1997-09-11 Work Session
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
WORK SESSION, SEPTEMBER 11, 1997
BOOK 26
PAGE 96
ASSEMBLY
The New Hanover County Board of Commissioners held a Work Session on Thursday,
September 11, 1997, at 10:30 AM. in Room 501 of the New Hanover County Administration
Building, 320 Chestnut Street, Wilmington, North Carolina.
Members present were: Commissioners Buzz Birzenieks, Charles R. Howell, Vice-Chairman
William A Caster; Chairman Robert G. Greer; County Manager, Allen O'Neal; County Attorney,
Wanda M. Copley; and Clerk to the Board, Lucie F. Harrell.
Commissioner Ted Davis, Jr., a local attorney, could not attend the Work Session because
of a court hearing.
Chairman Greer called the Work Session to order.
Deputy County Manager, Andrew 1. Atkinson, reported the Work Session was called to hear
presentations on programs for the aging administered by New Hanover County and other agencies.
He introduced two representatives from New Hanover Regional Medical Center, Ms. Ruth Glazer
and Ms. Ada Atkinson, who work with the aging population.
Deputy County Manager Atkinson stated that persons were living longer and reported
between 1991 and the year 2010, the 60+ population was predicted to increase by 45% with the
overall population increasing by only 33%. With continued growth in the 60+ population, more
services will be needed for the elderly. He requested the Commissioners to keep these figures in mind
when hearing the presentations from the Department of Aging, Department of Social Services, and
Health Department.
PRESENTATION BY THE DEPARTMENT OF AGING
Ms. Annette Crumpton, Director ofthe Department of Aging, reported the mission statement
for the department was to provide services which promote wellness, encourage independence and
enhance quality oflife for all persons sixty years of age and older.
The Department of Aging does not receive Medicare or Medicaid funding. Funds are
received from the following sources:
(1) Home Community Care Block (HCCB) Grant: Approximately $400,000 is received annually
from the HCCB grant, which is comprised of85% federal funding, 5% state funding, and 10%
local funding. The grant funds are distributed to all programs except the Retired Senior
Volunteer Program (RSVP).
(2) Retired Senior Volunteer Program (RSVP): Funding in the amount of $46,000 is received
through the National Senior Service Corporation for administration of this program.
Discussion was held on the total budget for the Department of Aging. Director Crumpton
reported that grant funds were received in the amount of $400,000 plus $46,000 for the RSVP
Program; however, the total budget for the Department of Aging was approximately $1,000,000.
Slides were presented reflecting the following services provided to the 60+ population:
(1) Congregate Meals: Currently there are five (5) sites spread throughout the community. The
program currently serves 419 clients with 38,363 meals served.
(2) Home Delivered Meals: Currently there are 356 clients served with 67,709 meals delivered.
Volunteers pack and deliver the meals.
(3) Transportation: Currently there are 350 clients served by the Human Services Transportation
System with a total of 20,531 trips made over the past year. Clients are transported to
medical appointments, nutrition sites, drug stores, and grocery stores.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
WORK SESSION, SEPTEMBER 11, 1997
BOOK 26
PAGE 97
Discussion was held on the persons eligible to receive home delivered meals. Director
Crumpton advised that all clients must be 60 years of age pursuant to State regulations; however,
clients are prioritized locally according to physical conditions and inability to be transported to
nutrition sites. There are approximately 67 clients that need to be served. Due to the shortage of
volunteers and lack of funding, there is a waiting list for the home delivered meals. Meals are served
five days a week and the food must be delivered within an hour to keep the food at a specified
temperature. The Meals on Wheels Council, a non-profit organization, delivers meals on weekends
to a smaller number of clients that have no family members or other persons to provide meals.
(4) Information & Referral Case Assisted: This program provides information and resources to
persons moving into the community with specific needs. The program serves 450 clients.
A case worker visits the home to determine the needs and connect to other County resources.
The major focus is to keep persons living in their homes.
(5) Care Management: This program serves five clients and provides the services necessary for
the clients to remain in their homes.
( 6) In-Home Aide Program: This program serves 123 clients with 16,780 hours of service.
Personal care is provided through contracted services to allow the client to remain in the
home. A great deal of dialogue occurs between the Departing of Aging to be sure the
agencies providing the services do not duplicate efforts.
(7) Adult Group Respite: This service is contracted with Elderhaus to provide family members
time away from caring for their elderly parents.
(8) Adult Day Care: This service is contracted to provide care for elderly persons while the
members of the family are working.
Director Crumpton advised that funding was distributed by the Home Community Care Block
Grant for the programs; however, clients capable of paying for services are encouraged to pay. Also,
clients using the Human Services Transportation System are requested to pay when resources are
available.
(9) Senior Center Activities: The activities focus on wellness, education and social events. The
Senior Center serves approximately 6,999 individuals who come in once or twice a week. The
Center serves 52,455 persons who come in more than three times a week.
In closing, Director Crumpton expressed appreciation for being able to discuss the programs
rendered for persons 60 years of age and older. She stressed the importance of providing services
that promote wellness and encourage independence for these citizens.
PRESENTATION BY THE DEPARTMENT OF SOCIAL SERVICES (DSS)
Mr. Wayne Morris, Director of the Department of Social Services, reported the department
provides a variety of services to aged and disabled residents of New Hanover County. The goal is
to provide services to these persons so they can remain in the least restrictive setting. Some of the
programs do not distinguish between aged and disabled, with other programs using different
definitions for "the aged."
The following programs are administered by DSS:
(1) Medicaid: This program includes all adults that are age 65+.
(2) Food Stamps: This program includes persons that are age 60+.
(3) Evaluated Reports of Abuse, Neglect and/or Exploitation of Persons 60+: Once a report is
received, an evaluation is performed and a determination is made as to the services needed
to take care of these citizens. A majority of the reports involved self-neglect.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
WORK SESSION, SEPTEMBER 11, 1997
BOOK 26
PAGE 98
DSS workers assist with placing these citizens in rest homes or nursing homes if needed. The
number of 60+ clients during the past year was 292.
(4) Adult Day Care: This is a small service contracted through Elderhaus for 13 clients that are
60 years or older.
(5) Provision of Case Management Services: This program enhances personal care to 38 aged
persons in Adult Care Homes. This assistance has prevented these clients from being moved
to costly nursing homes.
(6) Transportation: This program provides transportation, case management, emergency financial
assistance to 824 aged residents.
(7) Supervision of Adult Care Homes: DSS is responsible for supervising 22 Adult Care Homes
with a total of 661 beds. A case worker must visit each home once a month to evaluate
services and be sure that residents are receiving proper care.
Director Morris presented the following statistics:
(1) In the month of August, D S S assisted 1,178 elderly adults to supplement diets with Food
Stamps. DSS assisted 213 elderly adults in the Adult Care Homes. The total cost of the
program is $1.5 million with 50% paid by the State and 50% paid by New Hanover County.
(2) DSS provided limited Medicaid benefits to 585 adults age 65+ through the Medicaid for
Qualified Beneficiaries program. Medicaid pays only Part B of the Medicare premium and
hospital co-pay for Medicare. Part B covers medical insurance that must be purchased, at
approximately $43 per month.
(3) DSS provided full Medicaid coverage for 1,824 residents age 65+ at a cost of $22 million.
The racial breakdown of recipients is 47% white, 40% black, and 13% unknown. Full
Medicaid coverage includes payment of Part B of Medicare, hospitalization, doctors, dental
care, eye care, medical equipment, nursing home care and up to six prescriptions per month.
(4) In August, 523 disabled and aged residents received Medicaid assistance with long-term care
costs. Out of this number, 365 residents were placed in New Hanover County nursing homes
and 158 in nursing homes located outside New Hanover County. Currently, there are 709
nursing home beds in New Hanover County.
(5) Nursing Home care costs are in excess of$3,000 per month, per person. In FY 1996-97,
Medicaid payments to long-term care facilities for New Hanover County residents totaled
$13.6 million. This figure does not include drugs and fees for doctors.
(6) Heating assistance in the amount of $81,000 was provided to elderly adults last year.
(7) The Director ofDSS serves as guardian for 17 incompetent elderly adults.
(8) The Community Alternatives program for disabled adults is operated by New Hanover
Regional Medical Center. The program is funded by Medicaid with a County cost of
approximately 5%. Statewide, 76% of all nursing home care residents are Medicaid qualified.
Discussion was held on the supervision of Nursing Homes. Director Morris advised that
pursuant to State regulations, DSS could not become involved with the supervision of nursing homes.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
WORK SESSION, SEPTEMBER 11, 1997
BOOK 26
PAGE 99
Commissioner Birzenieks inquired as to the amount of assets that a person can own to receive
Medicaid assistance?
Director Morris responded an individual can have $2,000 of cash reserve. All income, social
security and retirement, less $30 for personal needs, must be turned over to the Nursing Home to
defray the cost of care. The remaining nursing home care is paid by Medicaid. If a client is in a
nursing home with a spouse remaining at home, a certain amount of income can be protected for the
spouse. The home and one vehicle are not counted as assets. Currently, the average cost of a nursing
home is $3,600 per month.
In closing, Director Morris reported based on June 1997 figures, the 65+ population
constitutes approximately 10% of the average monthly Medicaid caseload and 25% of all Medicaid
expenditures, which is $20 million out of $80 million. He stated with adults living longer, these
figures will only increase.
PRESENTATION BY THE NEW HANOVER COUNTY HEALTH DEPARTMENT
Ms. Beth Jones, Communicable Disease Director, reported the Health Department provides
services to all citizens ofN ew Hanover County regardless of age. Programs targeted specifically for
the 60+ population are as follows:
(1) Influenza, Pneumonia, and Tetanus Vaccines: The largest outbreak of influenza in history
occurred in 1918 and was known as the Spanish Flu. The epidemic began in a mid-west U.
S. Army Base. The soldiers carried the flu to Europe when fighting in World War I and
approximately 500,000 people died throughout the world because of Spanish Flu. The next
epidemics of influenza occurred in 1957, known as Asian Flu, and in 1968, known as the
Hong Kong Flu. Data collected over the years has indicated that persons who take the
influenza shots annually have less severe case of flu. The elderly are encouraged to take flu
shots because of their vulnerability to influenza.
(2) Tuberculosis Screening and Treatment: There were three (3) active cases of tuberculosis in
1996-97 among the 60+ population and 90 patient encounters for preventive medicines.
Screening and treatment of tuberculosis among the elderly is of great importance.
(3) Evaluation ofInstitutions and Nutrition Sites: Routine inspections of institutions and nutrition
sites provided by the Environmental Division of the Health Department greatly benefit the
60+ population even though the program is not targeted for this group.
(4) In-Home Health Services: Nurses go into homes for people who are not eligible to receive
Medicaid or Medicare reimbursements, but are in need of care. Evaluations and monitoring
of the patients are maintained and many small services are provided to allow these clients to
remain at home.
(5) Nursing Clinics: There are five (5) Nursing Clinics spread throughout the community that
provide screening services with no fees charged. Many diseases have been prevented from
developing through screening services.
(6) Adult Health Screenings: Screenings are provided before the age of60 at various work sites.
The workers are checked for cholesterol, blood pressure, and blood sugar. If necessary,
prescription medication is provided.
(7) Monitoring of Adult Day Health Care Centers: There are two (2) Adult Day Health Care
Centers, Elderhaus and Liberty Commons. A Health Department Nurse in conjunction with
DSS staffis required to visit each adult day care center once a month and visually inspect the
facility for safety, medical, and nutrition needs.
(8) Vial of Life: This program is sponsored by the Junior Sorosis and New Hanover Regional
Medical Center. Persons are identified and given stickers to be placed on windows
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
WORK SESSION, SEPTEMBER 11, 1997
BOOK 26
PAGE 100
denoting that important medical information is contained in a vial in the refrigerator so
emergency personnel will be aware of these conditions when responding to calls.
(9) Educational Programs: The following educational programs for the elderly are administered:
(1) Safety Proofing Your Home; (2) Exercise and Nutrition; (3) Quit Smoking; and (4)
Summer Safety.
(10) Breast and Cervical Cancer Control Program: This program provides pap smears, breast
checks, and mammogram screenings. The service is free for women over the age of 50 if
financial guidelines are met. Medicare and Medicaid will not pay for screenings provided by
this program.
(11) Laboratory Services: This program provides Community Health Wellness screenings with 300
clients served from the 60+ population.
In closing, Ms. Jones spoke on the importance of immunization programs and screenings that
are provided to the elderly as well as to the overall population. Preventing diseases or early detection
of many diseases can be controlled or cured.
In closing, Deputy County Manager Atkinson reported if these programs were not offered
to the elderly, the following consequences would occur:
· Disease would spread more rapidly.
· Neglect and abuse of the elderly would go unchecked.
· Medications could be administered inappropriately.
· Caregivers would provide inappropriate care.
· Families may be unable to work.
· Elderly caregivers' health would deteriorate due to the lack of assistance.
· Unhealthy lifestyle practices would go unchecked.
· Malnutrition could occur.
· Hospital admissions would rise, accelerating the Medicare and Medicaid costs.
· These programs have been designed to protect the health and safety of persons taking care
of themselves.
· A rise in incidences of food and waterborne diseases in the community could increase.
· Many elderly residents would not be able to remain in their homes.
ADJOURNMENT
Chairman Greer, on behalf of the Board, expressed appreciation to Director Crumpton,
Director Morris, and Ms. Jones for the informative presentations. He adjourned the meeting at 11:40
AM.
Respectfully submitted,
Lucie F. Harrell
Clerk to the Board