To: Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Public Health Nursing Services
End
Recommended Action:
Recommended action
Adopt a Resolution amending the Department Allocation List for the Department of Health Services to delete 1.0 vacant Full-Time Equivalent Public Health Nurse II and add 1.0 Full-Time Equivalent Senior Public Health Nurse, effective November 24, 2026.
end
Executive Summary:
The Department of Health Services (DHS) requests approval to replace 1.0 vacant Full-Time Equivalent (FTE) Public Health Nurse II with 1.0 FTE Senior Public Health Nurse within DHS Public Health to support Human Services Department (HSD) Adult & Aging programs.
HSD and DHS maintain an intra-county Memorandum of Understanding (MOU) for Public Health Nursing Services that establishes the departments' respective roles in providing nursing care planning, health service brokering and monitoring, health education and training, and health reassessment for clients served by HSD Adult & Aging programs. The current service model embeds DHS Public Health Nurses within Adult & Aging programs as part of an interdisciplinary approach to serving older adults, individuals with disabilities, and their caregivers.
The proposed add/delete maintains existing nursing capacity while better aligning the position classification with the level of independent clinical judgment, complex case consultation, coordination, and senior-level nursing expertise required by the assignment. HSD will fund the incremental salary and benefit costs associated with the Senior Public Health Nurse classification. Following approval of the position change, HSD and DHS will update the FY 2026-2027 Public Health Nursing Services MOU and associated budget to reflect the Senior Public Health Nurse classification and corresponding costs.
Discussion:
The Department of Health Services (DHS) Public Health Division and the Human Services Department (HSD) Adult & Aging Division maintain an interdepartmental partnership to provide public health nursing services to older adults, individuals with disabilities, and other vulnerable adults served by Adult & Aging programs. The partnership uses a dual-discipline model that integrates Public Health Nurses (PHNs) with Adult & Aging social services staff to provide collaborative and holistic services designed to support clients in remaining safely in their homes and communities.
Under the Public Health Nursing Services Memorandum of Understanding (MOU), DHS provides nursing services supporting In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), Home and Community Based Alternatives (HCBA), Adult Protective Services (APS)/Public Guardian, Linkages, and California Community Transitions (CCT). The MOU establishes the departments' respective responsibilities for nursing care planning, health service brokering and monitoring, health education and training, and health reassessment for clients served by Adult & Aging programs.
The DHS Health Care Coordination program supports this work by connecting medically vulnerable populations to essential healthcare services and promoting continuity of care for individuals with complex health needs. Within the HSD/DHS partnership, PHNs provide nursing expertise and consultation to clients and social workers as part of an interdisciplinary approach to assessing client needs and developing plans of care. Adult & Aging remains responsible for client care plans, while DHS is responsible for employing, supervising, and evaluating the PHNs assigned to the programs.
Current Staffing and Program Need
The current MOU provides for 9.55 FTE of DHS staffing to support Adult & Aging programs and includes Public Health Nurse II, Senior Public Health Nurse, Supervising Public Health Nurse, Health Program Manager, and management-level support. Within this structure, IHSS is currently supported by 2.0 FTE Public Health Nurse II positions, while Senior Public Health Nurses are assigned to MSSP, HCBA, APS/Public Guardian, and Linkages/CCT.
One of the 1.0 FTE Public Health Nurse II positions is currently vacant. HSD and DHS reviewed the nursing needs of Adult & Aging and determined that replacing the vacant Public Health Nurse II with a Senior Public Health Nurse would better align the classification with the level of responsibility needed to support the programs and provide greater flexibility to deploy senior-level nursing expertise where needed.
The Senior Public Health Nurse will primarily support IHSS and may also be assigned to other Adult & Aging programs, including MSSP and HCBA, based on program needs. The work requires independent clinical judgment, consultation regarding complex client needs, coordination with social workers, healthcare providers and community partners, and the ability to serve as a senior nursing resource within the interdisciplinary service model.
The MOU identifies specific nursing responsibilities and program requirements across the Adult & Aging portfolio. For IHSS, PHNs support durable medical equipment needs and paramedical tasks and provide consultation to IHSS social workers, clients, and providers. MSSP maintains prescribed care-management staffing ratios, and HCBA maintains Care Management Team caseload thresholds established by the California Department of Health Care Services. The MOU also identifies nursing responsibilities within APS and requires a registered nurse to determine level-of-care eligibility for CCT.
Moving the vacant allocation to the Senior Public Health Nurse classification will provide HSD and DHS greater flexibility to meet these varying nursing needs while maintaining the overall staffing capacity supporting Adult & Aging.
HSD/DHS MOU and Funding
The proposed add/delete does not increase the overall number of nursing positions supporting HSD Adult & Aging. HSD will fund the incremental salary and benefit costs associated with replacing the Public Health Nurse II with a Senior Public Health Nurse.
The current MOU covers the period of July 1, 2025 through June 30, 2026. Following approval of the requested position change, HSD and DHS will update the FY 2026-2027 Public Health Nursing Services MOU and associated budget to reflect the Senior Public Health Nurse classification and applicable salary, benefit, and indirect costs.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
June 2026 Budget Hearings
Fiscal Summary
|
Expenditures |
FY26-27 Adopted |
FY27-28 Projected |
FY28-29 Projected |
|
Budgeted Expenses |
$259,784 |
$270,781 |
$278,904 |
|
Additional Appropriation Requested |
$3,110 |
|
|
|
Total Expenditures |
$262,894 |
$270,781 |
$278,904 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
$262,894 |
$270,781 |
$278,904 |
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$262,894 |
$270,781 |
$278,904 |
Narrative Explanation of Fiscal Impacts:
Human Services Department funds the public health nursing services provided by Department of Health Services to Adult & Aging programs through an intra-county MOU. The FY 2026-2027 MOU provides the existing framework for the departments' public health nursing partnership and identifies the staffing levels and classifications supporting each Adult & Aging program.
The proposed action replaces 1.0 FTE Public Health Nurse II with 1.0 FTE Senior Public Health Nurse. Human Services Department will fund the incremental salary and benefit costs associated with the Senior Public Health Nurse classification. The estimated FY 2026-2027 increase in Salaries and Benefits is $3,110, reflecting a partial-year fiscal impact based on the anticipated recruitment and hiring timeline following Board approval. HSD will fund this incremental cost through a corresponding increase to the HSD/DHS MOU, with funding coming from State and Federally funded programs impacts by the positions, including IHSS, APS, HCBA, and MSSP.
Following approval of the position change, Human Services Department and Department of Health Services will update the FY 2026-2027 Public Health Nursing Services MOU and associated budget to reflect the Senior Public Health Nurse classification and the applicable salary, benefit, and indirect costs. The classification change will therefore be incorporated into the interdepartmental funding arrangement between Human Services Department and Department of Health Services.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Public Health Nurse II |
10,800.85-13,127.98 |
|
1.0 |
|
Senior Public Health Nurse |
11,569.60-14,063.71 |
1.0 |
|
Narrative Explanation of Staffing Impacts (If Required):
The requested change does not increase overall staffing. The existing vacant 1.0 FTE Public Health Nurse II will be replaced with 1.0 FTE Senior Public Health Nurse. The change will provide greater senior-level nursing capacity and clinical support for the work performed in partnership with HSD Adult & Aging.
Attachments:
Attachment 1 - Personnel Resolution
Related Items “On File” with the Clerk of the Board:
N/A