HomeMy WebLinkAboutResolutions - 1983.02.24 - 11520February 3, 1933 Miscellaneous Resolution
BY: HEALTH AND HUMAN RESOURCES COMMITTEE
IN RE: COMMUNITY MENTAL HEALTH GERIATRIC OUTPATIENT SERVICE PROPOSAL
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Mr. Chairperson, Ladies and Gentlemen: .
WHEREAS the Oakland County Community Mental Health Services Board has
been invited by the Michigan Department of Mental Health to submit a proposal
for a comprehensive geriatric outpatient service to meet the mental health needs
of our growing population of elderly citizens in the County; and
- WHEREAS the Community Mental Health Services Board has prepared a
detailed program and budget proposal for this "Oakland County Geriatric Mental
Health Service" which has been reviewed by your Committee; and
WHEREAS such a program could be effectively integrated with other
Community Mental Health services to provide a continuum of public mental health
treatment for older persons with psychiatric problems; and
WHEREAS creation of an Oakland County Geriatric Mental Health Service
would demonstrate the strong commitment of the County and Community Mental
Health Board to the specific needs of elderly citizens, who are at present
very much underserved by the Community Mental Frealth system; and
WHEREAS approval of five and one-half additional FTE positions proposed
for the Geriatric Mental Health Service would allow the Community Mental Health
Services Board to recall some staff who have been laid off due to State budget
cuts in other areas and/or forestall additional layoffs which may otherwise
be necessary.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners
authorize creation of an "Oakland County Geriatric Mental .Health Service" as
proposed by the Community Mental Health Services Board, including the requisite
County matching funds and five and one-half additional FTE positions, effective
April 1, 1983 and subject to final approval of 90% State of Michigan funding for
the program. I
BE IT FURTHER RESOLVED that this program is contingent upon the availability of
existing budgeted County match for Community Mental Health programming.
Mr. Chairperson, on behalf of the Health and Human Resources Committee, I move
the adoption of the foregoing resolution.
HEALTH & HUMAN RESOURCES COMMITTEE
Mari ynn Gos1ing, ChairFThrson
OAKLAND COUNTY GERIATRIC MENTAL HEALTH SERVICE
PROGRAM DESCRIPTION
Oakland County Community Mental Health proposes 'to create a directly operated
program providing a broad range of outpatient services for: (1) adult mentally
ill and OBS residents of all ages in nursing homes in the County; (2) similar
persons in Clinton Valley Center and Walter Reuther Psychiatric Hospital who
need nursing home placement; and (3) mentally ill and OBS residents of the
community aged 60 and over.
The specific services to be offered by the Geriatric. Mental Health program are:
1. Pre-screening of persons aged 60 and up for potential admission to Clinton
Valley Center, including returns from nursing home placement, with an emphasis
on finding alternatives to hospitalization.
2. Placement of Oakland County patients in CVC and WRPH into Oakland County
nursing homes when appropriate: services would include pro-discharge evalua-
tions, and active referral and placement into nursing homes with provision
of CMH continuing treatment services.
3.. General outpatient diagnostic and. treatment services for those aged 60
and over, including persons who are homebound, whether in dependent living
or in senior housing facilities. For clients able to come in to CMH outpatient
clinics, linking to appropriate CMH services will be the goal. For those who
are homebound, outreaching services will be provided by the Geriatric Mental
Health program, including individual and group therapy as appropriate, and
psychiatric supervision of medications. Training for families will be offered
to help them care at home for mentally ill/OBS family members. The program
will respond to client-defined and family-defined mental health crisis
situations, and assist elderly persons in maintaining themselves or. being .
maintained in the least restrictive residential setting suited to their needs.
4. Crisis intervention for the defined client population after hours, at
nights and on weekends and holidays will be provided by the Board's emergency
service, Common Ground of Birmingham, either on the phone or face-to-face for
walk-in clients. This service also includes psychiatric intervention when
indicated.
5. Service to residents of nursing homes will comprise continuing treatment
for those who have been placed from CVC or WRPH, and appropriate 'outpatient
care for other residents who do not have a State hospital linkage. Since
nursing homes have a professional health care team on staff, CMH Geriatric
Mental Health Service will emphasize a consultative model in this setting,
with evaluation of the client and case consultation to the nursing home
staff, and follow-up at periodic intervals. However, direct services will
be offered where they are appropriate, including individual and group psycho-
therapy. An important part of the CMH Geriatric Service is psychiatric .•
consultation to the attending physician in the nursing home. For residents
who have been placed from CVC or WRPH, the Geriatric Mental Health- Service
clinician assigned will function as the case manager, and follow the client
for at least the 12 months mandated by DMH, but in fact for as long as the
client continues to be appropriate for Community Mental Health Services.
6. In-service training for nursing home and senior housing facility staff,
and any other suitable groups; program consultation to nursing homes and
other facilities and agencies for older adults.
,7. Evaluations for Oakland County Probate Court in questions of guardianship
or conservatorship, and Continuing orders for ,CVC patients who have been
transferred to WRPH and are Oakland County residents.
The business hours of the Geriatric Mental Health Service would be 8:30 AM
to 5:00 PM Monday through Friday. The Service would ideally be sited on
Clinton Valley Center grounds as a central location and to facilitate a
close working relationship with the State hospital. We propose to use
office space in the Outpatient Clinic building at CVC, where other CMH
services are housed.
There would be no fee for direct or indirect services to nursing homes or
their residents, but Community Mental Health Would seek all available third-
party reimbursement, especially Medicare and Medicaid. Community clients,
if not covered by Blue Cross or another third-party benefits provided,
would be charged a fee for service baSed on their ability to pay, on the
regular CM sliding fee scale. Exceptions could be made at the discretion
of the clinician in charge of the individual case.
An advantage of the proposed program is that it would be tied in most closely
to all Oakland County Community Mental Health Services, assuring a continuum
of care for the clients, and an inter-disciplinary approach to their needs
and problem, with input from p sychiatrists, social workers and psychiatric
nurses. Psychological testing, when indicated would be available in CMH
outpatient clinics. We propose to redirect one-fourth of the time of our
Recipient Rights/Community Consultation OffiCer - to provide administrative
supervision of the new Service and assist in some of the more sensitive and
technical activities of the Service, such as in-service training for nursing
homes. Our psychiatrist-Chief of MI Adult Services will also be available to
provide clinical supervision for the personnel of the Geriatric Mental Health
Service,
We plan to seek the participation of student nurses and mental health workers
in the program, as well as volunteers.-- who would be trained by program staff.
We would also expect that there will be a close liaison with volunteer groups
like FISH (for client transportation), and other agencies in the County
serving older persons, particularly Catholic Social Services Senior Companion
and Foster Grandparent Programs.
Because of the particular treatment needs of the client-population to be
served, and with the use of a consultative model for nursing home residents
and the linking of a portion of the clients to Community Mental Health
outpatient clinics, it is anticipated that the attached staffing pattern for
the Oakland County Geriatric Service will accommodate an open caseload at
any one time of about 360 clients.
-2-
1984 1983
9 MONTH PHASE FULL YEAR COST PROGRAM BUDGET
OAKLAND COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
OAKLAND COUNTY GERIATRIC SERVICES
PROPOSED COUNTY BUDGET 1983
Salaries
---7F-VSychiatrist . $32,436 -
2 Clinicians (MSW's) 51,532
2 Psychiatric Nurses 35,510
1 , Clerk III 14,116 .
.10 Clinical Supervision (Redirection) 7,328
.25 Program Supervision (Redirection) 7,782 $111.„528 $148,704
Fringe Benefits 35,389 - 47,185
Insurance 1,004 1,339
' :e Supplies 525 . . 700
Equipment Rental 675 900
Copier Costs 600 . 800
Communications 1,257 1,676
Rent 3,000 4,000
Custodial & Building Maintenance 1,875 . 2,500
Staff Transportation 6,150 8,200 •
Drugs _ . 750. -.. . - 1,000
. '.,-orkshop Consultants 750 1,000
Travel 8 Conference 150 - 200
Publications 75 100
TOTAL PROGRAM $163,728 $218,304
SOURCES OF REVENUE
State Match
County Match
Medicare
Medicaid
Redirection
TOTAL REVENUES
$129,158
13,182 (1)
3,729
3,000
14,659
$171,327
18,450 (2
4,972
4,000
19,545
$163,728 $218,304
(1) 9'; for 6 months; 91/2% for 3 months.
(2) 9% for 9 months; 10% for 3 months.
BAM/pj v
/83
FISCAL NOTE
BY: FINANCE COMMITTEE, DR. G. WILLIAM CADDELL, CHAIRPERSON
IN RE: MISCELLANEOUS RESOLUTION #83011 - COMMUNITY MENTAL HEALTH GERIATRIC
OUTPATIENT SERVICE PROPOSAL
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Mr. Chairperson, Ladies and Gentlemen:
Pursuant to Rule XI--C of this Board, the Finance Committee has reviewed
Miscellaneous Resolution #83011 and finds the following:
1) This proposal would expand current Community Mental Health services,
2) No additional County funds are necessary,
3) The proposed 5.44 new positionS are Other Source funded and require
Personnel Committee approval prior to implementation,
4) Continuation of this program will be reviewed as part of the annual
budget process.
FINANCE COMMITTEE
State Operated Services
GRAND TOTAL
Revenues
1,835,796 1,835,796
10,535,392 (149,069) 10,386,323
10,535,392 149,069
51,000
373,229
7,479,015
657,448
35,741
14,572
75,409
13,182*
8,699,596
1,835,796
13,182
149,069
3,000
3,729
129,158
FINANCIAL ANALYSIS
COMMUNITY MENTAL HEALTH GERIATRIC OUTPATIENT SERVICE PRO"MSAL
Program
Administration
Board Hosp. Liaison Team
Southwest Oakland CMH Clinic
Catholic Social Services
Family & Childrens Services
Jay Shop
. Pontiac General Clinic
Children's Short-Term-
Residential
M/R-Adult Activities
M/R-Counseling & Evaluation
M/R-Respite Center
Community Living Center
New Horizons
Parents Foundation
Common Ground Emergency
Service
Jewish Vocational Service
PGH Alternative Treatment
Child & Adolescent Clinic-
Pontiac
Child & Adolescent Clinic-
Royal Oak
Child & Adolescent Day
Treatment
S.O.L.E.C.
Southwest CMH Clinic
South CMH Clinic-Satellite
Southwest Day Treatment
Geriatric Outpatient Service
Total CMH Programs
1982-1983
Adopted Budget
645,464
135,624
206,867
7,000
456,200 4
175,652
840,198
47,500
836,008
626,100
26,560
82,984
402,671
78,653
178,300
497,579
194,634
695,552
374,242
313,690
561,764
265,105
242,142
8,550,527
Revised Difference
1982-1983 Favorable/
Adopted Budget (Unfavorable)
645,464
135,624
206,867
7,000
,456,200
175,652
840,198
47,500
836,008
626,100
26,560
82,984
402,671
78,653
178,300
497,579
194,634
695,552
374,242
313,690
561,764
265,105
242,142
149,069
8,699,596
660,038 660,038
(149,069)
(149,069)
Medicaid 48,000
Fees 369,500
State Match (90.875%) 7,349,857
County Match (9.125%) 657,448
County Match - 100% 35,741
Local Match - Donations 14,572
State Pick-up of County Title XX 75,409
Other Revenue ---
Total Revenues 8,550,527
State Operated Services 1,835,796
GRAND TOTAL 10,386,323
*The $13,182 represents County matching funds, however it is anticipated the Total
CMH Programs budget will be reduced due to State deficits, exact amounts to be determined--
in the near future. Such a reduction would decrease the County Match more than the
$13,182 now requested. For this reason, M.R. #83011 states this Geriatric Outpatient
Service Proposal is contingent upon the availability of existing budgeted County match
funds,ensuring the County match will be less than or equal to the $657,448 budgeted.
#83 0 11 February 24, 1983
Moved by Gosling supported by Rewold that resolution #83011 be adopted.
AYES: Olsen, Page, Pernick, Price, Rewold, Wilcox, Aaron, Caddell,
Calandro, Doyon, Foley, Fortino, Gosling, Jackson, R. Kuhn, Lanni, Law,
McDonald, McPherson, Moffitt, Moore, Nelson. (22)
NAYS: None. (0)
A sufficient majority having voted therefor, resolution #83011 was adopted.
STATE OF M1CH1GAN)
COUNTY OF OAKLANO•
I, ,Lynn D. Allen, Clerk of the County of Oakland and having a seal,
do hereby certify that 1 have compared the annexed copy of
Miscellaneous Resolution .# 83011 adopted by the Oakland County Board of ComTlissioners
at their meeting held on February 24, 1983
with the original record thereof now remaining in my office., and
that it is a true and correct transcript therefrom, and of the
whole thereof.
In Testimony Whereof, I have hereunto set my hand and affixed the
seal of said County at Pontiac, Michigan
this 24th day of „FehruarY 1983
LM/D. ALLEN, County Clerk/Register of C