Rock Island Today

The Rock Island County Hope Creek Care Center Board of Directors met Sept. 19 to review the preliminary July reports.

Here are the meeting's minutes, as provided by the board:

Hope Creek Care Center Board of Directors Minutes Monday September 19, 2016 5:30 pm

The Hope Creek Care Center Board of Directors met at the above date and time in the Conference Room at Hope Creek Care Center, 4343 Kennedy Drive, East Moline, IL. Chair Jessey Hullon called the meeting to order at 5:33 p.m. Minutes as follows:

1) Call to order and roll call

Committee members present: Jessey Hullon, Gregg Johnson (arrived at 5:34 p.m.), Michael Kelly, Bryon Tyson, Ginny Shelton

Committee members absent: Carol Near, Rod Simmer

Others present: Dave Ross, Hayleigh Covella, Kenneth Maranda, Deb Kettler, Lynda Vogt, Tom Dryg, Bill Gabelmann, Carmen Meade, Jacqueline Cripe, Cindy Fleener

2) Approval of the minutes from the August 10, 2016 meeting

Mr. Johnson is present.

Motion to approve: Ginny Shelton 2nd: Michael Kelly Voice vote Motion carried

3) Public comments

There were no public comments.

4) Consider financial report

Mr. Gabelmann noted that August 1st was when they signed the engagement letter. He wanted the committee to know what they’ve been doing since then. After discussions with Ms. Palmer and Mr. Ross, they decided to roll forward the financial statements they had last done in July 2015. Mr. Dryg has everything brought forward to July. They have also been putting together and strategizing what type of reports they need. They always like to do a cash flow projection. He noted that since they issued the items in the packet last week, they already got updated information that what is on the report isn’t quite right. Mr. Gabelmann noted that they will get things fine-tuned. They had the privilege last time they worked with the county of three years of history and knowing where the cash flow was. They’re trying to get caught back up on that. For example, they’re still projecting $1,050,000. Looking at the spreadsheet, that will get Hope Creek through, but the big thing on cash flow is December 1st when bond payments are due. They were still projecting out $1,050,000 in monthly cash flow. July was actually about $1.17 million and August was about $1.1 million, so it’s coming in slightly higher on collections than they had before. On the expenditure side, they have to get more fine-tuned because they also know where total payables are based on Ms. Palmer’s reports, but not how they’ll get paid. They also recently found out that some IGT payments are going up. They used to be budgeted at about $165,000 per quarter, but the last one received was $230,000. There are a lot of positive cash flow things coming in, but full activities still have to be considered to get through that December 1st loan payment. It still looks like there will be positive cash flow available, but it will get really thin. In the past, Mr. Gabelmann explained that they always warned about timing of payrolls and the timing of payables. Payables are consistently done around the third week of the month because that’s when they get approved through the entire process of the HHS committee and the full Board. That one’s easy. For payrolls, September is a three payroll month, so that can hit hard if there are big payments coming in October. They try to watch that. Mr. Gabelmann noted that Mr. Dryg sill start developing a 12-week weekly cash flow report now that they get better information. That’s primarily for Mr. Ross and the county to be watching. Right now things seem somewhat comfortable that Hope Creek can hit that December payment, but it all depends on cash flow. He reminded the committee that the payment on the bond is due December 1st, so when they take a look at the December cash flow, it starts with $1.3 million going out the door right away. That’s going to change because bunds were refunded and it will be lower.

Mr. Gabelmann explained that cash flow is what he goes over. The report for July is a preliminary because they still have reports to finalize for July, but it is a snapshot based on Ms. Palmer’s reports. August is already done and out the door, but on a substantially cash basis, August generated a small deficit of $39,000. There are total cash receipts of $1,096,000 and expenditures on a payables basis of about $1,100,000. That’s not in the packet, but is something he wanted to identify. Also in August was a $431,000 tax levy distribution back in, so that’s a very positive cash flow. Mr. Gabelmann noted that they are very excited and appreciate the opportunity, but it will take a little time to get that history rebuilt. They have all the detail built in from the past. Now they can start seeing where the cash flow is running.

Mr. Dryg noted that the July financial statements are in the packets. The main difference, if the committee were to compare that to how Ms. Palmer keeps her fund balance statement, is Mr. Dryg puts on the building and the debt. Those are the two primary differences. They make some accruals for expenses like payroll through the end of the month. Mr. Dryg noted that interest on bonds is generally accounted for when paid by Ms. Palmer, but he accounts for some monthly costs to that because interest accrues as they go along. Bed taxes he accrues for on a monthly basis because that’s based on census count on a monthly basis. Mr. Dryg also gives credit for taxes equally throughout the year instead of sporadically as payments are made in different installments. They know over the course of the year about what the facility will receive and he doesn’t want that to be a big bump in these statements, so he is leveling that out from an income statement perspective.

Mr. Hullon noted that for the eight months ending July 31, 2016, the report is showing an income loss of $468,000. He asked if that is correct and if Mr. Dryg has reconciled with HDG’s numbers. Mr. Dryg said he did not reconcile with HDG’s number. He went from what Ms. Palmer reported and then adjusted for certain accrual items.

Mr. Dryg pointed out that the balance sheet shows about $3.9 million in current assets and $3.1 million in current liabilities including the principal portion of the bond payment coming due December 1st. He wanted to talk a little bit about the cash flow statement which takes the facility from an accrual number to cash. Year to date, it shows that Hope Creek started the year with $277,000 and through those eight months, the facility generated $298,000 in positive cash flow. Some of that is from loan advances. Hope Creek ended the period with $575,000 in cash. Regardless of what he does, this schedule will always agree with what the county says the cash balance is. He adjusts for accruals that are made in the P&L. Two pages after that, the year-to-date, there’s a very summarized statement of revenues and expenses. Mr. Dryg directed the Board of Directors to the eight months ended. Total revenue is down a little bit, $9.9 million versus $11 million a year ago. Salaries are down considerably, but IMRF and FICA are being accounted for in another fund now. That’s where that decrease is coming from. Other services and charges are up $2.4 million versus $1.4 million one year ago. Mr. Dryg thinks that’s primarily the management company. Below the operating line, he draws a line there because he wants to show reliance on taxes and transfers out for operating income or loss. The nursing home tax levy is down a bit. Expenses are down last year from the year before and Mr. Dryg is continuing that trend. Interest is down slightly due to the 2013 refunding. Transfers out are up because of the change in staying current with transfers to the General Fund Insurance Fund to support the General Fund’s activities which support the home.

Mr. Tyson asked if the items Mr. Dryg talked about, the other income and expense items, are included up above. Mr. Dryg said no. Mr. Tyson said they’re separated out, then. He noted that if he compares the 2016 column on one page to the page that has the one month, there are some slight discrepancies with operating expenses. It’s $10,414,000 versus $10,400,000. Mr. Dryg agreed.

Mr. Hullon asked if next time they can mark pages so rest of the Board that is not counting savvy can jump to that page number. Mr. Dryg said that used to happen. Mr. Gabelmann noted that there are likely some formatting errors because of some new software.

Mr. Dryg explained that the difference in the numbers is probably just due to classification. It comes down to same bottom line number. Mr. Tyson noted that it’s only $14,000. Mr. Dryg said there could be an account that was created that didn’t get included in the format for the financials. He said he would look into that.

Mr. Gabelmann noted that one of Mr. Hullon’s questions was on the $400,000 on the operating side. He asked him to keep in mind that the bottom three numbers are bad debt expenses, amortization expense, and depreciation expense. Those all add up to almost $530,000. Those are non-cash items. That’s why Mr. Dryg pointed out on cash flow where the gain or the income from operations or loss is only a $39,000 loss when it’s added back. That’s not really cash basis. They maintain almost cash neutral prior to debt service for the year. Even with the debt service that has come in and the tax anticipation warrant, the home is still up about $300,000 for the year. Part of the idea for the night is to present financials and for the Board of Directors to feel free to comment if something’s not understandable or if they want more. That’s what they want to do. They want to get back in the flow with this group in particular. He noted that they can absolutely number the pages to make them easier to go through.

Mr. Hullon noted that the other service and charges they are attributing to HDG is almost $1 million. Mr. Dryg said he needs to look into that for sure. He explained that agency cost is also included in that line item. Mr. Gabelmann asked Mr. Ross if he knows roughly how much the payments were that went to HDG. He asked if they were half a million. Mr. Ross said more than that. They were in the $600,000-700,000 range. Mr. Gabelmann said they’ll look into it. Mr. Hullon said HDG is the lion’s share. Mr. Ross noted that that’s throughout their tenure. They’re only talking since December 1st, so that’s less than that. Mr. Gabelmann said they’ll look and find out.

Mr. Dryg continued that, as Mr. Gabelmann said, they’re glad to be back. He knows the Board was expecting August. They’ll get to that point. Mr. Hullon said it’s alright; they’re getting there. He noted that it’s a slow process.

5) Consider Hope Creek marketing efforts

Mr. Ross explained that they want the Board of Directors to know some of the marketing efforts that they are already undertaking at Hope Creek and some of the things they are considering and that are in the works.

Ms. Vogt explained that she has the rehab group here, Consonus. They are working together on new marketing efforts. Ms. Kettler put together folders so the Board of Directors can see everything they are working on.

Carman Meade, Regional VP of Operations for the Midwest for Rehabilitation Services at Hope Creek, introduced herself. She noted that it’s unusual that she’ll speak towards some marketing, but that’s what healthcare is now. She knows Ms. Cripe, Ms. Fleener, and Ms. Kettler will talk about programs Hope Creek, but noted that when they talk about marketing, they have to recognize that 18 months to two years ago it was much different marketing than what needs to occur today. She explained that while beds need to be filled, the way to fill those is changing quickly. They used to speak to the future. Thanks to the ACA, they are in the future. Basically what occurs is hospitals currently have the ability to refer people to multiple skilled nursing facilities or home health or assisted living services. Moving forward, they’ll want to align with preferred providers. They’re following the triple aim effect through ACOs, Accountable Care Organizations, which both Genesis and UnityPoint Trinity are part of. Ms. Meade noted that it’s important that Hope Creek is aligning itself to be one of those partners. Hope Creek has one foot in one territory and one in another. They have basic Medicare typical skilled stays, but also a stronger managed care ACO presence. As an industry, depending on where you are geographically, you can be in one or the other sooner or later. Consonus’s home office is in Portland. They have 60-70% ACO involvement. In the Midwest, they have less than that. In this market, there is already a very strong ACO presence. That’s telling them that they need to be prepared to be one of those preferred partners. They want to be on the list and align with their objectives.

Ms. Meade explained that hospitals look at the continuum of care for a patient per episode, from the moment the episode occurs to 60-90 days out. They will be responsible for that level of care at the lowest cost possible. They will see where patients are and want to move that along quickly, with hospitals high, then independent rehab units, then skilled nursing, then home health, then outpatient. Considering the cost component, ACOs are going to want to create standards that really push down further to less dependence or need of care because of cost. As a facility, Hope Creek has to ask how it can become a preferred partner. Within Consonus, they also own and operate 26 of their own facilities and they have pharmacies, home health, etc. This is something as a company that they have been preparing for strategically for five years.

Ms. Meade explained that in order to be a preferred partner, there are a couple of things that need to happen. One is quality measures. Right now, ACOs are using the CMS 5-Star Standard. They are also using short-term and long-term quality measures also through CMS. Consonus has the ability to get that data through the 25th of any month. That’s very good to have. If Hope Creek is not at a 5 or 4 or 3, it’s recognized if they have created a plan of improvement in addressing those areas. Consonus also has pulled and provided to Ms. Vogt what the competitors’ 5-star ratings are to see where Hope Creek is across the board compared to other facilities ACOs may be considering. Consonus can also provide the facility with quality measures, both short- and long-term, compared to competitors. That’s not to be used in any fashion that’s not appropriate, but to know where Hope Creek is aligned compared to those nearby.

Another step forward that Hope Creek needs to take to be considered a preferred partner is really understanding current, up-to-the-hour measures as far as cost. The contribution in being a preferred provider is providing an incredible level of care, showing quality, inside of a cost reduction program. They need to provide the same quality outcomes in a shorter amount of time. The facility has to have the ability to measure that. Consonus does. Ms. Meade explained that cost would mean readmissions back to hospital. That is the #1 cost in a patient’s episode of care. ACOs want to partner with facilities that have a triage or a plan to reduce readmission to hospitals, whether they have a nurse, a hospitalist, triage through nursing, and supervisors keep the readmissions down.

Another piece of the cost in this whole process is the length of stay. ACOs look at facilities that can rehab the patient to the next level of care the soonest, or a shorter length of stay, but still maintain quality and still provide the best possible scenario for no hospital readmission. Again, the hospital is responsible from the episode to 90 days out. This isn’t just skilled nursing. It’s assisted living. It’s home health agencies. There are a lot of positives that come out of this. The collaboration of care is absolutely one of them. It’s a great opportunity. The sooner Hope Creek masters this, the better they’ll be overall as far as revenue and the ability to retain and receive referrals from hospitals.

As far as the rehab industry, when they work within an ACO, they them. They need to be partners. The facility needs them for a referral sources, but also because what used to be a length of stay of 20 days in a facility, they are wanting to push and get that closer to 12 days. While they’ll get the same number of referrals, the beds aren’t filled as long because they are reducing the length of stay. While doing that, they align themselves so they can then create strategies to find other ways for admissions into the facility.

Ms. Meade noted that she could go on and on about this for a very long time. If the Board wants to hear it all, she’d be happy to come back. There are a lot of considerations occurring right now and she does this a lot with her position. She’s at ACO meetings and at the hospitals. She’s there representing the facilities. That’s what she does at her level. She goes to North Carolina tomorrow for an ACO meeting. Ms. Cripe will attend a Telegen meeting here in the Quad Cities this Wednesday. It’s interesting to hear the dialog about the changes. Everyone feels like they’re on the radar, but it’s every component of health care. At an ACO meeting Ms. Meade had been at recently at a UnityPoint in Madison, they said they realized that length of stay is going down and they may be pushing patients not to come to a hospital and to go instead right to skilled nursing. Ms. Meade noted that one door is narrowing while one is opening up. It’s really an exciting time to be in health care as frustrating as it can be. They consider it very much an opportunity. She noted that Ms. Vogt knows Consonus is there to help. They have a plan. They have deadlines. They have people assigned to the task. Any time anyone wants any additional information about health care and changes moving forward, Ms. Meade would be happy to do that.

Mr. Hullon asked what kinds of measures have been designed for nursing homes. For physicians’ offices, he knows those things. They have that portion. He asked, for nursing homes, what have they defined as measures. Ms. Meade said the 5-star rating, short- term and long-term quality measures, readmission rate, and length of stay are all monitored. They track the patients they admit here that are readmitted back to hospital. They monitor ER visits. The last thing is customer satisfaction. It’s the triple aim effect, essentially. Those are the five areas they refer to. Consonus creates a plan for each of those and the building knows where they are currently at and how to improve that. CMS gives them the 5-star rating and the short-term and long-term quality measures up through the 25th of the month. CMS, however, as far as readmission rate and length of stays is dated. All of that is claims-based. It’s 2014 data. That’s why Telegen is having the facility use a hospital tracking system for ACOs to correlate that. Consonus has a data analytics division. They have the ability to align with the facility’s electronic health record and rehab software to create all the data they need specific to the building. That gives them the live data to the point of if someone goes in and discharges a patient, the readmission rate. It lets them know who discharged them, what physician recommended it, the time of day, and the day of their stay. All of those things trended out create a method for them to acknowledge where there is a problem and create a plan. They may find out that Friday night admissions that come in by 5:00 p.m., 12% are readmitted by Sunday afternoon. Now they have a hospital that has a shared interest because they’re ultimately responsible. They can take a look at that and say, “This is why admissions in the morning are so important.” Then, when they call the physician, it’s not an on-call physician who has never seen the patient and who would be most comfortable saying they’re not 100% sure and it’s better to send them back. That’s how they create plans. When they know it’s a certain time of day or certain arrangement that’s creating readmissions, they can create plans to reduce that. That’s how Consonus aligns themselves as a privately owned company. Speaking to those terms at ACO meetings and with ACO Directors gets them to look up from their desks and say, “Wow. How are they calculating readmissions within 30 days and are they doing it right?” They don’t take the month of June admissions versus the month of June’s readmissions and create a percentage. That’s not the CMS definition. They need to make sure that’s calculated correctly. A lot of things occur that set Hope Creek up to be strong at this. Ms. Vogt knows Consonus is here for whatever Hope Creek needs. They also have a data analytics division who can come out and speak if that’s of interest. Truly, to start seeing and looking at the numbers and feel comfortable with what they are. The most important piece is a plan for improvement. At least they know where that lies and what they can see is the best use of their time.Ms. Meade explained that there is data they are using that as a platform is provided to the facility. Ms. Meade pulls it all for Hope Creek and how the facility compares to competitors. The disadvantage is that not everything is to the moment. The analytic division interacts with Hope Creek’s electronic health record. Consonus also uses Point Click Care. They have a strong relationship with them. They can work with any electronic health record, but it’s nice when it is Point Click Care because they know the key points and target areas. That data is only good as the information that is put in and what they do with it once they get it. From a training aspect, it’s about making sure things are entered and not skipped over. Again, she can go over that at a later time more in depth.

Ms. Meade noted that she is happy. She thinks this week that Ms. Kettler has done an awesome job. They have some great ideas to get name and branding out there.

Deb Kettler introduced herself. She has worked at Hope Creek almost 10 years, but has only done admissions. She is very excited to be involved in marketing now. Her background is marketing. She studied it at Saint Louis University and did her internship with the Cardinals. Ms. Kettler explained that members have two sections in their folders. One is paper clipped. The group will go over that in a few moments. Her section starts with the marketing materials. She explained that they are in the process of updating these. The brochure is old, but she will get it updated through Printers Mark. The one in the folder is from when Hope Creek first moved here. They depleted almost all of their materials because when HDG came on, they thought things would change and would be updated. They depleted everything and never got their name or the logo they wanted on anything. She will get everything updated.

The next thing Ms. Kettler has created is a couple of templates through Printers Mark. Those will be put on heavier weight paper. If there’s anything Hope Creek wants to market or talk about – programs, employees, anything going on at the facility that they want in the doctors’ hands – she can type it up and get it out. One thing she’ll be doing is meeting with doctors and physicians. Another part of marketing she’ll be working on, she saw ta gentleman in an ad a few weeks ago who is a new physician to ORA. She thought she’d better make contact with him. She’ll make sure to reach out to new physicians in the area to get some marketing materials to them. She’ll go out and introduce herself, get Hope Creek in the door, and let them know about all the programs Hope Creek has.

Ms. Kettler explained that Hope Creek signed a contract with the American Heart Association this year as a part of major advertising. This November, they’ll be involved in the Go Red for Women Luncheon on November 1st. Hope Creek is one of the top sponsors and will have a huge display. The theme will be Move for a Healthy Heart Sponsor. Consonus is working with her on a display and a table. They were also asked to give a donation item and Ms. Kettler is very excited. She has a friend who owns the Twilight Riverboat. She contacted her and asked if she would be interested in donating an item. She actually gave them two two-day cruises to next year’s boat. That’s an $800 value that will be donated to the American Heart Association on behalf of Hope Creek. That’s a huge thing. Hope Creek is already on their website. She looked that up. They’re giving Hope Creek lots of props. Hope Creek is also involved in their Heart Ball on January 28th. Consonus is sponsoring a table for the facility at that event. For Go Red for Women, they anticipate 500 people at that event, so they’ll be reaching out to all kinds of people. It’s a huge plus to get involved with this group and reach out to those people, especially for future residents hopefully. Ms. Kettler said she didn’t realize how much that package was for the Twilight until this morning.

Ms. Kettler continued that the next thing she has to present is that they have been, since April or March, working with OnMedia who is doing digital marketing and TV commercials for the facility. Ms. Kettler provided a graph that explains what it means to do digital marketing. The second page defines terms. Pretty much, when someone is on their phone or iPad and they click a Hope Creek ad and go to the website, OnMedia tracks that for the facility. Hope Creek has had a total of 264 clicks. Impressions was 249,605. Ms. Kettler has some marketing media gurus that are helping her learn about this stuff. It’s the big wave of the future. She noted that not a lot of people watch TV anymore. They’re on laptops and computers. OnMedia did mention that’s why they’re digging into digital marketing. It has been successful so far.

Ms. Kettler noted that the last thing she has is New Chapters, which will be the group’s very last thing. That’s a program Consonus does. They have done it with three Hope Creek residents and she’ll let them speak to that.

Mr. Hullon asked how much it cost to be a sponsor for the American Heart Association. Ms. Kettler said $2,500.

Ms. Kettler noted that they are still working on Facebook and have billboards. She forgot to mention that. Mr. Hullon said he knows. He sees the billboard every morning when he pulls into his clinic. Ms. Kettler said that in October, it’s moving to that big intersection by Panera.

Mr. Hullon asked Ms. Kettler to break down how many places Hope Creek is advertising or marketing right now – the billboard, digital marketing, and commercials. He asked what station those are on and if OnMedia sold them a package. Ms. Kettler confirmed. Mr. Hullon asked who is tracking these results as they come in. Ms. Kettler noted that she and Ms. Vogt just talked about that this morning. It is on their referral sheet, “How did you hear about us?” That referral sheet is only in the Admissions office. Mr. Hullon asked if they are starting to track that. Ms. Kettler explained that when new residents come to the facility, they have a resident advocate and a manager who go and meet with that resident within the first 24-48 hours. They list some questions: “How was your night?” “Were you in pain?” There are about 10 questions. “Is there anybody that has done anything exceptional for you?” They are going to add, “How did you hear about Hope Creek?” so they can capture that aspect of how they really got that person in, whether it was through a family member or the billboard. She doesn’t think someone will say they came to Hope Creek because of a billboard, but that billboard might remind them that Hope Creek is still out here.

Mr. Hullon asked how much the billboard cost. Ms. Kettler said $4,250. Mr. Hullon asked for how long. Ms. Kettler said it’s for five four-week flights, so five months.

Mr. Hullon asked about digital marketing and the person who sold her this or talked to her about that. Ms. Kettler said OnMedia, which is the most expensive thing. Mr. Hullon asked if that person told Ms. Kettler what age bracket hits the digital marketing. Ms. Kettler said no. Mr. Hullon said millennials: 18-34 year olds. He asked how old the average patient is. Ms. Kettler explained that the average patient isn’t making the decision to come here. It’s their family members or grandchildren. Ms. Shelton said it’s 50-60 year olds. Mr. Hullon asked how many 50 year olds use digital marketing. Ms. Kettler said she does every day. She is part of that group. The families that come in, the older they are they aren’t making the decision about if they want to come to Hope Creek. It’s their children or grandchildren making that decision. They don’t know who to pick, so their family is online looking things up and trying to find out who has best website, Facebook reviews, etc., and they’re calling mom and telling her where to put grandma. Ms. Kettler is just saying, “Make sure you come check us out first. We’re the nicest place in town.” Mr. Hullon asked how much that cost. Ms. Kettler said $14,000. Mr. Hullon asked for how long. Ms. Kettler said from May 1st to November 30th. She asked if Mr. Hullon wanted her list and explained that it shows what they picked out for the advertising campaign for this year. They didn’t go with Channel 8 or mainstream TV stations because they felt the presidential campaign would blow them away. They picked OnMedia because they could pick channels and switch around and they could get some digital marketing, which they’d n ever done before. They did one commercial for the facility. They’re getting ready to do a second commercial. Ms. Kettler also got a little part of a freebie talking about OnMedia and Hope Creek for a testimonial.

Mr. Kelly asked if Ms. Kettler would consider using mainstream after the election. Ms. Kettler said it depends on cost. It’s very expensive to be on TV. As a group, they’d have to talk about it. She knows Channel 8 and Channel 4 want to set up meetings to give her the packages for next year. She knows they have to get that together soon and present it.

Ms. Shelton asked if Mr. Clyde is the one who is working with the health benefits as far as the new package for the county. Mr. Ross said yes. Ms. Shelton would like Ms. Kettler to reach out to Mr. Clyde because one thing that really alarmed her is that the benefit package for county employees does not pay for rehab at Hope Creek. Ms. Kettler said she’s aware of that. Ms. Shelton said she asked about it and they said they don’t offer services. The county is looking at new benefits, so maybe they can work with Mr. Clyde because there is something wrong with that. Ms. Kettler said she did run into somebody for that insurance company at a meeting last week. She explained to them that Hope Creek loses people because it’s not in network. Ms. Shelton said there’s something wrong with Rock Island County employees not being able to go to Hope Creek for rehab. Ms. Kettler said she got a contact and gave it to the Business Office Manager last week. That is something they’re working on. She’ll have to work with Mr. Clyde and the insurance contract. Ms. Shelton said she knows the county is looking at different companies.

Ms. Vogt noted that one thing they want people to understand, and she’ll have Ms. Cripe explain it, but they discovered when they were looking at marketing that Hope Creek has at least two programs within Consonus that are not otherwise in the market. They need to look at marketing those programs. Hope Creek needs to separate itself from other facilities in the area. They’re excited about adding an outpatient element.

Jacqueline Cripe introduced herself. She is the Area Director who comes to Hope Creek monthly. She works with the rehab department consistently and works with the facility to fine-tune areas that are concerns for them. She also provides added support to Ms. Meade from the corporate level. Ms. Cripe wanted to go over the brochures they have started to put together. She explained that VitalStim is a standardized form of therapy their speech pathologists use. They have to be certified in the program and they do have a certified therapist who does this on a consistent basis. That in itself, marketing that, there are patients out there who need that type of therapy and not every skilled nursing facility offers that.

Ms. Meade noted that an actionable item is to determine how many therapists are certified within a 50 mile radius. It’s generally less than five, so that’s quite marketable. Few members are certified in that program. That’s something Ms. Cripe and Ms. Kettler will work on hitting a targeted audience with that program.

Mr. Kelly asked if VitalStim is an acronym. Ms. Meade explained that Stim is short for “stimulation.” Ms. Cripe continued that they use electrodes that help with the swallowing function of the patient.

Ms. Cripe explained that they also have Omni-VR, a virtual rehabilitation system. It’s actually, to go old school, it’s kind of like a Wii. It enervates the patient and gets them moving without realizing how far they’re reaching or how many steps they’re taking. Speech and Occupational Therapy use that consistently. She and Ms. Fleener talk about that program monthly and how it’s being utilized and how many patients are involved in those programs.

The next thing in the folder is a facility brochure. Ms. Cripe and Ms. Kettler are working on updating some key components of the facility and advertising that. Consonus is providing the first 100 of these brochures. Ms. Meade explained that Consonus has several different brochure templates and the facility can put in their own information. Then, Consonus provides 100 and gives the facility the digital file so they can print them where they want to. There is no cost. She knows Ms. Kettler and Ms. Cripe are looking at different types of things that help with marketing.

Ms. Cripe said she’d have Ms. Fleener talk about the next thing, which is the newest program they have certified a therapist in. Cindi Fleener, the Rehab Director, introduced herself. She explained that LSVT Loud is a standardized protocol delivered by a speech pathologist. They have to be certified. One of Hope Creek’s therapists recently got certification. It’s a 12-hour course. That program is designed to help people with Parkinson’s or neurological disorders to improve the quality of their voice. Someone with a soft voice, muffled speech, or monotone speech would benefit from this program. It’s a very standardized treatment that she does. They are looking to market that to neurologists and EMTs in the area. It’s a program a lot of people are calling around and looking for. There is also a physical therapy piece to it called The Big. Ms. Fleener’s next goal for this year is to get certified in that so they’ll have both pieces since it’s a service that’s in demand right now.

Ms. Meade noted that any way the facility can get involved with the Parkinson’s Association and do fundraising would be fantastic. That’s another program that has few certified therapists and they want to make it loud and clear that it’s available at Hope Creek. For a family with a Parkinson’s patient, it’s absolutely a benefit.

Ms. Vogt noted that they’ve already gotten two individuals. They are looking at launching outpatient therapy with these programs. They’re looking at trying to diversify a little bit. They don’t have to just think in terms of Medicare A and Medicare B. There are other things are out there too that they need to tap into. Once Hope Creek gets them in the door, those patients will think about Hope Creek the next time they need a stay if they have a good experience.

Ms. Cripe explained that the facility is also working with Post Script. She has done an electronic version where Ms. Kettler can take a picture of a patient upon discharge. It will talk about the functional outcomes as far as where they came in on evaluation and where they are on discharge, along with a brief summary of how the patient came to Hope Creek and a thank you for the referral. It’s nice to put that on a piece of paper and thank the physicians who are referring to Hope Creek and make it personalized. There is also a bio of the therapy team in the department now. Consonus does not share therapists among other facilities. They only work here. That is a very key point when they are consistently seeing the same therapist and getting to know them.

Ms. Cripe also presented the New Chapters program. She noted that she has been with Consonus four and a half years and has done three New Chapters herself. It’s a program like Make-a-Wish for the geriatric population. A patient is selected in the rehab department and they talk to them about their goals. Maybe they’ve done something in the past or want to in the future and they make that come true. They work in therapy for them to be able to perform that task. They have done three at Hope Creek. The first one they did made the news, which is free advertisement. Ms. Cripe noted that if they do a New Chapters, they contact the news and newspaper. It gets positive information out in the community. Ms. Cripe showed a video of that news segment to the Board of Directors (http://wqad.com/2014/09/23/82-year-old-quad-city-man-gets-his-wish- granted/). Ms. Kettler noted that all of the ladies in that video were Hope Creek employees and almost all of them still work for Hope Creek. She added that the gentleman featured passed away a few weeks after that. It was very special for him to be able to do that.

Ms. Kettler noted that they also got their 104 year old on the news. She sent a picture and a press release. They talked about her and wished her a happy birthday on the news that night.

Ms. Kettler noted that Hope Creek also has a commercial. It is airing on some OnMedia channels.

Ms. Shelton said she is glad to hear there is a marketing effort. She noted that she knows they get the veterans contract and asked if there are any plans to try to expand that. Ms. Kettler explained that it’s a year-by-year contract. Hope Creek is the only place in the area with a VA contract. Ms. Shelton said she knows how far it is to go to the homes and how difficult it is. Ms. Kettler explained that they screen every referral from every VA that they get. They’re supposed to get one from Georgia today and are waiting on that fax.

Mr. Hullon asked if those folks were part of a marketing company that Hope Creek has hired. Ms. Vogt said they’re part of Hope Creek. Consonus has been with them for about two years. It’s contractual. Hope Creek went with them because they offered a lot more. Ms. Kettler said they gave a huge presentation about a year ago and it never went anywhere. Mr. Johnson said he wonders where this was at two years ago. Mr. Ross said that if he knew all the stuff he and Ms. Vogt have talked about.Mr. Johnson said he’s absolutely stunned.

6) Consider management report (occupancy, staffing, etc.)

Mr. Ross said he’d take Items 6-9. He noted that he knows they like to keep meetings to about an hour and they are past that. He’ll try to go quickly without rushing.

Mr. Ross presented the management report. Reports on occupancy, aging, and agency are in the packets. For agency usage, the reports show numbers for July 2015, August 2015, July 2016, and August 2016. To keep things relatively brief, he’ll just stick with August 2016 numbers. When Hope Creek can’t fill slots with its own staff, they have to use a staffing agency. In August, Hope Creek paid $77,500 in agency. The majority of that is CNAs. On average, second shift at least, but probably 2nd and 3rd, there are 12 openings on CNAs for every shift, every day that they can’t fill. It’s costing a lot of money. Ms. Shelton asked why and if it’s because of the shortage. Mr. Ross said there are a variety of reasons. A lot of that is what he’ll talk about under Item 8. He and staff have been brainstorming ways to help correct that for the good of the home.

Mr. Ross noted that the next sheet is Accounts Receivable aging. For those that aren’t sure how to read the report, the far left is different categories of payers. The top is the date or how many days the money has been owed and has yet to be paid. Mr. Ross said his main concern is 120, 150, 180, and 210 days. He doesn’t want it to get to that point, but once it gets there he wants to know they’re doing something to get it paid. There is $2.7 million in aging currently. Of that, about $1.8 million is 90 days or less. He’s not as worried about that. He doesn’t want to get it to the 120. He wants to collect before 60, ideally. Hope Creek still has a lot owed of money to them. The 210+ days is over half a million.

Mr. Ross noted that the next sheet is what they’ve collected and reduced aging by this month. The 210+ days is about $90,000, $89,724.26. That’s a good thing. The report is going to show each month. The home will start implementing some KPIs, Key Performance Indicators. They can implement them facility-wide. They’ll start with a few of them and talk about them with the Board of Directors next month. One of them is going to be a certain dollar amount collected post-120 days every month. They want to make sure to put in that effort and see if it’s working. If it’s not working, then staff is just spinning its wheels. He wants to know they’re being effective in reducing the money owed to Hope Creek.

Mr. Hullon noted that, talking about that 210 days, that money in the industry he lives in is called “dead money.” Mr. Ross noted that on the report, they can see the payer categories. The main one. Mr. Hullon said it’s Medicaid IL at $169,000. For his practice, eventually whatever aging amount you’re carrying, what they owe, will disappear because they’re not going to pay you. In this industry, he asked if the state will honor its obligation. Ms. Vogt explained that the only thing Hope Creek has going is a county home is paid first. The pending amounts, they go back and pay.Mr. Hullon asked if they can talk about the $686,000 from Medicaid. Mr. Ross said that is the total. Mr. Hullon asked, of the current $287,000 on the books right now, what ratio Medicaid is paying. Mr. Ross explained that the $287,000 is money that is newly billed. Mr. Hullon asked how current they are paying and if they’re paying 50% of that money or 40% of that money or what. Mr. Ross said he doesn’t know. Mr. Hullon noted that the ratio will keep going further south. Mr. Ross explained that the current $287,000, 30 days is $42,000; 60 days is $52,000. Clearly they are paying quite a bit relatively quickly or those numbers would be higher moving out. They would be incrementally going up. Mr. Hullon noted that otherwise that $169,000 will be ballooning. He pointed out that the other big number is Private Pay IL. He asked what is happening there and noted that it’s $140,000. Ms. Vogt asked if that’s the hospice private pay. Mr. Ross said it’s labeled “Private Pay Illinois.” He hasn’t sat down with the Business Office Manager. Mr. Hullon said they need to look into that because someone has that money and he wants it. Ms. Vogt explained that insurance might be picking up their portion and the families are responsible for paying room and board.

Mr. Ross explained that a lot of efforts in the past haven’t looked at this and made a concerted effort to say, “What is this? Let’s go after it.” He explained that some of it will clearly be written off at some point, but that doesn’t mean they’re just going to write it off. They will go after everything they can.

Ms. Shelton asked how long it takes to process an application when they go from private pay to Medicaid. She noted that it’s a big concern. Ms. Vogt said it’s about 90 days before starting.Mr. Ross thought it was well over a year. Ms. Vogt explained that usually they’ll retro-pay it back if they approve it, but they have all that money sitting on the books until it is. Ms. Shelton explained that people come in on private pay and spend down. She asked at what point they can apply for Medicaid and how much money they have left before then. Ms. Vogt said they work on it way ahead of time. They get social services involved with those families and start applying. Ms. Shelton asked if it’s 20, 60, 90 days.Ms. Vogt said it depends on if they’re on spousal impoverishment or what the situation is. Ms. Shelton asked when it is if there’s a lien on their property. Ms. Vogt said they turn that over to the State’s Attorney’s Office. They are talking to a collections agency tomorrow because they’ve been missing that area. Ms. Shelton said that someone told her that if they don’t file in a certain period, they can forget it.

Mr. Ross noted that this all leads into the census. Between October 2015 and July 2016, the average has been 217.34. One of the KPIs he wants to develop is a percentage occupancy in the building and a certain percent at or below for Medicaid. He wants to be careful because as a county home that’s one of the things they do, but it’s also the worst payer both for how long it takes and how much they get for the services they provide. Right now, to be at 90% which is what they’ve talked about once they get the Admissions RN running, they need to be at 220. They’re pretty close now and there’s no reason they can’t be there. Without doing a lot of the math and numbers, they’ve been averaging 56% Medicaid. For the past two weeks, it has varied from 55-53%. Mr. Ross would like to see it at 51% or less, but that’s a sensitive subject.

Ms. Shelton noted that it still concerns her that the law says they have to accept patients from other counties. Mr. Johnson said that leads him to a question. There was recently a big article about Mercer County Nursing Home. Genesis bought them and they’re in a big flap about property taxes. The county says they have to pay. Where he is getting a rumor is that Mercer County Genesis is sending a lot of Medicaid patients Rock Island County’s way now and there has been an uptick. Mr. Ross said not at Hope Creek. They might have gone to others in Rock Island County. He noted that Hope Creek has a say on who they accept. Ms. Shelton said Ms. Vogt mentioned that last month. She asked if it’s a policy or a statute. Ms. Vogt said she’s not aware of anything legally. Mr. Ross said Hope Creek can choose who they accept, but once they accept them, it’s more difficult. Ms. Shelton asked if Hope Creek accepts them, and if they have the beds it’s the humane thing to do, if they can negotiate with those counties and ask if when they go on Medicaid.Mr. Ross said no. The facility is responsible. Ms. Shelton explained that if she sends her child out of state for college.Mr. Johnson said he wants a clear understanding. The reimbursement rate for Medicaid is a loser for any facility that takes them. Mr. Hullon asked for the number again. Ms. Vogt said $130 tops. Mr. Hullon asked if it can be lower. Ms. Vogt said yes. Mr. Johnson said Mr. Ross told him that Hope Creek gets somewhat compensated by the state for taking in Medicaid patients. Mr. Ross explained that Hope Creek gets money, but not the amount it gets from Medicare or private pay. Ms. Shelton said it’s a loss of $70 per day. Mr. Ross said that’s what they subsidize. Mr. Johnson said he understands that they want to take in those patients, but how they can compete with privately owned homes. Mr. Ross explained that that’s why they’ll always have some taxpayer subsidy. The goal is to reduce that.

Mr. Ross noted that the census report also shows admissions, discharges – voluntary or otherwise, room reserves is where someone checks themselves out of the facility and they plan on coming back, and then the last column is where they came back. He will get this report to the Board of Directors on a regular basis so they can compare month to month and see what they can do differently.

7) Consider Board member facility tours

Mr. Ross said this is easy. He asked the Board of Directors members to call Ms. Vogt and she’ll set up a tour time. It can be whatever’s convenient. He encouraged members to do that sometime between now and the next meeting so the next meeting can be more of a chance for them to say what they saw and talk about it. That way, they can start getting into what the Board of Directors sees that Hope Creek needs to do.8) Consider employee recruitment/incentive initiatives

Mr. Ross explained that this is some of the stuff that staff came up with and presented to him. They talked internally about how they cannot keep paying these agency costs. Overtime costs last month were ridiculous. Those alone were for last payroll were for 788 hours of overtime. That’s plus the $77,000 of agency they paid for last month. 788 hours of overtime is $221,000. That’s a lot of money – a ridiculous amount. They talked about what they can do and what the problem is. Mr. Ross noted that, clearly, CNA agency use is a problem. That’s mainly second shift, but also third shift.

Mr. Ross explained that one thing they’re looking at is changing hours for nursing staff to help accommodate what they say is an issue for start and end times, especially for third and first shifts, where that starts and ends, so the nurses can get their kids off to school. The hours they’re looking at also help tremendously with meal service. Right now, third shift serves breakfast before they leave. They have the fewest number of nurses and staff. They’re looking at shifting the meals to 7:00 a.m., noon and 5:00 p.m. Mr. Hullon asked what they are now. Ms. Vogt said 6:30 a.m., 11:30 a.m., and 4:30 p.m. They’re looking at moving days from 6:00 a.m.-2:30 p.m., 2nd shift from 2:00 p.m.-10:30 p.m., and 3rd from 10:00 p.m.-6:30 a.m. Mr. Ross said that leaves the day shift with the most staff for breakfast service as well. That’s something that would be good for family and residents as well as staff.

Mr. Hullon asked about how that works with the union contract. Mr. Ross said he met with Mr. Morga on everything. He’s supportive and will get back to Mr. Ross on it. Mr. Hullon said as long as they have them engaged.

Mr. Ross noted that there were several things they talked about. An issue is getting staff here, specifically CNAs, on second and third shift. Right now, they have PRNs. PRN status means they don’t have a regular shift, but they are supposed to work a certain number of hours per month. He’s not sure what that number is, but it’s minimal. Hope Creek currently gives those staff $1.00/hour more to do PRN because they have no benefits. They can only work 19 or 20 hours per month because, in part, of the union contract. They aren’t union. Part of the problem with the PRNs right now is they are not picking second and third shift. They’re picking the shifts they want and getting paid more for it. One of the things Mr. Ross and the staff are looking at is de-incentivizing them by taking that $1.00/hour away. Right now they get paid more. They’re looking at a way to incentivize them and other part-timers to become full-time. They’re also looking at other staff at other facilities. Other facilities are reducing staff because their census numbers are down. Mr. Ross wants them to come to Hope Creek.

Mr. Johnson asked if the union okay with this. Mr. Ross said he talked to them. The main guy is. He wants to run it by some other people, but it sounds very favorable. Mr. Johnson explained that he has to run it by his executive board. Mr. Ross said he’s working with them. That’s the main thing.

Mr. Ross said he’d rattle off some of the other things they’re doing. He noted that some of them have a plus next to them as far as things that will cost them, and some have a minus, meaning they’ll save money. Mr. Ross provided handouts to the group.

Mr. Ross noted that the RN Supervisor item has nothing to do with filling positions and getting more staff here, but this is an inequity in the facility. Currently, supervisors are not paid for supervising. They’re paid the same rate they’d get for pushing a cart. He and the staff believe they should get $2.00/hour more for certain supervisors, three or four. The total cost, because not all are full-time, is $14,000/year. That is direct payroll, not FICA or IMRF. Those are other funds. That’s just straight salary. Mr. Hullon asked what they are paid now. Mr. Ross said the regular salary.

Mr. Ross moved on to the shift differential. He noted that this is one they’ve monkeyed with in several ways. Currently, CNAs, LPNs, and RNs who work second or third shift get $0.20/hour more. They believe that is not incentivizing people, clearly, because they can’t fill the positions. They want CNAs to get $1.00, LPNs $1.20, and RNs $1.40. With the number of hours on second and third shift per month, that additional money is $179,292 per year.

Mr. Ross noted that the scheduler is at 0.8. They are not at full-time at 1. He wants that person to go to full-time. That person is 0.8 and working a bunch of overtime. They are hoping that overtime will be significantly reduced or eliminated by making that person full-time. It’s an extra $1,280 to do that.

Mr. Ross said for sign on bonuses, if someone is hired here and commits to a second shift slot as a CNA where there are 17 vacancies, they would get $500: $200 upon signing, $100 after six months, and $200 after a year. LPNs would be the same. There are three vacancies. The total cost to the facility would be $217,749. Mr. Ross noted that there this is a risk/reward situation. The risk is they will pay this, but there is a savings. That’s the potential reward. They have a Restorative Care Manager opening where they can hire an LPN instead of an RN and save $5,000/year. They have numerous part-time vacancies that have been open two years and filled with agency. Once there is staff in place, if they can get those positions filled, those can all be eliminated. They are eliminating that $1.00/hour premium for the PRN. Then there is the overtime savings when positions are filled. Mr. Ross noted that this is a subjective number. There will always be some overtime. There will be vacations and things like that. For the sake of what they’re doing, agency usage is at $77,000. If they cut that in half for the sake of a subjective discussion on savings, knowing that they’ll always pay money to either an agency or overtime, the potential savings is $552,391 for cost per year + $77,494 in for a month x 12 months / 2 to calculate half the savings – the guaranteed cost $217,000 = $800,000 in savings. Mr. Ross noted that even if they don’t come close to that, they believe they will be at a net positive by doing this. There is a risk to it because the question, for the sake of argument is, “Is $1.00/hour enough to incentivize staff to take a shift and keep it?” Mr. Morga says he believes so. Hope Creek’s staff believes so. Ms. Shelton said she has talked to him too. Mr. Ross said he was questioning Mr. Morga if a sign-on bonus of $500 is enough. Mr. Morga told him it absolutely is for CNAs. These are the things he is considering. Ms. Shelton said one of the things that interests her, since her husband was ill for a long time, is they had visiting nurses and home health care. The people in their home were nice and she’d ask why they were doing it. A lot were retired. It mind-boggled her that they didn’t want part-time work at some place like this.

Mr. Ross reiterated that they struggle with filling shifts. He noted that the members can see what Hope Creek is paying now. He believes that if they can turn it around it will make a huge difference. The average CNA hourly rate Hope Creek pays is $12.46/hour. Factoring in FICA and IMRF, it’s $14.93/hour. LPNs are at $17.10/hour and $20.49/hour with FICA and IMRF. RNs $21.82/hour and $26.15 with FICA and IMRF. Overtime, which includes FICA and IMRF, for CNAs is $22.39/hour, for LPNs is $30.74/hour, and for RNs is $39.23/hour on average. Agency for CNAs is $23.00/hour or $0.61/hour more. LPNs are $33.00/hour or $2.26/hour more. RNs are $42.00/hour or $2.70/hour more. Those numbers tell him that they’re better off filling shifts with overtime than agency when they can, but he wants to reduce all of those. He really wants to reduce agency. Those numbers are important to understand.

Mr. Ross noted that another thing is they’ve recently had a vacancy for the Director of Housekeeping and Laundry. They want to eliminate that position. He was making $40,000/year plus benefits. That’s really nothing for the job, but what they want to do is there are two employees in-house that they want to split that person’s responsibilities between. Right now, one of those employees is making $39,000-something per year. He’ll go to $47,476 come December 1st because of the new DOL regulations for exempt employees. Mr. Ross doesn’t want to put him there. He wants to put him at $53,000. Mr. Johnson asked for that person’s current title. Mr. Ross said it’s the Activities Director – Mr. Shuman. He does a fantastic job and is an exceptional hard worker. He does a great job. They want to give him $6,000 more than he would otherwise get. The other person, Mr. Ross doesn’t know his title. Ms. Vogt said Engineering Director. Mr. Ross explained that he’s at $50,000 now. He would also move to $53,000. That’s a total of +$9,000 and a reduction of $40,000. That $40,000 is the old job. The total is positive $31,000. Plus there’s no health care because they already get it. That will save between $31,000- 45,000. Mr. Morga is on board. Mr. Tyson asked if that’s in addition to the $799,000 calculated. Mr. Ross said yes. They believe this will work. They can do it from a workload perspective. Mr. Shuman is doing a phenomenal job. He already took that role on without getting paid for it. They know he can do it. He already supervises eight employees in Activities. He’ll have more.

Mr. Ross said he is interested in the Board of Directors’s input on this prior to him doing it. He’ll start there. He asked if there is any negative knowing the union is on board. Mr. Johnson said he doesn’t see a negative. The time to do it is now because they want to do as much as they can. The union is very pleased they turned a corner and that HDG is gone. Their members have been dangled out there and there has been so much uncertainty about Hope Creek. All these positive things will really. Mr. Ross said they’ll help morale. Mr. Johnson agreed. He noted that maybe they’ll show up to work more. The time to do this is now. If they try these things six months or a year from now.Ms. Shelton said right now they’re excited. Mr. Ross said he’s not comfortable doing this without the Board of Directors’s recommendation. He’d appreciate the support, but if they’re not ready to do it they‘ll have to delay it. Ms. Shelton noted that she likes that they’re doing it from within. Ms. Vogt noted that the other key piece is that when they bring their own staff in, the quality indicators go up. They have to get the 5-star turned around. Mr. Ross said they believe it will definitely help. He, Ms. Vogt, and others meet with the family council every month and one thing important to them is that they have the same staff here. When they have agency, they don’t have a clue who that person is and they don’t have a vested interest in the facility. That continuity of care is very important clinically and emotionally for families and residents. Ms. Shelton agreed.

Mr. Hullon noted that when they are talking agency usage, that means they have a shortage of staff. Mr. Ross confirmed that those are spots they can’t fill it with regular or overtime. He noted that in doing this, one of the goals is trying to get away from agency usage, which is a shortage of staff. By going with a different wage system, they’re still mining out of the same staff pool. He asked Mr. Ross if he’s saying they’re going to bring in more staff. Mr. Ross said they’ll hire 17 new CNAs. Ms. Shelton noted that other nursing homes are cutting staff. Mr. Hullon said he’s trying to figure out where the bodies will come from to satisfy the lack of agency use.

Mr. Hullon said his second question is bonuses. He asked what stops a CNA from cashing in that bonus and then reneging. Mr. Ross said they have to be at Hope Creek the full year to get the same amount. They’re dividing it out $200, $100, $200. Ms. Shelton explained that they have to go with same job schedule as any other employee. Mr. Tyson asked if Mr. Ross is including the cost of additional hires.Mr. Ross said he’s looking at that now. They were looking at the differences between the pluses and minuses. Mr. Hullon asked if he added the additional cost. Mr. Ross said they’d have to do that. He said he knows where Mr. Hullon is at now. Mr. Hullon said it’s been a long meeting and he thinks they need to go back and rethink this. Mr. Ross said he knows where they’re coming from. Ms. Shelton asked if there is any reason they can’t take the numbers home and study them and meet again in, say, two weeks. Mr. Ross said there’s no reason. Mr. Johnson asked if they need to take it to the full County Board. Mr. Ross said if the Board of Directors recommends it, he’ll just do it. He wants more time. He said he would get ahold of Mr. Hullon and some confirmation from Mr. Morga and he should have that by this time.

Mr. Hullon added, thirdly, that they had a union contract get passed with no raises. He noted that this is above and beyond the union contract. He asked if they will amend it. Mr. Ross said it would be an MOU. They have already talked about it. Mr. Hullon asked how that MOU will affect the next contract. Mr. Ross said MOUs do not. It’s all in how they word it. Once they implement this, he doesn’t want to be stuck doing it if it’s not working. Mr. Morga said they could word it into the MOU. Mr. Johnson said it would be a mutual opt out.

Mr. Kelly asked when this would be monitored and by whom. Mr. Ross said by himself and Ms. Vogt monthly.

Mr. Maranda reminded the Board of Directors that the third year is the wage reopener so they don’t know what it’ll be. Mr. Ross said that’s another motivator to help accomplish it. He knows the information they need to get. He’ll get it and confirm with the union and confirm with Mr. Hullon and decide whether to meet before the next meeting.

9) Update on Administrator hiring process

Mr. Ross explained that they had one additional applicant for the Administrator position. That person was interviewed already. He has already met with this person and offered that person the position. That person has accepted it. Mr. Ross asked the Board of Directors to please welcome the new permanent Administrator, Ms. Vogt. Everyone applauded. Mr. Ross noted that it’s a fantastic thing for the facility. Ms. Shelton said that’s wonderful. She noted that people do not like change. They like continuity. Mr. Ross said she’s doing a fantastic job. She has the respect of staff and his respect. Mr. Kelly noted that a good indicator is that she knows the first names of a lot of people here. Mr. Hullon welcomed Ms. Vogt. He said she is a strong plus to this community of Hope Creek Care Center and he has heard nothing but great things out of her.

10) Board of Directors member opportunity for brief comments (no decisions will be

made)

There were no comments.

11) Adjourn

Motion to adjourn: Michael Kelly2nd: Gregg Johnson Meeting adjourned at 7:18 p.m. by Chair Jessey Hullon

Future scheduled meetings on October 17, November 14, December 19, and January 16