hearing and seeing none. All those in favor? Those opposed? All right. That's done. So next year when I'm looking for public participation, I'm panicking that we don't have it. And then Jules was the one who said, oh, no, no, no, we do that one at the September meeting. So I thought, oh, my gosh, we didn't get that one done.

Mr. Chair? Yes. Just a comment, and I wasn't able to make it, but we never get anybody coming to this, right? And we're having it later in the day because we expect we're going to be able to get more people. Would it make sense to just have it in the normal time? Sure.

It's statutorily. We have to have it after 3.30. Oh, we do? Yeah. So it's the one meeting that in the state statute says you have to have it after 3.30. It's like a weird time.

3.30 or 4 p.m. Well, I think it's because they want the working class to be here, you know, if they're working and they have that chance to come and make a comment.

Well, did we ever have it earlier in the day? It seems like I remember we used to.

Well, you would know best because you're...

I've been here a long time, yeah. Well, maybe not.

I was going to be really polite.

The memory is getting worse, though.

I can double check the statutes, but that was always my understanding. Okay. All right. Just a comment. All right. Thank you. And just for the minutes, Patty has joined us online.

Hi, Patty. Just wave.

She probably can't hear us yet, but she has joined us.

Patty, can you hear us?

Hmm.

I hope so. It'd be kind of not fun to be sitting there staring at us.

Anybody know a sign language?

Hi, Patty. Send her an email. Maybe she has her email up. I don't know.

Oh, okay, good.

All right, well, if we can get her on, that'd be really nice. But it's good to see her there.

So she's not excused. She's a Pressington.

All right, opioid committee update. Recommend a list of opioid funding to the Health and Human Services Board. You all were given a copy of the recommendations at the last meetings, and you were charged with making sure that you looked it over and made any questions and wrote them down if you had anything that you needed to discuss. Nick is just going to kind of run through a little bit of those again to kind of get your mind set there. So if something jogs your memory that you wanted to ask, this is the time. Because then we're hoping to, if it becomes an issue, then we have to call another meeting. And we do have one more as an ad hoc meeting. We can call one more meeting to address that issue if we need to. But if we don't, if we can just circumvent that and just take it right on to county board and to approve it, that would be really good too. So Nick, take it away.

Sure. So just to back up. So what this was is there was a class action lawsuit for pharmacies, anybody who provided opioids or created the opioids. So Purdue was the largest one that went through a bunch of settlements. There was a whole bunch of legalese happening. So in the end, what happened was over the next 20 years, counties that were involved and the state for this lawsuit will be receiving funding to mitigate opioid issues. We have received, I think it's at the bottom of the page, $287,945 so far. Some of that is prepayment. So some of the pharmacies, some of the groups decided to get their payment out of the way or do larger sums up front. We're anticipating about between $10,000 and $15,000 a year going forward for the next, I think it's 14-ish, 15 more years. So what the state, through this Process said is you have to have a opioid committee to review how opioids have affected your community So the county put together an opioid committee on that committee was I think it was over a dozen people which represented all different areas of the county including schools hospitals Any other medical providers our health department our children and youth departments law enforcement the schools So we had a whole group of individuals. We did four meetings. The first meeting was introducing each of those areas and saying, hey, this is how it's affected us. So schools talked about how we saw, you know, children having access or experimenting earlier. Education, it depends on what, you know, they had some issues. Interesting insight, law enforcement, what they're seeing with hybrid drugs or the escalation of use of methamphetamines, things like that, because of the pre-use or the addictive level of the opioid drug. all groups went through kind of where they were dealing with the opioid crisis. So then second and third meeting, we started to discuss, okay, what are the available uses? So the state released a 200-page packet that said, here's how you could use it. The biggest thing was you can't supplant. So we can't, what that means is we, like, say if we gave ourselves funding to the health department, we can't say, oh, look, we're already doing this education. Now we don't have to use our levy dollars and or other grant money, and we can just keep that money and use it for something else. So it all had to be new or additional services in your community. By the time we got to the third meeting, fourth meeting, everybody kind of presented their ideas on what might help the community and how to spend the funding. And that's where we came up with this list of quite a few items for the first three years. After the first three years, obviously, we'll continue to receive funding. But at that point, the rules are you've established kind of how you want to spend them. This group would then just continue to recommend how to allocate that additional funding. So if certain things are working, you would say, yep, keep doing this with that additional funding. A lot of the things on here are one-time projects. program costs. There are some things and mostly in our house, I guess, our county oversight would be continued costs that we could allocate funding. When we looked at outside funding of programs, it was more of the one-time funding. So In the end, this is the list we came up with. I would say if the biggest ones were like in-house, that health department, Kayla, the children and youth, so TIFF's department with the health, children and youth with Kayla. They had some really good, John had some stuff too with behavioral health. They have a lot of good programming additions to what we're already doing. And they're here if there's questions about that. The outside stuff, for example, was like working with the schools and allocating money for them to work through either presenters coming in as one school or as all the schools get together to have speakers talk about drug abuse or addiction or things that preventative measures up front. We talked to His House of Hope, which they're doing drug rehab programming and allocating funding for some things. They requested very specific stuff. We set aside money for, because His House of Hope is for males, if there was ever a program in the area that would work with females, we have the money set aside that they would get equal amount that his House of Hope would. Some of the other highlights were like where we struggle as being rural is getting individuals to programming and or housing them once they are at programming. So we set aside quite a bit of money for that where it's it would assist families with, you know, staying somewhere. So it'd be like a grant program, um, whether it's like the hotel or the location, uh, or just getting them there with transportation. Um, that was a big one, uh, that we talked about for the law enforcement, they brought up, um, testing, uh, a machine that would test, um, any drugs that they found for like, um, not fentanyl, is that the big one? I want to say amphetamines, but it's fentanyl where it's instead of them having to risk their contact. It's a machine that tests it without contact. It's like contactless rather than you open the bag and something might come out that's there's some process or some machine that's not cheap that would be available for all law enforcement. It would be centrally located. So when you do have that situation, you could test it. what that'll help is preventative measures in our jail system and it'll get people to recovery quicker rather than waiting to find out if they're have blood tests you know after their blood tests or um withdrawals so those are kind of the highlights if you want staff is here to highlight what their requests are otherwise like paula said is The next step would be you guys approving or we'll put together a resolution to approve this to go to the full board. And really, some of this can be done immediately. Some of it's more long term that we'll be looking at.

So are there any questions or discussion? Joe?

So, just for the outside groups, was His House of Hope the only one that requested funding? I'm just curious.

Yeah, so we didn't have any, well, we didn't have them on the committee, so there are outside groups, right? Like, they're still, the schools were considered outside, but yeah, His House of Hope was made aware of the funding through their drug programming. And actually, it was a good education for our staff because they presented, His House Hope presented on what they're doing, what they're working on, who can be their clientele. So it was a good eye opener for if we have clients ourselves that could be sent there or work with that programming. But yeah, His House Hope was the only place nonprofit or group that came forward saying, here's specifically what we could use help with.

Madam Chair, may I?

Sure.

I just have a question. I think it's a legitimate list. I'm not questioning the list. How is it going to be administrated? Who decides promotion, advertising, and education for preventing misuse of opiates? Does an outside entity become aware of it and come and ask for the money, or do you already have somebody that it's your mark to? How is this administered?

Yeah, Tiff can talk about it. But yeah, it's just internally... So we have to report this every year, I believe. So they have to track it and bring it forward. But you can talk more about that.

Yeah, and so a lot of those activities, initiatives are already in place by our Substance Use and Mental Health Coalition. So they can expand upon those. We have the experts at the table. Some of them here are on the committee. So we're going to be using evidence-based information, but it would be probably made by those individuals themselves. Those are the ones that we initially requested that funding.

So it's more of expanding of programs and creating the wheel. None of this is recreating or creating a specific program.

We're enhancing what we already have.

Yeah, or the region has. So to the west of us, they spent quite a bit of money on billboards and advertisement, not saying that's what we're going to do, but we could latch onto that and say, expand that program and put stuff up here.

So the... framework for administrating this is already in place.

The state has some of those campaigns already in place, so we won't be reinventing the wheel. We'll be using it the most efficient way that we could, just bringing that information here. Good question, though.

I'm done.

Oh, okay.

For now.

For now. Mr. Coppish. How long will the funding continue? Do you know as a squad?

Yeah, so we got the bulk of it right now, and I believe we have like 14 years left or 50. It was like a 20-year payout for a lot of these. We were lucky. We got money, and it's going to help. There's a lot of programs we can put in place. We are nowhere near some of the big ones. Some are getting a million bucks now. And what those we're seeing is they are putting rehab centers in and bigger things. We don't have anywhere near that. We talked as a region about some of that stuff, but even if you pooled eight or ten of our counties, it doesn't. You'd be subsidizing it somehow as a region.

Any other questions? No? Well, what's your pleasure, Board? Thank you. Are we going to send it back to opioid committee for some reason? Or are we going to stop it here and move it on to county board?

Yeah, we need to bring a resolution.

Yeah, we'll bring the resolution, but we need to at least say we're going to go with that.

I'd make a motion. Now we move forward with the list as presented. I'll second.

Okay. Motion by Mr. Baratka, second by Mr. Popish to move this forward. And any discussion at that time about this? Okay, hearing and seeing none. All those in favor? Those opposed? Oh, there you are. Hi, Patty. Hi. Okay, good. There you are. All right, so the motion has carried, and we will move that forward. I would like to thank the Opioid Committee because we won't see them again. I'd like to thank them for all the work that they did in taking the time to bring the research to us and helping us with that, and his House of Hope staff I guess we can contact Mr. Diston and Robert and see what we can do with that. Okay. All right. We'll move forward then. So we'll bring that next month to the resolution, right? And then to the county board.

So county board will see it probably October if you guys have an October meeting.

Okay. Sounds good. All right. Annual report. You received this last time as well. Nice big reading. I thought it was well put together and very informative. I thought this is something that you should actually just keep on hand if you really can't remember what that acronym was or what it meant or who's in charge of that department. I mean, if you're at a loss of how you need to discuss what those are, This is very well done. So all we're going to do here is it's been presented to you. So just wondering if there was anyone that had any questions, you do have some of the managers here and they can discuss anything that you had or comments. Stacy, you didn't get a chance to read it, but that's okay. If you have questions, you can contact Sarah and go from there. We're going to go through it today. Oh, at the orientation. That's right. There is an orientation this afternoon in case anyone had forgotten. I understand Supervisor Ulrich will be there and Stacy, our new gal here, will be there. If anyone has an inkling to go there, you can still get into it for this afternoon.

Okay.

Any comments for the... This is just an FYI. We don't need to approve this and send it. It just goes on file.

Just a question. As going through it, something didn't make sense on page 14.

Okay.

And that first highlighted one, you got 26 children referred and 60 children served. Does that make sense?

Okay.

So what that means is these kids are in this program long term. So we served 60 children in that year, but some of them were already in, and we had 26 new referrals.

And the reason I ask is because the next item down says 60 children served, and I thought maybe...

Yeah, so just the Children's Community Option Program funding, that funding we only use for children in children's waiver. So it's a supplemental funding that pays for things that maybe children's waiver won't pay for. So certain items that might be helpful to make their life easier, that this, the regulations that are put upon CLTS don't cover. So then we go through a process, talk about it and approve it and then those items are covered.

Thank you. Well, Chrisanne's not here, so I got to ask somebody.

Let me ask somebody. That's okay. I'm all right with that.

All right. That's it. Although it's a great report. I agree. Really a nice report. Yeah, I agree. Especially the director's comments. It was just wonderful.

Yeah, I know.

What are you asking for?

Any other comments or complaints or concerns? No? Well, good job. Well done. Thank you. A lot of work in there. All right. So let's go to the resolution. So we have a resolution in front of us to support sustainable state funding for local public health departments. I'm just going to read a couple things. I'll let Sarah take over. Whereas in Wisconsin, local health departments, LHDs, are legally required to provide a core set of public health services under state statutes chapter 251 and Wisconsin Administrative Code chapter DHS 140. And whereas responsibilities, LHDs, have expanded significantly in recent years due to emerging public health threats, workforce shortages, and increasing community health needs. And whereas local health departments rely significantly on a combination of limited state aids, categorical grants, and local state tax levy to find these mandated services. And then it goes on, but I think Sarah can figure that out to tell us at the end. I'm just going to say, but be it further resolved, that the state of Wisconsin recognizes public health as a core governmental function and prioritizes sustained investment to ensure consistent services delivery across all jurisdictions and be it further resolved that a copy of this resolution be forwarded to the governor of Wisconsin, members of the Wisconsin State Legislature, the Wisconsin Department of Health Services, and all Wisconsin counties. And in a nutshell, Sarah, I'll take it over.

Or Tiffany. Tiffany, did you get a chance to talk to other health officers or

Yeah, there's actually quite a few other counties that are passing similar resolutions just because of the fact of there are those core functions that we need to provide. And over the last few years, we are seeing funding being cut and cut and cut just alone. The lead grant that we receive, it's just to help supplement the activities that we do for lead follow-up for children in older homes and things like that. And that got sliced in half. We're looking, I mean, if you look at dollar amounts, I don't think $1,500 is a lot of money to support those funds when you're looking at the number of children in our community. So this is just, that's just an example. There are other ones, too, that we are looking at. But this is just that support and that formal support. you know, look at what we need and so that we can make sure that we are keeping our community healthy and safe. And unfortunately, dollars go along with that. And we're trying to take every great opportunity that we can to apply for other grants, which when I give my report in a little bit, you'll get to hear those but some of those that are those core functions, it just needs more.

Yeah. Okay.

So Sarah said that's it. That's in a nutshell. That's exactly what it is so. What's your pleasure?

You wanna go first show or should I? I motion to approve and forward through board.

OK, most motion by Mr Copish to approve and forward this to the County Board and Mr Warko second set. Any other discussion? Hearing and seeing none. All those in favor?

Those opposed?

Sorry about that. We got you in. It's that voice above that comes in. Okay. That passes and we'll see that at county board then. Thank you. Next we have public health unit. Tiffany, you just like that microphone. Come on up.

I understand. First of all, thank you for that support. That's much appreciated from a public health standpoint and I'm sure from the community as well. Thank you. Okay, the person on my list here is just a, it's not anything in paper that you have, just a verbal report from the Health and Wellness Coalition. So just mentioning back on some of those grants, there was a grant opportunity. I had mentioned a couple of months ago There were some ARPA funds that were left. We could apply for a mini grant. We requested $2,000 and after a few things, we ended up getting almost $6,000. So we welcomed that in. So I was able to get a little overview from the Health and Wellness Coalition of what we're kind of using that for. So we wrote it with the thought of our physical activity and our nutritional needs of our community, which is in our community health assessment and our community health improvement plan. So we looked at the They looked at the food insecurities within our school. One of our schools already had a fuel zone cart. As we know, hungry children have difficulty learning in school. It's hard to focus. And if you have a well-nourished belly, you usually have a well-nourished brain to be able to learn. So what we ended up doing was using some of the funding to purchase a fuel zone cart for the Phillips School District and for the Prentiss School District. So with that, they are gonna be able to have some easy accessible foods for children if they need it, like in the morning, in the afternoon, just to keep them nourished throughout the day. Obviously, we know that our school systems do a great job during the lunch period and stuff like that. But again, that's what they can provide. And we know that there's children that come to school hungry and they go home hungry. So we're just kind of helping to offset that. Additionally, they were able, the Health and Wellness Coalition worked with one of the local medical clinics to help look at food items for those carts too. So together we were able to combine on that. Additionally, one of the things that was looked at from the Health and Wellness Coalition is a couple years ago when they did the bento boxes, they did an assessment to see what was needed in the community and a lot of people talked about wanting cooking classes and how to cook on a budget and healthy foods and not knowing how to prepare them and things like that. Since then, we luckily have the YMCA that's providing some cooking classes, but we were trying to look to see how can we spread that a little bit more throughout the community. With the timeline we had for the grant, it was kind of difficult to make another food cooking class. So what we ended up doing is we ordered a bunch of crockpots with this funding. And the Health and Wellness Coalition individuals will be going to a few events here. They're going to be looking at the Phillips Farmer's Market later on this month, Park Falls Farmer's Market later on this month. and then at the Senior Living Expo. So with that comes a crock pot. There's going to be some education that they're going to have. Our WIC dietitian is going to be actually at many of those events talking to them about, hey, these are food items that are here at the farmer's market. Here's maybe an easier way to make them. And then family or whomever participates in just that little bit of activity with learning. they'll get a free crock pot to take that home. So we're asking them to try to purchase something from the farmers market at the same time and then give us some feedback. So additionally, we're looking at providing them to some of our families that are on case management. Even if some of the foster care families would need an item like that, we would be able to have those. And then the Youth Olympics that we did last year, that was more or less for socialization, physical activity, getting the whole family out and about. So they were able to use that funding to purchase supplies for that too. And then to kind of expand on some of the coalition activities for other nights not just that like the wednesday night um live and the music in the park they were um wanted to purchase some more activities for youth and for families in general so it was like um the larger uh connect four games and just things like that just to add more activity jenga all of that kind of stuff so um i know these may seem like small things um at times but when um to be able to use this and to see what it does for each individual that comes up. I mean, if we're serving 50 50 individuals crockpots, that's 50 more families that are that are getting that education that are getting that support from from our coalition. So any questions on that? And then the next thing we have on here is our flu clinic schedule. So this year we have our high dose, which is 65 and older. We're going to have the flu block and our regular flu zone. So the cost and everything is on the one side. And then we showed you what our October calendar looks like. This will be us going into the schools, into some of the businesses, and then our community flu clinics. So we're kind of here, there, and everywhere. And then not to mention having those vaccinations as well at our clinic site here and in Park Falls. And then the last thing we have on here is our community health assessment survey. So every three to five years, public health departments do a community health assessment. We have typically done it every three years because we've partnered up with medical facilities. By state statute, we only have to do it every five years. The medical group that we had been working with, they are kind of going with their own because things have changed for them. So we wanted to stick with a similar community health assessment that we've been providing the last couple of years so that we can continue to monitor the trend of the health of our community during that time. So from, you know, three years ago, we're hoping to actually expand this one for five years. So this is now active. We will be putting it, actually giving an online format of it pretty soon here. And we're going to be doing the assessment through the end of this year. Come beginning of next year, we're going to look at the data, bring in all of our secondary data, and then have our stakeholders meeting where at that time, that group will decide these are the priorities that public health should be working on over the next three to five years. So, and spins off of that is the work on the coalition, which we just talked about back at the, you know, with the ARPA funds and all of that, you know, Health and Wellness Coalition and the Substance Use and Mental Health Coalition. All of that work is back into what the community tells us on these surveys. so question about the surveys tiffany how how are you getting these surveys out yep so um they will be um they will be um electronic here soon as well we're going to be taking them to all of our flu clinics that we have we do have them available um at the like our outside displays in our hallway um any of the community events that we're going to senior expo all of that we're going to be providing providing these. So our public health update will have a link to them. We'll be putting it on the website. We're going to try to saturate so that we can get it back to the senior dining sites.

Yes. Yep. Absolutely. Yep.

Yep.

Yep. Okay. Good. Any questions? Yes.

Just a comment. What might be interesting, you know, I'm looking at this. and trying to figure out, okay, what am I gonna, how am I gonna fill this out? And if I wasn't on this board, I wouldn't be aware of a lot of things that are going on. So the average person in the county may have a perspective that may be right or may not be right. I was wondering if the department heads would do the same thing and come up with a consensus of what the people that are actually dealing with the problems think the problems are to compare with what you get from the public to see if there's a connection or mismatch, which then we may have to do something to make sure the public is better informed. Does that make sense?

No, that makes a lot of sense.

Because you guys have a whole different knowledge base than I would as the average citizen.

But you have a better knowledge base than the average citizen.

Because I'm on this board.

Because we're on the board. Right. Yes, so I can see that. When I look at that, I think too. Just think about it. Yeah.

Maybe it'd be worth...

And I think that's a lot that has to do with the stakeholders meeting as well, because it's usually a lot of those, it's the schools, it's, you know, members of, you know, members of the board, it's all the department heads that are there. So we're looking at the the data, we're looking at one, the survey results, we're looking at what the secondary data shows us. So what do the county health rankings say? County health rankings say that, you know, 14% of our county doesn't live near a grocery store or 25% of our county doesn't have broadband access. So we take all of that and compile it together, and then the individuals that have those experiences, like you're saying, that directly work with it, we're the ones that are going to prioritize what we think are the top three that we need to work on.

So we are doing that. Yeah. Okay, but it would be interesting to see the actual public input versus what you come up with.

And we can try to break that out, too, if we...

Well, and Bob, I think, you know, when there's the stakeholders, anybody on the board here can go to that, you know, and it's very, very informative because we do go through all of these. So if you have that interest, make sure that you let Tiffany know. Yes, Joe.

I think what Bob's trying to get at, too, is that you have data compared to present to the board that shows here's what the public's thinking. Here's what we're thinking as the board and the professionals. Do we need to do something more educational wise to get the public more up to speed? We know. Is that kind of what you're looking for, Bob? Something at this level to say, OK, here's the public. Here's us. We're close. We're not. Do we need to adjust from there? I think what you're doing is awesome because you're getting to the root problem. But I think what Bob's looking at is do we have a root problem with communication to the public? And is there a way to address that?

Nope. I completely understand that. And that's where a lot of our work with our substance use mental health coalition and our health and wellness coalition, that's where we try. the best that we can to get that information out to the community. So we're always open to more ways. I mean, you know your constituents best. So if they're not hearing that information, bring that back to us. Bring it back to me. Bring it back to Sarah. Bring it back to our Health and Wellness Coalition, our Substance Use Coalition, and we'll do better.

Well, I think what kind of haunts me a little bit as a supervisor is I'm thinking of my district, and it's pretty remote. I mean, we all are, but, you know, I have Ogema and Spirit. Not Ogema. I have, you know, down there, Knox and Spirit and Emory. And heck, I can think of how many people out there probably have never seen this. at all you know and I'm thinking okay now I think it might be my responsibility as a supervisor to maybe take packets of this when I visit their towns and maybe that's what we need to do is make sure that we keep them in our car and take them there I just I just I just know that there are a lot of people that aren't getting these and and you're not you're not getting the information you need from those deep-seated areas that's what I'm thinking

I'm hoping.

But it's a good cause. Go ahead.

And it's nothing coming from the department that I see. You guys are doing an awesome job. It's just being able to zero in on, okay, we don't know what we don't know. And data will always show you what you don't know because you guys use it all the time. And I know Bob does all the time. So I think that's the key point that we're looking at is, is there one other piece of data that we can provide to you guys through this survey that can say, oh, there's a point that we can go after too. So no, I think you guys are doing an awesome job.

Yeah, I agree. Just to piggyback on what George has said, I think you guys are doing a great job. You said you can do better. Well, we're always looking for ways to improve, but you're doing a great job.

Thank you. Always. Thank you. All right. That was very good. Thank you, Tiffany. Aging and Disability and Senior Services Unit, all I see on here are things that Dawn can cover. Oh, and then Patricia, she's back on here. So we are here. So are you ready to give a report on the TCC? Patty?

Hi. Yes, we held a meeting on Monday the... I don't have a calendar in front of me. I was absent from the meeting by mistake, but I was emailed that it was low key, uh, just routine reports and everything is fine. And we have another meeting scheduled in November.

Okay, thank you. I think Nick has some updates, if you don't mind.

It's not even major. The one thing that did pop up, I agree with Patty, it was a quiet meeting. There's not a lot going on generally in the county besides it's still got great ridership. It's a great program. What the concern is, is we received an email from the federal government saying that the funding for a lot of this programming may be reduced by about 23%. So, if that were to happen, it would be a huge, huge hit to this Bay Area Rural Transit programming. Obviously, costs go up every year with fuel or just buying new buses and paying people. So, to have a 23% hit on your budget is substantial. I had the numbers. It's millions of dollars for the program. So we're continuing to watch it. We did reach out to legislators saying this would not be ideal. This is a great program for rural communities. Transportation, I get where some of this stuff is coming from, right? They're saying, well, why are we helping these big, big, big metros with their busing program? But again, if it's getting people to work and it's getting people around the community, I don't understand how it's not a... viable or good program. So we're continuing to watch that. But again, that's the biggest concern we're seeing is if that funding were to be reduced, that's going to be big, big changes for the program. So on the local side of things, we are reaching out to the municipalities that we service or are partially servicing to request 2027 contributions. So, so far, we've heard back but not guaranteed from Park Falls and Phillips. We asked for an additional $500 from each of them this year, so I believe it's $13,000. I didn't hear anything negative about we can't put that in our budget, so that should be fine. Five Field last year gave $1,500. We reached out to them. They said thank you, as in we'll probably do it again. And then Butternut, I haven't heard back from, but they didn't give anything last year, but they wanted, you know, we did it late after the budget was already done last year. So this year we made sure to get the request in early. I haven't heard back, but I'm assuming they'll have one of us or I'll go to their evening meeting and request or kind of explain what the program is, why it's important. Bay Area Rural Transit also, Pat from their group comes and joins in those meetings because he has a who rides it and why it's important to their community. And then Eisenstein has requested that we're on their agenda for the 28th, if that makes sense. I think it's a Monday, Monday, the 28th to present. I can't remember how much we requested. Was it 1500 from them or just, I mean, even if they get 500, right? So it's a new contribution. We requested 1500 from them. So we'll go to that meeting and, explain why it's important to continue this, because on our end, we're maxed out on the grant that we use, so we need any assistance to maintain this program going forward. And just back up a little bit, the reason why we use a grant for this is because the whole community or the whole county is not necessarily served by the program. So we do five miles from Park Falls, five miles, or not from, but five mile radius from the city center of Park Falls, five miles radius from City of Phillips. We can go a little farther if there's time, but the buses have been very popular, so they don't have time to run the seven miles out to get It's a rider, but it doesn't hurt to ask if you're outside those limits. And then we have a, there's a bus that runs back and forth from Park Falls to Phillips, and then from Park Falls to Manaqua. The Park Falls to Manaqua one is mainly used for dialysis. We work with the hospital over there. We make sure the dialysis patients all can get in at the exact same time, so we pretty much reserve, I think it's four or five seats over there. They get on the bus, they get over there together, they can get back on the bus and not have to wait four extra hours for the next round trip. So that's worked out really well for families, and we want to continue that.

Down the lake?

We requested to them. I haven't heard back, but they did receive the doctor. I feel like we might have heard back from them as in, like, we'll put it on the agenda. But yes, we did reach out to Tona Lake also.

Okay. Any other comments?

Thank you, Patty. Yes, thank you. All right. ADRC governing board. Dawn, I have my minutes here, but they're not my minutes. They actually sent them to me, but I'm going to have you report. I don't think I had my head in the game during that meeting too much, so I had some personal issues going on.

All right. Well, good morning. So on the governing board meeting, so they went over the year-to-date financials, and the report was that there was really nothing unusual about them, pretty much the same as you would expect for the first quarter. And then they had a discussion in action on the 55,500 additional allocation that the of the north received from the state. And so that was approved and the decision was to split that between the 5 counties. So each county got 11,100. An additional allocation for the 2026 year. And let's see, they did go over the first month of using time and task for billing for the ADRC. So this is something different that's coming out of pure place instead of them filling out those spreadsheets. So this is the first month that they've done that. And so they did talk about that a little bit and overall it went pretty well. There's a few bumps in the road and they're still working on it, but they feel like for the first month is pretty good. So then, let's see. They talked about some openings that they have on the governing board and it's LCO and Redcliffe. They are still looking for people to fill those openings and then some hiring, some positions that are open in the tribal update. And I think that's about all I had notes on. Anything else, Paula, that you noted? I'm looking over.

I had Natasha send over her minutes and I know I don't see anything that you didn't, that you needed to discuss. Okay. So thank you. All right.

So then moving on to the Woodlands Commission meeting. So they had elections for chair and vice chair and secretary, I should say. And it looked like to me that the same people were reelected to those positions. They had a policy review, which I found very helpful on why the commission was established back when it was done, because I didn't have that background, so I actually found that very interesting. And it was really nice that they kind of went over all of that. And then they did the 2025 budget review, and I'll just say that they did very well in 2025. They ended up with a surplus at the end of the year, so overall they did well. Then they talked about the 2026 budget, where it stands so far. 2026 is not going as well. So then the next talk was about why that's happening, and that was in their census update, and their census is overall down. And so that is why their budget is not looking as healthy in 2026. So they have a number of open beds and they're kind of working to. To get those filled, but it's been a little concerning and 1 of the. One of the things that was brought up is that the MCOs, so that would be like Inclusa and MyChoice, have been going in and making the determination that people that are at nursing homes do not have a skilled nursing need. And they're saying if they don't have a skilled nursing need, Inclusa will not pay for them to stay there. So there was a number of people that were moved from the nursing home into a lower um lower need like an assisted living or stuff like that so that's one of the things they were tying into the reduced census so then they did the rate setting for 2027 in the enhanced rate for 2027 it's going to be 80 a day which Am I right, Paula, in saying that's the same as it was this last year, I believe? That's right. They're just holding the same.

Yes.

Okay. And then there was another presentation about population growth and staffing shortages, which we're seeing everywhere, staffing shortages, nursing homes that can't fill beds because they don't have enough staff to care for the people they have there. So that was also a very interesting presentation, I thought. Kind of the... might say the wave that is coming for all of us. And I think, I'm trying to see if I missed anything. I think that was about it.

Yeah, if you weren't there in person, and I wasn't as well, they did a campus tour. Yes. Right. Yes. And they did say that they'd like to offer that again. And I would suggest that if that does happen, that we take a ride down there.

Okay.

Yeah, we can certainly do that. It's very interesting. It's been a while since I went on it. I don't even think I went the extensive one. But, you know, just like getting that report about the history of, you know, Woodland Enhanced, being there to see the facility would make sense too also, especially when you're dealing with giving all of these, you want to put something to make sure. So when that does come up, let's talk about that, okay?

Okay, yeah, that sounds good. I think, what do I have? The next meeting's in February, so. February 25th. Yep. So obviously that'll be weather-limited. Yeah, weather-dependent, yes.

Yes, so any questions? And if not, thank you, Dawn. Oh, you're welcome.

Thank you so much.

And economic support, I understand Beth is not here, so Sarah will.

Every year we bring this policy to the boards to be reviewed and approved. This here policy is for energy assistance. It's no cost for the county. It is a state and federal grant to assist households who are losing their home energy source. And here it explains the guidelines that we need to occur in order for them to receive the assistance and explains how the department can grant the exceptions. Thankfully, we've kind of gone through this every year. We need to have an approval on this.

So we need approval of this. This would be this one that you have in your packet. And like Sarah said, every year we go through this. So who would like to be the lucky person to make that?

I'll move to approve.

Popish moves to approve. Mr. Warko waved his hand. He's seconded it. Okay. Any other discussion? Hearing and seeing none, all those in favor? Aye. Those opposed? Okay.

Can I ask a question? How much money goes through this program usually in a year? Do you have any idea? No.

Carrie, do you have an idea of how much goes through?

Yeah.

Well, we've got a huge grant.

I know what we get for our grants, and then there's a different portion that kind of just gets funneled through the benefits. The benefits should be in our annual report that the community received. Otherwise, our grants are typically We did get notification that next year it's not setting down, but it did jump up almost 90,000.

Oh, wow.

Okay.

And most people take the whole 1,200, I suppose.

You know, we don't use this really a lot. No. Yeah.

Okay. Thank you.

Yeah. Okay. So that motion has carried. Did we vote on it?

Yeah.

Yeah, we need approval. We need approval. All those in favor? Aye. Those opposed? All right. Motion's carried. And the approval is there. I don't need to sign anything, do I? No. All right. I ask that every year.

Just in case.

All right. Next one, fiscal and administrative unit. Carrie, come on up. High cost placements reports.

Okay.

Before I jump too much into it, I did just want to give Katie Voss a shout-out on our annual report. She's the one who kind of put that together. Our Unit 3 just kind of give her the information and all sorts of different just not organized at all. And she does a really good job of organizing that all and getting it done for us.

Well, thank you for bringing that forward. You make sure she knows that we really appreciate it. Okay. I will. Thank you.

I have a lot of stuff going on here, I guess. Okay, so we do have our original high cost placement report on the children and youth, and then also the AODA. As we've kind of discussed, those expenses do kind of tend to be about a month and a half to two months behind, and we had kind of let you know that there were going to be some higher costs rolling in that are now starting to be reflected. Were there any questions on this report?

Do you think for our upcoming budget, you might do a better job on the budget? I know you got to work with those people in accounting.

Yeah, no, I don't know.

I mean, you don't have much left to spend.

No.

Okay.

So then, like we had kind of talked about last meeting, we were going to start working on giving you guys just a little bit of something different that kind of dives a little deeper into some of these numbers. um so i do have just a little snapshot of just an example of a program to see if this is kind of what you'd be looking for and if so then we can do some more of the work to dive into the a little bit deeper oh she's got it okay

Thank you.

I should have called you.

I just looked over. Oh, thank you. What are you saying?

Okay. So that was just a joke. But sometimes that's how I feel some days, trying to explain things. So I had just put together just a random thing. Because Bob did like that one chart that we had that had stuff all over the place.

Oh, I liked that too.

Yeah, it didn't make too much sense. She's talking about this, Jill. I don't want to waste county resources. I know. yeah there you go this one is okay so I do have a real report and it's this kinship one so kinship this one was a little bit easier just to pull out just by how we have our accounts and everything set up but kinship is embedded in into this bigger report that you get. One of the things, too, when we kind of started looking at it more, it's like, well, kinship isn't necessarily a high-cost placement. It's a little bit on the lower end. So would that be something that we really would want in the high-cost placement? When we kind of started looking at everything that goes into here, we could potentially maybe separate that out a little bit by placement so you can get a truer picture of where the high cost placements are at. Granted, it's a lower cost placement, so it's not gonna have a huge sway in like the numbers that much, but we could kind of dive in a little bit. So for the kinship here, and this is just, Throwing it out there, you can provide feedback, like, no, we don't want this, or what we were thinking, something else like this. So this is just a sample. We kind of broke it down by the revenue and expenses, and then what is kind of the personnel cost that goes into it, and then also the operational parts of it. And then what that revenue is, that also offsets that expense. So for kinship, we do get a grant. We get two different grants actually for it. The one is an assessment and that one does tend to be for more of our personnel costs for when they go in to assess if a home is like ready or get it set up for that placement to be there. Then the kinship benefits, that is for the eligible caregivers who are taking care of the children. And Sarah, feel free to interrupt if I'm not explaining it all entirely. But so that's the funds that then kind of just get filtered through that go to the caregivers taking care of that placement. So that one is technically a placement cost, but it's a benefit. That one, too, tends to be 100% reimburse that placement does through our grant. They do kind of look at our statistics, what our projected caseload is, and then throughout the year they'll kind of reevaluate and see where we're at. This funding actually comes in two separate segments throughout the year, too, so I'm thinking that's kind of when they take a look and adjust it. Also, too, the department at the state level, if they have extra funding and we are like, you guys are way off on your estimating here, we need more money, they'll sometimes, we can put in that request, and if there's additional funding, they'll recoup us for that. Then I guess also too to note, on your big report, it says how expenses come in about one and a half to two months later. That's also the same thing with the revenue. So we report our expenses monthly at the end of the month. So August just ended. We will be reporting our August expenses at the end of September, and then we get reimbursed for that then in October. So you can kind of see how that's why looking at this right now, there's more expenses, but that's because not all of our revenues come in yet. And then on the flip side is just kind of breaking the kinship out by revenue and expenses throughout the course of the year.

years. Yes.

Giving you just kind of that snapshot. And you can see in 2025, it's like, oh, well, how did we get more revenue than expenses? That doesn't make sense. Well, what happened there was in one of those cases in 2024, you can see there's a bigger gap. We did end up getting additional funding, but it was after period 13, much later in the year. So it kind of just fell and sat into 2025. So any questions about that? Is this information something that you would maybe like to see for some of the other different placement types? Or is this too much detail, not enough detail?

This was kind of that start of the breakdown of The chart we normally give where it just says here's all our high cost placements and it really didn't talk about what revenues came in and what part was levy versus like this one is all was in that number, but really it was a break even so it inflates the total cost, but it also gets offset. So. It's something we're reviewing or working on, but it is a hard... It's hard. There's so many programs, so many line items, and every year it seems to change because some legislator says, oh, I want a different name on the program costs or the grant should go this way or you need to apply this way and use it this way. So our numbers change like the wind with some of that, but it all in the end was a number. We just never had the revenue that showed how much are we... using levy or not using levy.

As clear as this you're saying?

Yeah, so that would be roughly that was the start of like the deeper dive.

For those of you who cannot see this is I don't know, it looks like a game a kid would play on. I don't know.

Whatever.

Anyway, kind of fun.

I appreciate it.

I thought that was very informative to break that down a little bit more. So thank you. If you can do that every so often, I think it's good.

Thank you.

Okay. I do miss your sheets that you did have these kinds of things before. She giggles. Okay. Any questions for Carrie? No? All right. Thank you, Carrie. Okay. Thank you. Director's Report, Sarah Rees-Soha, Agency Updates.

Go ahead. I'd like to introduce Stacey Pomeray, and Stacey is filling our position. It's the RN, and we're statutorily have to have an RN on our board, and I'd like to thank her. She's a manager at the Aspires Regency and DeRoy. So I'd like to welcome her and really appreciate her sitting in.

I received this letter yesterday in the mail. Well, where else would I receive it? It comes from the State of Wisconsin Department of Health Services, Division of Public Health. And it's addressed to me, carbon copy to Tiffany, Sarah, and Krista Kupp, our Western Region Director. I'm going to read it. I'm very proud of this, and I think kudos should go out to where they need to. Dear Paula Hodek, the Wisconsin Department of Health Services, DHS, congratulates Price County Health and Human Services for demonstrating the infrastructure and program capacity to be certified as a Level 2 health department. I'm happy to report Price County Health and Human Services provided all services required by statute and rule. Wisconsin's public health systems rely on close partnerships with local entities and leaders. Local leadership is critical to ensure public health responsibilities and services are implemented in ways that are tailored to local strengths and needs. I want to acknowledge the work of Price County Health and Human Services staff. Health Officer Tiffany Palachuk did an excellent job of providing quality evidence of meeting statutes and rules. Although Wisconsin administrative code and statute require the health departments to be reviewed at a minimum every five years, Price County Health and Human Services volunteered to be reviewed early as part of a DHS-led initiative to balance the number of reviews each year. This will help ensure adequate DHS 140 program capacity and support high quality reviews. We appreciate Price County Health and Human Services flexibility and willingness to assist with this project. I also appreciate the support of the Price County Health and Human Services Board for maintaining a strong public health department. When the basic needs of people and communities are met, they can better prevent and recover from challenges to their health and well-being. I am sure with ongoing support for evidence-based quality public health initiatives by you and your fellow board of health members, the Price County Health and Human Services will continue to protect and promote the health of the people in your jurisdiction. Sincerely, Paula Tran, State Health Officer and Administrator. I want to make sure I want to read this to the county board as well. I think they all need to hear this. This is very nice. Nice job. Thank you, Tiffany and your crew. Thank you. Actually, I'm going to pass this down to you, Jules. If you will make sure this goes in the county board packet, that would be good.

Okay. Also, I received an email from Steve Budnick. He's the Northern Income Consortium Administrator. And he had indicated that they, Northern Income, they had a budget training program to ensure case accuracy. And before the training, all staff were required to do an activity that also had a quiz. The quiz had some trick questions. So anyone who received 100% truly deserves recognition. Only a fraction of the Northern Income Maintenance Consortium staff scored 100%. So I was really proud of the Price County team. So Deanna Hertland, Susie and Christine 53 took the test and our three out of eight had 100%. So that was pretty exciting. That was pretty awesome for them.

Okay, um, next I have for personnel. All right.

Um, we have interviews for our behavioral health position, um, social worker on September 14th, and also for our Ogima and park falls nutrition site managers. We have that on September 14th. Um, we did have two resignations. Um, one resignation is from Kim Polster, who is our fiscal legal assistant. Um, she will be retiring, um, in December. But she gave us notice because we're going to need to have some overlap for the amount.

Are you wanting to say something?

Oh, I saw him pull up and I thought, oh. So, yes, an extreme amount of knowledge. And what she does, there's so many different programs dealing with the children and youth. And then Jasmine Marlinga, who is our foster care coordinator, has resigned. And so she'll be done in the beginning of October. So we will have that position, which is a part-time position.

All right.

All right. So I see nothing else on the board. The next meeting is October 14th, 2026. And with that being said, hearing no objection, I call this meeting adjourned.

Thank you all.

Thank you, Patty.