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Health & Human Services Agency (HHSA) recommending the Board consider the following:
1) Designate a maximum of $5 million in Public Health Realignment fund balance to be used to purchase and/or build a new building in South Lake Tahoe to be used by HHSA staff, including but not limited to Public Health, Social Services, Community Services staff and potentially other county departments such as Child Support Services, which could benefit the community by having access to services in the same location; and
2) Direct the Chief Administrative Office, Facilities Division, to work with HHSA relative to its South Lake Tahoe space needs and identify options for consideration, including but not limited to buying and renovating an existing building or the construction of a new facility.
FUNDING: Public Health Realignment.
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DEPARTMENT RECOMMENDATION
HHSA recommends approval of this recommendation and if the County is successful in identifying a suitable building, it will address ongoing facility issues relative to the El Dorado Center and provide a long term benefit to the South Lake Tahoe Community by using ongoing state and federal funds for service delivery instead of being used to pay lease costs, and allow for improved service integration that will benefit services to clients.
DISCUSSION / BACKGROUND
Currently, HHSA maintains staff for Social Services, Public Health, Community Services, and Mental Health programs in South Lake Tahoe. Staff for these programs are located in three separate locations; the El Dorado Center and Johnson Center Buildings which are County owned facilities, and the Mental Health Building at 1900 Lake Tahoe Blvd., which is leased space.
Public Health Realignment Funds
In January 1991, the Governor proposed a transfer of responsibility for community-based mental health programs and AB 8 county health services program from the State to the counties as part of a "realignment" of state and local programs. The proposal was a major component of the administration's initial plan to address the significant funding gap that faced the State in 1991-1992.
Programs that were included in the realignment legislation included community-based mental health services, public health services, and indigent health services. Additionally, cost sharing ratios for programs such as California Children's Services were adjusted in conjunction with the realignment legislation.
In approximately 2008-2009, Public Health saw an increase in fund balance due to County-wide reductions in force and changes in service delivery by merging with the Mental Health Department. Over the next few years, PH began to redefine service delivery and organizational structure. As the economy has improved, PH has seen an increase in fund balance due to cost savings in combination with increased realignment revenue. In FY 2013/2014, PH had additional fund balance increases due to the Agency reorganization, salary savings and a substantial reduction in A-87 costs.
HHSA anticipates ending FY 2014/2015 with approximately $6 million in Public Health Realignment Fund Balance.
Other options for the use of PH Realignment Funds
Over the past 6 months HHSA has explored a variety of options relative to the use of the Public Health Realignment fund balance. While HHSA is recommending to use the funds to purchase a building in South Lake Tahoe, one other desirable use of the funds would be to pilot an extensive 'wrap' program of services to families.
Based on community health assessments by Marshal Medical Center and Barton Memorial Hospital, as well as current Public Health data, El Dorado County has a high prevalence of substance abuse, domestic violence and late access to prenatal care, all of which have negative impacts on other parts of the County's service delivery system, including Public Safety, Child Protective Services, Mental Health, Ambulance Services and primary healthcare.
HHSA developed a proposal to use the Public Health Realignment fund balance to provide extensive services to this population over the next three years to see if systemic improvement could be made in El Dorado County. While HHSA feels this program would be very beneficial to the community, the costs to support this program totaled approximately $1.2 million/year, meaning after 3 years the program would no longer be sustainable. In order to be sustainable, the County would need to discontinue using Public Health Realignment funds to support the Animal Services Division (approximately $250,000/year) and the California Forensic Medical Group contract for medical services in the jails and juvenile halls (approximately $700,000/year), and instead use General Fund money to support these programs.
While this option may result in more immediate outcomes, since the program is not sustainable at this time using the funds to purchase a building will have a longer term benefit on the entire scope of services in the South Lake Tahoe region, as well as assist in addressing the ongoing facility challenges relative to the El Dorado Center.
Social Services Staff in El Dorado Center
In July 2009, the County chose to relocate Social Services staff from leased office space to the El Dorado Center as a result of budget shortfalls. Currently, there are approximately 46.6 FTEs assigned to work in the El Dorado Center, which include staff assigned to CalFresh, CalWORKs, Child Protective Services, Adult Protective Services, the Workforce Investment Act program, and In Home Supportive Services.
El Dorado Center Facility Issues
In June 2013 Vanir Consulting issued a report to the County that concluded "The building has too many costly deficiencies which would indicate that the relocation of the County Department to an appropriate building or replacement of the building would be more cost effective."
Specific challenges for HHSA staff include a lack of climate control, lack of parking for staff and clients, drainage issues resulting in periodic flooding, and most importantly, the building does not comply with the Americans with Disabilities Act (ADA). Currently, HHSA has an audit finding relative to the Workforce Investment Act (WIA) program which identifies the restrooms are out of compliance with ADA requirements. In April 2015, HHSA received approval of an extension in order to comply with ADA requirements, but we are required to post signs at the restrooms stating the County is aware the restrooms do not meet ADA standards and is in the process of identifying a plan to comply.
Service Integration Benefits
Co-locating Public Health, Social Services and Community Services staff, and if possible other County departments such as Child Support Services, in one location will allow for further service integration. For example, Public Health staff would be onsite and more readily available to assist Child Protective Services and Adult Protective Services when they identify a family who would benefit from the variety of public health services, including nursing consultations, vaccinations, and education. Another example is clients obtaining services from the Social Services - Income Maintenance Division would also have easier access to the variety of Community Services programs designed to assist low-income families.
Leased Space versus County owned space:
With the exception of the Public Health Division, federal and state funded HHSA programs such as Mental Health and Social Services operate out of leased space. Currently, HHSA anticipates spending approximately $1.07 million/year ($89,778/month) in lease costs. As a result, this money is unable to be used for services to our community.
HHSA recently conducted a survey of all counties in California, and of the 33 counties who responded, approximately 45% of those counties operate their federally funded Social Services programs out of county owned buildings in order to free up funds for services.
In addition, the CAO's Facilities Division has explored a number of options for leased space in the South Lake Tahoe region and found there are limited options. The majority of space is smaller than desired and would result in operational challenges by separating staff into multiple locations resulting in obstacles to effective collaboration and service integration. The Facilities Division was able to identify a location large enough to support the CalFresh, CalWORKs, and the One Stop Employment Center programs in the Social Services Division for approximately 29.6 FTE but the lease costs would have totaled approximately $22,000/month. This amount is equivalent to 2 FTE Social Worker allocations that would need to be eliminated, further impacting essential services and having a negative impact on child safety. In addition, HHSA would still need to identify additional space for Child Protective Services and Adult Protective Services at an additional cost.
ALTERNATIVES
The Board can choose to not approve this recommendation and direct the Chief Administrative Office - Facilities Division to continue looking for leased space for Social Services staff. This action is not recommended because it will require HHSA to reduce staffing levels in programs that already have higher than recommended caseloads.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
Chief Administrative Office - Facilities Division
CAO RECOMMENDATION
Give direction to HHSA on how to move forward with the evaluation of its building needs in South Lake Tahoe.
FINANCIAL IMPACT
There are no costs associated with this recommendation at this time. In the event the CAO's Facilities Division is able to identify a suitable location, a recommendation for approval to use the Public Health realignment funds for this purpose will be made to the Board.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Provide one Certified Minute Order to HHSA Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT
HHSA Strategic Plan - Goal 4: Agency Infrastructure, Objective 4.2.15: Create a more effective working environment at the El Dorado Center for clients and staff.
CONTACT
Don Ashton, M.P.A., Director