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HomeMy WebLinkAbout1988-01-04-HSC-min.pdf Minutes of Joint Subcommittee on Senior Health Monitor Program Planning Monday, January 4, 1988 at Council on Aging Present Terry Cent, Dorothy Boggia, Ruth Butler, Council on Aging; Bob Cushman, Sylvia Perlman, Renee Cochin, Human Services Committee; Linda Crew Vine, Executive Director, Council on Aging; Steve Baran, Human Services Coordinator Terry Gent began by saying that his principal difficulty was with the proposal for a Senior Health Monitor program which had come as a surprise He was accus- tomed to business proposals which had different information, namely, a description of objectives, goals and clarification of what was already being done He went on to say that the Council on Aging had been going through an evolution At the present time the Board has increased responsibility beyond what it had at an earlier time when the Council on Aging director was essentially supervised by the Human Services Coordinator At the same time the Board does not have control over staffing and job descriptions These are controlled by the Town Manager At this point the Human Services Committee has no authority over the hiring and firing of staff The Council on Aging has also evolved in the types of programs it undertakes such as the SPANS program (social visiting of the elderly by students) financed half by the School Coumiittee and the Social Day Care Program for people who would otherwise be in a nursing home This program comesclosest to a care program with criteria related to physical well being It has State funding so that the program does not lose money Terry said that the Senior Health Monitor program faced the same opportunity as the Social Day Care program, but he had major difficulty with its budget which reflected seven different funding sources with none of those funding sources committed in writing to guarantee a second year of funding In sum, Terry said that what he was looking for in a proposal was a budget, a desutiptfonof the product, an evalaution approach and discussion of how funding contingencies in the second year would be overcome It would not be wise to mount a program which could run into negative comments Bob Cushman reviewed the background for the proposed program. Visiting Nurse and Community Health, Inc when it undertook this program faced an unclear funding future since it began with State demonstration funds which were subse- quently withdrawn At the same time the mission of the Human Services Committee was going through its own evoluntionary change so that it moved from a responsive to a proactive stance, sought to put the Senior Health Monitor program on a firm administrative and financial basis Terry said that he perceived that human service administrators were not usually well trained to administer programs financially, but Renee Cochin and Ruth Butler saw the origins of the problem in the vicissitudes of State and federal funding Ruth flet that the Human Services Committee had succeeded in helping to put VNCH on a firm footing just as it had done earlier with CMARC Minutes of Joint Subcommittee on Senior Health Monitor Program, page 2 Renee Cochin noted that comments had been made by Terry Gent about the Council on Aging being in a state of transition, thought that this might reflect concerns about the role of the Council on Aging as expressed through its budget When she interviewed Linda Crew Vine earlier about the Council on Aging budget she felt that Linda had seemed unsure about the mission of the Council The Board should be examining its mission with help from the Town Throughout the human services field there was extreme discomfort as State and federal money was withdrawn creating tensions for the Town Tery Gent said that the Board had decided to go beyond the walls of the COA building and was prepared to recommend policy This, nevertheless, did not solve budgetary proglems In 1988 there was no money for this program. In reply Renee suggested as a scenario that the Council on Aging could begin by stating its belief that the program was worthwhile In turn this culd be followed by a Human Services Committee recommendation to the Selectmen The Selectmen in turn could make recommendations to Town Meeting Even though the Town is concerned about Proposition 21, money for the teachers, etc , it was still possible for the groups to begin the funding process by going on record with stating the belief that the program was worthwhile Ruth Butler said that she had been very disappointed with the proposal and that the Human Services Committee was only giving lip service to a policy of prevention Furthermore, there was no mention of proposed outcomes, no involvement of elderly, no factual references to demographic data and the possibility remained that the frail elderly client would be subject to a variety of assessments as she perceived was the case for clients followed by the Minuteman Home Care Corporation Her comment regarding ongoing weekly health visiting was "so what?" * The proposal failed to take advantage of a whole new technology that permitted the evaluation of physical functioning and family care Renee, responding, said there were a number of outcome measures that could be adopted such as numbers of hospital days, numbers of visits to the emergency room, numbers of visits to the physician, but she doubted what the meaning would be of such data for a small number of clients Steve said that a beneficial (or harmful) effect might besuggested :hrough outcome measures for this population, but there was no way of proving t..at the outcomes were a result of the program intervention (without a control group) Renee felt that it could be illusory to wait until the program was perfectly designed if, indeed, that could be brought about The concern was whether this was within the mission of the Council on Aging Terry said that the desire was to be pragmatic, not perfect,and the problem was with administration since Linda's time was limited Bob said that the Committee had not understood that there would be a large problem with management since it was believed that the newly hired case manager codld undertake management duties Dorothy said that she wished to come to the defense of Linda There was no problem between Linda and the Board as far as communications were concerned She questioned the Human Services Committeedesiring to turn over to the Council ( a program that was not doing well *At this point Bob said that the "so what" had been answered through the testimony of physicians and field observations of the Human Services Committee providing a positive evaluation 6 Minutes of Joint Subcommittee on Senior Health Monitor Program, page 3 Steve Baran commented that he and Linda had jointly developed the proposal He took exception to it being treated as solely the product of the Human Services Committee Moreover, the program had not been understood to be anything more than a step beyond where it stood already since the intent was simply to expand the amount of visiting nursing and case management already in place Moreover, the Council on Aging already was doing a form of case management, and the proposal sought to build on what was being done by the outreach worker and senior aide Terry Gent corrected Steve noting that the COA did only evaluations and referrals, not case management Sylvia Perlman said that she, too, had a problem in understanding what was being proposed, but the fact was that the program was ongoing and a success Terry Gent said he was uncomfortable with expanding the program at this time Perhaps the Human Services Committee should continue to fund the program at its present level Ruth said that the opportunity to mobilize the community should not be ove_looked The COA sub-ommittee members will report bark to the Boar- at its me ting on January 12 The Board has decided to move ahead with the program. The joint subcommittee will meet on Tuesday, February 2 and prior to that the COA will prepare a memorandum to the Human Services Committee members of the joint sub- committee Respectfully Submitted, �r��,,��lyy\pp��UU11�.►�, Stephe Swan, Human Services Coordinator