 Welcome to Sheboygan County Government, working for you. My name is Adam Payne, Sheboygan County Administrator and co-host of this program with Mike Vanderstien. And we've been giving this program now for a number of years. I think we've actually done over 100 programs now and if you've been following us, you know, every month we try to bring a new department and a director of that department to talk a little bit about roles and responsibilities and what's going on in Sheboygan County. And today we're very pleased to have Tom Eggebrecht with us, who is the director of our Health and Human Services Department. Welcome Tom. Thanks Adam. Now you may not have seen Tom that frequently or perhaps never before because he's only been with us for a year, though frankly it feels longer because he just hit the ground running and has done a tremendous job for us. And Tom, why don't you start by sharing a little bit about your background and what your impressions are now that you've got a year under your belt here? Sure. I came here from Brown County just about a year ago, Adam, as you mentioned. Finally as you know, I was called upon to provide some comments for an employee newsletter about myself and about my experiences and I think at that time I indicated that it felt very difficult to explain what it's like to be in a place that you never knew you would be, but now that you're here always felt like you belonged and I continue to stand by that comment. I continue to be overwhelmed and awestruck by the beauty of Sheboygan County. I love its culture, I love the diversity and truly appreciate and enjoy the people I work for and with and that includes our staff, that includes you gentlemen, that includes the county board, business partners that I've had the chance to meet. I think everyone has been very, very supportive, very, very gracious in their interactions with me and even though we disagree at times, I think we need to disagree at times. I think we do that with respect and I think we have a shared vision and a common purpose and I'm delighted to be here. And we're delighted to have you and it is hard to believe it's only been a year because it feels longer because I think of the comfort level and the good working relationships that you very quickly established here and though you do have background as working in the health and human services arena, there's still a learning curve, you know, getting a feel for a new environment and again it seems like that all came together real quickly for you. Please touch on your background a little bit. Brown County, before that, Manitowoc County, what kind of experiences did you bring to Sheboygan County? I started many years ago in Milwaukee County working for private agencies along with my wife and in a number of non-profit endeavors and about the late 80s I became developmental disabilities coordinator in Manitowoc County, spent about 10 years there, moved up to Brown County, worked in Green Bay with county government there as director of community services and part-time interim director for that department. So when the opportunity opened up here, I felt it was a good fit and coincidentally I'd had the opportunity to meet a number of people from Sheboygan County over the years and was always impressed with their style, their grace and I thought it would be a great fit for me so again glad to be here. Health and Human Services Department, one of the most important in your mind perhaps the most important department in Sheboygan County, one of 21 departments, the largest budget nearly 32 million, what are the key core services that you're responsible for overseeing there? I thought Adam might be interesting just to talk about history a little bit and why do we have Health and Human Services at the county level. And you look back at this state's evolution and it was not uncommon for most counties to have specific properties or facilities that would house persons who were homeless, that would house vagrants, would house persons with illness, disabilities, etc. I took a look at some Sheboygan County history and I see that $3,000 was allocated in the late 1870s I believe to build what they called an insane asylum and in 1917, $15,000 was allocated to purchase what was called a poor farm so those kinds of settings became collecting points if you will for all of those individuals that I described concurrent with that state institutions were constructed, intended to fill some of that purpose so over the years I think families were called upon to try to manage on their own or they could turn to state and other institutions for that care and once Medicaid was created on the federal level as a health insurance program we began to see nursing homes be called upon for a lot of that care also. So the state and federal governments ultimately decided that was not the most efficient, most cost effective way to deliver service so through federal rules states were called upon to develop a system of community services and in Wisconsin that responsibility falls to counties. Most states do that directly in Wisconsin that falls to counties so the simple purpose there is to try to keep people out of institutions to try to promote self-sufficiency and we do that in all of the work that our department is performing and that gets referenced in number of state statutes that folks could take time out to look at if they were so inclined so economic support benefits for example we determine eligibility and provide access to a number of benefits like food share and Medicaid health insurance that I just referred to and chapters I believe 46 and 49 would be the reference points for that responsibility. Our division of social services gets involved in investigating caregiver abuse and neglect basically families who aren't doing the proper job with their children. We also respond to juvenile justice concerns and provide family support services and most of that work is defined under chapter 48 and 938 of the state statutes. Our division of community programs along with many many community partners provides behavioral health counseling and treatment. We also provide aging programs most notable of that is our senior meal program and many folks might realize that we operate an aging and disability resource center that moved into Sheboygan Falls on Forest Avenue about a year ago and that's a location where folks who are facing issues involving aging or their families can get information and assistance on a variety of topics. They can receive benefits counseling and also eligibility determination for state and federal long term care programs and lastly we operate our division of health and the bottom line there is to promote and protect community health and that's through disease control that's through maternal and child health programs and also environmental health and that's where we inspect restaurants and other businesses. We do water sampling and lead screening and abatement programs. Outstanding outstanding brief history and overview. The economic downturn no doubt has put increasing pressure on some of the important services you provide. What would be some examples of what's happening in health and human services as we get through this difficult period in our in our country? Yeah I would say Adam that impact over the past year plus has been significant and at times unprecedented. Last year we saw a 68% increase in our food share caseload, 59% increase in immunizations given you might remember last year at this time we were talking about H1N1 flu, 59% increase in immunizations given to county residents and about a 34% increase in energy assistance applications. So right now through the department we've got more than a million dollars per month that's being infused into local businesses like Pick and Save and Pigley Wiggly and Wal-Mart and others in the form of food share benefits during last year's heating season we provided about $2 million worth of assistance to folks and concurrent with all of that we had many many requests for other assistance, 9,000 requests for assistance at the ADRC. I think the climate has taken its toll in terms of people's well-being and perception of well-being so 3,200 calls to our mental health crisis line. So in short I would say the downturn has created a great workload within our department. And as you mentioned earlier you know county government really the right arm of state government were providing services many of which that are required or mandated by the state. These incredible increases or demands for services that we've needed to respond to locally I imagine there must be then a fair amount of state and federal funding helping support those programs or if not how are we handling that? Well that answer is actually yes and no I mean so we we serve as a pass through for many federal benefits food share benefits for example as more people have needed assistance more federal funds have flowed to us in the form of benefits we've also seen the state expand Medicaid eligibility under programs like Badger Care, Badger Care Plus, Badger Care Core and that has responded to many of those needs at the same time our administrative resources have not been able to increase accordingly. So the analogy might be in disaster relief efforts it doesn't do you a lot of good to have large stockpiles of donations if you can't get them out to people in need so our staff had had to work extremely hard in order to manage that without increases in staffing. The only exception that we've seen was in the area of public health where we had some federal stimulus funds that were able to provide us with resources to hire some limited term nurses during our immunization campaign but after that was done we went back down to our prior levels and in fact our workforce this year is smaller than it was last year and it's going to be smaller next year yet. In fact our workforce is smaller today than it was a decade ago and that may continue depending on what happens at the state level and and the level of service that people have come to expect and what they're willing to pay for but it's rather remarkable and frankly it's it's incredible that our team here not just Sheboygan County but counties throughout the state but particularly Sheboygan County the the workload increases we've absorbed and really trying to hold the line on the property tax levy at the same time. Chairman Mike Van Der Stee and the county board has provided three consecutive property tax reductions as Tom knows this year just adopted a budget for 2011 that'll be a modest two and a half percent increase but still the first increase in four years and to put this in perspective if the count if the state if the state fully funded all of the mandated or required programs that the health and human services department alone is responsible for providing how much could the property tax from your department alone be reduced. Our current contribution Adam is in the range of 13 million dollars per year there's a small amount of discretionary spending that falls under that category if we take that out there's about 12 and a half million dollars that is dedicated to the cause of mandated services. To be fair local units of government when those state statutes were created that I referenced a few minutes ago we're called upon to provide a fair share match if you will for state and federal funds in general that is about a 10 percent match requirement so some programs now require 40 percent match but if we're fair and we take those match requirements out of the equation we'd have about another million or two million that we could take off the top but that would leave about 10 million dollars of local contribution that's going toward services that the state is mandating be delivered beyond our original match requirement. And as Tom is aware and certainly Chairman Van der Steen and any of us associated with county government it's a frustrating pickle to be in when you don't receive sufficient funds of course that puts all the pressure on the property taxpayer and we're working so hard to keep property taxes in check or in fact provide property tax relief. Difficult to do when you see the service demand increases particularly the last couple of years a very challenging situation for the county board and we're obviously doing the best we can. Very nice explanation thank you Tom. Tom you've had a chance to go through a full budget cycle now with the 2011 budget and you know we've been asking all departments to do more with with fewer funds and sometimes fewer people like you mentioned but what what have you done to respond to this and how are you keeping your your department functioning and vital. I would say there's several things that we're trying to do Mike and and among those first and foremost is I feel strongly about creating what I'll call a a culture of participation asking our staff to be part of that solution and I'm very pleased to say that they've responded that to extremely well and that shows up in the form of keeping families together keeping communities healthy and as I mentioned earlier keeping people out of institutions. The example I could give you if we have a youth that lands in state corrections rather than remaining in the community that's about a hundred thousand dollars of annual expense that comes our way. As recently as 2006 we had on average about 22 kids in juvenile corrections at any point in time. We're currently averaging two or three kids in juvenile corrections so that makes a big big difference but it's not our staff alone. I need to compliment and acknowledge families as a player in that mix schools are a player community partners are a player law enforcement and the courts. If any one of those parties doesn't do its part then we end up again faced with that institutional care and cost that I mentioned. We're also turning to technology. Our economic support staff for example is now able to accept and process applications online as opposed to during face-to-face interviews. We'll be equipping all of that staff with phone headsets so that they can enter information on the computer while they're taking phone calls. We're also beginning to explore some software solutions that will direct calls in a more efficient manner. The way it works right now is a consumer might call a staff member who's busy or not available leave a voice message. That staff member will try to reach the consumer at a later point find that consumer not available and we can spend a lot of time playing phone tag. There's software solutions out there that would allow us to direct that call to the first available staff member and I think that has great application not only in economic support but in other parts of our operation as well. We've tried to expand revenues where that's possible. We've obtained certification for a few new Medicaid programs. We've applied for some grants and when we do that we try to establish rates that recognize our administrative costs so that we can offset a part of our expense and then lastly when all of that fails we do turn to expense reductions and that primarily has come in the form of staffing reductions as we talked about a few minutes ago. So when vacancies open up in our department we're trying to look very critically at whether or not we can get that work done in another way, reprioritize things in different ways in order to achieve some savings. Well thanks for all you're doing in that area and it's good to hear that the staff is responding and really helping in those efforts. Absolutely. You know we just had some sweeping changes in the elections and I'm just wondering from this early perspective after the election what changes do you see coming from the state or federal government and how they're going to be dealing with departments like yours and counties in Wisconsin? Well I can tell you Mike I don't think any relief is on the horizon. I think right now we have what could be called a perfect storm related to the baby boom generation. We have increasing numbers of persons who are growing older. We have a shrinking workforce and we've over relied upon property tax to provide services. So what that amounts to is we're going to have increasing numbers of people needing services and support and fewer numbers of people contributing toward the cost of those services or support. So something has to give and I would say in the short term we are seeing and we'll continue to see some increased calls for accountability and efficiency and over the longer term we're going to see some calls for system redesign and that could show up in the types of services that are offered and that could show up in the way those services are delivered. Tom in the way those future services you know get redesigned. What kind of impact is that going to have on the average person that accesses those services? Some examples of that Mike that I could point to would involve school districts for example in the state we have 400 plus individual school districts. They each have their own costs and cost structures and questions are being asked right now as to whether or not we should be supporting that number of school districts is it possible to combine any of them. Local units of government typically offer their own police and fire protection and we see questions being asked as to whether or not that makes sense or whether we should go to some shared resources and that also extends into questions about even if a municipality continues on its own as we've seen in Sheboygan do we have the right number of stations do we have the right number of resources are we providing the right services or should changes show up there. So to be fair I think that is going to extend down to health and human service departments as well. 72 counties in the state most of which operate their own departments. The question is now being asked as to whether or not it makes sense to combine some of those efforts and allow those services to be delivered outside of county boundaries. So an example there would be just as a hypothetical perhaps at some point down the road we could see Milwaukee County providing health and human services in Sheboygan County. I'm not saying that's going to happen but that's kind of the model. So along with that I anticipate Mike that there will be some changes in eligibility. We're already seeing that with social security benefits you know to access full benefits at retirement is going to eventually require an older age than it does right now and we're probably going to see some changes also in terms of the benefit array that's offered under individual programs. So we've enjoyed I think as baby boomers were contributing to the cost of that service delivery we've enjoyed a great amount of support and service from government and I think we're on the threshold of seeing that trend reverse because there's just not sufficient resources out there to continue on the same path. OK the other thing that we've been working with over the last several years is family care. What's the current status of family care and how has that impacted the operations over the last several years while we've been involved. And I'm glad you asked about that Mike family care is a perfect example of that redesign that I was mentioning a moment ago. Up until two years ago Sheboygan County was responsible for providing its own long term care programs. Two years ago Sheboygan County joined with several others in allowing a private managed care organization to assume delivery of that service package to local residents in replacement of county government. So that's an example of a redesign that has already started. Family care I would say two years in for Sheboygan County has enjoyed some good success. I think first and foremost waiting lists that used to exist for long term care services have been eliminated. I would say that the partnerships that providers of service in Sheboygan County and the managed care organization have forged have been very very positive and that has translated into generally a pretty high level of consumer satisfaction that has not always been the case in other counties and other regions across the state. And again I think that speaks to the people that are working within the system here. So that's all been very positive but I would also say that there's some clouds on the horizon. After two years of experience here in Sheboygan County we've seen the managed care organization sustain losses for two years running. Losses in the second year have been greater than the first year and as part of a state budget correction we're anticipating that rates available for family care are going to be adjusted downward. So when you mix those things together current losses with reduced revenues it doesn't feel like that future is all that rosy. The legislature in its last session did authorize an audit of the family care program. As you might recall family care was based upon some pilot efforts that were initiated a decade or so ago. The early results of those pilots suggested that we as a system could save better than $400 per month per every person enrolled in family care if that program were taken from counties and placed under other management structures. I think it's a reasonable question now to ask whether or not those projections were actually sound whether those savings can actually be realized and again when you take a look at the losses being sustained by those managed care efforts it's likely that there may not be sufficient funds to deliver on the vision of family care as it was first conceived. So we're expecting that audit to be done in a report to be issued in February of next year. I anticipate that if funding proves to be an issue in the program we'll see some calls for improved efficiency. As I mentioned I expect that the eligibility for the program could become a little more stringent and it may be reasonable to expect that the service array might be scaled back a little bit too. But more to come on that we anticipate that audit as I said we'll take a look at what that has to say and then the state legislature is going to have to wrestle with what the longer term solution is on that. It's good to hear that the waiting lists are down I know those were bothersome for quite some time but I guess we'll have to stay tuned and see how things go. With that I'll turn it back over to Adam for some closing comments. Well it is the season by the time many of our viewers see this they may already be full of turkey and dressing and had a nice holiday and of course Christmas is just around the corner and I know that the Health and Human Services Department has a number of real nice holiday type programs that where people can donate and people in need can be reached. Could you touch on those please? Sure absolutely. Despite you know all of the doom and gloom of state and budgets and federal budgets I'm pleased to say that our local citizens have continued to be extremely generous in their contributions and that includes churches and civic organizations and they donate a lot of food baskets and things like personal hygiene products not only during the holidays but throughout the year. That includes charitable foundations we've got the upcoming Festival of Trees celebration and we're in a partnership with Sheboygan Press called Share the Spirit and that was founded several years ago as a joint venture with our office on aging and that solicits contributions and provides funds for older persons and others in need just to get little things that are special to them during the holiday season. We have a very very generous business community and businesses like Acuity Insurance and Johnsonville are at the top of that list and then there's also private citizens who wish to remain nameless but step forward continuously to make donations and sometimes that shows up in the form of mittens or blankets that they've made. I can tell you that about two weeks ago a person previously unknown to our department stopped in and provided $2,000 to purchase food cards for persons in need not not expecting recognition not wanting thanks and simply asking that we get those to deserving people so you know there's times where that kind of generosity perplexes me it's like where does that come from but it always also humbles me and it's very very heartwarming to have that occur. Thank you and thank you for joining us Tom Eggebrecht health and human services director I hope you got a good flavor for just the character and the quality of the person we have leading this department and the outstanding people that work with him thank you for joining us next month our highway commissioner Greg Chanel is going to be here to talk a little bit about road projects as well as well as making sure people are driving safely so again happy holidays thanks for joining us see you next month.