To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services, Human Services Department
Staff Name and Phone Number: Tina Rivera, 707-565-4774; Angela Struckmann, 707-565-5802
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Department of Health Services Staffing Allocation - Senior Public Health Nurse
End
Recommended Action:
Recommended action
Adopt a personnel resolution amending the Department of Health Services allocation list to add a 1.00 full-time equivalent Senior Public Health Nurse position allocation, effective July 11, 2023.
end
Executive Summary:
The “Care Management Team Ratios and Participant Contact Requirements and Tracking” are mandated by the State of California through the Home and Community Based Alternatives (HCBA) Waiver Program and determine the ratio of public health nurses to social workers facilitating the program. The nurses evaluate a very vulnerable, high acuity population with the goal of enabling them to remain at home rather than be cared for in a hospital setting. Partnering with social workers, the nurses meet clients at home and then re-evaluate their situation as frequently as every 180 days. The ratio of client to nurse is 40:1 for the highest acuity client to as infrequently as 365:1 for the lowest acuity client. Currently, there are two Senior Public Health Nurses assigned to 140 active clients (70 clients each) and there are 25 community members on the wait list. Given this current data, the Department of Health Services (DHS) is requesting a 1.0 full-time equivalent (FTE) Senior Public Health Nurse (PHN) to participate in the HCBA Waiver Program.
Discussion:
The Senior PHN, in collaboration with the Human Services Department (HSD) Adult and Aging Division plays a lead role in the local administration of the statewide HCBA waiver care management program. The Senior PHN provides comprehensive case management services to medically vulnerable individuals in the community and is responsible for conducting home visits, addressing physical, cognitive, functional, psychosocial, nutritional, medical, nursing, and rehab needs. Additionally, the Senior PHN Nurse works independently, utilizing nursing assessment and problem-solving skills, to provide recommended and interventions to promote the overall health, safety and support of the HCBA client at home. They identify immediate and ongoing risk factors, and possible resources to reduce risks which impact supporting the client in their home. They provide advocacy and education to community partners and the multidisciplinary team of care providers regarding ongoing health care needs. They work closely with physicians, clinics, and community agencies to assess and determine health care needs, disseminate health information, and have an understanding of community resources.
The overall benefit of this staffing request will be to increase the program’s capacity to serve vulnerable community members. These benefits align with the Board’s Strategic Priorities. Because the HCBA Waiver Program is state mandated, adding a Senior PHN will ensure the program maintains compliance with staffing ratios and allows for wait-listed community members to enroll in the program.
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 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Prior Board Actions:
N/A
Fiscal Summary
|
Expenditures |
FY 23-24 Adopted |
FY 24-25 Projected |
FY 25-26 Projected |
|
Budgeted Expenses |
$224,777 |
$236,016 |
$247,817 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
$224,777 |
$236,016 |
$247,817 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$224,777 |
$236,016 |
$247,817 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$224,777 |
$236,016 |
$247,817 |
Narrative Explanation of Fiscal Impacts:
The salary and benefits costs for the Senior Public Health Nurse will be provided by HSD through a memorandum of understanding with DHS.
Funding will be allocated from the following revenue sources on an ongoing basis: state and federal funds via Section 1915(c) of the Social Security Act and State Welfare and Institutions Code §§ 14132(t), 14137 which mandates Medi-Caid/Medi-Cal Waiver programming, including the HCBA Waiver.
The Department of Health Services will request FY 23-24 appropriations via the Quarter 1 Consolidated Budget Adjustments.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Senior Public Health Nurse |
8,635 - 10,496 |
1.00 |
0.0 |
Narrative Explanation of Staffing Impacts (If Required):
The priority to increase this allocation is high given State mandates for the program and the need to be in alignment with mandated staffing levels. There is no alternative for coverage because nurses currently have full caseloads in the programs in which they currently work and are unable to increase their case numbers.
Attachments:
Attachment 1 - Personnel Resolution
Related Items “On File” with the Clerk of the Board:
None