North Central District Health Department Patrice Sulik MPH

North Central District Health Department Patrice Sulik, MPH, RS-Director of Health

Local Health Departments in CT • In CT-there are 66 local health departments (LHDs) • 20 Districts (serving 123 towns), 33 Municipal and 13 Part-Time • LHDs are funded through the state, municipality and fees • LHDs are tasked with providing the 10 essential services

Ten Essential Services

North Central District Health Department • Founded in 1974 with East Windsor, Ellington, Enfield and Windsor Locks. • Stafford, Suffield, Vernon and Windham joined in subsequent years. • We currently serve the largest population in CT-approximately 166, 000 residents. • Main Headquarters are in Enfield; 3 satellite offices throughout the District. • Comprised of A 21 -Member Board and 4 “divisions”-Administration, Environmental Health, Community Health, Public Health Preparedness.

Moving the District forward • A new Director was hired in 2016 -the Board tasked the Director with conducting a thorough assessment of the District and identifying priority areas to address. • Taking a close look at the finances and budget was an early priority. • Exploring the frequent staff turnover was another priority.

BUDGET/FINANCE

State Per Capita Funding • Prior to FY 2010, the state per capita for health districts was $2. 08. The funding rate for FT municipal departments was set at $1. 18 and $0. 49 for PT health departments • In FY 2010, the rate was set at $1. 85 for districts serving 3 or more towns or a population over 50, 000. FT municipal departments received $1. 18 if they served 50, 000 or more. There was no funding for PT health departments. • In recent years, the funding rate of $1. 85 has not consistently been funded in full.

State per Capita Funding $1. 85 FISCAL YEAR END: POPULATION TOTAL PERCENTAGE FUNDED 06/30/15 166, 440 $307, 914. 00 100% 06/30/16 166, 603 $292, 542. 74 94. 91% 06/30/17 166, 207 $272, 924. 70 88. 76% 06/30/18 165, 433 $306, 051. 05 100% 06/30/19 165, 564 $273, 060. 67 89. 15%

District Town Per Capita Rates • Range of per capita rates across the state: $4. 67 -$20. 79. • There is some correlation with lower rates for larger districts-not complete correlation. • More than half of the health districts had a rate increase over the past year. • North Central has held our current per capita rate for 5 years. • Similarly sized departments with robust Community Health programs have rates between $5. 50 and $7. 37.

General Fund Revenue General Fund FY 2014 -2015 FY 2015 -2016 FY 2016 -2017 FY 2017 -2018 State per capita 307, 914 292, 543 272, 925 306, 051 Town per capita 777, 275 778, 036 776, 187 772, 572 Fees/Permits 361, 888 386, 900 399, 271 406, 680 Other Income 28, 971 7, 889 32, 694. 86 36, 268. 27 Total 1, 476, 048 1, 465, 368 1, 481, 076 1, 521, 572

Grant Revenue Grants FY 2014 -2015 FY 2015 -2016 FY 2016 -2017 FY 2017 -2018 Preparedness 62, 752 129, 391 122, 192 Lead Poisoning 26, 976 29, 950 39, 719 N/A Block Grant 32, 259 43, 795 45, 653 43, 311 Opioid Abuse N/A N/A 34, 000 Total 121, 987 203, 136 214, 763 199, 503

Total Revenue Total FY 2014 -2015 FY 2015 -2016 FY 2016 -2017 FY 2017 -2018 General Fund 1, 476, 048 1, 465, 368 1, 481, 076 1, 521, 572 121, 987 203, 136 214, 763 199, 503 1, 598, 035 1, 668, 504 1, 685, 774 1, 717, 871 Grants Grand Total

Grants-Current Fiscal Year • The CT Department of Public Health offered 2 additional grant opportunities to the Health District. • We were asked to serve as fiduciary and coordinator for indoor asthma program, “Putting on Airs” ($29, 238) • We were asked to accept a small lead poisoning prevention work for one of our Member-Towns ($20, 500). This could lead to more opportunities for lead poisoning prevention funding.

Budget Process • The budgeting process spans several months. • Both revenues and expenditures are estimated conservatively. • Finance Committee work sessions are scheduled to gain input and address questions and concerns from the Board. • Some line items are more challenging to estimate. • Changes in personnel can have significant impact on budget.

Focus on Expenditures • Cost efficiencies accomplished since 2016 include: -Significant reduction in cost for audit -Remove need for outside accountant to perform routine work -Maximized savings on agency cell phones by tracking and adjusting shared minutes plan. -Comprehensive cost study on office supplies, janitorial supplies, field supplies-ordering is done quarterly

General Fund Expenditures FY 2018 -2019 FY 2019 -2020 $ % Salary/Wages 870, 923 59. 8% 915, 102 60. 02% Payroll Taxes 71, 823 4. 93% 74, 848 4. 92% Benefits 182, 965 12. 56% 218, 126 14. 34% Sub-Total 1, 125, 711 77. 29% 1, 208, 076 79. 46% Total General Fund Expenditures 1, 457, 057 100% 1, 520, 272 100%

Staffing Fiscal Year Full Time (37. 5 hours/week) PT-various hours Total Number of Employees 2015 -2016 13 4 17 2016 -2017 15 5 20 2017 -2018 13 5 18

Staff Composition FY 2018 • • 1 Director and 2 Environmental Health Senior Management Staff 6 FT Sanitarians 2 PT Sanitarians 1 FT Public Health Preparedness Coordinator (Grant Funded) 1 FT Health Educator (Primarily grant-funded) 1 Public Health Nurse (Grant Funded) 1 Bookkeeper, 1 FT Admin. , 4 PT Admins.

Employee Retention • Frequent staff turnover (sanitarians) was identified as a major concern for continuity at the Health District. The result is significant number of staff with less than 5 years experience. • Non-competing wages and benefits were identified as being a major factor in staff turnover. • Addressing staff retention was identified as a strategic priority by the Board. • A wage and benefit study was performed and the wages were increased to a current average of health district wages in this region of the state.

Wage Increases • The Health District does not have bargaining units. • Most positions have step increases that are awarded with satisfactory performance evaluations. • There had not been a cost of living increase from 7/1/16 -7/1/18. • Wage increases due to wage study ranged from 0%-22. 10%, depending on position.

Employee Benefits • • Health Insurance-employee pays 16% of premium cost Dental Insurance-employee pays 12% of premium cost Life Insurance, Disability Insurance-paid by health district Pension-health district contributes 4. 5% of employee wages; 5 year vesting • Pre-Tax Savings Plans-optional for employees • Vision Insurance –paid by employees

Employee Benefits • Tuition Reimbursement-up to $1, 000 a year for courses related to position. • Paid Time Off • Vacation-10 days per year. After 5 years, an additional day per year up to max of 15. • • Sick Days-12 days per year; none are carried over or paid out. Personal Days-3 days per year. Holidays-13 paid holidays per year-12 scheduled and 1 floating. 1 -3 days bereavement according to personnel policies.

Health Insurance • Significant increases in small group pricing over the last few years resulted in annual insurance changes. • Aetna pulled out of the small group market. • The District switched from a gold to a silver level plan and then to a high deductible plan to contain costs. • The District switched to the state insurance plan December 1, 2018 -in order to stabilize rate increases by joining a large group. Our rates are no longer related to the age of the insured.

Excess Revenue over Expenditures Fiscal Year Excess Revenue % of Excess due to Vacant Positions Other contributors to excess revenue 2014 -2015 217, 790 95% 2015 -2016 251, 558 97% 2016 -2017 169, 672 63% Vehicle expense, professional and contract services, programmer, 2017 -2018 204, 444 40% Vehicle expense, professional services, programmer, increase in revenue

Access to Health District Financials • The quarterly financials are provided with the Board Meeting agenda packets that are sent to each Board Member and filed with our Member-Town Clerks as well as the Health District’s website. • The Health District conducts an audit each fiscal year and puts out a public notice when copies of the audit are available.

Programmatic

Sanitarian Duties • Complaint Follow-up • Lead Case Follow-up • Soil Test Evaluation • Well Permits • Septic Plan Review • Recreational Water • Food Service Inspections • Septic Inspections • Emergencies • Food Service Plan Reviews • Daycare Inspections • Temporary Event Consults • Hotel/Motel Inspections • Temporary Event Inspections • Public Pool Inspections

Routine Food Inspections-Enfield • For 2018, the required number of inspections based on 143 food service establishments would have been 451. • All food establishments were inspected; not all were inspected at the frequency set forth by the state. 381+ inspections performed (85% inspection rate)

Temp. Event/Farm Market Vendors District-Wide Year # temp event/farm market vendor permits 2014 383 2015 441 2016 428 2017 453

Community Health Programming • Historically, there had been significant community health programming throughout the District. • In recent years, there was minimal community health programming due to limited grant funding-staffing-1 PT Public Health Educatorposition vacant. • Currently, we have a FT Public Health Educator and a Public Health Nurse 30 hours per week.

Current Program Areas • • Conducted a Community Health Needs Assessment Active in opioid abuse/prevention Contributed to community garden projects in each Member-Town Providing flu vaccinations Providing Hepatitis A vaccinations to high risk populations Providing home visit asthma program Lead poisoning prevention activities in 1 Member-Town.

Increased engagement in Enfield since 2016 • Thompsonville Community Garden • Enfield Together Coalition • • • Youth and Family Services • Enfield Safe Harbor Enfield Food Shelf • Area hospitals Enfield Hunger Action Team Asnuntuck Community College North Central Opioid Addiction Taskforce

Collaboration • The District has formed a Health Advisory Council comprised of key stakeholders in our Member-Towns. • The District has formed an opioid advisory group for our opioid prevention grant. • The District is collaborating with other health departments to seek grants together and to share costs for database programming.

Public Health Preparedness • We have participated in regional Ebola and Radiologic Incident Exercises in recent years. • This year we will exercise our smallest Point of Dispensing (POD) location with our staff. • Subsequent exercises will be at larger POD sites and involve local CERT Teams and Medical Reserve Corps (MRC) volunteers • The District is working on a proposal to create an MRC-subunit for the District.

Moving Forward

Moving Forward • The Health District implemented a Leadership Initiative Training to bring along experienced staff and prepare them for future leadership positions. • This will lead to succession planning as long-term staff are eligible for retirement at any point within the next 1 -4 years.

Moving Forward • The Board is reviewing proposals for a Project Manager to lead a remodeling project for the District Main Headquarters. • The Board has provided input on a quarterly reporting document that would be distributed to Town Council Members. • Once the Community Health Needs Assessment is finalized, it will be presented District-Wide. Stakeholders will be invited to participate in the creation of a Community Health Improvement Plan for the District.

Board Meetings • Board Meetings are scheduled each month, except for July. Meetings are the second Wednesday of each month. The Meetings are located in Member-Towns across the District; several meetings each year are held at our Main Headquarters in Enfield. • We welcome your attendance!