Fulton County Board – Ad-Hoc Health Committee Meeting Minutes
Committee: AD-HOC Health meeting
Meeting Place: Fulton County Courthouse, 100 N. Main Street, Court Room 201, Lewistown, IL
Date: July 13, 2023
1. Call to Order
James Barclay (present/xxxxxx)
Barry Beck (present/xxxxxx)
Laura Kessel (present/xxxxxx)
Dan Kumer (present/xxxxxx)
Brian Platt (present/xxxxxx)
Lisa Thompson (present/xxxxxx)
John Spangler (present/xxxxxx)
OTHER BOARD MEMBERS: Dave Widger, Ryan Sloan
ELECTED & APPOINTED OFFICIALS: Tammie Denning – Clayberg Administrator
STAFF: Cindy Simpson – Fulton County Board Administrative Assistant, Diana Keime – Business office manager The Clayberg
GUEST(S) – Ben Hart, Steve Hart, Connie Hoselton and Jennifer Clyatt all from Heritage Operations
MEDIA – John Froehling – Democrat, Mark Bixler – BYS
2. Roll Call
Roll call was taken, quorum was present
3. Approval of Previous Minutes – June 29, 2023
Member Kessel moved to approve the minutes from June 29, 2023 with a second from Member Platt. Motion carried by voice vote with all voting ayes.
4. Call for Additions/Deletions To and Approval of the Meeting Agenda
Member Beck moved to approve the agenda with a second from Member Thompson. Motion carried by voice vote with all voting ayes.
5. Announcements, Communications and Correspondence – None
6. Public Remarks
Name: Connie Davis
Address: Cuba, IL
Topic: Decision regarding the Clayberg
Connie discussed her mother is currently a resident at the Clayberg. Her experience at the Clayberg has been very positive. The staff is very caring and vested in their residents. Connie would like the committee to consider what the organizations say and don’t make a decision tonight and to check references from both companies. Connie encouraged the committee to do their homework on both companies and come back later with a decision or changes that can be implemented. The Clayberg impacts all of Fulton County. Connie encouraged the committee not to sell the Clayberg. Selling is done when all else fails financially, the failure to the residents and staffing. Connie feels the Clayberg is very salvageable and viable to the community.
Name: Angelia Ellis
Address: Smithfield, IL
Topic: The Clayberg
Angelia is a registered nurse for over 17 years. Angelia stated these are her own words and feelings and are not those related to or reflect the job she performs or her employers’ views. Angelia stated in 2021 she became the Power of Attorney for her grandmother, whose independence began to deteriorate. Angelia began having to make decisions for her previously active grandmother, who needed more assistance with her daily activities. Angelia discussed the small home like environment at the Clayberg and residents are happy and well cared for. Angelia stated during her visits with her grandmother, there was not a time she did not boast about the staff and care she received at the Clayberg. Connie, believes her grandmother is so happy due to the longevity of the employees at the Clayberg. Angelia’s grandmother stated the staff at the Clayberg have become her family.
She asked what happens when the county no longer owns the Clayberg. The facility will face struggles of finding staff. Not every employee is going to want to work for a new company regardless of the longevity or locality of the employees’ own homes. Some employees will retire or find other jobs that offer better pay, better benefits or choose to work for a staffing agency. Current employees will lose their county benefits and will seek better options elsewhere.
The Clayberg or whatever name the nursing home will be, will need to hire nurses from a staffing agency.
The residents in the nursing home will suffer, the once familiar faces will no longer be working at the nursing home.
The veterans, homemakers, farmers and business men and women that shaped Fulton County will no longer be recognized. The residents deserve to have a safe and compassionate care in a home that is community based. Instead, the county will turn their backs on the residents and hope the new management and ownership will come in and provide the same level of hometown care.
What happens in a year from now when the new owner decides the new building is too small and is not providing enough revenue and decide to sell. Angelia stated she hopes no one here needs long term care or nursing home care in the future for themselves, family or a friends. Angelia stated this is one of the few county homes left in the area.
A quick Google search provided an Essential Community Facilities grant program that is offered to rural areas for nonprofit entities such as nursing homes.
Spending extra dollars on more in-depth training will help the facility improve and is well worth the investment.
Angelia invited everyone to visit other nursing homes in the area and compare the other homes to the Clayberg. Anyone can view any surveys and citations that have been given in Illinois. Please strongly weight the concerns that have been brought forth and who this affects is the elderly population in our community.
Name: Dr. Joshua Bowers
Address: Canton, IL
Topic: Clayberg Quality and Future
Dr. Joshua Bowers stated he is the Medical Director at the Clayberg. Dr. Bowers stated he believes the Clayberg is the best facility in Fulton County. This is Dr. Bowers’ favorite place to go and the staff turnover is low and the care given is great. The Clayberg feels like home. Dr. Bowers stated there are residents the staff take care of as if they are the staffs loved ones. Dr. Bowers’ opinion is to keep the Clayberg.
Name: Mayor Douglas Schmidt
Address: Cuba, IL
Mayor Schmidt addressed Chairman Spangler and Members of the Fulton County Board.
As Mayor of Cuba, Douglas Schmidt is here on behalf of the Cuba City Council. The Cuba City Council strongly encourages the Fulton County Board to maintain the Clayberg Nursing Home and Rehabilitation Facility in its current, county-owned status.
The Cuba City Council was surprised at the recent news that an Ad Hoc Health Committee had released RFPs to find temporary outside management company or a broker to sell the Clayberg. Cuba officials were left out of this very important conversation.
Cuba is a small town with the population of approximately 1,132 residents. The number of residents has been declining at a rate of 1 to 2 percent annually. The stress on Cuba is visible in the absence of a grocery store and low student enrollment. The City is doing everything possible to maintain a respectable and good quality of life in Fulton County.
Mr. and Mrs. Cecil Clayberg, in memory of their son James, a pilot missing in action during the Korean War, donated the land with the specific direction to build a public owned nursing home. Since the donation 53 years ago, the Clayberg has stood as a monument to the honor of James. Selling the Clayberg would be disrespectful to the Clayberg family.
Employees and staff continue to keep Clayberg at the forefront by hosting events for the school and community, fireworks, Easter egg hunts, Halloween activities, musical performances, etc. An annual fundraiser for the Cass Putman Rescue Services is run by Clayberg volunteers and is a significant source of funding. It is one of the most attractive, well-maintained public properties in Cuba.
With the closing of coal mines, the Clayberg became the second largest employer in Cuba. Many of the 70 employees live in the community. The employees that do not live in Cuba, IL, along with families, visitors, vendors and supporting agencies, still buy food, fuel and necessities at local businesses.
A for-profit company would make employees essentially start over, with wages and benefits would decrease, probably starting at minimum wage for CNA’s despite some having 15 plus years of service. Others may be forced to leave Cuba for better opportunities, and leave the community.
The sale would have serious repercussions for Cuba and the rest of Fulton County. The probability of such a small facility to continue to operate once sold to a private investor or for-profit corporation is a risk. It is was a gamble Cuba can’t afford to lose.
Fifteen years ago Cuba faced this same issue. The Cuba community rallied behind the Clayberg then and was instrumental in a referendum put to the voters of Fulton County and subsequently passed. It would be an unnecessary drain on our time, energy and resources to fight a battle already decided by the voters of this county.
a. Presentation by Heritage Business Operations
Ben Hart stated Heritage Operations Group is located in Bloomington, IL. Heritage Operations Group has been in the health care business for over 60 years. Heritage provides professional management services on behalf of other owners. Currently, Heritage manages 9 skilled nursing facilities for local municipalities and non-profits in central Illinois. It operates 10 assisted or supportive living facilities and owns and manages one county nursing home in Petersburg, Illinois.
Ben Hart stated Heritages believes there is a need for county nursing homes. Ben encouraged people and the County Board to check Heritage’s references. Heritage believes they can help with the Clayberg and preserve a future for the nursing home. There is a rich history of the quality of care at the Clayberg coming from people’s comments.
Ben stated Heritage works on behalf of Fulton County as the owner of the Clayberg. Heritage is looking to work in partnership with the county, not in conflict.
Steven Hart stated Heritage has no interest in changing the name of the nursing home and the people who work at the Clayberg. A management company for the Clayberg would be a nice balance so the county can own the nursing home. There are strong incentives for the county to own the Clayberg. Heritage would be a network of homes and expert individuals in helping local management understand regulations and interpret guidelines, enact IT policies and guidelines and provide back office support. Ben Hart discussed the State of Illinois gives each nursing home a strive score. The score is how the county is staffing to provide quality care at the nursing home. The state and Federal Government recommends 100% of strive. Heritage seeks to be at 100% of strive. Heritage operates 10 assisted or supportive living facilities. Heritage has opened their own nursing agency to combat the rising cost of nursing agencies as well as the quality of workers from outside the community. Pharmacy services are provided to Heritage’s owned and managed long-term care facilities.
Heritage would help with the day-to-day operations, a strategic operating plan and implementation of tools to monitor labor and non-labor expenses.
Coordinate purchasing efforts with vendors to obtain better pricing, coordinate and monitor compliance needs, accounts receivable and payable activities along with monthly billing.
Heritage would provide Human Resource matters, administer payroll, and compile required labor reports, coordinate case management for prior authorization, identify and establish information technology best practices and preferred vendors. Heritage would advise on the up-keep and maintenance of the facility’s property and equipment.
Connie Hoselton has been with Heritage for 35 years as the Human Resources and Chief Operation Officer. Management provides the back office support, but the people on the floor provide the care and make everything happen. The focus for the facility is on patient care not the back office process and compliance issues and reporting. A model could be set up for staffing patterns to assist. Heritage will provide the payroll support. HR is so important recruiting and retention of employees. A big focus is retaining employees. Heritage will not come in and change policies, Heritage will make suggestions for any changes.
Ben Hart added that Heritage became involved with Sunny Acres in Menard County. Heritage has been at Sunny Acres for approximately 6 – 8 years. All the employees are county employees and employees retained their state pension at Sunny Acres.
Jennifer Clyatt, Administrative Director Health Information Technology has been with Heritage for approximately 10 years.
Jennifer grew up in Eureka, IL and worked in the hospital system for many years. Jennifer’s first career was nursing and she understands about quality care. Jennifer transitioned to information technology and supervises the Facilities Department.
Heritage will provide oversight and guidance for life safety and IDPH regulatory requirements to the facility’s leadership team. Heritage has over 30 years of expertise in Life Safety and the requirements for skilled, assisted, supportive and independent living.
The IT support is provided 24/7 and is IDPH ready for any survey preparedness. Budgeting is provided and Capital Budgetary, with 3 to 5 year forecasting plans. Heritage will come into the facility and make any recommendations that would benefit Fulton County. Volume purchasing by Heritage does provide lower costs to Fulton County for software and services. A PointClickCare champion is available for the staff to consult with.
From an IT stand point, Heritage would provide the infrastructure, including Wi-Fi for business and guests. Security is always a concern, as Heritage does not want any breaches of data that would affect the business. HIPAA expertise and guidance for both private and security regulations would also be provided.
Heritage would provide management of computer equipment including desktop, laptops and other mobile devices.
The coordination of USAC Grant opportunities for rural health providers. A grant from the USAC Rural Health Grant can be applied for. Grants for Fiber and Broadband would pay up to 60% of the installation.
Steve Hart discussed the streamlining of processes and to be more data driven to provide trending on staff, to help reduce work load and increase value. Removing any repetitive work would help with reporting. This removes the burden from the staff at the Clayberg.
Vendor negotiation would save money and streamline processes.
Steve discussed a turnaround plan, would help size the occupancy, improve revenue and reduce expense without sacrificing quality of care.
The CNA 10 year subsidy program provides partial funding of CNAs wages bases on each individuals years of experience working as a CNA. Heritage has a submission form for tracking the subsidy program and makes the reporting to the state more reliable.
Heritage takes invoices and makes a report for budgeting for food purchases and kitchen supplies.
The onboarding plan for the first 4-6 months of a management agreement with the Clayberg, Heritage would have Connie Hoselton working 2 to 3 day a week working at the Clayberg as the management consultant during the transitioning processes. The management consultant would satisfy the role of Regional Director of Operations for a 4 to 6 month period.
After a 6 month period Connie, would be at the Clayberg approximately 1 or 2 times a month.
Connie discussed the onboarding of IT processes and a lot of the work is done on the front end before the contract becomes effective. This allows the Heritage team to assist Fulton County’s Management and would help Heritage know what the current state is at the Clayberg. Heritage would come in and look at and assess: the nursing call system, the door alarm systems, computer systems, network, contracts and key vendors. What is Fulton County paying for those contracts with vendors and is better pricing available by going through Heritage. All of this information lets Heritage be prepared on the first day of the contract with Fulton County to provide the services negotiated.
Connie stated IT is so important, and Heritage would come in and replace network equipment, with equipment that Heritage has people certified to work on. Fulton County will be connected back to Heritage’s infrastructure. There will not be a big capital expense for Fulton County, as there will not be servers on site at the Clayberg the server would be connect to Heritage’s. A percentage would be paid to Heritage of the services quarterly. An assessment would be done to determine: how many access points are needed for guest Wi-Fi, or Point of Care devices for the care givers.
Heritage will provide Fulton County a high level capital budget and a 3 to 5 year budget plan.
Steve Hart stated in February of 2023 the State of Illinois dropped the tax rate for county owned nursing homes. All nursing homes not county owned pay $19.20 for the non-Medicare occupied bed tax and the county owned nursing homes pay $7.00 for non-Medicare occupied bed tax. This saves approximately $15,000.00 per month in taxes paid.
Member Barclay inquired if Heritage has experience working with union facilities. Ben Hart stated Heritage currently does not have any unionized facilities.
Member Barclay inquired if there is a union problem, how this would be handled by Heritage.
Ben stated Heritage would not have any impact on union issues. Heritage is happy to work in a union or non-union environment. Heritage is willing to help with any union issues or keep it at the county level.
Member Beck inquired about staffing and when the union needs to be notified of issues.
He asked if Heritage will have an administrator at the Clayberg to assist with any issues or problems that arise.
Ben stated Heritage is here to be a back office management company and Heritage is willing to offer their expertise and management staff and bring in any ideas to benefit the Clayberg. Heritage’s view is they want to work in the best interest of the residents while collaborating with the ownership and employees that work at the facility. The employees are very important as they provide day to day care to the residents of the Clayberg. The best decision making is when parties can work together in the best interest of who they are there to serve.
Member Barclay stated Fulton County wants to keep as many local workers as possible. Ben stated the most important thing is to keep the current staff, it is not to bring in staffing agency workers. The staffing issues are a real issue across the health care industry.
Member Kessel inquired about the several home Heritage sold or has for sale.
Ben Hart stated Heritage is a for-profit, family owned company. The founder and primary shareholder of the company passed away, and the second generation ownership made a lot of decisions and not all the family members wanted the responsibility and burdens of dealing with banking institutions. The ownership base decided to reduce the capital structure of Heritage and focus on two primary things; the professional management services and the institutional pharmacy. It was not for any reasons based on distress of the company. Heritage’s financial base is very strong and this allows Heritage to focus on the Professional Management part of the business.
Member Kessel inquired what if Fulton County does not want the entire package being presented and Fulton County wanted to pick 3- 5 aspects for Heritage to manage.
Ben Hart stated Heritage has never done less than a complete management proposal. Heritage believes they work best when they have the ability to work in all aspects or all-encompassing approach to the business.
Heritage prefers not to break down the proposal.
Member Platt inquired about the Wander Guard System. Currently, parts for the system are not available making it a problem to secure one of the doors. The only bid received was for $50,000.00 for a 6 door system. What could Heritage do to help Fulton County with the bidding process.
Connie stated Heritage would work with venders, a lot of vendors offer hardware or software as a service for systems like Wonder guard. The software would eliminate the initial capital investment in a system and would be paid on a monthly subscription cost. Connie stated Heritage would get the bids and Heritage strives to get 3 bids. Once the bids have been received, Heritage would make a recommendation to Fulton County.
Member Widger inquired how much the service will cost the county per year.
Ben Hart stated Heritage charges on a percentage of the revenue basis and is a 5% flat rate. No other services being offered are charged as service fee. Software licenses and equipment would have an additional charge to the county.
Member Barclay inquired about equipment that is brought in.
Ben Hart stated the equipment is based on a 3 year term and payment.
Member Barclay inquired if the contract is broken, where the biggest fees are.
Connie stated the biggest charges are on equipment, routers, software, computers. Heritage would offer a payment schedule to pay for the equipment over the first term of the agreement and the equipment would be county owned.
Member Kessel inquired if Heritage has any procurement issues for a certain amount that needs to be bid.
Ben Hart stated any financial decision over $10,000.00 would come to the county for approval.
Chairman Spangler inquired with the Clayberg being a smaller facility, does Heritage see any challenges with the facility.
Steven Hart stated he recently ran a facility of approximately 50 persons and stated with a county owned home the county can make money. The benefits of having the facility and the county tax subsidy is huge.
Member Barclay inquired about the back office people and how this would affect their jobs.
Ben Hart stated Heritage has one other facility with county back office personnel.
Member Kumer inquired if the facility loses a member of management, what is the procedure to find the best candidate or an interim person for the job.
Jennifer stated if Heritage has talent within, they would try to promote or Heritage would recruit on all of the job boards for the position. An intern may be brought into the facility if the position cannot be filled right away.
Steve Hart stated when a key position is being replaced Heritage works with the employer. The employer has the final say on who is hired.
b. Presentation by Helios Healthcare advisors
Mario Wilson, Managing Director at Helios Healthcare Advisors, LLC, which is a third party company with 30 years of experience as a broker, discussed the potential sales process.
Mario stated Helios only advises on health care sale transactions.
Mario stated the financial situation at the nursing home can be corrected and Fulton County is exploring all the options. The environment is difficult to operate these types of facilities for the county. Mario stated the trend in the past 10 years across the county is due to the change in regulations and issues with staffing is causing financial strain.
With financial issues this affects resident care, clinical rating and CMS rating and can be a challenging situation to figure out what path is best for the county.
Given the nursing facility has been in the county for so long, it makes the decision to sell very difficult. The decision process is difficult and the residents and staff need to be considered.
Whoever comes into the facility as the new owner, the union employees are taken care of and they will find a way to maintain the facility as a nursing home. Helios has to think about the client (Fulton County) and what the concerns are related to what happens to a private facility if the county decided to dispose of the asset. If the decision is made to sell this nursing home, Helios would provide potential prospects, who have good reputations and understand how to work with unions and would be a reputable buyer.
Across the county, counties that have nursing homes have gotten out of the nursing home business due to financial stains or staffing issues.
Member Barclay inquired there are concerns a big company will purchase the facility and shut the nursing home down.
Mario stated having and selecting the right buyer by their reputation and how the buyer handles acquisition is very important. Helios will provide detailed information on every potential buyer. Helios is familiar with every nursing owner and operator and has dealt with them in the past as the industry is small. Helios gives honest advice and opinions to the county for the best decision to be made. Once offers are procured on the facility, Helios would sit down and discuss the merits of each offer and provide the opportunity to have a discussion with the potential company and their intent for the facility, as well as what the company intends to do with the employees and how the company plans to work with union.
Scale is how the nursing home business operates. Helios is seeing many smaller, individually owned facilities being sold.
Member Spangler inquired with the scale and the Clayberg being so small how is it marketable.
Mario stated the facility being small has great physical plant and great quality ratings from the clinical perspective and this is very valuable to a potential buyer. The consensus is the smaller facilities that are county run or privately owned try to reduce their costs in certain areas and make the facilities very attractive to buyers. The status in the community make the facility of interest for buyers.
Mario stated if Fulton County needs additional help, to contact Helios.
c. Discussion/Action: Hiring management consultant or broker for the Clayberg Nursing home.
Member Spangler asked the committee for any thoughts they have for the management company and the broker.
Member Barclay stated the management company has downfalls and pluses. Dealing with the union workers would be a learning process for the management company.
Member Thompson stated she does not think the union would be impacted. The administration would be running the facility and the county would still negotiate the union contracts.
Member Platt stated the management company would develop HR policies and the policies would be factored into new policies.
Member Kessel suggested members of the public and staff members of the Clayberg submit in writing any suggestions and solutions to the County Board Office. Another meeting is needed in two weeks once the committee has had time to review both presentations.
Member Kessel asked what is the best solution, which the county and the employees of the Clayberg can live with.
Member Beck stated this is similar to the situation as the Astoria nursing home and no solution was found and the home was closed.
Member Barclay stated the management company would come to the Fulton County Board for decisions.
Member Kessel stated the management company answered a lot of the questions she had and has the expertise.
Chairman Spangler stated he spoke with Menard County Board members about Heritage and Heritage got a great review.
Member Barclay stated he was not interested in the brokerage firm to sell the Clayberg. There were not a lot of firm answers on selling the facility.
Member Kumer stated, the committee has heard from the broker and the management company. The one thing the county has failed at is, 8 years ago a referendum was passed by the taxpayers of Fulton County and petitions have been signed with over 1200 names to keep the Clayberg. Both offers need to be withdrawn and keep the Clayberg as is.
Member Thompson inquired with Member Kumer what the solution is for the Clayberg. Member Kumer stated the money the Clayberg lost was Covid funds for the last 2 years and every business has lost money during this time.
Member Barclay stated there are issues at the Clayberg with staffing and the Clayberg cannot keep borrowing funds from the next year to keep operating. The funds will eventually run out. Outside staffing is very expensive and cannot continue.
Member Barclay stated normally the county would not have Covid funds to offset the loss.
Member Kessel stated not every detail in running the Clayberg needs to be known to the public. There are very concerning issues going on at the Clayberg being addressed. Member Kessel stated this is not about shutting the Clayberg down, it is about exploring alternative options to operate the Clayberg. The county is exploring options to make the best decision for Fulton County. The members of the Fulton County Board do not have nursing home background experience.
Member Barclay stated the committee does not want the facility to close.
Chairman Spangler stated the social media posts have been disturbing and demoralizing to board and committee members.
Member Barclay stated he visited the Clayberg on July 13, 2023, and the facility is a great facility but solutions are needed.
A member of the public inquired if a letter could be sent to the residents and employees regarding the intent for the Clayberg.
A member of the public stated Fulton County is surrounded by nursing schools, and asked why the county doesn’t recruit at these schools. Fulton County offer nursing students a percentage be paid for their schooling in return for working for Fulton County for X amount of years.
Nester Madson, former Fulton County Board Member stated, nursing employees leave for more pay and fail to realize the benefits associated with working for the county.
A member of the public inquired if there is currently a staffing issue at the Clayberg. The public member stated she worked at the Clayberg and left to work at the Courthouse, because of the DON currently employed at the Clayberg. The DON management skills was the reason she left the Clayberg. The member of the public inquired about returning to work for the Clayberg part time as a CNA and the DON stated there was not a CNA position open at that time. She offered to work weekends or after 5pm at night.
A member of the public commented when negotiating with the union to include a MOU for sign on bonuses for employees, add longevity bonus or offer schooling incentives. If the county does sign-on bonuses, be sure the county has a contract. Another suggestion was to contact head hunters for staffing issues or administration. The biggest part of the budget is staffing and insurance. Check with the county attorney about the Tort and Liability Insurance Funds, as this could be used toward the administrator’s salary.
Chairman Spangler stated there have been a lot of management conflicts and personality conflicts at the Clayberg.
The next committee meeting will be July 31, 2023 at 6:00pm at the Fulton County Courthouse.
Member Kessel moved to adjourn at 8:35 pm with a second from Member Platt. Motion carried by voice vote with all voting ayes.