Nov 19 Regular Monthly Meeting: October 21, 2021
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
October 21, 2021 @ 4:00 PM
TRUSTEES: Barb Bodnar Kerry Bartlett
Ann Marie McCrystal Marybeth Cunningham
Michael Weiss Karen Deigl
STAFF: Kate Voss Jennifer Frederick
Jennifer Peshke, Esq. Ann Marie Suriano
ATTENDEES: Eric Garza Elizabeth Appleton
Michael Birnholz Myra Weiss
Liz Bruner Brett Hall
Philip Cromer Vicki Soule
Convene Meeting – Marybeth Cunningham, Chair
Mrs. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM by welcoming those in attendance and via Zoom. Rabbi Michael Birnholz provided the invocation and Dr. Weiss led the group in the Pledge of Allegiance.
Consent Agenda- Marybeth Cunningham, Chair
Mrs. Cunningham asked for a motion to approve the budget discussion meeting minutes dated September 7; first public budget hearing minutes dated September 8; chairman’s meeting minutes dated September 22; final public budget hearing dated September 23; regular monthly meeting minutes dated September 23; and an October disbursement of $757,613.06. Mrs. McCrystal made the motion which was seconded by Mrs. Bodnar. The motion carried unanimously.
District Counsel Report – Ryne Hartt, Esq.
Mr. Hartt provided the District Counsel report on behalf of Mrs. Peshke who was out of town. He stated that their office has responded to questions from Trustees as they have arisen pertaining to various matters the Hospital District is handling at the present time. The right of way transaction with the County has been completed and they are still working with Cleveland Clinic’s counsel and the VNA’s counsel to amend the existing Agreements to reflect the changes. Additionally, they are looking into how a potential county ordinance change regarding stormwater retention, may impact the IRC floodplain and stormwater code changes, as it relates to the property the Hospital District owns. Lastly, Mrs. Peshke and Mrs. Suriano attended a meeting with County representatives, as well as the CCIRH representatives and their counsel, to learn more about this issue. She will report more on this matter as it develops.
Financial Statement Review- Allen Jones, Treasurer
Mr. Jones provided his treasurer’s report and stated that the District just completed its 20-21 fiscal year and that October begins the new 21-22 fiscal year. He explained that as of Sept 30, the District had just over $6.4 million in cash and investments. After a monthly disbursement of $757,000, approximately $5.6 million in cash and investments remain. The District is not likely to receive any tax revenue in October and early November, so these funds will support operating expenses and funded agency payments, until tax revenues begin to be received towards the end of November. Mr. Jones further explained that the District has now completed its commitment to funding indigent care at CCIRH, and monthly spending is now below $800,000. Additionally, with the approved FY 21-22 millage rate of .7144, he estimates that tax revenue will total a little over $14.7 million. This amount is approximately $1 million less than the previous fiscal year but still on average is about $1.2 million per month, giving the District sufficient funds to cover its projected spending and to support healthcare solutions to improve the health of the community. Further, Mr. Jones stated that in the previous fiscal year the District earned a little over $55,000 interest from the State of Florida Fixed Income Trust managed by Water Walker. This is down considerably from the previous fiscal year, since interest rates plunged in response to the pandemic. Mr. Jones stated that this promises to be a transformative year for the District and he looks forward to much public engagement as they move through the Strategic Visioning process.
Executive Director Report- Ann Marie Suriano, Executive Director
Mrs. Suriano stated that she provided her written report to the Trustees ahead of time and has no further updates at this time.
Funded Agencies Semi Annual Report- Senior Resource Association- Liz Bruner, VP Philanthropy
Ms. Bruner addressed the board and provided an update concerning Senior Resource Association (“SRA”) and their Emergency Meals on Wheels and Public Guardian programs, which the District currently funds. She will also discuss the newly funded Emergency Alert Response System (“EARS”) program which the District is now supporting in FY 21-22. She began her presentation by providing an update concerning the Public Guardian Program. As of August 31, they were actively managing 29 cases and the goal for next fiscal year is 35. She reviewed further data concerning this program with the Trustees. Next, she discussed the Emergency Meals on Wheels program and the criteria needed for a person to receive this service. She reviewed the program’s outcomes measures and stated that 30 seniors received 1,061 emergency meals and 13% requested meal deliveries for 14 additional days. 93% of those individuals were not re-admitted to a hospital or healthcare facility and 2 converted to private-pay Meals on Wheels service, to continue nutritional support. Lastly, she discussed the EARS program. Through a collaborative effort with Pat Knipper from the VNA, a request to the District was made to further support this program and some of the most vulnerable seniors in the community. To be eligible for this program a person must be an Indian River County Resident; at least 60 years old; or 18 to 59 and designated as disabled; and have a gross annual household income that does not exceed 200% of federal poverty level guidelines. She further reviewed the referral and intake process and stated that SRA receives referrals from VNA and other organizations for clients requesting service and a case manager is assigned to assist the clients with the application process. Once the application is reviewed and approved, the case manager completes an in-home assessment and the ADT referral form for qualified clients. There are three types of systems available for the client to choose from and the case manager helps in choosing the best fit for the client. All the systems are equipped with 24/7 monitoring by senior sensitivity-trained technicians; fall detection technology; amplified hearing & voice for 2-way conversation; and are waterproof which is ideal for bathroom use. There was Trustee discussion surrounding this program and the type of monitoring SRA does to make sure that the clients are compliant in wearing the device. Ms. Bruner indicated that case managers provide follow up visits to clients, and a wellness check is also conducted. Additionally, many of these clients also utilize the Meals on Wheels services and are monitored through that program as well. She indicated that SRA will provide the Trustees with semiannual updates on the EARS program and thanked the Trustees for their support.
Mental Health Collaborative- Brett Hall, Executive Director
Mr. Hall addressed the Trustees and provided an update concerning the Mental Health Collaborative and the McCabe Connections center. Mr. Hall stated that Collaborative has completed its use of CARES Act funding that they received and through an unmet needs committee, they identified areas they could help improve upon. With the funding they were able to train additional clinicians to provide mental health services. Those clinicians were also trained in additional areas of mental health support and best practices. He explained that prior to COVID, 1 in 5 individuals were seeking mental health services. Through the pandemic that number has increased to 2 in 5, and this is expected to increase again, after the peak in psychological crisis. Another initiative they focused on was seniors in long term care facilities, who were experiencing depression and isolation due to the pandemic. They partnered with some local facilities and provided support to care givers and residents, and have seen positive results. Additionally, around $15,000 in CARES Act funding was reimbursed to residents who applied for reimbursement for mental health services they sought. He further discussed that over the next 3 years, Indian River County will receive around $700,000 through the American Recovery Plan, to provide mental health services in the community. With this in mind, Mr. Hall is pulling community leaders together and developing a strategic plan that will outline how to best allocate these funds. Additionally, the Collaborative launched a mental health literacy campaign and hired a marketing firm to help assist with this campaign. He also provided an update concerning Mental Health First Aid, which is still being offered to the community. Johns Island Community Service League has provided funding to train an additional 11 instructors, which will help in achieving the goal of providing this training to 1,200 people in Indian River County, per year. More information on this program can be found on their website. He then provided an update concerning the McCabe Connections Center. He indicated that their walkthrough volumes are still low, but they continue to provide connections services through telephone calls. He has seen an increase in 30–40-year old’s seeking mental health services and there have been delays in getting therapy services for individuals with commercial insurance. In those cases, their organization will provide temporary resources for that patient, until they are able to be seen by a clinician. Additionally, they are working on developing a clinical training institute initiative, with a goal of Indian River County being a destination for mental health education in the State of Florida.
Tykes & Teens: Evidence Based Mental Health Programs Funding Request- Eric Garza, CEO & Elizabeth Appleton, Director of Mental Health
Mr. Garza addressed the group and provided a brief historical background of Tykes & Teens and stated that they have been providing mental health services to children and adolescents on the Treasure Coast for the past 25 years. He also discussed other programs that Tykes & Teens operates, specifically the Infant Mental Health (“IMH”) program which began in Indian River County in 2016. Ms. Appleton then provided a summary of their funding request. She stated that they are requesting the addition of one full time salaried Mental Health Consultant position, along with the cost of specialized training for that individual, which results in a total request of $83,326. She explained that the addition of one consultant will allow the IMH therapists to increase client availability. There was further discussion surrounding the need for this service and Ms. Appleton reviewed some data and outcomes on the same. Dr. Weiss voiced his concerns over the data being discussed and felt it was not accurate. The Trustee also question how to measure the success from this program and if they have trackable metrics. Ms. Appleton reviewed outcomes and successes that have been achieved in these classrooms through this program. It was further discussed that they would provide additional data and updates to the Trustees throughout the year. After further Trustee discussion, Mrs. Cunningham made a motion to approve the request, which was seconded by Mrs. McCrystal. The motion carried 6-1, with Dr. Weiss in opposition.
We Care Funding Request FY 21-22- Robi Robinson, Executive Director
Mr. Robinson stated that he has submitted a draft proposal for funding the operations of We Care, for the Trustees to consider. He stated that since June, the We Care Board has met several times and has now hired a consultant to review the clinic data gathering and reporting methods. A draft has been developed of this data and has been sent to Mrs. Suriano for review. Their Board has also met to review and discuss the proposed drafts and has provided feedback as well. He has also worked with TCCH and WFHC to explain the new model and continues to develop better working relationships. As a follow up to some concerns the Trustees voiced at yesterday’s Chairman’s meeting, Mr. Robinson spoke with Mrs. Suriano to discuss the same. One major concern was that many Trustee felt that this proposal was not a new model, however the funding request has now been reduced by almost half. It is proposed that a health care navigator and assistant will now process and manage referrals instead of an RN or physician, which will be cost savings. Mr. Robinson further stated that they will continue to hold their clinics to provide specialty areas of services such as ophthalmology or mammograms. There was Trustee discussion and many felt that discussions with Dr. Mackett and CCIRH should take place to identity further gaps in connecting patients to specialists. There was also discussion concerning the cost of services through Vero Radiology, who up until recently identified as a private entity, but is now under the ownership of CCIRH. Mr. Jones addressed the group and stated that he believes this board is more comfortable with funding patient outcomes, rather than agency expenses and it has been difficult to obtain data from We Care that shows how many patients were successfully connected to and obtain specialty services and treatment. There was further discussion and many Trustees were comfortable with the ophthalmology/cataract clinic funding requests as outlined. Mr. Robinson asked if the Trustees would be willing to approve the ophthalmology/cataract clinic request as proposed and then allow the We Care Board to further address and update their proposal, post these discussions. Mrs. McCrystal made a motion to approve the funding request to support the ophthalmology/cataract clinic in the amount of $20,000. The motion was seconded by Ms. Deigl and the motion carried unanimously. Mr. Robinson stated that he will gather more information and research for consideration, and bring an amended proposal back to the Trustees before December.
There was no public comment and the meeting was adjourned at 6:30 PM