Pagel1  Wilkes County Board of Health Meeting Minutes  August 12, 2024  The Wilkes County Board of Health held a regular business meeting Monday, August 12th, 2024, at 5:30 p.m. att the' Wilkes County Health Departmentint the Ann Absher Conference Room. Board ofHealth members  ina attendance were:  Ms. Susan Bachmeier Dr. Sarah Miller-Wyatt Dr. Keaton Mash Dr.G Gary Nash Ms. Adina Watkins Ms. Shirley Randleman Ms. Martha Brame Ms. Heather Conlon Ms. Deborah Britton Dr. Laura Hubbard  Ms. Rachel Willard, Mr. Jared Belk, Ms. Nancy Moretz and Ms. Jennal Daye were also in attendance. Prior tot the. August meeting, packets containing the materials to be discussed were mailed and sent via email to 1. Welcome and Introductions: Ms. Rachel Willard welcomed everyone and called the meeting to 2. Adoption of Agenda*: Ms. Martha Brame madei the motion to adopt the agenda fori the Board of Health meeting for August 12th, 2024; the motion was seconded by Ms. Deborah Britton, and 3. Approval of Minutes*: Dr. Gary Nash made the motion to approve the minutes from the June 3rd, 2024 meeting; the motion was seconded by/ Ms. Adina' Watkins, and unanimously approved.  each' Wilkes County Board member for review.  order at 5:30 p.m.  unanimously approved.  4. New Business  Policy Approvals*  Ms. Willard explained tot the board that we are bringing these two policies back because we had our Federal site visit in July, and they recommended that we make ai few changes. Highlighted areas indicate a change ini the policy: Ar majority oft the changes arej just adjustments to wording tor make the policy clearer and provide  examples.    Page/2  i. Feel Policy*  ii. Sliding Fee Policy*    Page/3  Motion made by Ms. Deborah Britton to approve the updated polices; motion was seconded by Dr. Laura  Hubbard, all werei in favor, unanimously approved.    Page/4  Bad Debt*  Wikes County Health Department heaith and  ea oure  THRU: TO: Wikes Counly FROM DATE:  DATE:  Ms. Willard stated that we bring this report every six months to the! board for review, she explained that this six month we were up al little bit. We are at $9,924.98 with al little over $1,800 being from patients who have transferred their care elsewhere. We are still in the safe zone buti it has increased more than it has been in the past. For our newer people this means the patient cannot be seen in Adult Health, Child Health or Motion made by Dr. Gary Nash to approve Bad Debt; motion was seconded by Dr. Keaton Mash, all were  Immunizations until they have paid 25% of that debt.  ini favor, unanimously approved.  Ending Financial Report FY 23-24*  Ms. Nancy Moretz presented the Financial Report to the board, she stated that ourf fiscal year ended June 30th, 2024. Our Revised Budgeted Revenue was $6,864,441, Actual YTD Revenue was $5,962,821. We did collect over what we budgeted for permits andi fees. Our Revised Budgeted Expenses was $2,731,310, Actual YTD Expenses for our general account was $2,290,979 which is about 84%. Our Revised Budgeted Expenses for Programs was $6,749,206, Actual YTDI Expenses was $5,192,293 or 77%. That gives usa overall Revised Budgeted Expenses of $9,480,516 and Actual YTD Expenses of $7,483,272. Motion made by Ms. Martha Brame to approve thel Ending Financial Report; motion was seconded by Dr.  Keaton Mash, all were int favor, unanimously approved.  5. Old Business HRSA Site Visit  Ms. Willard said shej just wanted tot talk al litle about our federal site visit, we do have to complete this visit every three years. It went phenomenal. The site visitors met with our FQHCI board and they couldn't praise    Page 15  enough about! how involved and well educated our members are about the services we provide. We did have 61 findings when they left, we are still within our 14 days crow period. That period is where you have the opportunity tot fix anything. As of last week, our federal representative said thata alli the things wel had submitted have been corrected. They were very complimentary of our staff, and very wellp prepared. We have learned some things from our site visitors and! hopefully our report will report fully compliant with no conditions on our grant. We did ar really good job and I'm very proud of our staff for pulling it together.  6. Administrative Report Departmental Update  Ms. Willard gave the departmental update starting with we havet four openings right now. The openings include an Environmental Health Specialist for onsite, Contract Interpreter, Nutritionist, and al Provider. On the flipside, we have had five new hires since we met in June. Dana Gustin, one of our new providers is now seeing patients on her own, and doing really well. She is up to three patients in the morning and afternoon. We are still working oni i2i but we are running into technical issues and questioning the validity of the data. We are hopeful come September we will bei fully live. Late notice but Jenna passed out an infographic, this is our healthcare connection grant that we work with the Hospital and the Care Connection Pharmacy team. This just talks about all the work they have done in thel last year. Wel have been able to reduce ED: admissions by 33% and" 11% reduction in avoidablei inpatient admissions. For every $1 we put into the project we are getting $19 back, that's huge. We have had this program since 2012. Report Below.  AccessHecithsb VA/ILKES  OURI IMPACT 24  -------- Tomaisaimpocyt theneboi piantoascosa Tonagemanta perviceshorhignarnt spatientsw wthdronic condhona.  supports  roviding voidoblel  10.011 s-deypierplionta ald  THE NEED  dognoulics  2,517 LTS  NETWORKI RETURN ONI INVESTMENT $19: 1  OUR APPROACH  0pp000pe pappap  Ms. Willard reviewed the following reports. She stressed thei importance of how important the foundations report is to setting our public health program priorities andl legislative ask. Ms. Willard noted that this report has been reviewed with the board prior to this meeting, but felt it was important to discuss again due to the second report. The department continues to use this report as as spring board for discussion when new ideas or programs are discussed internally. A perfect example of this is how we came to go under contract with i2i. This allows us to use real time data to make decisions in the clinic. It also allows us to export data in a visual way tot tell our story to the community andt truly show the impact we are making. We are also striving and being more strategic with continuing education to make sure we have a resilient and competent workforce. Ai focus has been on burnout and resiliency SO far. As you can see this report talks al lot about data and telling your story. The second report was releasedi in May and is a real forecast of what our nursing staffing will look like in ai few years. As you can see, the numbers are going down dramatically with lessi interesti in staying in the field as well. Ms. Willard went over several of the barriers for each arear noting    Page 16  salary, burnout and safety are large concerns. Ms. Willard pointed out toi thel board that North Carolina ranks 33rd in the nation for payf for RNs, then when on to say that Wilkes County starting salary from a nurse is even lower. Commissioner Shirley Randleman asked what we started our nurses out at? Ms. Willard stated she did not have the number right in front of her, but it was close to $52,000 with the state average being $77,000. Thel board asked what we could do toi increase nurses' salaries. Ms. Willard shared that ity would be up to the Board of County Commissioners to make those changes tot the pay scale. Ms. Shirley Randleman stated she was taking notes and would take this report back to the board. Ms. Willard shared that the report included behavioral health workers as well. Again, Ms. Willard stressed the critical role that the nurses playi in our department, and how we need to be thinking about what this means for our NC IOM Task Force Publication: ittps-/nciom.orglouncations-l-nealtr-an-opportunity-investing: NC IOM Workforce Publication: ittps-/nciom.org/ssuepne-neatnr-care-worstorce.current-status-  organization, community, state and nation.  n-tne-future-olloca-pubic-neattr-nth-n-north-carolina cohingforwarc-and-pand-possible-solutions  Annual Report  Mr.. Jared Belk presented the Annual Report to thel board.  Report below.  ANNUAL REPORT VA/ILKES From the Publie Health Director, Rachel Willard.  Nohigh  E Promoting Health and Preventing Disease in Our Communily"  NORTH CARDLINA Local Health Department Accreditation  Wiaesboro, 306 NC 28697 Po4513480 Fe 330451-7813    Page17  H  How We Served the Community  Moble Expanded! School Hesitn (MESH)  Communlcable & Sexsally  h Dapartmant Rerunu  -Coury Fund daria Ns  shota/Vacchnes)  Board Member Terms Reappointment  Ms. Willard explained to thel board thati in October we willl have to vote on our reappointments and new board members coming on. Idid talk to Chris today and hei is willing to serve again. Ms. Adina agreed to  serve again as well as Dr. Hubbard.  Ms. Adina Watkins Mr. Chris Anderson Dr. Laura Hubbard  ii. Rotating Off  Ms. Willard stated that we do have Dr. Nash and Ms. Deborah Britton rotating off this year. They havel both served nine years. Dr. Nash's spot may be al hard one to fill SO hopefully we will find ap potential replacement. Howi ity works is it will on the county's website as al board vacancy, anyone who responds in we will bring to the! board. Anyone that has any suggestions for a public board member, we will take that  into consideration as well.  Ms. Deborah Britton Dr. Gary Nash  7. Closed Session  Motion to goi into closed session under Section 143-318.11 (a)(5) of thel North Carolina General Statutes to consider the qualification, competence, performance, character, fitness, conditions of appointment, or    Page/s  conditions ofi initial employment of ani individual public officer or employee orp prospective public officer or Motion made by! Ms. Martha Brame; motion was seconded byl Ms. Deborah Britton, all were ini favor,  employee, known as the personnel exception.  unanimously approved. Motion to come outi into open session.  Motion made by! Dr. Keaton Mash to approve Rachel Willard, Health Director 2024 annual performance evaluation and job description; motion was seconded by Ms. Martha Brame, all were inf favor, unanimously 8. Adjourment:Dr. Garyl Nash made a motion to adjourn; Dr. Sarah Miller- Wyatt seconded,  approved.  unanimously approved.  Next Meeting date: The next Board of Health Meeting will be on October 14th, 2024 at5 5:30 p.m. int the  Ann Absher Conference Room at Wilkes County Health Department.  Minutes respectively submitted by: Jenna Daye, Administrative Assistant  Bachmeier  dei