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2006-931-Minutes for Meeting August 30,2006 Recorded 9/19/2006D ESCHUTES COUNTY OFFICIAL RECORDS rf NANCY SLANKENSNip, COMMISSIONERS' JOURNALNTY CLERK ICJ 2006.931 1111111111111111111 II I1 ~~~~i 111 09/19/2006 04:32:34 PM 2008-931 Do not remove this page from original document. Deschutes County Clerk Certificate Page If this instrument is being re-recorded, please complete the following statement, in accordance with ORS 205.244: Re-recorded to correct [give reason] previously recorded in Book or as Fee Number and Page LLI~~ ~ ❑ Deschutes County Board of Commissioners 1300 NW Wall St., Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.orc MINUTES OF ADMINISTRATIVE WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS WEDNESDAY, AUGUST 30, 2006 Commissioners' Conference Room - Administration Building - 1300 NW Wall St., Bend Present were Commissioners Dennis R. Luke, Bev Clarno and Michael M. Daly. Also present were County Administrator Dave Kanner; Anna Johnson, Commissioners' Office; Scott Johnson and Lori Hill, Mental Health Department; and, for part of the meeting, Joe Studer, County Forester and Marty Wynne, Finance. Also present was media representative Keith Chu of The Bulletin. No other citizens were present. The meeting began at 1: 30 p. m. 1. Finance Department Update. Marty Wynne gave an overview of the recent activity in his department. He noted that the investment portfolio is at an almost 5% yield, and the total is the highest yet, at approximately $5 million. A copy of the Finance Department report is attached. 2. Discussion of Oregon State Hospital Master Plan, Phase II. Scott Johnson explained that the State is working on a master plan for its state hospitals that will be in place until 2011. He is working with Crook and Jefferson counties to develop a strategy to make sure Central Oregon is properly represented within the system. The current plan is for two facilities - with 300 and 600 beds - on the west side of the Cascades; but east of the Cascades would have only two 16-bed secure facilities. Minutes of Administrative Work Session Wednesday, August 30, 2006 Page 1 of 2 Pages Recommendations need to be submitted within the next 60 to 90 days. He will keep the Board advised. 3. Other Items. A discussion took place as to whether the Board or the Chair should sign applications for grants. Commissioner Luke pointed out that often grants obligate the County to certain things. Joe Studer said that the rules have been modified regarding the National Fire Plan for fuel management. The County is to implement the plan in areas where fire plans are not in place. The overall grant is $14 million, and Oregon will get $3 million. He will refocus his efforts in this regard. Also, there are five other grant applications available for $200,000 each, part of which is to increase composting efforts. There is a 50% "soft" match; and the County can use Title III funding. Being no further discussion, the meeting adjourned at 2:50 p.m. DATED this 30th Day of August 2006 for the Deschutes County Board of Commissioners. D nnis R. Luke, Chair Bev larno, Vice Chair U - aWL-4f ATTEST: Michael M. Daly, Co missioner (~Q 6bA--- Recording Secretary Minutes of Administrative Work Session Wednesday, August 30, 2006 Page 2 of 2 Pages arm 2 Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.ora ADMINISTRATIVE WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 1:30 P.M., WEDNESDAY, AUGUST 30, 2006 1. Finance Department Update - Marty Wynne 2. Discussion of Oregon State Hospital Master Plan, Phase II - Scott Johnson 3. Other Items Please note: Meeting dates, times and discussion items are subject to change. All meetings are conducted in the Board of Commissioners' meeting rooms at 1300 NW Wall St., Bend, unless otherwise indicated. If you have questions regarding a meeting, please call 388-6572. Deschutes County meeting locations are wheelchair accessible. Deschutes County provides reasonable accommodations for persons with disabilities. For deaf, hearing impaired or speech disabled, dial 7-1-1 to access the state transfer relay service for TTY. Please call (541) 388-6571 regarding alternative formats or for further information. Monthly Meeting with Board of Commissioners Finance Director/Treasurer AGENDA August 30, 2006 (1) Monthly Investment Report (2) July Financial Data (n N M d ti 4 v- N 0 E 9 F- v 14- M } O = G N a 60 d } C E io N N (0 ~M~pp N 14 ' e} f~ I' = m ~ V(OV MO 3 fR 6f~ ('4 O C O O O O a+ cc CO = O E z O O W LL 643~ 49 > Q1 - c E C C w d O V O E o U U') m CC W LL N q W C > O E > E O d 0~ o O G to 0 cr) 0 0 CO C d O W O N O r O M ((D OV O I~ ' O ' O 0 C14 U) 0) O w r O (O O O v co tf) (O N 69 N N ` U a s ti w c U) 0) a.E U) Qa~ v,0c EUF-m ~,m Y4 !0 E N ~(ri N -oc-... OF=Z) lim -i FO- I et G ~ R g (7 m N C N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cl 0 0 0 O O O O O CO O O O O O O O N O~ O O y O O N ti co N N O N O O O N O 64 IQ R d ~ Y I- Y V N m Y U m C C N a ~ ~ l0 N lQ ` C O> LL m C m U > o 7 E d>, C o m Y V Q r m m m (A c 0 0 z m > rnm li Y Y =3 N ca 3 E d 7 ki(/3 d m (p O O O 8 mm0U1u)( 0 0 0 0 0 0 D O 'a N ~ N r r ~ N E U 7 C W E y r N a N QNW(D V L m U E to V? N N E O on -j LL M W dl to . 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Memorandum Date: August 28, 2006 To: Board of County Commissioners Mike Maier, County Administrator From: Marty Wynne, Finance Director RE: Monthly Financial Reports Attached please find July 2006 financial reports for the following funds: General (001), Community Justice - Juvenile (230), Sheriff's (255), Health (259), Mental Health (275), Community Development (295), Road (325), Community Justice - Adult (355), Commission on Children & Families (370-399), Solid Waste (610), Health Benefits Trust Fund (675) and 9-1-1 (705). The projected information has been reviewed and updated, where appropriate, by the respective departments. Cc: All Department Heads RESOURCES: Beg. Net Working Capital Revenues Property Taxes Gen. Rev. - excl. Taxes Assessor County Clerk BOPTA Board of County Comm. District Attorney Finance/Tax Veterans Property Management Grant Projects Total Revenues TOTAL RESOURCES REQUIREMENTS: Expenditures Assessor County Clerk BOPTA BOCC District Attorney Finance/Tax Veterans Property Management Grant Projects Non-Departmental Contingency Transfers Out TOTAL REQUIREMENTS Appropriation Transfers NET (Resources - Requirements) GENERAL FUND Statement of Financial Operating Data One Month Ended July 31, 2006 Year to Date Year to Date Year End $ Revised Bud Actual Variance FY % Coll. % Budget Projection Variance Variance $ 6,215,445 $ 6,690,346 $ 474,901 100% 108% * $ 6,215,445 $ 6,690,346 $ 474,901 8% 1,429,167 55,561. (1,373,606) 8% 0%' 17,150,000 17,150,000 0% 183,016 374,209 191,193 8% 17% 2,196,196 2,196,196 - 0% 91,194 224,700 133,506 8% 21% 1,094,328 1,094,328 - 0% 186,163 198,089 11,926 8% 9% 2,233,958 2,233,958 - 0% 1,494 4,425 2,931 8% 25% 17,925 17,925 - 0% - - - 8% n/a 200 200 - n/a 19,594 1,071 (18,523) 8% 0% 235,126 235,126 - 0% 20,913 54,623 33,710 8% 22% 250,950 250,950 - 0% 6,000 - (6,000) 8% 0% 72,000 72,000 - 0% 4,933 4,725 (208) 8% 8% 59,191 59,191 - 0% 167 167 - 8% 8% 2,000 2,000 - 0% 1,942,641 917,570 (1,025,071) 8% 4% 23,311,874 23,311,874 - 0% 8,158,086 7,607,916 (550,170) 8% 26% 29,527,319 30,002,220 474,901 2% Exp. 288,658 258,668 29,990 118,761 84,880 33,881 5,803 3,264 2,539 51,073 42,747 8,326 338,073 294,547 43,526 63,239 51,101 12,138 23,491 13,427 10,064 13,378 13,794 (416) 7,272 6,932 340 75,883 84,655 (8,772) 310,513 989,535 (679 022) 1,296,144 1,843,550 (547,406) 1,077,383 0 1,077,383 2,373,527 1,843,550 529,977 5,784,559 5,764,366 (20,193) 8% 7% 3,463,890 3,463,890 - 0% 8% 6% 1,425,129 1,425,129 - 0% 8% 5%- 69,638 69,638 - 0% 8% 7% 612,880 612,880 - 0% 8% 7% 4,056,876 4,056,876 - 0% 8% 7% 758,871 758,871 - 0% 8% 5% 281,897 281,897 - 0% 8% 9% 160,532 160,532 - 0% 8% 8% 87,265 87,265 - 0% 8% 9% 910,595 910,595 - 0% 8% n/a 3,726,151 - 3,726,151 100% 8% 12% 15,553,724 11,827,573 3,726,151 24% 8% 0% 12,928,595 12,928,595 - 0% 8% 6% 28,482,319 24,756,168 3,726,151 13% 1,045,000 5,246,052 4,201,052 Preliminary as of August 2, 2006. Unappropriated ending fund balance. COMM JUSTICE-JUVENILE Statement of Financial Operating Data One Month Ended July 31, 2006 Year to Date Year End RESOURCES: Bud et Actual Variance FY % Coil. % Bud et Projection Variance Beg. Net Working Capital $ 364,451 $ 652,905 $ 288,454 100% n/a $ 364,451 $ 652,905 $ 288,454 Revenues Federal Grants 1,125 - (1,125) 8% 0%' 13,498 13,498 - SB #1 065-Court Assess. 3,500 2,289 (1,211) 8% 5% 42,000 42,000 - Discovery Fee 250 10 (240) 8% 0%- 3,000 3,000 - Food Subsidy 3,167 - (3,167) 8% 0% 38,000 38,000 - Juvenile Crime Prevention 26,317 - (26,317) 8% 0% 315,808 315,808 - Inmate/Prisoner Housing 5,833 300 (5,533) 8% 0% 70,000 70,000 - Inmate Commissary Fees 233 - (233) 8% 0%' 2,800 2,800 - Contract Payments 55,393 - (55,393) 8% 0% 664,712 664,712 - Miscellaneous 42 - (42) 8% 0% 500 500 - MIP Diversion Fees 167 275 108 8% 14% 2,000 2,000 - Interest on Investments 1,250 2,460 1,210 8% 16%` 15,000 15,000 - Leases 2,993 5,253 2,260 8% 15% 35,914 35,914 - Level 7 10,487 - (10 487) 8% 0%' 125,839 125,839 - Total Revenues 110,757 10,587 (100,170) 8% 1% 1,329,071 1,329,071 - Transfers In-General Fund 467,772 467,772 - 8% 8% 5,613,267 5,613,267 - TOTAL RESOURCES 942,980 1,131,264 188,284 8% 15% 7,306,789 7,595,243 288,454 REQUIREMENTS: Exp. Expenditures Community Justice-Juvenile Personal Services 205,317 183,039 22,278 8% 7% 2,463,806 2,463,806 - Materials and Services 143,061 79,224 63,837 8% 5% 1,716,736 1,716,736 - Capital Outlay - - - 8% 0% 100 100 - Juvenile Resource Center Personal Services 229,318 211,967 17,351 8% 8%. 2,751,815 2,751,815 - Materials and Services 18,171 9,725 8,446 8% 4% 218,055 218,055 - Capital Outlay - - 8% 0% 100 100 - Contingency 13,015 - 13,015 8% n/a 156,177 - 156,177 TOTAL REQUIREMENTS 608,882 483,955 124,927 8% 7% 7,306,789 7,150,612 156,177 NET (Resources - Requirements) 334,098 647,309 313,211 - 444,631 444,631 c RESOURCES: Beg. Net Working Capital Revenues Tax Revenues - Current Tax Revenues - Prior Federal Grants U.S. Forest Service State Grant SB #1065-Court Assess. Marine Board Lic. Fee Narcotic Task Force Girt. Transp. of State Wards SB 1145 City of Sisters Security & Traffic Reimb Seat Belt Program Inmate Commissary Fees Soc Sec Incentive-Fed Miscellaneous Medical Services Reimb Restitution Sheriff Fees Court Fines and Fees Impound Fees Interest Interest on Unsegregated Rentals Interfund Contract Sale of Eqp & Material Total Revenues Transfers In TOTAL RESOURCES SHERIFF Rev Detail Statement of Financial Operating Data One Month Ended July 31, 2006 Year to Date Year End Budget Actual Variance FY % Coll. % Budget Projection Variance $2,177,260 $ 2,178,764 $ 1,504 100% 1,230,001 - (1,230,001) 28,750 46,022 17,272 3,439 2,167 (1,272) 6,000 - (6,000) 10,060 7,815 (2,245) 3,542 2,289 (1,253) 8,245 - (8,245) 8 - (8) 417 - (417) 140,217 384,364 244,147 31,211 31,211 - 7,000 320 (6,680) 500 625 125 4,167 - (4,167) 250 - (250) 1,000 3,161 2,161 1,400 - (1,400) 83 - (83) 12,250 14,146 1,896 12,500 6,470 (6,030) 6,667 3,700 (2,967) 8,333 9,249 916 667 63 (604) - 3,647 3,647 34,214 16,592 (17,622) 83 - (83) 1,551,004 531,841 (1,019,163) 225,874 185,581 (40 293) 3,954,138 2,896,186 (1,057,952) REQUIREMENTS: EXPENDITURES & TRANSFERS Sheriffs Division Automotive/Communications Investigations/Evidence Patrol/Civil/Comm Supp Records Adult Jail Transport/Court Security Emergency Services Special Services Division Training Division Contingency 100% $ 2,177,260 $2,178,764 $ 1,504 8% 0% 14,760,006 14,760,006 - 8% 13% 345,000 345,000 - 8% 5% 41,270 41,270 - 8% 0% 72,000 72,000 - 8% 6% 120,718 120,718 - 8% 5%` 42,500 42,500 - 8% 0% 98,944 98,944 - 8% 0% 100 100 - 8% 0%. 5,000 5,000 - 8% 23% 1,682,606 1,682,606 - 8% 8% 374,529 374,529 - 8% 0% 84,000 84,000 - 8% 10% 6,000 6,000 - 8% 0% 50,000 50,000 - 8% 0% 3,000 3,000 - 8% 26% 12,000 12,000 - 8% 0% 16,800 16,800 - 8% 0% 1,000 1,000 - 8% 10%6`-- 147,000 147,000 - 8% 4%'- ' 150,000 150,000 - 8% 5% 80,000 80,000 - 8% 9% 100,000 100,000 - 8% 1% 8,000 8,000 - 8% n/a - 3,647 3,647 8% 4% 410,568 410,568 - 8% n/a 1,000 1,000 - 8% 3% 18,612,041 18,615,688 3,647 8% 7% 2,710,483 2,710,483 - 8% 12% 23,499,784 23,504,935 5,151 Exp. 8% 7% 1,811,964 1,811,964 - 8% 4% 1,145,591 1,145,591 - 8% 7% 1,804,509 1,804,509 - 8% 7% 7,515,095 7,515,095 - 8% 6% 583,385 583,385 - 8% 7% 7,390,287 7,390,287 - 8% 8% 205,713 205,713 - 8% 7% 126,313 126,313 - 8% 9% 519,115 519,115 - 8% 19% 166,798 166,798 - 8% n/a 2,031,014 - 2,031,014 Transfers Out 16,667 - 16,667 8% TOTAL REQUIREMENTS 1,958,316 1,520,873 437,443 8% NET (Resources - Requirements) 1,995,822 1,375,313 (620,509) 150,997 124,785 26,212 95,466 46,283 49,183 150,376 124,233 26,143 626,258 547,632 78,626 48,615 37,813 10,802 615,857 538,900 76,957 17,143 15,934 1,209 10,526 9,245 1,281 43,260 44,907 (1,647) 13,900 31,141 (17,241) 169,251 - 169,251 0% 200,000 200,000 - 6% 23,499,784 21,468,770 2,031,014 - 2,036,165 2,036,165 SHERIFF Exp Detail Statement of Financial Operating Data One Month Ended July 31, 2006 Year to Date Year End Budget Actual Variance FY % Coll. % I Budget I Projection Variance RESOURCES: Beg. Net Working Capital $ 2,177,260 $ 2,178,764 $ 1,504 100% 100% $ 2,177,260 $ 2,178,764 $ 1,504 Total Revenues 1,551,004 531,841 (1,019,163) 8% 3% - 18,612,041 18,615,688 3,647 Transfers In 225,874 185,581 (40,293) 8% 7% 2,710,483 2,710,483 - TOTAL RESOURCES 3,954,138 2,896,186 (1,057,952) 8% 12% 23,499,784 23,504,935 5,151 REQUIREMENTS: Exp. Sheriffs Services Personnel 88,169 82,245 5,924 8% 8% 1,058,026 1,058,026 - Materials & Services 60,293 40,563 19,730 8% 6% 723,517 723,517 - Capital Outlay 558 - 558 8% 0% 6,700 6,700 - Total Sheriffs Services 149,020 122,808 26,212 1,788,243 1,788,243 - Automotive/Communications Personnel 20,772 20,014 758 8% 8%" 249,267 249,267 - Materials & Services 74,685 26,269 48,416 8% 3% 896,224 896,224 - Capital Outlay 8 - 8 8% 0% 100 100 - Total Automotive/Communications 95,465 46,283 49,182 1,145,591 1,145,591 - Investigations/Evidence Personnel 128,621 118,083 10,538 8% 8% 1,543,451 1,543,451 - Materials & Services 18,805 6,150 12,655 8% 3% 225,658 225,658 - Capital Outlay 2,950 - 2,950 8% 0% 35,400 35,400 - Totallnvestigations/Evidence 150,376 124,233 26,143 1,804,509 1,804,509 - Patrol/Civil/Comm Support Personnel 561,558 524,760 36,798 8% 8% 6,738,693 6,738,693 - Materials & Services 44,200 22,872 21,328 8% 4% 530,402 530,402 - Capital Outlay 20,500 - 20,500 8% 0% 246,000 246,000 - Total Patrol/Civil/Comm Supp 626,258 547,632 78,626 7,515,095 7,515,095 - Records Personnel 44,616 35,717 8,899 8% 7% 535,397 535,397 - Materials & Services 3,791 2,096 1,695 8% 5% 45,488 45,488 - Capital Outlay - - - 8% 0% 2,500 2,500 - Total Records 48,407 37,813 10,594 583,385 583,385 - Adult Jail Personnel 496,290 469,175 27,115 8% 8% 5,955,481 5,955,481 - Materials & Services 113,009 56,379 56,630 8% 4% 1,356,106 1,356,106 - Capital Outlay 6,558 13,346 (6,788) 8% 17% 78,700 78,700 - Total Adult Jail 615,857 538,900 76,957 7,390,287 7,390,287 - Transport/Court Security Personnel 15,639 15,583 56 8% 8% 187,665 187,665 - Materials & Services 1,496 351 1,145 8% 2% 17,948 17,948 - Capital Outlay 8 - 8 8% 0% 100 100 - Total Transport/Court Security 17,143 15,934 1,209 205,713 205,713 - Emergency Services Personnel 8,900 8,704 196 8% 8% 106,795 106,795 - Materials & Services 1,618 541 1,077 8% 3% 19,418 19,418 - Capital Outlay 8 - 8 8% 0% 100 100 - Total Emergency Services 10,518 9,245 1,273 126,313 126,313 - Special Services Personnel 35,561 42,319 (6,758) 8% 10% 426,733 426,733 - Materials & Services 5,857 2,588 3,269 8% 4% 70,282 70,282 - Capital Outlay 1,842 - 1,842 8% 0% 22,100 22,100 - Total Special Services 43,260 44,907 (1,647) 519,115 519,115 - Training Personnel 9,935 30,824 (20,889) 8% 26% 119,223 119,223 - Materials & Services 3,956 317 3,639 8% 1% 47,475 47,475 - Capital Outlay 8 - 8 8% 0%: 100 100 - Total Training 13,899 31,141 (17,242) 166,798 166,798 - Non-Departmental Materials & Services 1,977 1,977 - 8% 8% ' 23,721 23,721 - Transfers Out 200,000 - 200,000 8% 0% 200,000 200,000 - Contingency 169,251 - 169,251 8% n/a- 2,031,014 - 2,031,014 Total Non-Departmental 371,228 1,977 369,251 2,254,735 223,721 2,031,014 Total Requirements 2,141,439 1,520,873 620,566 23,499,784 21,468,770 2,031,014 NET (Resources - Requirements) 1,812,699 1,375,313 (437,386) - 2,036,165 2,036,165 HEALTH Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital Revenues Medicare Reimbursement State Grant Child Dev & Rehab Center State Miscellaneous STARS Foundation OMAP Family Planning Exp Proj Grants School Districts Contract Payments/ESD Miscellaneous Patient Insurance Fees Health Dept/Patient Fees Vital Records-Birth Vital Records-Death Interest on Investments Donations Interfund Contract Total Revenues Transfers In-Reserve Fund Transfers In-General Fund TOTAL RESOURCES REQUIREMENTS: Expenditures Personal Services Materials and Services Capital Outlay Transfers Out Contingency TOTAL REQUIREMENTS NET (Resources - Requirements) Year to Date Year End Bud et Actual Variance FY % Coll. % Budget Projection Variance I ~ I $1,300,000 $ 1,321,668 $ 21,668 100% - 39 39 132,485 120,788 (11,697) 2,702 - (2,702) 12,915 - (12,915) 450 - (450) 13,942 10,570 (3,372) 35,417 - (35,417) - 2,500 2,500 1,260 - (1,260) 4,250 - (4,250) 42 - (42) 4,263 3,544 (719) 12,629 10,226 (2,403) 3,333 3,730 397 7,500 6,110 (1,390) 4,167 4,195 28 983 546 (437) 8,950 11,200 2,250 245,288 173,448 (71,840) 200,842 200,842 - 1,746,130 1,695,958 (50,172) 338,111 297,728 40,383 115,817 58,163 57,654 2,042 - 2,042 500,000 500,000 - 44,336 - 44,336 102% $1,300,000 $1,321,668 $ 21,668 8% n/a - 39 39 8% 8% 1,589,820 1,589,820 - 8% 0% 32,428 32,428 - 8% 0% 154,982 154,982 - 8% 0% ' 5,400 5,400 - 8% 6% 167,300 167,300 - 8% 0% 425,000 425,000 - 8% n/a' - 2,500 8% 0% 15,123 15,123 - 8% 0% ' 51,000 51,000 - 8% n/a - 500 500 - 8% 7% 51,150 51,150 - 8% 7% 151,550 151,550 - 8% 9% 40,000 40,000 - 8% 7% 90,000 90,000 - 8% 8% 50,000 50,000 - 8% 5% 11,800 11,800 - 8% 10% 107,401 107,401 - 8% 6% 2,943,454 2,945,993 39 8% n/a . 100 - (100) 8% 8%' 2,410,109 2,410,109 - 8% 25% 6,653,663 6,677,770 21,607 Exp. 8% 7% 4,057,331 3,907,331 150,000 8% 4% 1,389,804 1,389,804 - 8% 0% 24,500 - 24,500 8% 77% 650,000 650,000 - 8% n/a 532,028 - 532,028 1,000,306 855,891 144,415 8% 13%- 745,824 840,067 94,243 6,653,663 5,947,135 706,528 - 730,635 728,135 MENTAL HEALTH Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital Revenues Marriage Licenses Divorce Filing Fees State Grants State Miscellaneous Title 19 Liquor Revenue ABHA Client Support Funds School Districts Mental Health Jail Comp Miscellaneous Patient Insurance Fees Patient Fees Interest on Investments Rentals Donation Administrative Fee Total Revenues Transfers In-General Fund Transfers In-Other TOTAL RESOURCES REQUIREMENTS: Expenditures Personal Services Materials and Services Capital Outlay Transfers Out Contingency TOTAL REQUIREMENTS NET (Resources - Requirements) Year to Date Budget Actual Variance FY % Coll. % $ 3,059,533 $ 3,347,448 $ 287,915 100% 458 805 347 8% 11,250 14,581 3,331 8% 717,687 299,395 (418,292) 8% 29,803 - (29,803) 8% 19,369 - (19,369) 8% 7,167 11,492 4,325 8% 2,500 - (2,500) 8% 5,833 390 (5,443) 8% 600 - (600) 8% 7,042 - (7,042) 8% 21,619 3,708 (17,911) 8% 6,926 556 (6,370) 8% 9,167 14,302 5,135 8% 1,667 - (1,667) 8%° 167 - (167) 8% 185,417 185,417 - 8% 1,026,672 530,646 (496,026) 8% 115,304 115,304 - 8% 21,516 12,264 (9,252) 8% 4,223,025 4,005,662 (217,363) 8% 558,773 533,118 25,655 8% 694,655 115,918 578,737 8% 417 - 417 8% - - - 8% 152,107 - 152,107 8% 1,405,952 649,036 756,916 8% 2,817,073 3,356,626 539,553 Year End Budget Projection Variance 109% $ 3,059,533 $ 3,347,448 $ 287,915 15% 5,500 5,500 - 11% 135,000 151,900 16,900 3% ; 8,612,242 8,325,514 (286,728) 0% 357,634 357,634 - 0% 232,422 290,075 57,653 13% 86,000 91,668 5,668 00/0 30,000 30,000 - 1% 70,000 70,000 - 0% 7,200 7,200 - 0% 84,500 91,137 6,637 1% 259,428 259,068 (360) 1% 83,117 27,939 (55,178) 13% 110,000 122,194 12,194 0%! 20,000 16,500 (3,500) n/a ! 2,000 3,403 1,403 8% 2,225,003 2,611,955 386,952 4% 12,320,046 12,461,687 141,641 8%' 1,383,648 1,273,022 (110,626) 5% 258,195 551,430 293,235 24% 17,021,422 17,633,587 612,165 Exp. 8%' 6,705,276 6,705,276 - 1% 8,335,860 8,335,860 - 0% 5,000 5,000 - 0% 150,000 150,000 - n/a 1,825,286 - 1,825,286 4% 17,021,422 15,196,136 1,825,286 - 2,437,451 2,437,451 COMMUNITY DEVELOPMENT Statement of Financial Operating Data One Month Ended July 31, 2006 Year to Date Year End Budget Actual Variance FY % Coll. % Budget Projection Variance RESOURCES: Beg. Net Working Capital $ 1,063,210 $ 1,997,313 934,103 100% n/a $1,063,210 $1,997,313 934,103 Revenues Admin-Operations 9,271 14,593 5,322 8% 13% 111,250 111,250 - Admin-GIS 1,008 413 (595) 8% 3% 12,100 12,100 - Admin-Code Enforcement 34,147 42,747 8,600 8% 10% 409,765 409,765 - Building Safety 205,458 269,763 64,305 8% 11% 2,465,500 2,465,500 - Electrical 52,188 59,822 7,634 8% 10% 626,250 626,250 - Contract Services 108,634 - (108,634) 8% 0% 1,303,605 1,303,605 - Env Health-On Site Prog 82,658 80,610 (2,048) 8% 8% 991,900 991,900 - Env Health-Lic Facilities 43,810 22,293 (21,517) 8% 4% 525,725 525,725 - Env Health - Drinking H2O 4,750 - (4,750) 8% 0% 57,000 57,000 - EPA Grant 24,757 - (24,757) 8% 0% 297,078 297,078 - Planning-Current 110,406 106,711 (3,695) 8% 8% 1,324,875 1,324,875 - Planning-Long Range 61,798 49,308 (12,490) 8% 7% 741,575 741,575 - Total Revenues 738,885 646,260 (92,625) 8% 7% 8,866,623 8,866,623 - Trans In-CDD Reserve 8 - (8) 8% 0% 100 - (100) Trans In-CDD Bldg/Elec 17 - (17) 8% 0% 200 - (200) TOTAL RESOURCES 1,802,120 2,643,573 841,453 8% 27% 9,930,133 10,863,936 933,803 REQUIREMENTS: Exp. EXPENDITURES & TRANSFERS Admin-Operations Division 270,803 165,419 105,384 8% 5% 3,249,633 3,249,633 - Admin-GIS Division 14,190 8,918 5,272 8% 5%' 170,285 170,285 - Admin-Code Enforcement 19,733 17,446 2,287 8% 7% 236,800 236,800 - Building Safety Division 89,804 127,582 (37,778) 8% 12% 1,077,642 1,077,642 - Electrical Division 32,977 30,470 2,507 8% 8% 395,729 395,729 - Contract Services 63,701 56,300 7,401 8% 7% 764,409 764,409 - Env Health-On Site Pgm 45,499 38,125 7,374 8% 7% 545,990 545,990 - Env Health-Lic Facilities 35,043 33,393 1,650 8% 8% 420,516 420,516 - Env Health-Grant Division 29,972 - 29,972 8% 0%_ 359,660 359,660 - Env Health - Drinking H2O 5,102 4,825 277 8% 8% 61,223 61,223 - EPA Grant 18,487 12,654 5,833 8% 6% 221,840 221,840 - Planning-Current Division 95,227 83,564 11,663 8% 7% 1,142,723 1,142,723 - Planning-Long Range Div 52,985 33,375 19,610 8% 5% 635,817 635,817 - Contingency 53,989 - 53,989 8% n/a 647,866 - 647,866 TOTAL REQUIREMENTS 827,512 612,071 215,441 8% 6%- 9,930,133 9,282,267 647,866 NET (Resources - Requirements) 974,608 2,031,502 1,056,894 - 1,581,669 1,581,669 ROAD Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital Revenues System Development Ch Forest Receipts State Grant Motor Vehicle Revenue City of Bend City of Redmond City of Sisters Miscellaneous Road Vacations Interest on Investments Donations Interfund Contract Equipment Repairs Vehicle Repairs LID Construction Vegetation Management Inter-fund: Forester Sale of Eqp & Material Sale of Public Lands Total Revenues Year to Date Year End Budget Actual Variance FY % Coll. % Bud et Projection Variance $4,643,357 $ 5,162,250 $ 518,893 100% 5,583 - (5,583) 257,083 - (257,083) 28,333 - (28,333) 658,333 671,631 13,298 14,583 - (14,583) 35,417 - (35,417) 4,167 - (4,167) 4,167 - (4,167) 167 - (167) 12,500 21,634 9,134 200 - (200) 62,500 - (62,500) 22,083 - (22,083) 8,333 - (8,333) 12,500 - (12,500) 7,083 - (7,083) 3,750 - (3,750) 45,833 - (45,833) 42 - (42) 1,182,657 693,265 (489,392) 8% n/ 8% 8% n/ 8% 8% 8% 8% n/ 111% $ 4,643,357 a 67,000 0% 3,085,000 a 340,000 9% 7,900,000 0% 175,000 0% 425,000 a 50,000 $ 5,162,250 $ 518,893 67,000 - 3,085,000 - 340,000 - 7,900,000 - 175,000 - 425,000 - 50,000 - 8% 0% 50,000 50,000 - 8% 0% 2,000 2,000 - 8% 14% 150,000 150,000 - 8% 0% 2,400 2,400 - 8% 0% 750,000 750,000 - 8% 0%' 265,000 265,000 - 8% 00X, 100,000 100,000 - 8% 0% 150,000 150,000 - 8% 0% 85,000 85,000 - 8% 0% 45,000 45,000 - 8% 0% 550,000 550,000 - 8% 0% 500 500 - 8% 5% 14 191 900 , , 14,191,900 - 0% 6,467 6,467 - 31% 18,841,724 19,360,617 518,893 Exp. 8%-' 5,412,405 5,412,405 - 2% 7,935,977 7,935,977 - 2% 3,675,000 3,675,000 - 0% 900,000 900,000 - n/a 918,342 - 918,342 Trans In-Road Imp Res 539 - (539) 8% TOTAL RESOURCES 5,826,553 5,855,515 28,962 8% REQUIREMENTS: Expenditures Personal Services 451,034 444,837 6,197 8% Materials and Services 661,331 168,902 492,429 8% Capital Outlay 306,250 77,135 229,115 8% Transfers Out - - - 8% Contingency 76,529 - 76,529 8% TOTAL REQUIREMENTS 1,495,144 690,874 804,270 8% NET(Resources - Requirements) 4,331,409 5,164,641 833,232 4% 18,841,724 17,923,382 918,342 1,437, 235 1,437,235 COMM ON CHILDREN & FAMILIES Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital Revenues Federal Grants Title IV - Family Sup/Pres HealthyStart Medicaid Child Care Block Grant Level 7 Services Juvenile Crime Prevention State Prevention Funds HealthyStart /R-S-G OCCF Grant Miscellaneous Court Fines & Fees Interest on Investments Grants-Private Total Revenues Year to Date Year End Budget., Actual Variance FY % Coll. % Budget Projection Variance $ 571,056 $ 546,785 $ (24,271) 100% 22,913 - (22,913) 3,467 - (3,467) 14,583 - (14,583) 4,725 - (4,725) 18,348 - (18,348) 35,130 - (35,130) 15,625 - (15,625) 23,808 - (23,808) 27,195 - (27,195) 917 - (917) - 2,243 2,243 1,250 2,918 1,668 1,000 - (1,000) 168,961 5,161 (163,800) 8% 8% 8% 8% 8% 8% 8% 8% 8% 8% 8% 8% 8% 96% $ 571,056 $ 546,785 $ (24,271) 0% 274,951 274,951 - 0%' 41,602 41,602 - 0% 175,000 175,000 - 0% 56,699 56,699 - 0% " 220,176 220,176 - 00/0 421,565 421,565 - 0% 187,500 187,500 - 0% 285,694 285,694 - 0% 326,345 326,345 - 0% 11,000 11,000 - n/a - 2,243 2,243 19% 15,000 15,000 - 0% 12,000 12,000 - 2,027,532 2,029,775 2,243 Trans from General Fund 28,197 27,531 (666) 8% Trans from Other 14,175 - (14,175) 8% Total Transfers In 42,372 27,531 (14,841) 8% TOTAL RESOURCES REQUIREMENTS: Expenditures Personal Services Materials and Services Capital Outlay Contingency 782,389 579,477 (202,912) 8% 41,715 34,233 7,482 8% 182,303 8,263 174,040 8% 417 - 417 8% 34,487 - 34,487 8% TOTAL REQUIREMENTS 258,922 42,496 216,426 8% 8% 338,369 338,369 - 0%' 170,100 170,100 - 5% 508,469 508,469 - 19% 3,107,057 3,085,029 (22,028) Exp. 7% 500,577 500,577 - 0% 2,187,640 2,187,640 - 0% 5,000 5,000 - n/a 413,840 - 413,840 1%. 3,107,057 2,693,217 413,840 NET (Resources - Requirements) 523,467 536,981 13,514 - 391,812 391,812 ADULT PAROLE & PROBATION Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital Revenues State Grant State Miscellaneous Probation Work Crew Fees Alcohol and Drug Treatment Miscellaneous Electronic Monitoring Fee Probation Superv. Fees Sex Offender Treatment Fees Day Reporting Fees Interest on Investments Leases Rentals Total Revenues Year to Date Year End Budget Actual Variance FY % Coll. % Budget Projection Variance $ 350,000 $ 341,768 $ (8,232) 100% 98% $ 350,000 $ 341,768 $ (8,232) 171,377 560,019 388,642 8% 27% 2,056,519 2,056,519 - 1,109 2,709 1,600 8% 20% 13,306 13,306 - 2,833 4,347 1,514 8% 13% 34,000 34,000 - 81 - (81) 8% 0% 970 970 - 483 235 (248) 8% 4% 5,800 5,800 - 12,500 5,885 (6,615) 8% '4% 150,000 150,000 - 18,333 13,421 (4,912) 8% 6% 220,000 220,000 - 250 - (250) 8% 0% 3,000 3,000 - 28 - (28) 8% 0% 330 330 - 1,667 2,415 748 8% 12% 20,000 20,000 - 500 - (500) 8% 0% 6,000 6,000 - 23 150 127 8% 54% 280 280 - 209,184 589,181 379,997 8% 23% 2.510.205 2.510.205 - Transfers In-General Fund 110,666 110,666 - 8% Transfers In-Video Lotter 8,333 8,333 - 8% TOTAL RESOURCES 678,183 1,049,948 371,765 8% REQUIREMENTS: Expenditures Personal Services Materials and Services Capital Outlay Contingency TOTAL REQUIREMENTS NET (Resources - Requirements) 198,411 183,962 14,449 8% 49,027 31,772 17,255 8% - - - 8% 9,903 - 9,903 8% 257,341 215,734 41,607 8% 420,842 834,214 330,158 49% 227,990 227,990 - 8% 100,000 100,000 - 33% 3,188,195 3,179,963 (8,232) Exp. 8% 2,380,927 2,380,927 - 5% 588,329 588,329 - 0% 100 - (100) 0% 118,839 - (118,839) 7% 3,088,195 2,969,256 (118,939) 100,000 210,707 110,707 SOLID WASTE Statement of Financial Operating Data One Month Ended July 31, 2006 i Year to Date Year End Budget., Actual Variance FY % Coll. % Budget Projection Variance RESOURCES: Beg. Net Working Capital $1,018,342 $ 1,572,478 $ 554,136 100% 154% $1,018,342 $ 1,572,478 $ 554,136 Revenues State Grant - 20,000 20,000 8% n/a - 20,000 20,000 Miscellaneous 2,333 2,710 377 8% 10% 28,000 28,000 - Franchise 3% Fees 13,333 - (13,333) 8% 0% 160,000 160,000 - Commercial Disp. Fees 92,700 129,538 36,838 8% 12% 1,112,400 1,112,400 - Private Disposal Fees 163,083 199,497 36,414 8% 10%' 1,957,000 1,957,000 - Franchise Disposal Fees 365,822 404,079 38,257 8% 9%- 4,389,860 4,389,860 - Yard Debris 4,721 6,609 1,888 8% 12%' 56,650 56,650 - Special Waste 2,500 2,387 (113) 8% 8% 30,000 30,000 - Interest 6,667 7,757 1,090 8% 10% 80,000 80,000 - Sale of Equip & Material 2,167 2,551 384 8% 10% 26,000 26,000 - Total Revenues 653,326 775,128 121,802 8% 10% 7,839,910 7,859,910 20,000 Trans In-Code Abatement 20,000 20,000 - 8% TOTAL RESOURCES 1,691,668 2,367,606 675,938 8% REQUIREMENTS Expenditures Personal Services Materials and Services Debt Service Capital Outlay Transfers Out Contingency 131,825 128,357 3,468 8% 311,627 122,067 189,560 8% 30,763 - 30,763 8% 22,729 - 22,729 8% 200,000 - 200,000 8% 42,910 - 42,910 8% TOTAL REQUIREMENTS 739,854 250,424 489,430 NET (Resources - Requirements) 951,814 2,117,182 1,165,368 100% 20,000 20,000 - 27% 8,878,252 9,452,388 574,136 Exp. 8% 1 1,581,897 1,581,897 - 3% 3,739,527 3,739,527 - 0% 369,159 369,159 - 0%. 272,750 272,750 - 0% 2,400,000 2,400,000 - n/a 514,919 - 514,919 8% 3% 8,878,252 8,363,333 514,919 - 1,089,055 1,089,055 Health Benefits Trust Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES Beg. Net Working Capital Revenues: Internal Premium Charges P/T Emp - Add'I Prem Employee Prem Contribution COIC Retiree / COBRA Co-Pay Interest Subrogation Miscellaneous Total Revenues TOTAL RESOURCES REQUIREMENTS Expenditures: Personal Services Materials & Services Conferences and Seminars Claims Paid-Medical/Rx Claims Paid-Dental/Vision Refunds Insurance Expense State Assessments Administration Fee PPO Fee Printing Program Expense/Supplies Other Total Materials & Services Capital Outlay Contingency Year to Date -Budget Actual Variance FY % Coll. % Year End Budget Projection Variance $ 6,800,000 $7,163,864 $ 363,864 100% 105% „$6,800,000 $7,163,864 $ 363,864 850,000 879,225 29,225 8% 9% 10,200,000 10,200,000 - 15,000 10,782 (4,218) 8% 6% 180,000 180,000 - 29,417 26,075 (3,342) 8% 7% 353,000 353,000 - 59,583 61,392 1,809 8% 9% 715,000 715,000 - 33,333 48,122 14,789 8% 12% 400,000 400,000 - 20,833 26,827 5,994 8% 11% 250,000. 250,000 - - - 8% n/a - - - - - - 8% n/a ' - - - 1,008,167 1,052,423 44,256 8% 9% 12,098,000 12,098,000 - 7,808,167 8,216,287 408,120 92% 43% Exp. 11,215 8,250 2,965 8% 6%. 250 - 250 747,644 647,381 100,263 107,871 61,596 46,275 - (339) 339 32,500 26,512 5,988 3,333 - 3,333 20,000 18,649 1,351 2,917 2,568 349 1,000 - 1,000 917 - 917 1,450 1,409 41 917,881 757,776 160,105 645,729 - 645,729 18,898,000 19,261,864 363,864 134,582 134,582 - 8% 0% 3,000 3,000 - 8% 7% a) 8,971,725 8,415,952 555,773 8% 5% a) 1,294,448 800,742 493,706 8% n/a - (339) 339 8% 7% 390,000 390,000 - 8% 0% 40,000 40,000 - 8% 8% 240,000 240,000 - 8% 7% 35,000 35,000 - 8% 0% 12,000 12,000 - 8% 0% 11,000 11,000 - 8% 8% 17,400 17,400 - 8% 7% 11,014,573 9,964,755 1,049,818 8% 0% 100 - 100 8% 0% 7,748,745 - 7,748,745 TOTAL REQUIREMENTS 1,574,825 766,026 808,799 8% 4% 18,898,000 10,099,337 8,798,663 NET (Resources - Requirements) 6,233,342 7,450,261 1,216,919 - 9,162,526 9,162,526 a) Projection based on annualizing 4 weeks of claims paid. DESCHUTES COUNTY 911 Statement of Financial Operating Data One Month Ended July 31, 2006 RESOURCES: Beg. Net Working Capital $1,800,000 $ 2,280,963 $ 480,963 Revenues Property Taxes - Current 283,333 - (283,333) Property Taxes - Prior 5,250 10,221 4,971 State Reimbursement 1,750 - (1,750) Telephone User Tax 51,250 - (51,250) Data Network Reimb. 2,750 - (2,750) Jefferson County 3,417 219 (3,198) User Fee 1,994 - (1,994) Contract Payments 5,941 - (5,941) Miscellaneous 500 500 - Interest 4,167 8,238 4,071 Interest on Unsegregated Tax 167 15 (152) Total Revenues 360,519 19,193 (341,326) TOTAL RESOURCES 2,160,519 2,300,156 139,637 REQUIREMENTS: Expenditures Personal Services Materials and Services Capital Outlay Transfers Out Contingency TOTAL REQUIREMENTS NET (Resources - Requirements) Year to Date Year End Budget Actual Variance % of FY % Coll. Budget I Projection Variance 269,903 231,642 38,261 60,763 35,894 24,869 22,667 - 22,667 130,000 - 130,000 146,353 - 146,353 629,686 267,536 362,150 1,530,833 2,032,620 501,787 100% 127% $1,800,000 $ 2,280,963 $ 480,963 8% 0% 3,400,000 3,400,000 - 8% 16% 63,000 63,000 - 8% 0% 21,000 21,000 - 8% 0% 615,000 615,000 - 8% 0% 33,000 33,000 - 8% 1% 41,000 41,000 - 8% 0% 23,925 23,925 - 8% 0% 71,289 71,289 - 8% 8% 6,000 6,000 - 8% 16% 50,000 50,000 - 8% 1% 2,000 2,000 - 8% 0% 4,326,214 4,326,214 - 8% 38% 6,126,214 6,607,177 480,963 Exp. 8% 7% 3,238,832 3,238,832 - 8% 5% 729,152 729,152 - 8% 0% 272,000 272,000 - 8% 0% 130,000 130,000 - 8% n/a 1,756,230 - 1,756,230 8% 4% 6,126,214 4,369,984 1,756,230 - 2,237,193 2,237,193 1z, Deschutes County Fair - Fund 619 Revenues and Expenditures FAIR 2006 January 1, 2006 through August 18, 2006 RESOURCES: Beg Net Working Capital (7-1-06) Carryover as of January 1, 2006 REVENUES Gate Receipts Carnival Commercial Exhibitors: Outside Inside Food Livestock Entry Fees R/V Camping Concessions: Food Fair Sponsorship: Rodeo On-ground Stages Day Golf Carts Food Court Concert Presenting Sponsors Barn Sponsors Building Sponsors Grants T-Shirts Telephone Fees State Grant Interest Miscellaneous TOTAL REVENUES TOTAL RESOURCES Expenses: Expenses: Personnel Materials and Services Contingency TOTAL EXPENSES Net - Fair 2006 Transfer to Fund 618 NET AFTER TRANSFER Approved Additional Over Percentage FY 06-07 Actual to Projected Total Fair (Under) Variance Budget Date through Dec 31 2006 Budget from Budget 27,989 27,989 27,989 (0) 0% 414,000 429,944 25,862 455,806 41,806 10% 142,000 155,865 - 155,865 13,865 10% 92,000 90,700 - 90,700 (1,300) -1% 37,300 38,125 38,125 825 2% 14,325 11,625 11,625 (2,700) -19% 5,250 4,510 600 5,110 (140) -3% 17,000 18,903 - 18,903 1,903 11% 134,000 88,056 72,460 160,516 26,516 20% 35,000 40,375 1,050 41,425 6,425 18% 10,000 8,000 - 8,000 (2,000) -20% 13,000 8,000 5,000 13,000 - 0% 2,200 2,200 180 2,380 180 8% 3,500 3,500 3,500 - 0% 30,000 30,000 - 30,000 - 0% 18,000 18,000 18,000 - 0% 5,000 5,000 - 5,000 - 0% 25,000 5,000 5,000 (20,000) -80% 5,000 - 5,000 5;000 - 0% 5,500 3,867 3,867 (1,633) -30% 500 - - (500) -100% 46,000 - 46,000 46,000 - 0% 1,500 804 - 804 (696) -46% - 105 105 105 N/A 1,056,075 962,580 156,152 1,118,732 62,657 6% 1,084,064 990,569 156,152 1,146,721 62,657 6% 167,068 93,546 73,522 167,068 (0) 0% 680,681 449,302 150,000 599,302 (81,379) -12% 17,315 - - (17,315) -100% 865,064 542,848 223,522 766,370 (98,694) -11% 219,000 419,731 (67,370) 352,361 161,350 74% 219,000 - 219,000 219,000 - 0% - 419,731 (286,370) 133,361 161,350 Deschutes County Fair - Fund 619 Revenues and Expenditures FAIR 2006 January 1, 2006 through August 18, 2006 RESOURCES: Beg Net Working Capital (7-1-06) Carryover as of January 1, 2006 REVENUES Gate Receipts Carnival Commercial Exhibitors: Outside Inside Food Livestock Entry Fees R/V Camping Concessions: Food Fair Sponsorship: Rodeo On-ground Stages Day Golf Carts Food Court Concert Presenting Sponsors Barn Sponsors Building Sponsors Grants T-Shirts Telephone Fees State Grant Interest Miscellaneous TOTAL REVENUES TOTAL RESOURCES Expenses: Expenses: Personnel Materials and Services TOTAL EXPENSES Percentage Additional Over Change Actual to Projected Total Fair (Under) from Fair Fair 2005 Date through Dec 31 2006 2005 23,795 27,989 27,989 (4,194) -18% 359,202 429,944 25,862 455,806 96,604 27% 133,401 155,865 - 155,865 22,464 17% 91,650 90,700 - 90,700 (950) -1% 37,300 38,125 38,125 825 2% 14,325 11,625 11,625 (2,700) -19% 5,144 4,510 600 5,110 (34) -1% 15,689 18,903 - 18,903 3,214 20% 127,038 88,056 72,460 160,516 33,478 26% 34,175 40,375 1,050 41,425 7,250 21% 10,000 8,000 - 8,000 (2,000) -20% 13,000 8,000 5,000 13,000 - 0% 2,160 2,200 180 2,380 220 10% 3,500 3,500 3,500 - 0% 31,000 30,000 - 30,000 (1,000) -3% 11,000 18,000 18,000 7„000 64% 7,500 5,000 - 5,000 (2,500) -33% 5,000 5,000 5,000 - 0% 5,000 - 5,000 5,000 - 0% 5,506 3,867 3,867 (1,639) -30% 150 - - (150) -100% 46,456 - 46,000 46,000 (456) -1% 2,756 804 - 804 (1,951) -71% 438 105 105 (333) N/A 961,389 962,580 156,152 1,118,732 157,342 16% 985,184 990,569 156,152 1,146,721 161,537 16% 145,642 93,546 73,522 167,068 21,426 15% 607,253 449,302 150,000 599,302 (7,951) -1% 752,895 542,848 223,522 766,370 13,475 2% K9 IM QS Net - Fair 2006 232,289 419,731 (67,370) 352,361 143,867 62% Transfer to Fund 618 204,300 - 219,000 219,000 (14,700) -7% NET AFTER TRANSFER 27,989 419,731 (286,370) 133,361 158,567 DESCHUTES COUNTY-ANNUAL FAIR Budgeted and Actual Materials and Services Fair 2006 (January 1, 2006 through August 18, 2006) Engineering Medical Contract Mailing service Temporary Help - Office Temporary Help - Labor Temporary Help - Computer Transportation Comm Line Installation Indirect Charge - Legal Indirect Charge - Finance Indirect Charge - IT Indirect Charge - Tech Reserve Indirect Charge - Admin Svcs Indirect Charge - Personnel Food Booth Cash Control Gate Receipts Cash Control Major Entertainment Grounds Entertainment Sheep Competition Open Class Rodeo Security Water & Sewer Portable Sanitation Garbage Custodial/Janitorial Building Repair & Maintenance Equipment R & M Maintenance Agreements Copy Machine Rental Equipment Rental Membership & Dues Conferences & Seminars Bank Charges Insurance Premiums Telephone Cellular Announcements Promotion Printing Travel G rants/Contributions Premiums-Other Over/Short Custodial supplies Equipment R & M Suplies General supplies Office/Copier Postage Queen Court Program supplies Bldg/Grounds R & M Supplies Safety supplies Shop supplies Software supplies Special Supplies Straw & Hay Vehicle R & M Supplies Electricity Gas/Oil/Diesel Heating Oil/Propane Natural Gas Meeting Supplies Signage Minor Tools and Equipment Computers & Peripherals TOTAL Estimated (Through (Over)/Under Dec 31, (Over)/Under Budget Actual Actual 2006) Estimated - IOU (l tsu) (18U) 2,800 3,345 (545) (545) 13,200 13,200 13,200 7,500 3,060 4,440 4,440 35,000 19,715 15,285 - 15,285 10,000 6,260 3,740 3,740 14,563 6,221 8,342 4,856 3,486 6,172 4,069 2,103 2,056 47 16,132 10,025 6,107 5,376 731 2,275 1,282 993 760 233 3,791 2,229 1,562 1,264 298 1,849 1,086 763 616 147 5,250 5,250 - - 16,000 19,184 (3,184) (3,184) 128,300 128,300 - - 43,000 34,573 8,427 8,427 - 600 (600) (600) 40,000 4,060 35,941 - 35,941 55,000 59,203 (4,203) (4,203) 56,000 12,750 43,250 43,250 2,800 2,800 2,800 3,200 3,200 3,200 2,500 2,500 - 2,500 9,000 9,000 - 9,000 2,500 2,022 478 478 100 1,944 (1,844) (1,844) - 500 (500) (500) 400 600 (200) (200) 54,000 31,303 22,697 22,697 1,200 416 784 784 500 - 500 500 350 350 350 38,449 21,002 17,447 12,815 4,632 1,800 40 1,760 1,760 400 - 400 400 - 350 (350) (350) 28,000 19,519 8,481 8,481 6,000 5,303 697 697 4,500 2,126 2,374 - 2,374 21,000 21,000 - - 800 (1) 801 801 9,000 4,342 4,658 4,658 100 100 100 1,200 868 332 332 800 1,204 (404) - (404) 2,500 877 1,623 1,623 2,000 970 1,030 - 1,030 - 2,200 (2,200) (2,200) 3,000 2,835 165 165 - 399 (399) (399) 1,200 1,589 (389) (389) 250 564 (314) (314) 1,500 1,500 1,500 1,500 3,436 (1,936) (1,936) 500 500 500 17,000 17,000 17,000 2,200 2,088 112 - 112 600 197 403 3,000 3,000 3,000 - 177 (177) (177) 40 (40) (40) 680,681 449,302 231,379 27,743 203,233 Deschutes County Fair - Fund 619 Revenues and Expenditures Annual County Fair REVENUES: Gate Receipts Entertainment Carnival Commercial Exhibitors Livestock Entry Fees RV/Camping Concessions - Food Concessions - Entertainment Fair Sponsorship T - Shirts Sales State Grant Interest Lottery Grant Miscellaneous TOTAL REVENUES EXPENDITURES: Personnel Materials and Services TOTAL EXPENDITURES Gross Profit Transfer to Fair & Expo Fund TOTAL EXPENDITURES NET Retained Annual County Fair Fund Fund 619 Fair 2001 Fair 2002 Fair 2003 Fair 2004 Fair 2005 Fair 2006 " Cumulative 300,373 341,755 320,332 331,536 359,202 455,806 2,109,004 118,433 127,727 38,787 48,762 30,000 30,000 393,709 95,211 99,971 92,345 135,412 133,401 155,865 712,205 122,701 110,596 133,254 142,863 143,275 140,450 793,139 6,080 7,373 7,502 5,723 5,144 5,110 36,932 6,296 10,095 10,620 13,635 15,689 18,903 75,238 65,621 94,675 88,961 103,452 127,038 160,516 640,262 1,262 1,240 - 300 - - 2,802 37,850 78,360 69,342 74,100 87,335 96,305 443,292 - 3,815 1,569 2,117 5,506 3,867 16,874 43,056 40,868 39,200 35,141 46,456 46,000 250,721 1,130 2,471 1,390 1,401 2,756 804 9,952 - 10,528 15,000 5,000 5,000 5,000 40,528 3,170 2,581 983 1,981 588 105 9,408 801,182 932,054 819,285 901,423 961,389 1,118,732 5,534,065 39,121 107,624 124,434 134,533 145,642 167,068 718,422 544,651 639,523 578,611 558,993 607,253 599,302 3,528,334 583,772 747,147 703,045 693,526 752,895 766,370 4,246,755 217,410 184,907 116,240 207,897 208,494 352,361 1,287,310 154,556 172,102 185,000 191,000 204,300 219,000 1,125,958 738,328 919,249 888,045 884,526 957,195 985,370 5,372,713 62,854 12,805 (68,760) 16,897 4,194 133,361 161,352 " As of August 18, 2006 DESCHUTES COUNTY Annual County Fair (Fund 619) Balance Sheet August 18, 2006 Assets Cash $ 549,873 Accounts Receivable 156,152 Total Assets $ 706.025 Liabilities Accounts Payable $ 102,152 Accrued Liabilities 442,522 Total Liabilities 544,674 Fund Balance Fund Balance 161,351 Total Liabilities and Fund Balance $ 706.025 The "Fair Year" is January 1 through December 31. 3 0 n LL N O l0 N U m o O d d O M C t N N d C U U M O C _T L X N 7 O) W n p d L ~ 7 01 w C 7 N O O 10 C « 18, LL C. 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C N L G d C Y (6 d C d C O Q 0 Q a ~ F O > F i w 2 a 2 ) z 0 m w o = Z z m w n = a 0 > 1 O C 0 t Deschutes County - Fair and Expo Center YTD-Budget Basis Statement of Fin ancial Operating Data One Month E nded July 31 , 2006 Budget Actual Variance I F % Coll. % Budget Projection Variance RESOURCES: Beg. Net Working Capital $ 169,300 $ 230,614 $ 61,314 100% 136% $ 169,300 $ 230,614 $ 61,314 Receipts: Events 63,000 18,957 (44,043) 8% 3% 625,000 580,957 (44,043) Telephone Fees - Events - - - 8% 0% 5,000 5,000 - Parking Fees - - - 8% 0% 15,000 15,000 - Storage - - - 8% 0% 55,000 55,000 - RV / Camping - 135 135 8% 0% 140,000 140,135 135 Horse Stall Rental - - - 8% 0%' 55,000 55,000 - Concession % - Food 9,000 13,000 4,000 8% 5% 275,000 279,000 4,000 Vending Machines - - - 8% 0% 2,000 2,000 - Interfund Contract - - - 8% 0% 40,000 35,000 (5,000) Rights (Signage, etc.) 6,000 15,000 9,000 8% 16% 95,000 104,000 9,000 Grants 2,529 2,529 - 8% 8% 30,355 35,355 5,000 Miscellaneous 416 634 218 8% 13% 5,000 5,218 218 Interest 625 1,397 772 8% 19% 7,500 8,272 772 Total Receipts 81,570 51,652 (29,918) 8% 4% 1,349,855 1,319,937 (29,918) Transfer from General Fund - - - 8% 0% 300,000 300,000 - Transfer from Park Fund - - - 8% 0% 85,000 85,000 Transfer from Annual County Fair - - - 8% 0% 219,000 219,000 - Total Transfers - - - 8% 0% 604,000 604,000 - TOTAL RESOURCES 250,870 282,266 31,396 8% 13% 2,123,155 2,154,551 31,396 REQUIREMENTS: Exp. °i° Expenditures: Personal Services 69,233 67,533 1,700 8% 8% 830,872 829,172 1,700 Materials and Services 60,528 36,306 24,222 8% 5% 726,617 726,640 (23) Debt Service - - - 8% 0% 242,708 242,708 - Capital Outlay - - - 8% 0% 40,000 40,000 - Transfers Out - - - 8% 0% 135,000 135,000 - Contingency - - - 8% n/a 147,958 - 147,958 TOTAL REQUIREMENTS 129,761 103,839 25,922 8% 5% 2,123,155 1,973,520 149,635 NET (Resources - Requirements) 121,109 178,427 57,318 - 181,031 181,031 Revenue (Accounts Receivable): (Current Month Events 24,648 I Prior Months 2,400 Total Accounts Receivable 27,048 Deposits Received for Future Events: 2006: August 10,005 September 3,650 October 3,889 November 10,640 2007 75,712 2008 and Beyond 37,382 TOTAL 141,278 MEMORANDUM To: Board of County Commissioners, County Administrator and Finance Director From: Teri Maerki RE: RV Park Date: August 14, 2006 Attached is the report on the RV park reflecting activity through July 31, 2006. Copy: Mark Pilliod Dan Despotopulos U) F- U w O re, w 2 F- O C M Y Q O O oc Z N U LL M OZ_>, ~ 0-5 L '7 F- cn U o Q F- Z O U w F-- Z w U O a X w c m w N O O T LO M O to r- N ~ Itt O O N N CO tC r N O O 07 to O Cl) O M L' N N 00 O O N N M 00 r c- 0) N IN 00 00 ti ' n ti n N IN co' -0 O O 07 to O (Y) O M N L N V N 00 O r O m N N (Y) 00 C) r- r Q1 N N i i i O O rn O M O M Ll' N Ili N 000-o N N M CO I~ r r t71 N IN ti M rl- M CY) n ' ' a1 O M_ ' CY) M r r r r M r' r M N N N O co ' ~ O" NN O r M LO c1 LO (D LO r to O r 00 r M (D I-- (D N a r N N O o r- 0 00 00 O O qT Mr- Nt L' 'L' O N O N pl ' CO M N LO O [h ~ O O 00 "T 00 r T - co M 'IT O N ~ ti r N N o qlr ~t r o r to ce) r- O M r- O O M N' O N ' C \L M N pli M LO O r M tD N r 00 M t0 r r O N O O O r r D7 M N r r M M 00 O 00 M M r r M' cy ' N' C \L O (Y) LO 00 LO LO v v O tD ~ 'ct r r O O ~ t. 0 0 N t- (O 0 0 CD 0 lf) (O 0 0 0 0 et Cl) N N M O N O U U N d ~ m ~ Ln C:) 0) CY) O c v ~tS w r j N U N N R tn O N 4) U) LL N E 41 L c 7 w (1) O O (n a :3 OU U m " ::3 Y > m O~CV U m C O` N a_ O O 0 z - CL U m u+ c . w 0 O o O m w - L O a Q a ~ Q~ U Q O w F tF - ~ F - d Z N O r b9 N N (D O O N T 7 c rn c .c `m w aj m c ui E a) 0 O N C L rn m O ED F- M > a) O U O O U m O O a) m -0 Y LL Q \a\. 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C') N N ca CL 'O C L c0 ca C U) O CL x i L O iB a O W O U - Z F O cu C N N E N y U N N C ~ N O (0 _0 C N C N N O ~ U ~ O j cu N cn L N N ca -0 Y ~ Z Q W cr- ~ (0 o0°0 - U (N U Z CO c Q U U) O U o 0- Z (n w ~ Q co o ~ L co U LL. Z W (D 7 ('7 M M a) G) 00 to co N co M co eM N u to M (D to 00 w (0 (0 m IL IL LO oo 00 w 00 Iq co tV 04 IT C (O C6 (O LO tD tp M w O E Q c N E 'I G eF to O N O co) IT N O E r V- T O CN O CM N V* E r T T O U c o cn a) Q rn c c ca U 0 U O U) N p~ a 16 cn (U V N w V ~ d U U (a _ L iE c cn 06 N > U U C = N c ca °r aa) c C. w w O F- O F- F- O MEMORANDUM To: Marty Wynne From: Jeanine Faria RE: Solid Waste North Area Development Date: August 13, 2006 Here is the report for Fund 616 - Solid Waste North Area Development through July 31, 2006. The commitments and contracts will need to be added. I have not yet coordinated with Timm Schimke to determine this information. What has been added, is an adjustment for the Rate Reduction due to the earnings rate on the unexpended FF&E, Series 2003 process being greater than the borrowing rate. July 2006 is the first month in which this occurred. 9. L= O U N a> L U co a) 0 C E CD O Q O O N a) _ aa) M c T m 7 L Q -C m •1= O O a) a O >O a) U a c O Cl) N O O r T cM O LO T O I 00 co O) co _ ~ ~ 0 V) O CD 'T ti O N T r LO (p 0 It ' LL I'T OO O N T i O d O T O N T LO - i LO , O o co LO ti C~ r-- LO C4 N "T 1 I CD N N O r1' O W) OO O O CD O O O O (0 N OO r CO CD N 00 N co 1l I00 Lo 1- Cfl C7 CD C ) N ' ti (LO D C) 1~ LO lll' N (6 N (6 N T r N O N U- cc cc CD (0 O O c O 0 O ~ LO LC) IT LO O LO M T r O 0) CO f~ N CO O CD co 0 O 0~ tt O O - V N CD T N M O M Lf) LO N M } N N C) Vt C14 W V- T w ~ 6 O LL ~ T CO CO T r T LO CD LO Cf) C) C) Cl) r CO 0) CO co N Cl) r 'IT CD OO r- N O O T O 1 1 1 1 1 00 i M co N T N O O co Ni C6 C6 T L C) T C O N LW) N ~ LL N 'IT co Ln L N O N O CO O (D N 1` co (O T O O ' CO O CO co O O CD co CD '~7 co 1` 00 L[) O Ln O ' LO LO ' C \L O N CO O N N ti 0 V co LO LO ;T U O C70 QO 0 LO 0 co LO LO w N 00 LO v 0) r LO LO N N M Cl) T T M ~ LO 'I• m ' CO !Iw T LO r In I~ p) i C` O C) C) O I~ co 0) C OO 00 N Oo N N O CO CO U') LO } O CA LL O L LO C) U 0 cn O C a ) U CO C' cn . U a W Q 0 _ 1 A (0 a) Y 06 /c U 0 a) L m co vi a W N CD 7 0 O O O C _ °D U a) o w a O U C u U 0 ~ C c =3 m m a) d L O Z L FL L ) o O c of U- co ~ a) O _ L d =s Y 0 O d (n a) CL c C' a C 0 O 7+ a co K W co C N (n U N v-. F- 06 cB ~ C m > C L L3 a) co a O C c O L ~ U IC C C ~ co 0 a~ ~ +r 0 a W of = a> i a) -0 N 4r 0 m cm a ~ 1 , , D , Y ~ l S, Q 2 F - U m W To: Deschutes County Board of Commissioners, Dave Kanner From: Scott Johnson, Mental Health Date: August 27, 2006 Subj: Planning Process for Oregon State Hospital and Community Services We will be meeting Wednesday afternoon for a briefing regarding State efforts to overhaul the Oregon State Hospital system, which currently consists of the Salem and Portland campuses as well as Blue Mt. Recovery Center in Pendleton. I will provide you with a copy of the State Hospital Master Plan (the primary basis for the current initiative), highlight several aspects of the Plan and explore planning and advocacy that we might do over the next six months. This is a timely discussion with the recent announcement that the project is moving forward with the support of the Speaker of the House, President of the Senate and Governor Kulongoski. Current plans call for the opening of new 600 bed and 300 bed facilities in the Willamette Valley and two 16 bed secure facilities east of the Cascades. It is being proposed that the new hospitals open around 2011; the Plan forecasts needs through 2030. This topic is important for Deschutes County not only because of the use of OSH facilities and services by County residents, but also because the plan hinges on the availability of services, residential options and facilities in our area. Here are several things to consider: 1. OSH provides long-term care for the seriously and persistently mentally ill. Near term and on average, Central Oregon residents are expected to use about 22-26 beds at any one time. 2. While the call is for two 16-bed secure facilities east of the Cascades, that is not our primary need. Operating funds for targeted services are more important given the recent development of Sage View and the 5 Psychiatric Emergency Services beds at St. Charles. 3. Community respite and residential programs are critical to the Plan as are reduced length of stays at OSH. For example, the plan calls for 76 more beds in our area before the hospital opens in 2011, a very ambitious goal. The report shows our region with 36 beds currently. 4. In addition to funding to sustain current operations, community development will be needed for respite care, foster care or group homes, supported housing and affordable housing, more intensive case management, supported employment and our workforce development. 5. Population projections for Central Oregon are understated in the plan. So too may be mental health needs, particularly for the geriatric population and forensics. Additional information will be provided on Wednesday. Recommendations from our area are needed within 60-90 days. We are recommending a regional planning process to assure needs in our area are fully considered in the development process. m ~ O o c~ (n a) 0 O N _ O C: Q. N m to C6 a) 0 4-1 N O ~ XZ- 4-a C/) L C: o LL CD (1) U) O (D M U a) L O ~ O U) O 0 0 O ~ N U m M U c) ~ ~ E aQ 0 U i _0 U) w a) 0 cn o L cn 0) E ~ 4-U co U O - 0 4 N -r- + O O L ^ O - O It N N ~ N O ( m w o N co 7 70 N Q~ E O N U N O cn cn Ln -O O ~ ~ O w Co ~ U ~ N ~ O y- M '>O O Oa) C: c -0 U U 70 O'er ~4O L QU . ~ _ to N cn C: • . m O O 4-0 O O U O > OU 0 O U N p LO a) m a O cn co J ~ W D O O U) O O N U _ N C/) ~ O 0- O U) c n U O U L Q' ~J E F- Q . 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N _ Ca L Rt N L N O Ca 2t to w U CO 4-- 0 (DO F l O-0 ~a -0°6o (1) - N Co 04 00 ~ N U_ (D -0 N ~ :2 U) O 4-4 CIS 75 D CL U5 O O N O N m m E O 4- O Ca E U) N U U 0 Cll =3 O O U O cn CU V C Q to N L C6 L U) cn c: O N -F--+ C: 0 U) -a Co U cn ,C: cn E c N Cll O Q ~ C- LQ-) E Uv . C6 u) c6 -0 X O C O O Csj ~ .Q N O 04- O) ~O 0 c cn O C E m C I 0 > a) y_ O a) M 75- > : (n N C U C: ~ E O E m 70 :3 E cm a) c- E E ~ :t~ m U U O O o 4-0 O a) • cn o 4-0 L- m " U) C cn -C ) E a) O a o cm a) E m U I-j a) (D a) 0 _0 0 D c/i E - C: M C ~ N E E a) Q a) O C: +r O CU E - N E L Z ) z U) E _ . O Q m U m O =3 O -E-+ > O 6 O N rvoo cm 0 - U ~ ~ o o M ) a) ~ a) c ° 0 > 0 0 'a ~ ~ O , , c: a) c . L " 0 m m O ' 0- C~ 0 °0 cn :3 t~ 0 ' ~ W a) L 4 W cn O - ~ O o N a) O U) U U O 1 - 5 :3 a Q = 4~ O a) ~ C _ . O O U N U) ' a cOn a 0 0 =3 o C c ~ ~ ~ ~ x 0 . -0 0 7 = ~ ~ U Cl) Q = N Q 70 (n r- N M L6 POCUMENT POOR QUALITY . ' E AT TIME OF RECORDING rUA 4 Oregon State Hospital J. STATE OF OREGDN OFFICE `UF ,MENTAL HEALTH I~ND ADDICDON HRVICES 1 Framework Master Plan Phase II Report KN/1DA i-chitects Ftbr~_,ary ~?r~~, ?ooU L- L EXECUTIVE SUMMARY The intent of the Oregon State Hospital Framework Master Plan Phase 11 Report is to build upon the jr conclusions and recommendations set forth in the May 2005 Phase I Framework Master Plan with the rrx~ft goal of providing guidance to the Department of Human Services (DHS), the Governor, and the Oregon Legislative Assembly in setting the future for the State's Mental Health System. z-T While the Phase I Master Plan focused on the physical conditions of the Oregon State Hospital's (OSH) Salem campus, it also noted that Oregon's system of publicly funded care for adults with severe Oregon and persistent mental illness (SPMI) needs significant improvement. This Phase II report recommends state Hospital changes to the system, and clarifies the role and size of the Oregon State Hospital (OSH) within an x5 improved community-based system. S} ate of brt of of `Depari~7icri t 3 Humcm,5en,ices PROCESS " As with the Phase I Framework Master Plan, the consultant team has worked closely with the project's Steering and Advisory Committees. The consultant team interviewed multiple regional and community- based mental health service providers, acute care hospital program directors, current and former consumers of State mental health services, OSH physicians and staff, DHS personnel, and developers Framework of community housing. Included in this process were interviews with those who provide programs that Master. Plan serve as models for other communities and practitioners. Phase II 'Report FINDINGS Today, consumers of mental health services in Oregon are often kept longer than is clinically necessary in hospital and extended care community settings. The mental health system has been, and continues to be, under-funded. It is projected that Oregon's general population will grow by about 25% over the next 25 years. Similar growth in the number of Oregon's citizens with mental illness is anticipated. By year 2030 there will be 935 individuals on a daily basis who will need significant mental health services best accommodated within the State Hospital environment.. This would require a State Hospital of 1,100 beds based on an 85% occupancy rate. Further, it is also anticipated that by year 2030 there will be a need for approximately 2,630 residential program beds. This represents an additional 900 beds (beyond the current number) that will be required to serve residential mental r health needs best provided in the community. If no new community residential services are, in fact, provided a substantial number of the individuals who would utilize these beds could default to OSH potentially ballooning the State Hospital average daily population to nearly 2,000 patients. Oregon is in the process of shifting to a "Recovery Model" system of mental health care. This model encourages individuals with mental illness and caregivers within the mental health system to actively work toward individual consumers maximizing their ability to create the life they want for themselves. This model, with its focus on self-determination, challenges the "traditional medical" approach which 11) has guided the treatment of mental illness in the past. Fehruary 28. l Integral to this care model is the concept that persons will progress better in their home communities, / - self-directing their lives with support from their family, friends and skilled professionals. There is evidence that most people with mental illness do recover and go on to live productive lives as integral members DOCUMENT POOR QUALITY AT TIME OF RECORDING - " of society, reducing demand on state and local resources and support. Implementation of the Recovery i Model" requires improvements and investments in affordable housing, community-based services, discharge planning, early intervention, among others, all of which work to improve the flow of patients ' through a system of more responsive and functional care. •tj.*.? The needed investments in community services proposed within this report, will allow Oregon to build a new State Hospital System that is more efficient and will provide a more integrated continuum of . 't.* mental health care. Oregon State Hospital CONCLUSIONS AND RECOMMENDATIONS The State Hospital population has grown steadily in recent years and will continue to increase whether Scale of or dr or not there are any changes to the statewide system of care. However, with the changes proposed in A rnei Human SprOcc j this report - a focus on community based resources to facilitate more efficient and effective use of state hospital beds - the increase in the average daily population of the State Hospital could be limited to only 22% over the next 25 years. As stated above, during this same period of time there will be an estimated additional 900 individuals requiring significant community-based residential services. This fact emphasizes the need to enhance community-based resources concurrent with development of new state hospital facilities. Framework - Master; Plan Therefore, to improve the statewide system of care for those with mental illness this report recommends Phase 11 that the State of Oregon implement the following: Report • Replace the State Hospital with properly-sized and more efficient modern hospital facilities, designed to reflect and reinforce the "Recovery Model" of care; • Locate the State Hospital System facilities near to the homes of the majority of patients; • Continue the process of change already underway, embracing the "Recovery Model" of care and encouraging all communities and service venues to adopt this model's underlying philosophies and goals; • Improve the movement of persons through the system by adequate state funding of enhancements to acute care and community-based programs; • Improve access to family, friends and skilled professionals, thereby maximizing the opportunity for self-determination inherent in the "Recovery Model"; • Increase the available educational resources and information for the entire population, improving general awareness, knowledge and attitudes about mental illness and recovery. Oregon State Hospital System Facilities Recommendations f. `ti 1 t Based on implementation of the community-based enhancements described in this report, the following ebru rye 2s, ~oc~ are three viable options for State Hospital System facilities (these figures are based on opening new facilities by the year 2011 which incorporates projected bed capacity needs through 2021): DOCUMENT POOR QUALITY AT TIME OF RECORDING Option 1 r One 980-bed facility encompassing all inpatient beds, located in the North Willamette Valley region, and two non-hospital level, 16-bed secure residential treatment settings placed strategically IV 0, east of the Cascades. $297-307 million Project Costs. Option 2 One 620-bed facility located in the North Willamette Valley region, one 360-bed facility located south of Linn County on the west side of the Cascades, and at least two non-hospital level, 16-bed secure residential treatment settings placed strategically east of the Cascades. $324-334 million Oregon` Project Costs. State Hospital Option 3 State of Oiejoni One 600-bed facility located in the North Willamette Valley region, plus one 320-bed facility located D(_,par t ment Human Servir,_s` south of Linn County on the west side of the Cascades, and one 60-bed forensic facility in Central Oregon. $326-337 million Project Costs. Recommended Option This Master Plan recommends that Option 2 be funded to provide state hospital facilities located Frarriework near the homes of approximately 93% of the inpatients, along with much-needed alternatives to Master Plan hospital services for Eastern/Central Oregon. The historical utilization numbers for Eastern and Central Phase II Oregon do not support a medium or large state hospital in these regions. Report This recommended option (along with Option 1) calls for the development of two secure intensive ) residential treatment settings located east of the Cascades. These two program settings will provide the flexibility that allows an individual patient to receive safe and secure, up-front services. In many cases this is all that is needed to stabilize an individual and eliminate the need for long-term State hospitalization. These programs also serve as a step-down treatment site that allows individuals to < 4 stay a shorter time in the State Hospital by virtue of having a secure, non-hospital residential setting for them to return to that is near their homes. It is important to stress that, for any of these options to be successful the community based program enhancements outlined in this report need to be fully implemented Co munit -Base Enhancements Recommendations Enhancing the breadth and depth of community-based services is a critical piece of the state hospital master plan. This report provides estimates of beds needed in community residential programs, as well as associated costs. Not part of this study, but equally as critical, are other community services such as supported employment, case management, crisis intervention, and respite. While more detail is provided later in this report, the recommendations include: • More aggressive funding for 'front end' services that aid in the prevention and early intervention of those with mental illness, This master plan focuses on those services and settings that are needed when an illness has exacerbated to a point where no other care option exists. A greater emphasis on prevention and early intervention could contribute to further declines in state hospital needs, while aiding a greater number of those with mental illness. Some communities within the State currently K NI 1) February 18, 2006 DOCUMENT POOR QUALITY AT TIME Or RECORDING have treatment programs such as the EAST program. These programs effectively address the 1 issues of early intensive intervention for adolescents and young adults who are experiencing their T 1-, first severe mental health crisis. . • Continued financial support for the development and operation of community based residential programs to facilitate care in the least restrictive environment and promote a recovery orientation, t is • Providing counties with the financial support necessary to oversee and monitor the expanded ~ community based services as well as the increased numbers of individuals with mental illness Ore,on residing in their communities. State Hospital is important to note that some of the community cost estimates provided in this report can be State of O f o' accommodated in the current caseload growth factor within the OMHAS budgeting process. )t D t rn -.nt f- Human Servi ces Fr-aniework Master`Plan Phase 11 Report KII1) f obi Li w y 8, )006 t Holz= DOCUMENT P OOR QUALITY AT TIJ1~E OF RECORDING k TABLE OF CONTENTS ACKNOWLEDGMENTS I INTRODUCTION AND PROCESS 3 KEY FINDINGS 5 CONCLUSIONS AND RECOMMENDATIONS ....................................................23 NEXT STEPS ..................................................................................................................39 APPENDIX A. Community-Based Residential Program Definitions B. Community-Based Residential Development Programs C. Disposition of Current OSH Salem Campus Facilities D. Oregon State Hospital Development Options E. DRS and DOC Letter of Agreement F. Assumptions - State Hospital - Community G. Glossary of Terminology DOCUMENT DOOR QUALITY AT TIME OF RECORDING F Oregon s State,Hospital s State of Ore~Y Dchartr~cnr vi Humane Services Framework Master Ptah Phase If Report KN]1) f ebruary 28. ?006 ` ACKNOWLEDGWNTS Al,lftrl1 The consultant team of KMD Architects and Planners with New Heights Group, the mental health + , x ° systems specialists, would like to thank the many stakeholders, groups and individuals who have fr, ~r assisted in the planning process. We particularly appreciate the efforts and recommendations of the Governor's Mental Health Task j 3 Force in their 2004 Report. The Honorable Peter Courtney, Senate President, is recognized for his f r i ` efforts and focus on the plight of those persons with mental illness in Oregon. The bipartisan Legislative effort to keep this issue before the citizens has been particularly effective in bringing this topic to public Oregon S discussion. tate Hospital slate of OresOn`"i We appreciated the patients and staff of the Oregon State Hospital for their openness and enthusiastic p rrnci of interest in the project. A special thanks goes to Mr. Norman Miller, Project Manager for OMHAS, for his Hum m an 5e rvces absolute commitment to the mission, dedication to the effort, partnership in the implementation of this report, and wisdom. i We recognize that without the growing interest generated by these and others, Oregon's Public Mental Health System would continue to languish, out of the eye of the general public. Framework Master,. Plan Stakeholders Phase ll Report r Consumers, Peers, Survivors Community Mental Health Providers and Program Directors Consumer Advocates, Friends, Families, NAMI OSH Staff Advisory Committee Ken Allen, AFSCME, Executive Director Doris Cameron-Minard, NAMI of Oregon, President Dr. Marvin Fickle, MD, OSH, Superintendent Gina Firman, AOCMHP, Executive Director Bill Foster, DAS, Administrator Robert Furlow, EOPC, Superintendent Maynard Hammer, OSH, Deputy Superintendent Cliff Johannsen, PSRB, Psychologist Member and Chair Erinn Kelley-Siel, Policy Advisor, Governor's Office John Keogh, OSH, Program Director, Forensics Norman Miller, OMHAS, Project Manager i Robert Nikkei, OMHAS, Assistant Director Madeline Olson, OMHAS, Deputy Assistant Director Mary Philp, DOC, Projects Manager K ~7 David Romprey, Consumer/Survivor Council f cbruaIy ?s, you Dan Smith, SEIU Representative Nena Strickland, OSH, Program Director, Psychiatric Recovery Services Max Williams, DOC, Director DOCUMENT POOR QUALITY At TIME OF RECORDING Steering Committee Dr. Marvin Fickle, MD, OSH, Superintendent Gina Firman, Executive Director, AOCMHP Robert Furlow, EOPC, Superintendent Maynard Hammer, OSH, Deputy Superintendent Erinn Kelley-Siel, Policy Advisor, Govemor's Office Norman Miller, OMHAS, Project Manager Michael Morris, OMHAS, Acute Care Mental Health Services Manager Robert Nikkel, OMHAS, Administrator Madeline Olson, OMHAS, Assistant Administrator Consultant Team Architect KMD ARCHITECTS AND PLANNERS, PC 421 SW Sixth Avenue, Suite 1300 Portland, OR 97204 503.221.1474 James W. Mueller, Project Principal James R. Diaz, FAIA, Principal, Executive Mental Health Oversight Vernon L. Almon, Project Director Thomas A. Gross, Project Manager National Mental Health System Specialists NEW HEIGHTS GROUP, LLC 9815 J Sam Furr Road, #134 Huntersville, NC 28078 704.895.3410 Cecily Lohmar, Principal Howard Gershon, Principal DOCUMENT POOR QUALITY AT TIME OF RECORDING ; 44mi,4 Oregon State Hospital State OFeuon" Dc:partii~~~nt. bf Hunin Services Framework Master Plan Phase II Report K R'1I) 1 I NTRi0D UCT'10N The conclusions of the May 16, 2005 Phase I Master Plan indicate that Oregon's current system of care for those adults with severe and persistent mental illness (SPMI), while in the process of becoming more systematically community-oriented, is complex and at times is operating more as an aggregate of treatment settings rather than as a truly integrated system of care. In addition the Phase I Master u Plan notes that the existing facilities on the Salem campus of the Oregon State Hospital have physical limitations that cannot be remediated to provide safe and secure treatment environments. Consequently, the primary objective of this Phase II Master Plan is to evaluate the role and size of the Oregon State Hospital Oregon State Hospital (OSH) within an improved statewide system of care for persons with SPMI This ' . objective required that the consultant team review and evaluate inpatient and outpatient services State of OreUcTn Departnientcar throughout the State of Oregon and recommend appropriate changes and enhancements to the Ho M,111 Sewiccs system. Individual patient recovery, safety, and security are the primary goals of Oregon's Mental Health (MH) system. The options and recommendations that are proposed in this Phase II Master Plan are not intended to redesign the entire system, but build upon it. While the focus is on the Hospital, this report also describes improvements in community-resources that are needed to support the mission of the Framework :''F Hospital and to allow it to meet these overarching goals, Master Plan Phase 11 This report, by providing evidence-based information and insights, will assist the Governor and the Report Legislative Assembly as they formulate decisions about the future of Oregon's mental health services. PROCESS With the guidance of the Project Steering Committee and with review and input from the Advisory Committee, the planning process undertaken for projecting future OSH bed need and corresponding community resources included the following steps. 1. Review of available data provided by the State: • To understand historical utilization of OSH beds by program type, and to understand recent trends in admission patterns by county/region, length of stay, and wait lists for admission to and discharge from the State Hospital. Data for all campuses was included in this analysis. • The current inventory of community-based residential services by setting and region to understand current distribution of those non-hospital residential services.. 2. Interviews with selected representatives of "best practice" providers, as identified by the Master Plan Steering Committee, to understand their programs, critical success factors, how experiences K, N I I) might be applied to other providers across the State, and future needs and challenges. tcbru,1 r%; ?E, zoO 3. Facilitate five regional program meetings with provider and consumer representatives across the State to gather pertinent information and to understand area utilization challenges, delivery system HEN= needs, and their implications on OSH use. DOCWAE€,mT (POOR QUALITY AT TIME OF RECORDING 4. Meet with and interview individuals and groups who are or have been patients at Oregon State Hospital and those who are family and friends of patients. These have included persons who now provide an advocacy role for those with mental illness. rte. T.° 5. Interviews with OSH physicians, staff and administrators to gather information relative to needs, current programs and implications of hospital size. F 6. Interviews with representatives of local acute psychiatric inpatient units to understand both their challenges and their ideas regarding system enhancements. Acute psychiatric inpatient unit Oregon representatives were also invited to attend the regional program meetings. State Hospital 7. Meet with the Psychiatric Security Review Board to gain their perspective on the assumptions State of 0 loon- " le pe i e used for the State Hospital forensic population. p3r t n ( {of Human Services The qualitative and quantitative information that was gathered through this process provides the basis for the planning projections. The initial assumptions developed within this interactive process were reviewed with OMHAS staff for additional input into trends, patterns and implications. The consultant team then assimilated the data and developed projections that are based on accepted forecasting methodologies. It is important to note that any projections for a 25 year time frame are, at best, Framework estimations. Master:Plan Phase, II These Master Plan projections reflect 1) the future OSH bed need, and 2) the corresponding community Repo"rt residential and supporting program needs that are required to positively impact OSH patient admission and length of stay patterns. { j i i i1 f I) I ebfu7ry 28. 2005 bbWMINT POOR QUALITY # ME- OF RECORDING KEY FINDINGS STATE HOSPITAL .~y 'r The State Hospital provides long term care for those with severe and persistent mental ill ness (SPMI). There are three service areas: Adult Treatment Services (ATS), Neuropsychiatric Services, and , Forensic Services. Approach and Assumptions Oregon Projections for state hospital beds are provided through year 2030 and address the need across the tate Hospital entire State that is now served by the three campuses - OSH Salem and Portland campuses, and Blue Stace of' t? eoon ` Mountain Recovery Center (Eastern Oregon Psychiatric Center, Pendleton). Depirtrnent car HUman Services Each county is placed in one of six regions to better address the variations in utilization noted in rural vs. urban areas. The regions are similar to those used in other state planning activities and are shown below: j t' ATSOP COLD aeon R4YER - -'!1 F.r•am ework #MUL 'Master--Plan 41'ALI. C li f. r~ K < Phase 11 j Rppprt 5 [ M IL_. C GI .C^'_P M~~ ~I ~ Clll 4M,~ ~ r~.-~ -t I 1 ~o h r IIIOmU V~llm ~ r _ ~ crscnur ~ j i ~ C r rnl oast - C t' ocwss - I NottB Coast ~~NCCe L- ices~ Hna~et - F__ _ vAnE I Southern Orep n 1 't-J}7 ~ I ,r.l t it UrcS..n ~ € f I.S G'.IIhE 1 l 4CI141 I A`.l n plc n OSH BED NEED PROJECTIONS The projected need for OSH beds through 2030 is based on the following: • Historical utilization patterns of OSH by county and region. Utilization data includes age-adjusted use rates (OSH admissions per 1,000 population), wait lists for admission and discharge, and length of stay by program type. Extensive feedback from multiple stakeholders across the State for improved understanding of rcb L,a-y ?a', ooh the current system as well as opportunities for improvement. The input included: - Individual interviews with identified 'best practice providers' and consumers in the community; - Group meetings within each region to discuss historical utilization and future needs for both OSH and community based resources; DOCUMENT POOR QUALITY AT TIME OF RECORDING 1 - Interviews with OSH clinical and support staff, - Meetings with the Psychiatric Security Review*Board (PSRB) to review assumptions; and + A.,Arr, - Meeting with acute care hospital providers. • Discussions focused on the following: - Regional variations in OSH utilization and rationale; - Existing community resources and the types and numbers of services needed to minimize reliance on OSH beds; - Best practice models of care in the communities; and - Barriers to developing a more integrated continuum of care among community and OSH Oregon settings. State Hospital • Population projections by county and region focused on those age groups that most closely reflect the program type: State of Oregon ~ - Adult Civil (ATS): 20-64 year population segment oepartmene of_ Human Services - Neuropsychiatric: 65+ population - Forensic: 20+ population The process of focusing on the population segments most likely to use the services allowed the consultants to develop age-adjusted utilization rates and projections. Population projections were obtained from the Oregon Department of Administrative Services (DAS) Office of Economic Analysis. Framework • Projections were based on regional variations in use and regional demographic trends. Master Plan Phase II The following assumptions were made regarding the future need for OSH beds: Report • Adult Civil (ATS) ) State Hospital services for adults who have been civilly committed for hospitalization. This population currently occupies about 25% of the State Hospital beds. - Admissions to OSH. Considerable variation in use of OSH beds exists across regions. Bed projections assume this regional variation will continue. Admission rates (admissions per 1,000 adult population) have declined in the past years. This trend is expected to continue upon the development of more community resources. Changes in admission rates were adjusted for each region to reflect the continued variation in utilization by region. Rates were applied against the projected adult population by county in order to estimate future admissions to OSH. Length of Stay. OSH length of stay for ATS patients is anticipated to decrease from an average of 250 days to 175 days with the development of additional intensive case management and community residential programs. It is assumed that this length of stay decrease, and the community program development needed to facilitate earlier discharge, would occur by the year 2011 when new facilities open. Wait Lists for Admission and Discharge. Through development of additional community t N I I) residential programs, it is assumed that patients who would have been on a wait list will be VJ-, accommodated in the appropriate setting when clinically necessary. ! 1 DOCUMENT POOR QUALITY AT TIME OF RECORDING - , Neuroscience/Geriatrics State Hospital services for those with medical conditions that cause or contribute to psychiatric disorders. This group currently occupies about 15% of State Hospital beds and is centralized at r * the Salem campus. A,+fY> - Admissions to OSH. Unlike adult civil patterns, the admissions per 1,000 population for the j neuroscience/geriatric program have increased in recent years. For planning purposes it is ' assumed that this increase will continue as the incidence and prevalence of Alzheimer's disease, head injury, and other neurobehavioral diseases increases and as the current oregori population of persons with SPMI ages. These increases in the admission rates were adjusted state HoWtal to reflect the continued variation in utilization by region. These rates are then applied against Stag of ~Or~Qon~j the projected population of the 65+ age group, which is the fastest growing population segment De par i n jeflt ' in Oregon. Human 5e~3ces t.: - Length of Stay. Length of stay at OSH, with considerable variations per patient, averages 461 days for the neuroscience/geriatric program. Much of this condition is due to the limited s options available in communities for these patients. It is assumed that incentives will be provided to develop these community-based settings in the future, enabling a limited decline r in length of stay at OSH from 461 days to 400. As with the adult civil population, it is assumed = Frarnework 4; that the community program development needed to facilitate earlier discharge will occur by Jlitiaster Plan- year 2011 when new facilities open. Phase It .Report - Wait Lists for Admission and Discharge. Through development of additional community residential programs, it was assumed that patients who would have been on a wait list will be r. r~ accommodated in the appropriate setting when clinically necessary. g ' • Forensics The forensic population is committed through the criminal courts and currently occupies nearly 60% of the current State Hospital population. The forensic population is the most rapidly growing population at OSH. Admission decisions to z. OSH for both Aid and Assist and PSRB programs are determined by the judicial system and, as such, are not driven solely by clinical needs, but also by public safety considerations. Anticipating future changes in OSH utilization projections is difficult. For purposes of this report, only modest " changes in the forensic system are assumed because of judicial, clinical, and external non- i clinical forces. Among others these non-clinical forces include community fears and reluctance by some to site community services for this population in their neighborhood. Without significant { changes in the court and PSRB systems, the forensic patient population will continue to increase at dramatic rates. Admissions to OSH. No decreases in the admission rate to OSH are projected for the k `11) forensic population. It was assumed that forensic admissions would follow the projected intake rate developed by the Department of Corrections. ° F'ebr uary 28, 005 Length of Stay (PSRB). With significant development of community residential programs, the PSRB length of stay at OSH will decline from almost 1,000 to 800 days due primarily to a tt, 3,1 decrease in waiting for discharge upon assignment to the conditional release planning DOCUMENT POOR QUALITY AT TIME OF RECORDING process. The planning projections assume treatment success as a result of developing considerable PSRB community beds. Without this change, the length of stay will likely remain closer to current levels. It is important to note that these community beds are often the most difficult to develop in light of resistance from local residents. Length of stay reductions should be met by 2011 (when the new hospital facilities open) to meet occupancy level projections. - Length of Stay (Aid and Assist). The Aid and Assist length of stay will decrease from 165 days to 100. This decrease will be accomplished through enhanced evaluation techniques and improved linkages with the court system. Length of stay reductions should be met by 2011 (when the new hospital facilities open) to meet occupancy level projections. In addition to the above program assumptions, the Department of Corrections (DOC) will contract for dedicated beds at OSH to help manage the growing population of persons with mental illness in the prisons. The DOC will maintain 20 beds at OSH in 2011 and 40 beds by the year 2030. An 85% occupancy rate is assumed for all state hospital program areas and reflected in bed numbers and cost figures. This rate is a standard occupancy assumption for healthcare facility design. It provides the flexibility needed to manage census fluctuations as well as changes in patient acuity, gender, etc. OSH has operated above 100% occupancy in recent years. This reality has created issues regarding staff safety, staff to patient ratios, and general overcrowding. Estimates of state hospital bed need, development and operating costs are based on this 85% occupancy level. Oregon State Hospital Bed Need i' Given the above assumptions, beds needed for patient admission to OSH will be about 1,100 by year 2030. A total bed breakdown by program type follows: Total State Hospital Bed Needs Average Daily Population 2005 2011 2021 2030 ADULT CIVIL (ATS) 1931 1116 109 107 NEUROPSYCH2 114 996 140 184 FORENSIC 434 525 575 613 BED NEED 741 735 824 904 BED NEED @ 85% OCCUPANCY 8725 865 969 1064 DOC4 0 20 20 40 TOTAL 872 885 989 1,Y04 The 193 Adult Civil (ATS) patients include those at Blue Mountain Recovery Center (Eastern Oregon Psychiatric Center, Pendleton) z Neuropsychiatric beds include medical beds for those with medical and psychiatric needs. ' Using the 85% occupancy rate, this is the number of beds that should be available. Note the methodology used for calculating occupancy is to divide the number of beds ("BED NEED") by 85%. These are beds in OSH facilities requested by the Oregon Department of Corrections (DOC). e This number represents the current number of beds that SHOULD exist in the OSH system today to allow for a proper occupancy rate. 6 The decreased 2011 bed needs forATS and Neuropsych at the State Hospital are based on the development and implementation of significant new community-based services to accommodate an overall increase in these populations. 3 ~rict~ I Oregon State Hospital Stare of Orec,on D(-.'Part Inent- of Human Services Framework Master Plan Phase Il Report K ~l ll cbruary i8. ?006 DOCUMENT POOR QUALITY AT TWE OF RECORDING The major factor attributed to the growth in the neuropsychiatric population is the rapid growth in the 65+ population in Oregon. Future bed need by region and program type, excluding DOC beds, is shown below. The projected regional bed need reflects differences in population growth and historical use of OSH and is presented as a population-based distribution of beds. Total State Hospital Bed Needs by Region 2011^ 2021 _ 2030 REGION Adult ,Neuro-' Forensic Adult Neuro [Forensicl Adult iNeuroTForensic~ (ATS) Psych! (ATS)_Psych North Willamette Valley 79 69 304 82 100 325 83 134 344 North Coast 5 1 15 4 2 16 4 2 16 South Willamette/Central Coas 16 21 138 16 29 162 16 36 175 Southern Oregon 15 19 120 12 25 128 10 31 136 Central Oregon 4 4 14 3 6 17 3 9 19 Eastern Oregon 11 3 27 11 3 28 11 4 30 618 ~ 128 1165 The above chart excludes beds requested by the Oregon Department of Corrections (DOC). The need for investment in community residential and other settings is pivotal to OSH projections. Without community residential investment, which will be described in the next section, the beds needed at OSH could exceed those projected, increasing the size and cost of replacement facilities. This increase in hospital beds would occur largely because of unnecessary admissions and longer lengths of stay, both caused by lack of enhanced community resources. DOCUMENT POOR QUALITY At TIME OF RECORDING Y 1 Oregon State`Hospital State of"' repon, I <Dcp»rfrnent HiirriaYServicesy E_rame p k MasteF` Plan Phase II Report i yr- E. _.l KNJ1) I I e5ruary 23. 2606 COMMUNITY :BASED PROGRAMS Greater investment in local and regional services is needed to support development of a community- based system of care. While this master plan focuses on the facility plan for the Oregon State Hospital, projections are also provided for the number of community residential program beds and the increased funding of community front-end services needed in order to achieve the desired reduction in OSH length of stay and admissions. Without the enhanced communityprogramming, demand for OSH beds will substantially exceed projections of size and cost - . F There are two components of the community-based programs that affect OSH utilization: community- Oregon state Hospital based residential programs and critical "front-end" services. ; state, of Oreoon Community Residential Programs DcF~atin~ent of`' Human Services The community residential programs are a primary resource for diverting individuals who otherwise would go to OSH and for expediting the discharge of individuals from OSH. Thus, availability and access to these programs are keys to 1) reducing the patient population, 2) decreasing the length of stay at the State Hospital, and 3) maximizing mental health services in the community. Approach and Assumptions Framework Master'Plan ' As noted earlier, an inventory of existing programs by setting and region was developed from the Phase II OMHAS Iicensure database. In reviewing this inventory, it is clear that current beds are not distributed Report consistent with Oregon's population. This condition could contribute to difficulty in placing patients from OSH since patients often want to be discharged to their place of last residence. Projections for future community residential program needs were based on the following: • Developing an inventory of services by setting and location. Calculating the number of beds per 1,000 citizens for each setting and region. • Determining the number of patients currently waiting to be admitted to, or discharged from OSH who could be served in community residential programs. The wait lists identify setting type needed, Wait list days are incorporated into the current distribution model. • Incorporate the provider feedback obtained in interviews to adjust use-rates for community residential programs. The planning projections thus reflect more effective use of community residential programs as well as a population-based distribution of beds. The assumptions for community residential program development were: K ~l l) • Changes in OSH utilization will be enabled by community residential program development. I C'N nary 28, )00, Limiting the size of the hospital and its associated capital investment cannot occur without proper investment in the community residential programs. DOCUMENT AT TIME OF RECORDING - Many patients in acute care hospitals today could be accommodated primarily in community- based intensive residential programs such as Post Acute Intermediate Treatment Service (PAITS) rather than going to OSH. Length of stay within community residential programs will decrease as housing and other front- end community services are further developed. This change will provide discharge placement options as well as services that could prevent need for state hospital admission. Expansion of housing, intensive care management, support employment and other programs is needed to achieve this. • OSH wait list and length of stay adjustments and the corresponding community program development will occur by year 2011, before the opening of a new state hospital. This is an aggressive assumption, but necessary to achieve a more efficient operation and system of care. • Intensive case management functions will be integrated between OSH and the communities to facilitate discharge planning across all settings. Patient-centered mental health services are best managed at the community level. • Community residential programs will operate at 95% occupancy, consistent with current assumptions. This occupancy level allows the flexibility needed within residential programs to accommodate census fluctuations, privacy needs, and other adjustments needed to operate smoothly. Projected Community Residential Program Needs Given the planning assumptions above, a need for an estimated 2,633 community residential beds is projected in year 2030, up from a total of 1,729 today. The bed projections reflect a redistribution of beds based on Oregon's population. There will also be a shift in program type with a focus on developing beds in more secure settings for the patients who are more difficult to place; those individuals now have the longest stays at OSH. Community residential beds by region are shown below: REGION 20051 2011 2030 North Willamette Valley 857 1,098 1,361 South Willamette/Central Coast 373 431 531 North Coast 30 62 69 Southern Oregon 290 317 370 Central Oregon 36 112 153 Eastern Oregon 121 128 149 Total' 1,729 2,148 2,633 The 2005 numbers represent currentdistnbution of beds. K , a Oregon'. State Hospital l tivt~y, State of" reclon ` Dcpart_mntof' Huma , Sewices 5 Fr-ar,ework Master'Plart, Phase 11 Report, . The above bed numbers for years 2011 and 2030 by region provide a population-based distribution of K N11 1) community residential beds that better enables consumers to remain in their home region. An estimate of community beds based on program type is shown below, although this could change with adjustments l'`~' "`~r~ `r` in patient needs and treatment approaches. DOCUMENT POOR QUALITY AT TIME OF RECORDING .T: RESIDENTIAL BED PROGRAMS t 20053 2011 2030 w Allwr ` Adult Foster Home (AFH) 486 548 R id l 640 ~ es entia Treatment Facility (RTF - including Secure (SRTF)) 790 892 1,037 Residential Treatment Home (RTH - Including Secure (SRTH)) 109 204 241 , Supported Housing (SH) 2 119 165 185 PAITS 22 27 Intensive Residential 48 Enhanced Care (EC) 140 178 27 58 303 sx~ . Enhanced Care Outreach Services (ECOS) 63 r 86 142 ' Total 1,729 2,148 2,633, ' See Appendix G, Glossary, for definitions of Residential Program Types. Oregon ' 2 Supported housing needs are based on current programs supported by OMHAS. Other supported housing units are State Hospital unavailable; as such, the numbers maybe understated. a The 2005 numbers represent current distribution of beds. State of,Orreo,On Depar tftient of Human Services i Framework 'Master Plan Phase 11 Report K til 1) February 28' F'005 ` OCUMEN tl POOR AT -rITME QUALITY EC C3R®BfVG OPERATING AND DEVELOPMENT COSTS The estimated costs of operating the future system of care, including both OSH and the community residential programs identified above, were based on the current average daily OMHAS cost by program type. All costs - operating and development - are in 2005 dollars, with no accounting for inflation. Costs shown below are annual costs, not biennial. Operating Costs Assumptions in estimating operating costs in both the State Hospital and community residential settings are described below. • State Hospital - The OSH average cost per day will increase to a level more consistent with other state hospitals. Current budgets and client capacity suggest an average cost of $373 per day at OSH, 25% below comparable facilities for which data was available (see below). The average cost of $373 per patient per day includes the impact of the 30 additional staff members recently budgeted. The low cost per day could be due to continued understaffing, wages, older facilities, limited programming, or other factors. Facility Location I Bed Capacity Kansas - 422 Minnesota 247 Nevada 150 Washington 274 Washington 776 Cost per Paitient per Day (year 2004) $ 429 $ 408 $ 550 $ 531 $ 438 Average 374 $ 471 Oregon - 2005 Salem and Portland campuses) 681 $ 373 Oregon - 2011 Projections 885 $ 465 The increase in daily costs will allow OSH to reach improved staff-to-patient ratios and enhanced programming. While it is understood that the cost for care in Adult and Neuropsychiatric programs is more expensive than in Forensic programs, the average cost per day is estimated to be about $465 per patient for year 2011. r: Oregon State Hospital t,ite of Oregon g ~ ?Depart~ri~~nt,a~ OLIM11fl ser-1/1cc"s 9 Framework Master Plan' ` Phase II' Report • Community Residential - Operating costs for the community residential beds by region are provided below (all costs in 2005 dollars, not adjusted for inflation). The costs of operating the expanded community residential settings are based on the average 2005 OMHAS payments to these settings. Payments are based on occupied beds only, assuming community residential programs operate at a 95% occupancy rate. These estimates focus solely on the identified beds noted below and do not include costs for community case management, crisis, early intervention, housing and other front-end services. The State must assure, at a minimum, that ample and appropriate case management services are available for residents in these programs. Some of the support can be funded through case load growth. DOCUMENT POOR QUALITY" NT TIME OF RECORDING K17t) I obruary 28,-20ob _ 2005? 2007 2009, 2011 Community Beds Est. Estimated Est Estimated Est Estimated by Region Need Costs per . Need Costs per . Need Costs per Year Year Year North Willamette 873 999 $67,323,662 1,049 $70,718,102 1,097 $73,771,756 South Willamette 379 395 $26,324,069 414 $27,369,486 431 $28,482,057 North Coast 30 57 $3,601,773 60 $3,894,049 62 $3,999,230 Southern Oregon 290 295 $19,737,241 306 $20,089,308 317 $20,665,572 Central Oregon 36 95 $5,900,263 104 $6,753,083 112 $7,167,681 Eastern Ore on 121 118 $7,593,027 123 $8,097 976 $8,451,546 Total Community t Beds 1,729 1,959 $130,480,035 2,056 $136,922,004 2,14 142;537,842' In addition to the above operating cost estimates for the direct provision of care, an estimated 10%, or $14 million, is needed for counties to provide the infrastructure to support the expanded community based programs. Without this support, the expansion of services at the local level will add undue burden to local county mental health agencies. Estimated annual combined OSH and Community Residential operating costs for the next three biennia are shown below. 2405 20.07 2009 2011 Costs per Year Est Need Estimated Costs per Year Est Need Estimated Costs per Year Est Need Estimated Costs per Year Community Residential 1,729 $115,110,000 1,959 $130,480,000 2,056 $136,840,000 2,147 $142,870,000 OSH 741 $101,000,000 907 $131,510,000 888 $128,360,000 865 $124,600,000 Oregon Total 2,470 $216,110;00 2;866 $263,990,000 2,944 $265,300,060 3,012 $267,170,000 Costs have been rounded to the nearest $10, 000 Costs reflect total State costs, without federal matching funds. Historically, Medicaid has contributed to some community-based settings through a federal match; the amount has varied by year. Recently, national efforts have occurred to minimize and/or eliminate this funding to state psychiatric services; this funding has not been included in these dollars. Accordingly, if Federal matching funds are available, State costs will be less. f"~ NQ to j yr~f f ~ Oregon E State Hospitals ` State of Oreclon' Dcp~jrtnT ont of,,; Human Services. F Framewo'rki Master Plan:` Phase ll Report Community-Based Residential Development Costs Development costs for the community based residential services are based on recent historical experiences within OMHAS. These costs are applied against the number and type of projected new beds in each region. Costs reflect OM HAS funding only and may not reflect total costs to the providers. Average cost-per-bed assumptions include program start up, housing facility development, and changes necessary to accommodate recent fire safety standards for residential programs. In many instances, providers obtain additional funding from other state or private sources, but this has not been included in the cost estimates below. I~ NI I) I ebrLill 8. 0 16 QUALITY 'DOCU~"'E:N'T POOR AT°'-V~ 4: OF RECORDING t i The assumed average development start-up cost per bed by program type is shown below. Community Residential Program Type Development Cost Bed per Adult Foster Home $ 2,000 Supported Housing/ Case Management $ 2,000 Enhanced Care $ 35,250 Residential Treatment Facility $ 13,250 Residential Treatment Home $ 13,250 Secure Res. Treatment Facility $ 35,250 Secure Res. Treatment Home $ 37,600 Intensive Residential/Post Acute Intermediate Treatment PAITS $ 37,250 The estimated costs to develop the community residential programs that will be needed by year 2011 are shown below by region and biennium. Much of these costs are allocated to urban areas where there is the highest need for additional beds, particularly of the higher acuity type. The costs below address the additional beds needed to develop a population-based system of care. They are based on 2005 costs and do not include estimates for inflation. Estimated Development Costs - New Beds REGION 2007 2009 2011 North Willamette Valley ~ $3,467,100 $942,100 $854,001 South Willamette/Central Coast $1,302,300 $337,250 $372,851 North Coast $667,250 $85,750 $1,001 Southern Oregon $2,491,350 $222,000 $222,00( Central Oregon $903,450 $190,100 $172,50( Eastern Oregon $688,950 $124,350 $51 50( , TOTAL $9,520,400 $1,901,550 $1,673,85( Most of the community development will need to occur over the next five years so that these services are in place before a new state hospital opens. This development is key to the assumptions in state hospital utilization and corresponding bed need. Without these community programs operating before a new state hospital is built the decreases in length of stay and changes in use rates will not be realized. The large investment projected for community-based programs in the next biennium is required to begin decreasing the length of stay at OSH as well as to correct the current mal-distribution of community beds. It is important that shifts in the geographic distribution of beds occur as well as shifts in program types. In some areas an excess number of certain types of beds occur while in other areas a shortage of appropriate program beds is the result. The OMHAS budgeting process incorporates projected caseload growth to account for those who have been through the civil or criminal commitment process. The operating and development cost estimates in this report do not take into consideration current funding through the caseload growth budgeting process. This may result in dollars already having been budgeted thereby potentially reducing the amount of new dollars needed for operating and development costs. DOCUMENT POOR QUALITY AT TIME OF RECORDING, rr~~ F , s ,Oregon State Hospital State of10, remn Dcpar ' '4 o'f } Human 5.eriices 4. V , 3 Frame ork Master Plan ,Phase, II Report, K N1 D 1 fchruary28, 2005 t , Development Challenges Many of the beds needed in the future are for particularly hard-to-place clients, such as sex offenders, violent or aggressive individuals, etc., and others who will require secure settings. Many communities have been reluctant to develop programs for these more difficult patients and many remain at OSH beyond clinical necessity. Shifting case management and accountability to counties for patients in OSH may help develop these programs. Incentives and resources for developing these facilities may need to be established for community providers. In some cases, with a lack of provider interest or capacity, development of these more challenging programs might require state ownership and operation. State operation could make these programs more expensive and could further disengage communities from accountability for these patients, but could ensure sustainability for these treatment settings. The provision by the State of infrastructure dollars to the counties may allow them to develop these complex programs. COMMUNITY FRONT-END SERVICES This report was commissioned to focus on the State Hospital. It quickly became clear that one could not address the State Hospital without also addressing community-based services, of which the residential component is very large. However, to only focus on "bed needs" minimizes the importance of early intervention and community supports. The "bed need" orientation focuses on the most expensive aspects of the System of Care and addresses the needs of only a relatively small portion of the mentally ill population (of the 100,000 individuals served in 2005 by the public mental health system in Oregon, less than 1,000 were admitted to one of the State Hospital campuses). Without more aggressive funding of services to recognize and treat people earlier in their illness, demands on the State Hospital and other more expensive settings will continue to grow. These services are referred to in this report as "up front" or "front end" services and include: Crisis Intervention Services: Provided in local communities these services provide early assistance to those undergoing a rapid exacerbation of their mental health condition. - With adequate crisis services, many consumers could be stabilized early and resume their previous function more quickly. - Without these important services, treatment can be delayed, the consumer gets sicker, and hospitalization becomes the only remaining option. - While crisis services are provided for Medicaid patients as part of the Medicaid MHO rates, funding has been limited for the non-Medicaid eligible population. The non-Medicaid eligible clients represented an estimated 45% of the 2005 population served by OMHAS (based on the 2005 mental health block grant report prepared by OMHAS). Psychiatric Hold Rooms: Support, development and staffing are needed for psychiatric hold rooms in acute medical hospitals. These hold rooms, often associated with emergency departments, are a critical safety net in many communities. They serve as the only location that can provide a safe environment in which to stabilize patients during a crisis episode. The State of Oregon provides funding to some counties and regions to help offset the costs of "psychiatric holds." By Oregon statute the "County of Residence" is responsible for compensating the hospital for the "hold" as payer of last resort. The hospital is responsible for seeking all other funding sources prior to billing the county. The funds provided by the State through the county may or may not cover the county's full responsibility for these "holds", DOCUMENT POOR QUALITY AT -rim,OF RECORDING f iAw~ . Oregon State Hospital` State of or'econ Clepartrljenft o(,.' HunKan Services f Framework: Mast:er`PIan Phase 11 Report r K i1~1 I) F cDt-Lt z1 2S , 2006 - Many hospitals, particularly in rural communities, do not have the mental health professional staff needed to effectively staff these services. 1 4r'yiV. - Mental health patients using the hold rooms can cause considerable disruption in the t' emergency rooms, affecting emergency wait times and ultimately the treatment of others. - Payments received by the hospital may not adequately cover the true costs of these hold services. As a result of the above challenges, hospitals are feeling increasing pressure to close their hold rooms for mental health patients, cutting off a critical safety net for communities. Recognizing the Oregon g role these services play in the full continuum of care, increased State support for these services is L State Hospit4 warranted. State'-of_ oreson- De.i)art(pen`t of • Respite Care: It is often the case that a person with SPMI needs an occasional opportunity to pull Human Services out of their current life situation and receive support in a safe environment. Respite care programs are relatively inexpensive to fund and are often all that is needed to prevent further decompensation, and potential hospitalization. t n, Respite Care for Caregivers: Caregivers require a break in the day-in-and-day-out rigors of caring for those who need help caring for themselves. Evidence supports the need and benefit of Framework providers receiving compensated time-off, but currently little funding is available for this. While "Master Plan respite beds can be incorporated into community residential program settings, it is made difficult -Phase-II under current licensure and payment practices. Report , Y:. , Supported Housing and Affordable Housing has been addressed in Appendix D of this report. This service remains a critical need that can have a powerful effect on the ultimate use of state hospital beds and state supported services. The lack of available housing causes a domino effect for persons with mental illness, limiting the ability to work, afford treatment for their mental illness, and resulting in a more frequent need for hospitalization. Case Management Services are needed for all persons with SPMI, the most frequent users of the state continuum of care. Case management services facilitate the use of the most effective } and efficient levels of care, as well as help provide early intervention to prevent the need for more intensive care. Case management can contribute greatly to a lower cost system of care by ensuring individuals achieve the most appropriate care at the most appropriate time. While average case manager caseload sizes have slightly decreased in recent years, case management services are disproportionately distributed across the State. This condition results in excessive caseload sizes in some areas. There are also a significant number of low-income, non-Medicaid- eligible individuals who could benefit from these services, but funding for this is insufficient. Medication Subsidies are needed because of rising drug costs. Many consumers can manage their disease effectively with the appropriate medications and outpatient/case management services. Episodic exacerbations resulting in hospitalizations are often caused by a stoppage in medication due to affordability. Providing subsidies to assure that patients who have no drug F ° 20x!6 benefits receive the needed medication can help prevent acute or long-term hospitalizations, and contribute to more productive lives. H: IP , DOCUMENT POOR QUALITY AT TIME OF RECORDING • Supported Employment and Supported Education are needed to assist persons with SPMI I in obtaining and maintaining employment to break the cycle of dependency on state support and facilitate recovery. • Training and Education is needed for consumers, family members, and caregivers in new techniques of care, available resources, and support systems. Some of these resources are provided in a fragmented manner through advocacy organizations, providers, and other groups. The State is positioned to facilitate organizing these resources and disseminating the information to those who need the assistance. These incentives are critical components of the continuum of care, but are not currently receiving adequate funding. These services may be less visible to the State, yet the lack of such services contributes greatly to the ultimate use of more expensive state resources. Greater investment in these services at the community level will facilitate more appropriate utilization at OSH and contribute to a more recovery-oriented model of care for those with mentally illness. A look at other states that have attempted to decrease use of state hospital beds without adeauate funding of the community continuum of care shows that this approach can "backfire" resulting in an even higher reliance on state hospital services. The costs of these services remain under review but will no doubt be substantial. However, the greater the investment in the community level of care, the less reliant the communities will be on the more expensive state hospital. t DOCUMENT POOR QUAUTY RECORDING 1 r 4 ir~ySv1.{V'; Oregon- State Hospi,tah' St.zte.of Qre~,on` D'opirtment of Hunan -Services ~ F Framewr Maste' Plan" Phase II Reporu ;i f,N7D CONTINUUM OF CARE Severe and persistent mental illness (SPMI) is a chronic but treatable condition, with patients utilizing the mental health system at multiple points along a mental health service continuum of services and settings. As such, any one component of the service continuum of care cannot be addressed without affecting the other settings and services. The settings and services comprising the current continuum of care are provided in this report's appendices and include the following types of services: State Hospital - The State Hospital provides long term care for those with severe and persistent mental illness. There are three populations served by the State Hospital: - Adult treatment services focuses on adults who have been civilly committed and have severe and persistent mental illness. - Neuropsychiatric services include patients who have a medical condition contributing to their mental illness. This may include those with brain injuries, Alzheimer's, or other medical diagnoses. - Forensics services comprise the largest population within the State Hospital. These patients have been committed to the State Hospital for one of two reasons: > For determination - prior to trial - of their ability to aid and assist in their own defense (referred to as Aid/Assist patients), and > For being found guilty except by reason of insanity. These patients are then under the jurisdiction of the Psychiatric Security Review Board (referred to as PSRB patients). Acute Care Hospitals - Many of the acute care hospitals in the State provide a critical function in the continuum. The emergency rooms serve as a safety net provider for those undergoing an acute episode who may be of danger to themselves or others. Psychiatric hold rooms are often available in emergency rooms to manage these patients for a few days while awaiting commitment proceedings. In addition, several acute care hospitals operate psychiatric units to manage civil patients undergoing an acute episode. These units are designed for short-term care (less than 10 days); patients are typically discharged back to their communities or civilly committed to the State Hospital if continued long-term care is needed. State Hospital r State of Or>e~ ~•Y, . F~~man.Servicest i t . sr Fram~eworkk Ma's'ter Ptah Phase It,tiy Report • Community based residential programs include adult foster homes, residential treatment facilities, and enhanced care services among others (see Appendix A). These programs take residents who are not yet able to live independently, and assist them in developing the skills necessary for independence. Residents typically stay for months or years in these programs that provide a critical link in the system of care. • Community "front end" services include case management, crisis intervention, prevention, housing, supported employment, and respite care. These programs serve to maintain individuals with mental illness in the least restrictive setting, often helping them to live independently. These K ht f) services are oriented less around long-term treatment, and more around prevention, early detection F b ` and intervention. i Successful investment in properly sized new state hospital facilities relies on investment in other aspects of the mental health service continuum. Gaps anywhere along the continuum - whether it is DOCUMENT POOR QUALITY AT TIME OF RECORDING the limited availability of OSH beds or the lack of crisis services - will foster unnecessary utilization and/or lack of capacity across other services and settings. With any community enhancements it is + r~ > essential that counties be provided with sufficient infrastructure dollars (funds provided by the State to - a county) for program development and management. To work effectively, the service continuum must operate as an integrated and well-managed system. ` This Phase II report focuses on the master facility plan for OSH, yet outlines other system implications and opportunities that must be addressed for the OSH Master Plan to succeed. Some of the key findings of the master planning process are the following: Oregon state Hospjta( • Statewide System of Care State of ore ;on - Insufficient investment has taken place in community level initiatives that focus on prevention, pep.jrtifient of~ Hum m Servjces early diagnosis and treatment (front-end services). The result is an over-reliance on more r expensive services such as OSH, contributing to on-going capacity issues for the hospital. Greater investment in housing, respite, crisis services, supported employment, and other ; . , front-end services is needed to better manage utilization of OSH. t - Initiatives at the national level indicate that the more successful programs are those that use a recovery model and/or consumer-driven models of care. While OMHAS has supported Framework,' these approaches, more consistent definition and direction must be provided in how they Master Plan should be applied in the continuum of clinical settings serving the mentally ill throughout Phase II Oregon. Considerable variability now exists in how these initiatives are currently implemented. Report ` - Some communities within the State currently have programs that effectively address the issue of early intensive intervention for adolescents and young adults who are experiencing ! their first severe mental health crisis. One such initiative is the EAST program. These types of programs have proven very effective. - Better integration of agencies serving the mentally ill is needed to promote a more seamless approach to care: > The efforts of OMHAS and the Psychiatric Security Review Board (PSRB) should be more coordinated in formulating improved placement criteria for the forensic population. > OMHAS and community agencies must be better integrated to foster the seamless flow r of persons across treatment settings. > Acute care hospitals need to be better integrated with community-based programs, thereby eliminating discontinuity in the continuum. - The current service system is oriented around the case management of settings rather than consumers. Many community providers struggle to maintain involvement with their clients while they are at OSH. Case management, therefore, tends to be both limited and disjointed. Continuity is needed in a patient-specific case management system as it assists individuals moving through the entire continuum of care. • Community-Based Resources - The geographic availability of community residential services varies considerably across the K 11 U State. There are currently over 1,700 community beds serving adults across Oregon. This rcbruaiy 28, 20U6 number is neither sufficient nor appropriately distributed across the State to allow patients who are ready for discharge to leave OSH in a timely manner thereby producing longer lengths of stay at OSH. r , t L' DOCUMENT POOR QU ~ Y ALITY RECORDING > Data and feedback from individual interviews and regional program groups indicate that a few community beds are underutilized. Some of this is due to the geographic mal- distribution of beds noted above. > An overall lack of independent and supported housing opportunities for those persons with mental illness contributes to a longer stay in the residential program settings. The lack of affordable community-based housing delays individuals' ability to move from one level of treatment to another, thereby creating a backlog within the mental health system. Moreover, those with mental illness must compete with the general population for available housing. An adequate amount of affordable housing in appropriate settings with a orggon . ` geographical balance is critical to patient success as they move to independent or semi- State Hospital independent living. > Despite the defined roles of the different community residential programs supported by State'b,. rea0P DepJr rf N11t~of OMHAS, lack of consistency occurs in how residential services are actually used across , Human,ervices counties. Further, few financial incentives are in place to move clients through the continuum of care. For example, most programs are paid the same, fixed daily rate irrespective of how long a resident has stayed. As a result, clients may stay longer than is t , clinically necessary in community-based treatment settings. - While the State provides financial support to fund community based residential program development, there is little corresponding support provided to the counties for managing Framework these programs and residents. This infrastructure support is needed for community mental 'Master Plan' . health providers to foster program development, case management, technical assistance Phase II ` and regulatory monitoring of the community based programs. Rep-ort - Individual community settings need to be adaptable to a particular community's changing l needs, especially those serving smaller communities. Current licensure practices limit what l community residential programs can and cannot do. Flexibility in how these settings are used provides a more efficient system of care. > For example, residential treatment facilities may be needed and appropriate to provide occasional respite care or crisis services. This could facilitate better utilization of these ,t facilities as well as meet the needs of local communities. x - A more subacute level of care is needed to respond to a client's early episode, thereby either precluding or minimizing acute hospital care. This level of care may take the form of supported housing, intensive case management services, or a residential based program with professional staff to care for individuals who, in its absence, would otherwise need acute or i OSH hospitalization. The Post Acute Intermediate Treatment Services (PAITS) program is an example of subacute residential care. - The Oregon mental health system needs increased funding for supportive employment services. Gainful employment is a key factor in recovery. • Community Acute Care Psychiatric Units - Hospitals are experiencing increased financial struggles and psychiatric units, in particular, are under greater scrutiny as hospitals are faced with difficult decisions regarding which services to keep and which to exit. The difficult financial situation for hospital psychiatric k I U units has resulted in reductions in beds on some of those units and the closure of one psychiatric hospital. Acute care capacity in Oregon has been further reduced with the closure of two other hospitals related to poor clinical performance and overall hospital financial issues. This trend threatens a critical safety net and program setting for those with mental illness. t DOl`;I:. MFNT POOR QUALITY AT TIME OF RECOR DING - The length of stay within these acute psychiatric units is driven somewhat by the lack of availability of non-acute community-based services or state hospital beds, depending upon patient needs. Without these state hospital and community services, or with extended wait periods for these services, patients are prone to stay longer than necessary in the acute hospital setting. The above findings have implications for the State Hospital System: • Admission rates to OSH would decrease with greater availability of front-end services and programs at the community level. Early intervention services such as housing, crisis and case management often prevent the need for hospitalization or decrease the length of stay in the hospital. • Length of stay at OSH would be reduced if more community-based programs were provided to continue treatment upon discharge. Without residential placement options, patients stay longer at OSH, despite their clinical readiness for discharge. • Data indicates an increase in the numbers of geriatric, neuropsychiatric, and dual diagnosis patients will occur in light of demographic shifts and the methamphetamine epidemic. The future OSH patient will be more medically complex than today, requiring greater health care resources and staffing levels. • Federal budget proposals that result in any Medicaid or other entitlement program reductions or any rise in the State's indigent population could increase OSH utilization due to lack of other options. These unknown variables could not be factored into this analysis, yet are key issues to monitor and incorporate into any future planning. 1 DOC"UW~;E~uN POOR QUALITY Ad 7N4E__ OF RECORDING to _ _ t oregon State Hospital}-, r , x. t Sta.c of:Ore;orl Dcpa~tn cnt*of~' HUmarl Seri e5_' Framework] Master Plan Phase II Report K M f) I ~bruary 28, ;'C'~Ir• CONCLUSIONS AND RECOMMENDATIONS OREGON STATE HOSPITAL Some states have attempted to eliminate the state mental hospital from their continuum of services. M any of these states have come to find that such facilities fill a vital role, providing focused care, recovery, education, and training in a safe environment. The consultant team recommends that - t' Oregon continue to provide an array of mental health services through a state hospital system. Oregon Challenges for Oregon's State Hospital State Hospital • Nationwide there is a shortage of qualified professional psychiatrists, psychologists, and nurses. _St,-11(J of Oregon` Oregon needs to attract and retain the best physicians and professional staff. Lei 7r trnenl 6f Human Services • These professionals seek: - Professionally challenging work, - Competitive compensation and benefits, - Community amenities such as excellent schools, healthcare, recreation, arts, and social opportunities, - Opportunities for consultation with peers as well as continuing educational resources Framework, . . . Master.,Plan, • Neuropsychiatric patients require specialists who are even less available Phase II . Report } Oregon's demography places a majority of the population in one small region of the State. The remaining land mass is much less densely populated. • To receive specialized care, including mental health services, citizens who live in remote areas are required to travel long distances. - Improvements to the community mental health services may mitigate some of the inconvenience of remote services. r " - Standards of living sought by the majority of the mental health professionals may not be found in rural and remote communities. i • Provide limited mental health services to the Department of Corrections (DOC) population. (See Appendix E - Agreement between DHS and DOC) Underlying Functional Issues Oregon is committed to a continued shift to a community-oriented, recovery model of care and education. • A more decentralized delivery system will facilitate patient reintegration into their home communities. 1.111) • Oregon State Hospital plays an important role in the processes that lead to diagnosis, care and F c+br a ,y 13. ;oar recovery but not everyone with a severe and persistent mental illness will need the higher level of services of the Hospital. ~f DOOW4ENT POOR QUALITY A ' iME OF~ RECORDING - Center of Excellence - Oregon State Hospital needs to take advantage of closer associations with colleges and universities which offer cutting edge advancements in the care and treatment of those with mental illness via the following and other programs: k hy~. f , - Oregon Health Sciences University's Public Psychiatry program, } - Portland State University's Social Services programs, - University of Oregon's Clinical Psychology programs, - Southern Oregon University's Applied Psychology programs, - Oregon's nursing schools. : g < Oregon • This Master Plan is based on an anticipated total hospital need of 1,100 beds by the year 2030. State Hos'pitat - If no new community residential services are provided, a substantial number of the individuals who would utilize those beds could increase the State Hospital average daily population to ne l 2 000 ti tatc, of Oregon De. 3rtm nr of ` ar y , pa ents. N~iman~5e icesx Existing Hospital Facility Issues s • As concluded in the Phase I Master Plan report, the current Salem campus facilities are not " appropriate for long-term continued use for the care and treatment of those with mental illness. - Patient rooms are overcrowded and undersized relative to Oregon Administrative Rules (OAR). r, - Patients and staff spaces are not well designed for treatment, safety, or security. Fram`e0brk - Patient wards are overcrowded. ri r Maste'r~Plar~ - Structural conditions of many buildings housing patients do not comply with current seismic Pha`se' II requirements. Report - Buildings do not comply with current building or energy codes for secure psychiatric facilities. • The lease for the Portland Campus of OSH will end before 2015 with no guarantee of renewal. It is imperative that Oregon State Hospital should be located in facilities that are owned by the State t `r of Oregon to achieve long-term stability. ~ y i Proposed Schedule for Hospital Replacement • Initial construction projections suggest that if programming and design begin in mid-2006, facilities E could be operational by 2011. - • Rather than open facilities that would soon be overcrowded, it is important that the initial 2011 construction be sized to accommodate projected bed needs for ten years in the future (2021), with a support services infrastructure (kitchen, mechanical systems, utilities, electrical systems, etc.) " capable of sustaining growth through the year 2030. K>•tll February 28,z0o6 DOCUMENT DOOR QUALITY AT TWE 01-- RECORDING HOSPITAL LOCATION ANALYSIS As previously stated relative to the recovery model of care, it is desirable that those with mental illness be treated through community-based services that are located as close to their homes as practical. This applies as well to patients during their stay at the State Hospital. To facilitate the analysis of where hospital facilities might be located, the planning regions described in this report were used, combined with pertinent historical patient demographics. The regions were then analyzed relative to their perceived potential for accommodating a State Hospital. ROOD Rw" / BWM ~ i r-, /_a f L ~K J Sr NJ4kON Ak ILL J ~ CI.ACY. LI2A5 ~ ~ ~iIILAM LI YtAY ~MA}tF 1 _ 5 ~ mi tr rn~ l`r I i I I LJHN i I iJ 7 LANE 1 l enh~a 1 Of Ally J~' ((I ~orth'Nlllart~e't +'allrTy Nvrth caast F:L nIMn.IH Regional Location Considerations for a State Hospital Hospitalized patients should be accessible to their friends and families. Data analysis confirms that the communities that contribute the largest numbers of patients to the hospital are those regions that have the largest populations. Incorporating growth projections across the State, for each of the next 25 years: • 55% of the OSH patient population will come from the North Willamette Valley and North Coast Regions. • 38% will come from the South Willamette Valley, Central Coast and Southern Oregon Regions. • 7% will come from the Eastern and Central Oregon Regions. DOCUMENT 'POOR QUALITY Y~ `0re9,on State Hospitals; State .o Tr0 e.gon t Human Se- vices, ~ i ' C C f9 v Framewcki Master P,l' h- Phase II Report,.; t f 1' X1'11) Ieoruary 2&.016 _ l~ {4 Y ~ Evaluation of Oregon's Planning Regions Other factors in addition to population may affect the level of desirability of an area for possible placement of a State Hospital; however, most are directly related to population density. North Willamette Valley Advantages - Large population center is desirable for attracting and retaining qualified MH professionals. - Majority of MH professionals now reside in this area. - Major Healthcare facilities available. - OHSU and PSU readily available for research, innovative support, continuing education. - Region is the major source of patients (52%) - Readily accessible to interstate highway and regional transportation systems. - Patient access to community "lifestyle" activities and supportive services. - Close to the North Coast Counties. Disadvantages - Costs of living, land, and construction are high relative to some other areas in Oregon. - Metropolitan area is distant from southern and eastern communities. • North Coast Advantages Reasonably accessible to the North Willamette Valley. - Some communities would eagerly desire a state hospital as a boost to their economy. } - 3% of patients are from this area. Disadvantages - Population base could not support a state hospital facility. - Attracting and retaining qualified MH professionals may be more difficult here than in North Willamette region. - "Not in my backyard" (NIMBY) issues may be stronger here than in North Willamette Valley. - Limited access to major highway and transportation systems. - Limited patient access to community "lifestyle" activities and supportive services. South Willamette Valley/Central Coast Advantages Large population centers and major universities are desirable for attracting and retaining qualified MH professionals. Major Healthcare facilities available. Readily accessible to interstate highway and regional transportation systems. - Readily accessible from coastal, southern, and eastern Oregon communities. - Patient access to community "lifestyle" activities and supportive services. Second largest source of OSH patients (21%). Disadvantages - Cost of living, land, construction is high relative to some other areas in Oregon. - NIMBY issues may be stronger here than in North Willamette Valley. - Attracting and retaining qualified MH professionals may be more difficult here than in North Willamette region. DOCUMENT PQQP QUALITY AT TIME OF IRECORDING f y , <4 Oregon , State Hospital, State of cgdriI s Departmmtc' Human set k~. Framework Master>Plan~ Phase II Report` x t. 7 f K I 11) February 78. 2006 r • Southern Oregon Advantages - - Growing communities may be desirable for attracting and retaining qualified MH professionals. - Readily accessible to interstate highway and regional transportation systems. - Third largest source of OSH patients (17%). ; Disadvantages ^ . - Cost of living, land, construction is high relative to some other areas in Oregon. - NIMBY issues may be stronger here than in North Willamette Valley. s - Attracting and retaining qualified MH professionals may be more difficult here than in North QrcQOn Willamette region. State Hospital; Central Oregon • stare o`;Orc~un of Advantages Human Service - Rapidly growing area, reasonably central to populations east of the Cascades. - - Some trained MH staff available. - Region may be desirable for attracting and retaining qualified MH professionals. i - Some communities would eagerly desire a state hospital as a boost to their economy. - 3% of patients come from this area. i Disadvantages Framework' - Population base could support a small state hospital facility, but only if combined with Eastern Master: Pan 2 Oregon. There is some question as to whether or not it can be efficiently operated. Phase II - Cost of land and construction near population centers similar to North Willamette Valley. Report • Eastern Oregon Advantages - Northern portion is readily accessible to interstate highway and regional transportation system. - Eastern Oregon Psychiatric Center (Pendleton) now provides state hospital services to northeastern part of State. - Some communities would eagerly desire a state hospital as a boost to their economy. - 4% of patients come from this area. Disadvantages - Population base could support a small state hospital facility, but only if combined with Central Oregon. - Extreme northeast and southeast areas are not convenient to the rest of the east side of the Cascades. - Attracting and retaining qualified MH professionals will be significantly more difficult here 06 than in any other part of the State. - Limited patient access to community "lifestyle" activities and supportive services. K 11`l I) ferr uurti+ 2"", C0(; . 'Z)®CUMENT POOR QUALITY Facility Design Considerations The following design parameters reflect the results of our meetings and the expressed desires of patients, physicians and staff as related to the Recovery Model of care. • Designed for patient care, safety, and security: - Patients at various stages in their recovery may require protection from themselves and from real or perceived external hostilities. - Physical conditions may require readily available medical and continuing care. - Society may at times require protection from the patient. L r • Progressive and therapeutic work environment: - Modem staff working conditions including communication and flexible security technologies. - • A place in which the patients can be treated, learn more about their condition, and focus on the process of developing the skills necessary to manage their recovery. • An environment in which to heal: - At certain levels, it is a quiet, contemplative place; - At other levels it will provide space to teach and places for social interaction and sense of community. - It's a sanctuary, a recovery center. • Patient living units are to be flexible in utilization: - Units based on a prototypical plan provide greater future flexibility than do units that are specifically designed to accommodate one fixed program. - Maximum Security and DOC Units will have similar hard security requirements, permitting flexibility in utilization between the two program types. - Shared functional program space between units offers space efficiency and program flexibility. - "Swing" rooms between units offer flexibility in unit and program sizes. • Patients require. a variety of experiences to promote recovery in a normative environment: - Facilitate integration back to their home community. - Vocational, Educational, Training, Transition Planning, Peer Supports. - Indoor and Outdoor recreational opportunities. - Spiritual Center, Library. - Coffee shop, store, barber, salon. - Recovery Mail, Fitness Center, Arts & Crafts. - Outdoor and off-campus community life encounters. Human Servic'os..: J 4 fj 3+ 5 :Y~~f r 'Framew rC Masted an ti Phas II Report' .,IA jL2 ..f. 4 , J-1 f f -i a, • Facility appearance or image to reflect a'recovery" environment that also responds to neighborhood character: - Low rofile - one sto It X11 l) p ry preferred, however if the facility footprint becomes too large, it may become staffing inefficient. r Er , ,~~y 28. 2OL16 - Required security provided by electronics and "transparent" physical barriers in lieu of obvious } "security" fencing, k w - Large, internal courtyards and recreation areas secured, as needed, by buildings. xi - Visual connections to variety of outdoor spaces and act .ma y` POOR QUALITY tjML; F RECORDING • Peer Mentoring Center: - Would facilitate patient recovery, liberty, and encourage a sense of "community". - Training center for Peer mentors. - Repository and center for creative arts, drama, writing projects for hospital patients. - Dual-diagnosis, cultural, and diversity sensitive self-help groups for persons transitioning into the community. - A resource for those peers, consumers, survivors living near the hospital(s). • Peer-Run Store: - Retail for wares and crafts created by patients. - Provides opportunities for work experience by patients. 'DOCUMENT POOR QUALITY 9ME C?` tE~a93D9! Ally?. .r z t Oregon State Hospital i State of Oregcrn De p'a tf lCnt 0F" Human Services t r & Fr'amework'. Master PlaiJ,, Report i r cbrua y 1I. 1C0 E STATE HOSPITAL FAC1.1LITIES OPTIONS FOR LOCATION AND CONFIGURATION The following options for development and cost are based on occupancy by the year 2011 with capacity to meet patient needs through year 2021. This will create facilities to accommodate 980 beds. • Growth potential and support infrastructure is provided to accommodate the year 2030 patient projections of 1,100 beds. • Project costs consist of construction costs plus owner soft costs (see Appendix G, Glossary). All costs exclude purchases of land. For more detailed analysis of project costs see Appendix D. • Each of the options includes a conceptual drawing to show general relationships among the various hospital program elements. - These images are intended to indicate one possible site configuration, relative size, and suggested amenities and are not intended to indicate all possible solutions. - A conceptual drawing is provided for a 20-bed patient living unit that was utilized as a module for programming and campus development. - No drawings are included for the two 16-bed secure, non-hospital, residential treatment facilities recommended in Options 1 and 2. One may note that the estimated combined construction costs of Options 2 and 3 are greater than for Option 1 even though the number of total beds is the same. In addition the amount of land for each Option does not appear to be proportionate to the number of beds at a facility. The reasons for this are: • Multiple campuses will require more space for staff, more service spaces, and more engineered systems due to duplication of functions. • To lessen the amount of land consumed in the larger facilities, the concept diagrams make some use of two-story elements, where a single story facility may be preferred operationally. • It is assumed that the amount and variety of interior and exterior educational and recreational space will vary according to the number and types of patients anticipated at each campus. • Additional land is suggested to accommodate growth, at least for year 2030. Anticipated annual maintenance costs may be found in Appendix D. DOCUMENT FLOOR QUALITY AT TIME OF RECORDING Oregon State Hospital sti Q eSW Dcp m~~r of Human' Se~vicr s' 41, Frame d Master~P~ Phase II Repo Y 2 r i h 11'7 I)~ _ F~2Druary 28; 2006 j 1 i OSH Patient Living Unit Planning Module lil~ "Fill Aj t I ~ 1 , t 20-Bed Patient Unit Planning Module This 11,700 square foot planning module was utilized to facilitate development of an understanding of total hospital size and configuration that might be applicable to each of the following conceptual planning options for the new Oregon State Hospital. While the design of the various patient units will need to accommodate specific patient classifications, group and staffing program needs, it is desirable to have functional and flexible patient living units that can adapt to new program needs over time: • Maximum Security and DOC units will have similar requirements for "hardness" and security, permitting flexibility in those uses. • Program spaces may be shared between units as designs are developed in the next phase. • Secure outdoor activity space should be readily accessible. 100CU nENT POOR QUALrd 4 t< w .~Y Oregon State Hospital,, State OrE' De~l~~rtrnent ~f Hum,jn Services y t i t t ework Frap Mas, r Plan Phase II Report K ICI 1) FcbI Lielf zc, HA- OSH Option 1 One 980-bed facility encompassing all inpatient beds, located in the North Willamette Valley region, plus two non-hospital level, 16-bed secure residential treatment settings placed strategically east of the Cascades. r C G;_ S Fr ti1 G Q G;'Fa rJ C) -~a 6 yy E'T4 ~ ' N • ~ ti 1 ; - o. f 14 46'7 GILI~ F K~ r . t .a 3 r~ fy,-' 31 n ~CF vL iti11~1 AAI1 V" x I F! ~I II F, .i . SKI tf rrr __Yr ~Mt i C 1 1 - Il~'. ' , tl Fi F.fif. Fi ~Ll f3 C,, s ~J'~ 3g . u.. m fir= n a C uvxv_ ion evo~~- x-~c~-om xxY tiw>v ec.r:,.Yrzx~ qqy ynv -,c,~ or'o°''¢°""'o°.e"°a d Q.~wazaaneocrnm ce..~anx~oa-.+~«roaro TAIL vA'1 F. 4~ Aln ',lAfl. ';k~ Sl t _ I'iIHY t+'IIrY t, 980 beds / 1,060,000 SF Hospital / 120 Acre Campus / $293-304 million estimate projects costs this campus / Estimated Project Costs: $297-307 million (including the two Residential Treatment Facilities) Advantages Reasonably close to homes of 55% of the patient population (including the North Coast Region). - Ready availability of all levels of professional and support staff. Most efficient for professional and support staff, minimizing duplication of positions. Maximizes the amount of patient vocational and recreational opportunities. Current state hospital campus contains sufficient acreage and infrastructure, and perhaps is the easiest place to site the new facility. Oregon State Hp~,pital Ca x t St~`D De par 4or HUTall i. 4 7 17"g Fram'ewo~k Master Plan Phase 11 °t2epgr`,t c~ { rti,. S f{tN9f) y ?8. 20 oC Disadvantages Inconvenient access for about 45% of the patient population. } - Large two-story facility, necessitating use of elevators and stairs. , - Possibly difficult to site outside of current Salem campus. - Centralizing the hospital could further disengage OSH from communities . ~UOUMENT POOR QJ f` P" r `''PAE OF RECORDING \ OSH Option 2 One 620-bed facility (2A) located in the North Willamette Valley region, one 360-bed facility (2B) located south of Linn County on the west side of the Cascades, plus two non-hospital-level, 16-bed secure residential treatment settings placed strategically east of the Cascades. C+ cis ~ ; zrj icokit) ~G)' @ F+te E'er rig 60 ` e I ' r ,ncw~ , re « r~ i _E] ti tiJ 4 r y~F n a_~ t_ C-~ J o ~Yll O~~k'~S.~VC~JC-.•y_yJ ~ '1 4s.Ua:.ucXY~.c .ivy.. 'W U~w.JCFJ~`.kL,cVafxY'V 4J[rxxYLaUOrs:F.~f Ni~YrricxY'ixYYixYCrs ~ ~ Fr yia'nYx'd~'CV1JO U[q_~~:r~~px'U~ri.i) ~ I ax~~ar>rxxxn a~r.,»w:w vr_c.~ccu ~ Ooacrwooo«>xna JI ~ I ~ 0.~OtiOSX1~nU;MG,:IP] .a rr s}5 •LDS Option 2 - Campus A • 620 beds • 758,000 SF Hospital • 100 Acre Campus • $204-208 million estimated project costs this campus DOCUMENT ,-PPOOR QUALITY Oregon State Hospital S atr of Ore;on Department w. Human Services Framework Master Plan Phase 11, : Report" 1 K1 ID _ is ` F r i - ya H Fr ~ H„~,X.~ Y . gY o~ all OIL ro ~ F y n k w er rii ~3 Er mfr d' Ef f• iii :u -oe mcn Ylr 4 Q , 5fateHospitat . b 3F7 ..v 11ne r d 6 i I a F.- ~ State of1Or6oon - a D6P of I 'J . . • HUn er;nceS r d 3fl b19 i _ pp 00- { Framework • Master-:P,lan r; - G3 «0 f.,f ofa 0 Q,,Y fin. Rp,ort•.: 11T11 Y l - Option 2 -Campus B • 360 beds • 472,000 SF Hospital • 78 Acre Campus • $117-120 million estimated project costs this campus t Option 2 - Summary • Estimated Facility Size for Hospitals only: 758,000 SF Hospital A; 472,000 SF Hospital B ; . Estimated Land Required for Hospital Campus only: 100 Acres, Campus A; 78 Acres, Campus B Estimated Project Costs: $324-334 million, including both campuses and the two Residential Treatment Facilities. • Advantages - Two campuses provide 93% of the patient population with reasonable opportunity to be close " to home while still providing for some centralized administration. - Assures preferred single-story design. - Smaller, single-story facilities more easily accommodated in some communities. - Ready availability of all levels of professional and support staff. - Maximizes the amount of patient vocational and recreational opportunities. Current state hospital campus contains sufficient acreage and infrastructure, and perhaps is the easiest place to site one of the new facilities. It 11 U Two facilities are close enough to encourage interaction and coordination between staff. Disadvantages Duplication of support services will increase construction, administrative and operational costs. Land acquisition required for at least one of the facilities. Possible NIMBY issues. DOCUMENT POOR QUAL9T ~ ,~T TIME OF RECORDING OSH Option 3 One 600-bed facility (3A) located in the North Willamette Valley region, plus one 320-bed facility (313) located south of Linn County on the west side of the Cascades, and one 60-bed forensic facility (3C) located in Central or Eastern Oregon. Oregon, State Hospital State of OmC'on j I- ~6 Departmrot Human Se«s IAA ~ -F , ` Ifl ~ ' j _ ' E L Il~ ~ A0.t :r;~ ( % '-f} } kl y.l.r X l j} 'IL.1 YR X 'I r_ = x - Fran rework°: Master Phan Phase 11 Report .z , '~,if ~ 8 0 P N ` m ~ > t~Gi g_ _ 1L=h~c`Oa~;~ `til. 17 v Y1Y .^11.c ] t , y.~[Y xr~ x+~. ~ , 11 Q foci o .mss -x JG[r i~x~ u u~Y~:~v.~r.~dx~ i'x+W ~Y CalC0:1,TOfc~,1y~a.([YX'Ka>L~ U ~ -~q GVY:rts x~UV~cip ~ ~c~oxvaxwr. ec x'>r+cxtr»o- ~ ~ ~ Arts oru v - l ~ Y c >-~-r~oa~oc ~_~o i 2YXV:t.A~K ~:xX A oOC~UC.v]gWw~U'aoGO:'000 mVCa7~ck.W000Orx)<V ao,.00."%YIVO~W~7c>w ~ _ i tj 4 Y/«~J+~~^y /.^~ry^ 1.~ y~ y.✓1/.~,~,`~~!~~~_,-y ~^~y~ny~~ I i A-y ,WfiJ l.ll✓LU WJ4_W 1u +4 Iity4• +I Jt] WE W '1 ' 1_ ~1 e f T-4 I'll IIY 9 75 9 F Option 3 - Campus A • 600 beds • 716,000 SF Hospital • 100 Acre Campus • $198-203 million estimated project costs this campus K111) f:bru rV 1B. ?C:`b 00", ` ~ OOR QUALITY "ORDING ^ ~ ra E t G Ft Ft vi f arc i - 1 _ EI F J v j t 4 • y J ) p - l C, - .a ZP t% Fi 3 t J WMI . Oregon , ~r~:aF s~ E G~ 0-4~ 9- r : State Hospital E AcYU h ~.r•til1Fr r. o` y'~ ~ ln.ot6 ~ ~ olr Nlri t 11 M nAr f1 ; ` " S of Q Uri r 3 xs tate reg Dep,a Onerit cif r j E7 F3H t 19 ~ a•3 - © `hl~f~ b 49 -CCU ~q 0 Ij ' ~i .N rill _ Fl F~j Ei ~~tl OWYWOpDaw.000 ~ c~ E ~J Fx mework ~n.~n ticE ~ n o = - Master :Plan 5 Al, Phase Il p e~ _ c,+r r3 r,?_t3 C t ~ t3 t t3f~c s ~ ~z3-: _ ?cam.: L3 r.,R,e ort Option 3 - Campus B - • 320 beds • 406,000 BGSF Hospital • 78 Acre Campus • $106-109 million estimated project costs this campus A J. f ~I x i r f(, ~N~li t i u~R~~ f ~i ~ per' [ F to 'ta e , ~ p a c -iacuavs ~ _ K\1U Februai 2,8 20175 Option 3 - Campus C q-- " , 60 beds • 110,000 SF Hospital • 22 Acre Campus • $22-25 million estimated project costs this campus A d UME OP RECORDING Option 3 - Summary • Estimated Facility Sizes: 717,000 SF Hospital A; 406,000 SF Hospital B; 110,000 SF Hospital C ;K fy`tw Y Estimated Land Required: 100 Acres, Campus A; 78 Acres, Campus B; 22 Acres, Campus C • Estimated Project Costs: $326-337 million including all three campuses • Advantages - Three campuses provide reasonable proximity to home communities for about 96% of the '..1 .patient population. - Cost of housing and land may be less in some areas compared with the North Willamette Oregon Region. State H ospitaIL - Maintains a state hospital presence in the Eastern Regions. I State-of Oregon, D`ep3r tmenr ofi. ; • Disadvantages Hilman` Se-rv ces - Recruiting and retaining professionals is more difficult in Eastern region. ~t - 60-bed facility is operationally inefficient. r, - Size of 60-bed facility precludes the ability to provide a full array of vocational and educational I._ programs. - Duplication of support services will increase construction, administrative, and operational costs. F ra m ewo r l Master'Rlan Phase II Report ; Y [ 3 ~ I i sj yy 1 t~ ~t t) Fcbruarr2~, ~C06 FRI RECOMMENDATION No matter whi h f th h it l d l i t ti l t d b th i St t b c o e osp a eve opmen op ons s se ec e y e a e, t must e understood that the full project along with the community enhancements need to be provided. Any major modification or deletion will undermine the viability of the plan. . I KMD Architects and Planners with New Heights Group strongly recommend adoption of OSH Option 2. It is preferred for the following reasons: • In keeping with the Recovery Model, this option would provide the State of Oregon with: The opportunity for a significant majority (93%) of patients to have convenient access to their home communities, family and friends at the most reasonable cost. - The highest quality of care at the most efficient operational level. 32 much needed, high-level, multi-use secure residential treatment beds in Central and/or Eastern Oregon. This will provide the flexibility that allows an individual to receive safe and secure up-front services. • It would provide economic benefit to a greater segment of Oregon through development of multiple campuses, decentralizing the work force, and creating jobs in the community of location. • It would provide better utilization of the statewide continuum of mental health care. See Appendix D for additional information regarding OSH Options program size and projected costs. CONCLUSIONS AND RECOMMENDATIONS: COMMUNITY-BASED RESOURCES Sufficient funds need to be made available to community caregivers to provide enhanced support services for individuals with severe and persistent mental illness. An additional 419 community residential beds are needed by 2011 to support the size and scope of the State Hospital described in this report. A significant number of these beds have already been budgeted, but continued support is needed. OreState state of.OreSonl , Departri (ort~oo Human SeryricesO l~'r 4 xt ; ~ ~ ~l Framework ' `p~Nz Y lI~ i:V + Y Master=Plan Phase Ii 'r Report -_i Y: In addition to the dollars needed to construct the new community residential programs, infrastructure funding to the counties is needed to allow them to administer and monitor these programs. An additional 10% of estimated operating costs has been identified to support infrastructure development. In addition to the residential development by 2011, more aggressive prevention and early intervention services are needed to identify and manage those with mental illness early on. This is key to a recovery model and necessary to ensure more appropriate use of state hospital resources. More integrated, on-going case management is necessary so that those with mental illness can move smoothly across the system of care, accessing services as needed to maximize independence. Better integration among counties as well as between counties and the State Hospital is needed. DOCUMENT POOR QUALITY AT 7WE OF REE %00P. DING z K N,I U 1e~1L i,iry ?a, 2, o0 6 i 4 t l NEXT STEPS ~r The State of Oregon needs to consider the information provided in this report and set the direction for Oregon's Mental Health System by: t~xrs 1. Selecting the Oregon State Hospital Development Option. We recommend this be accomplished by May 2006. 2. Securing the services of a qualified architectural/engineering consulting team by Summer 2006 Oregon' to: Stag Hospit I a. Develop a program of spaces for the new hospital facilities, confirming site requirements. Sta ~of.Ore°bn~ b. Identify the location and specific site for construction of new hospital facilities 5 i . c. Establish the design and construction processes that will lead to the opening of new hospital Dc~E I~•t,nleril of Human C- ices facilities by 2011 based on an approved program of spaces and the selected hospital site(s). 3. Funding development of the Community Services component. These need to be in place prior to opening a new State Hospital facility. Framework Muster Plin Phase II Report,, fl, } x fit. t~ t K' NI I) February q a ~)OR QUALITY l ~y ,i, ~s~ f