Cass County Health, Human & Veterans Services 2020 Annual

Cass County Health, Human & Veterans Services

2020 Annual Report

Advisory Committee & Board Members

Cass County Health, Human & Veterans Services2020 Advisory Committee

Serving Health, Human & Veterans Services on behalf of the Cass County Board of Commissioners

Chair:Joan Kumpula Citizen Representative District 3

Co- Chair:John Warren Veterans Representative

Open Citizen Representative District 1Sherry Fitch Citizen Representative District 2Judy Berg Citizen Representative District 4Peggy Schluter Citizen Representative District 5Steven Fisker Medical ConsultantScott Bruns CommissionerOpen Leech LakeKathy Wagner Representing Low IncomeOpen School AdministratorLeslie Bouchonville Family CentersMargie Richardson Mentally Ill, Developmentally Disabled & ElderlyOpen Children & FamiliesDawn Peterson Emergency ServicesSteve Frawley Rural MN Concentrated Employment ProgramJudy Kadlec-Fuller Registered NurseLee Turney Veterans RepresentativeBernadette Miller Senior Transportation

Cass County CommissionersNeal Gaalswyk Commissioner District #1

Bob Kangas Commissioner District #2

Jeff Peterson Commissioner District #3

Scott Bruns Commissioner District #4

Dick Downham Commissioner District #51

Directors Statement

The 2020 Annual report as presented by Health, Human & Veterans Services reflects a year that tested our strength and commitment while facing undeniable challenges. While we could not change the “winds” we continuously adjusted our sails and persevered by remaining steadfast and focused on the needs of the population we serve. Led by our Public Health Division who came to the forefront and rallied our Divisions, we were able to assure our county remained informed and exercised safety and wellness in our daily lives.

Technology became even more of a necessity utilizing Webex, TEAMS, and Zoom which replaced many of our face-to-face contacts and meetings formerly held in person.

Our report indicates some programs experienced a decline while others had a significant up-tick related to the impact of COVID-19. Funding for our services was enhanced by the use of federal and state grants, allocations, waivers, and modifications. These dollars and state changes were geared towards quality enhancement and public safety due to the many limitations amidst the changes brought forth by the pandemic.

In 2020 our staff successfully brought forth new pathways, increased our collaboration and resilience while using our many years of collective experience and ability to serve our children and families, the elderly, Veterans, and individuals in need.

Each year, I remain grateful for the guidance and leadership provided to us by our County Board of Commissioners, Advisory Committee, and County Administrator.

Respectfully submitted,Michele Piprude, DirectorCass County Health, Human & Veterans Services

“ The purpose of life is to contribute in some way to making things better” - Robert F. Kennedy

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HHVS Highlights

Face Shields & Mask AccessoriesCass County was able to partner with Sourcewell to make Personal Protective Equipment for Cass County residents and businesses to include headbands to attach to face shields and face mask ear savers. Sourcewell provided Cass County HHVS and our Information Technology department each with 3D printers in early Spring of 2020 when this project started. Each department worked on printing the headbands and ear savers daily; each printing took about two hours to complete. Cass County ended this project late Fall of 2020.

3 Dimensional (3D) Printer Top - Ear SaverBottom - Face Shield Headband

Limited Access to County Buildings- Due to the COVID-19 Pandemic, Cass County HHVS has had limited access to our building since mid-March of 2020. The pandemic brought new challenges and opportunities as we learned to serve our clients differently than we had in the past. Communications began happening primarily through email and virtual meetings. With many of our staff starting to work from home, we could use this time to implement electronic filing systems for our Child Support and Social Services Departments. With Office Support’s help, we implemented new procedures to get this fully functional going into 2021. Office Support worked to make applications for all public assistance programs readily available outside of our building during and after hours. Cass County HHVS has adapted well to the changing times to ensure clients are still receiving the services they need. 3

HHVS Revenues &Expenditures

2020 HHVS Revenue

2020 HHVS Expenditures

Expenditures by Category

42%50%

8%

PUBLIC ASSISTANCE PERSONNEL SERVICES(SALARIES ETC)

SUPPLIES & MISCEXPENDITURES

9.78%

18.24%

32.77%

39.21%

FEES & OTHERREVENUEINTERGOVERNMENTALREVENUE-STATEINTERGOVERNMENTALREVENUE-FEDERALPROPERTY TAXES &PENALTIES

4

1.54%

10.24% 0.06%

33.39%54.77%

VETERAN'S SERVICES

PUBLIC HEALTH

ADMINISTRATION

INCOMEMAINTENANCE UNIT

Veteran’s Services

2014 2015 2016 2017 2018 2019 2020

The Cass County Veterans Service Office provided services to Cass County Veterans who were impacted financially by the COVID-19 pandemic. The Minnesota Department of Veterans Affairs accepted applications from Minnesota Veterans who the COVID-19 Pandemic had financially impacted. Eligible applicants must be a Veteran defined by statute or the surviving spouse and a Minnesota resident who was negatively affected financially by COVID-19. There are three one-time grants available, Disaster Relief of $1,000; Special Needs Grant of up to $3,000, paid directly to the vendor on behalf of the veteran; and a Distance Learning Support Grant of $3,000. Cass County Veterans Service Officers helped distribute the following funds:

$27,000 for Disaster Relief$9,000 Distance Learning Support$4,4774.86 COVID Special Needs

Claims Processed- Claims processed through the Cass County Veteran’s Service Office showed increasing annual trends with a sharp decline in 2020 due to added COVID-19 concerns and obstacles.

18-34 yrs.2%

35-54 yrs.16%

55-64 yrs.18%

65-74 yrs.36%

75 yrs +28%

Cass County Veteran Population by Age Range(18 Years +)

12%Of the County’s Population are

veterans

Veterans Population & Percent of change from 2015 to 2020 -

2,916 = 11.9% decrease 2020 Cass County Veterans

331,383 = 10.1% decrease 2020 MN Veterans

19,541,961 = 9.4% decrease 2020 U.S. Veterans

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Veteran’s Services

Expanding eligibility for the PCAFC (to pre -1975 Veterans)

Offering legal and financial services for designatedPrimary Family Caregivers of eligible Veterans in 2021

Making other changes affecting program eligibility and VA’s evaluation of PCAFC applications.

VA Caregiver Support - The U.S. Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers enhanced clinical support for caregivers of eligible Veterans who are seriously injured. Those who qualify are Veterans who incurred or aggravated a serious injury (including a serious illness) in the line of duty in the active military, naval, or air service on or after September 11, 2001, or on or before May 7, 1975.

Changes to this program include:

The State Solider Assistance Program (SSAP)SSAP provides aid in the form of Shelter Payments, Utilities, Dental, Optical, and Personal Needs Grants to Veterans and their Dependents; this year, the SSAP helped out with COVID-19 related issues as well..

Cass County received a total of $52,050.01 in SSAP funds. • $17, 275.17 was used for

Optical, Dental, Special Needsand Subsistence;

• $34, 774.84 went toward COVID-19related assistance.

New Agent Orange Presumptive ConditionsVeterans Affairs presumes that specific disabilities were caused by military service. This is because of the unique circumstances of a particular group of Veterans Military Service. If a presumed condition is diagnosed in a Veteran in a certain group, they can be awarded disability compensation. Veterans who may have been exposed to Agent Orange include Veterans who served in different locations, including Vietnam, the Korean Demilitarized Zone, on Thai Air Force Bases, at other locations, and who flew on or worked on C-123 Aircraft. The National Defense Authorization Act for Fiscal Year 2021 added three more conditions to the Agent Orange Presumptive-conditions list where Veterans who were exposed to Agent Orange may qualify for benefits: • Bladder Cancer• Hypothyroidism• Parkinsonism or Parkinson like symptoms

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Income Maintenance

Minnesota Supplemental Aid (MSA)Small extra monthly cash payment that helps adults who are

eligible for federal Supplemental Security Income (SSI)Total Persons Served - 499Total Dollars - $47,381.55

Average Cost Per Person - $94.95State Funded

Housing SupportA monthly payment to help pay room & board costs for

people who live in authorized settings and are 65 or older; disabled and 18 or older, or have blindness.

Total Persons Served - 1591Total Dollars - $561,012.47

Average Cost Per Person - $352.62State Funded Supplemental Nutrition Assistance Program

A Federal program that helps residents with low income buy food.

Total Persons Served - 26,059Total Dollars - $5,737,662.05

Average Cost Per Person - $220.18State & Federal Funded

General Assistance (GA)Monthly cash payment for adults who are unable to work who have little to no income, will return to work soon, are waiting to get help from other state or federal programs.



Minnesota Family Investment Program (MFIP)Monthly cash assistance for families with low incomes and

pregnant women. Total Persons Served - 9427Total Dollars - $3,985,600.77


Divisionary Work Program (DWP)Short-term work program that provides employment services and basic living costs to eligible families.



Child CareMakes quality child care affordable for families

with low income.Total Children Served - 112Total Dollars - $345,481.61

Average Cost Per Person - $3,084.66Federal & State Funded

Medical Assistance (MA)MA pays for qualifying applicants current and future

medical bills. Total Persons Served - 102,868Total Dollars - $ 110,468,506.44

Average number of people served per month - 8572State & Federal Funded

Emergency General Assistance (EGA)Helps in a crisis, including not having food, shelter, or utilities.

EGA is limited to once a year and only while funds are available. Total Children Served - 1Total Dollars - $331.80


Emergency Assistance (EA)Helps in a crisis, including not having food, shelter, or utilities. EA is limited to once a year and only while funds are available.

Total Children Served - 18Total Dollars - $5,412.77


55%

60%

State Threshold Range

Cass County Perfomance

SNAP Applications processed within

24 Hours

75%

90% 91%

State Threshold

Cass County

Cass County

SNAP & Cash Processed within 30 days

7

75%

90% 91%

Child Support

21.30%

49.70%

20%

Currently

Previously

Never

Percentage of people in Cass County receiving Child Support who have never, previously, or currently receive other public assistance benefits.

Total Collections in Fiscal Year 2020 $2,678,935.00

Collection Sources

$1,481,477.00

$246,911.00

$435,030.00

$73,093.00

$144,376.00

$296,632.00

Income Withholding

Re-employment Insurance

Federal Taxes

State Taxes

Other States

Other Sources(cash/checks)

Performance Measures for 2020Cass County State Performance Goal

Paternity 99.42% 90.00%Establishment 85.48% 80.00%Collections on Current 69.61% 80.00%Collections on Arrears 70.47% 80.00%

Cass County distributed $2,660,159.11

in Child Supportin 2020

Total amount Collected in 2020 $2,677,519.00

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Public Health - Children, Youth & Families

Cass County WIC Participants redeemed $348,547.75In food benefits during the reporting period of October 2019-September 2020

WIC is a nutrition and breastfeeding program that helps young families eat well and be healthy. The Cass County WIC program continued to operate during the response to COVID-19. Most services were offered over the telephone, with WIC benefits being added to participant’s e-WIC care remotely. The average participation rate for 2020 was 475 Participants, including pregnant, postpartum, and breastfeeding women, infants, and children ages one to five years old.

Nurse Family Partnership (NFP) to Maternal Early Childhood Sustained Home-Visiting (MECSH)

Our Maternal Infant Early Childhood Home Visiting (MIECHV) grant team and NFP county partners deter-mined, with the assistance from the Minnesota Department of Health, to move from the Nurse Family Partnership (NFP) evidenced-based home visiting program to another evidenced based nurse home visiting program as of November 1, 2020. This is a voluntary program supported by MIECHV Grants. The main focus is first-time moms; however, moms who have had several children and who are pregnant or within eight weeks of delivery can be served, allowing for increased eligibility for the program.

MIECHV Grant Award of $81,646.00 forOctober 1, 2019 - September 30, 2020

$120,257.00 was received in StateFunding to support Child and Teen Checkups Outreach Efforts to children in Cass County ages 0-21 who are eligible for Medicaid services.

COLLABORATIVE DRIVE THRU FLU CLINIC EVENT

Cass County Public Health was invited to collaborate with the Cass Lake Indian Hospital (IHS) and Leech Lake Public Health to provide a community drive-thru flu clinic at the Cedar Lakes Casino Parking Lot to Tribal and Non-IHS eligible members. This was a first-time agreement that proved to be a great partnership in which over 350 individuals were vaccinated in one day.

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Public Health - Home Health, Long Term Care, Prevention

Home Health2020 has brought unique challenges to Home Care Services. With 10,000 Americans turning 65 every day, the need for health care will continue to rise, and costs will continue to skyrocket. This is where hospice comes in. As the preferred choice for most patients, it also offers the greatest cost savings. For example, Medicare pays nearly $2,000 per day for a typical hospital stay and $450 per day for a typical nursing home stay, while home care costs less than $100 per day and helps many seniors remain independent at home. Home Health conducted 950 Skilled Nurse Visits, 541 Home Health Aide Visits, and 78 Physical Therapy Visits for a total of 1,569 Home Visits.

MNChoices AssessmentsMNChoice Assessment is a single, comprehensive, web-based

application that integrates assessment and support planning for all people who seek access to MN Long Term services and support.

Public Health Emergency Preparedness This year’s focus has been primarily on COVID-19 response. Public Health Emergency Preparedness (PHEP) was initially funded at $31,102.00 but, with the pandemic, PHEP received an additional $75,000.00 in grant dollars for response activities

Response Activities Included:

• Working with Long Term Care facilities in procurement ofPersonal Protective Equipment (PPE)

• Testing at Long Term Care sites• Responding to Business Complaints

• Consultation with Jail Health• Procurement of PPE for Agency Staff

• COVID - 19 Vaccine Planning• Establishing Isolation and Quarantine Sites

• Case Investigation & Contact Tracing• School Liaison Work under Emergency PreparednessAlong with many other activities that will continue into 2021

Statewide Health Improvement Program (SHIP)In the 2019-2020 grant year, Cass County was able to distribute almost $30,000 of SHIP allocated funds to the community in the form of mini-grants and contracts. In addition, SHIP was able to coordinate many Health and Nutrition projects with numerous Cass County Community Partners. Some included working with area food shelves to provide coolers, freezers, and other supplies, helping coordinate the free community meals program in Pine River Backus serving over 30,000 meals, and securing a COVID transportation Grant of $63,000.00, which was used to purchase a Cargo Van for food transportation through the Pine River Backus Family Center. SHIP coordinated many other activities throughout the county in 2020 as well.

COVID-19 VACCINE ARRIVES:Cass County Public Health received its first allotment of the Moderna Vaccine and began vaccinating Public Health Staff and Emergency Medical Services Front-line workers on December 28, 2020. Public Health will work to vaccinate all Phase 1 Groups.

461

492

516

2018 2019 2020

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Social Services - Adult & Children’s Mental Health, Chemical Dependency

DetoxCass County Spent $128,661.03

Adult Mental Health Intakes

Children’s Mental Health:

52 Children’s Mental HealthIntakes were processed.

57 cases remain open and are receiving

Children’s Mental Health Case Management.

100 of these Adult Mental Health Intakes included individuals being screened at the Cass County Jail exhibiting Mental Health symptoms.

61 of these intakes were individuals that Cass County pursued commitments on.

COVID- 19 Emergency Response Funds - On April 15, 2020, Cass County was awarded $50,000 for the use of COVID-19 Emergency Response funds. The funds are used to provide shelter space, purchasing vouchers for the cost of a motel or hotel rooms or funding other housing options, providing housing that promotes health and safety, or isolating homeless individuals exposed to or experiencing symptoms of COVID-19. These funds are available 60 days after the expiration of Executive Order 20-01 (COVID-19 Peacetime Emergency) or until funds are exhausted.

30% 31%27% 28% 28% 26%

15% 15%

8.70%14%

3.20%

43%46% 45% 44%

49% 47% 46% 46%50% 50%

47%

2020 2015

Comprehensive Re-Entry Program2020 Overall Recidivism for Cass County

Compared to 2015

Children were adopted to forever families in 2020 11

369

140

2020 2019

This program aims to connect inmates with programming or resources that would be beneficial to improve their well-being during incarcerations and have services and a plan to avoid re-entry to jail.11

Social Services - Adult Protection, Developmental Disabilities & Licensing

Adult Maltreatment Reports Trends

Foster Care Placement options for Children:Children thrive in stable, nurturing environments. Removing children from the people they love and environments they are familiar with can be traumatizing. When children must leave their homes, placement in foster care with relatives is considered irst. Across all children in foster care, there were 16,397 days spent in family foster care settings since the beginning of the year in Cass County. Of those days, 9,097 days were spent in relative foster care, relative pre-adoptive homes, or kinship care. The performance for Cass is 55.5% and the state performance standard for this measure is 35.7% or greater.

COVID-19 Housing Assistance Program GrantIn mid-October 2020, Cass County HHVS was invited to help with the Federal Government’s COVID-19 Housing Assistance Program Grant. This grant started in July of 2020 to help individuals and families with funding to keep them from falling behind in rent, mortgage payments, utilities, and insurance associated with housing costs. The goal was to prevent people from falling behind on payments that could lead to homelessness, assist landlords, mortgage, and utility companies in making them whole again after missing out on payments due to COVID-19 related circumstances. Cass County reports serving 59 households utilizing over $91,000.00 in Federal Grant funding from November 1, 2020, through the end of December 2020. .

Self Negelct

Caregiver Neglect

Emotional Abuse

Physical Abuse

Sexual Abuse

Financial Exploitation (non-fiduciary)

Financial Exploitation (fiduciary)

129

57

39

16

10

26

20 50

43

Familial Perpetrator Non-Familial Perpetrator

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Social Services - Child Protection

746

208

480

224

Child Protective Services

Child Welfare

2020 2019

Child Protection Intake Allegations

Opioid Epidemic Response:All Minnesota Counties received funding from the Child All Minnesota Counties received funding from the Child Protection Opioid Epidemic Response account, which is set up with the State of Minnesota and paid for by fees associated with pharmaceutical companies operated in Minnesota. Cass County’s allocation is $33,679.00, to be used by December 31, 2021. This funding will be used to supplement services to families currently involved with Child Protection, with a primary removal reason being parental drug abuse.

7%1%

6%

18%

68%

Mental Injury Threatened Injury Sexual Abuse Physical Abuse Neglect

Number of Intakesfor Child Protective Services and Child

Welfare Services

Child Foster Care Reimbursements Increase 35.2% Reimbursements totaled $194,134.00 in 2019 and $262,483.00 in 2020 The increase is contributed to staff training, awareness, diligence, and teamwork.

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Walker Office400 Michigan Ave West

PO Box 519Walker, MN 56484

Phone- 218-547-1340Fax- 218-547-1448

Cass County Health, Human & Veterans Services www.co.cass.mn.us

Backus Office2018 Washburn Ave East

PO Box 51Backus, MN 56435

Phone - 218-947-7530Fax- 218-947-7525

Documents

Cass County Health, Human & Veterans Services 2020 Annual